2. Sir Christopher Wormald

SIR CHRISTOPHER WORMALD (affirmed).

Questions From Lead Counsel to the Inquiry

Mr Keith: Are you Sir Christopher Wormald?

Sir Christopher Wormald: I am.

Lead Inquiry: Thank you very much, Sir Christopher, for coming today. Whilst you give evidence, could you please remember to keep your voice up, not merely so that we can all hear you, but also for the purposes of the transcript and the aid of the stenographers.

If I ask you a question which I have not made sufficiently clear, please do ask me to put it again. There will be a break at lunchtime, and it’s possible that you may get the benefit of a break in the middle of the afternoon, depending on where we get to.

You have provided a number of statements to this Inquiry, unusually named statements: first, second, fourth, sixth and seventh. I don’t think that we need to put them all up on the screen, but obviously, my Lady, could they all be published? Each one of them has been signed by you with the usual declaration –

Sir Christopher Wormald: Yes.

Lead Inquiry: – as to the truth of their contents, and plainly you adopt them all as part of your evidence?

Sir Christopher Wormald: Yes.

Lead Inquiry: I’d like to start, please, with addressing some of the structures which underpin the approach of the Department of Health and Social Care to its pandemic-related duties.

It’s convenient, perhaps, if you could just give us a very brief resumé, both of your position at the Department of Health and Social Care and of your career in the civil service.

Sir Christopher Wormald: Yes, thank you.

If I may, before I start, I would like to reiterate the department’s heartfelt sympathy for everyone who suffered in the Covid epidemic, both directly and indirectly, and also our thanks to the amazing staff in the health and care sector who helped us get through. I wanted to put both those things on record.

Yes, I am Permanent Secretary of the Department of Health and Social Care, which position I have held since 2016. Prior to that, I was the Permanent Secretary of the Department for Education, between 2012 and 2016, and before that I worked in a variety of roles at the Cabinet Office between 2009 – yes, 2009 and 2012, where I should put on record that a number of the conversations you had with the last witness I was supporting the coalition, including on a number of the decisions they took around austerity and the issues that were discussed this morning, which I ought to note.

Prior to the Cabinet Office, I was Director General for Local Government and Regeneration at the Department of Communities and Local Government, as it was then called, and then a whole series of other roles in the civil service at more junior levels prior to that.

Lead Inquiry: All right, thank you.

In the general scheme of things, in a department, particularly one as important as the Department of Health and Social Care, where does a permanent secretary come in the order of things?

Sir Christopher Wormald: Well, you have three roles as a permanent secretary. Well, I will say this, in a department like the Department of Health at this time, which is largely a strategy and policy department in this period. We’ve already heard some discussion about the changes in the 2012 Act. Before that it was a much more operational department –

Lead Inquiry: Sir Christopher, I’m so sorry to interrupt. The question really was: where is the permanent secretary in the general order of things? I’m going to ask you questions about the role of the Department of Health and Social Care, and of course we’ll go into those issues.

Sir Christopher Wormald: Yeah. Okay. Sorry, it’s important to the role that you play, but yes. You do largely three things: so you are chief executive of the organisation, which means you lead the staff of the department, you are the chief adviser on policy to the Secretary of State, and you are the accounting officer for the budgets that Parliament delegates to the department.

Lead Inquiry: The Inquiry has heard evidence that the Department of Health and Social Care was designated as what is known as a responder, in fact a Category 1 responder, under the Civil Contingencies Act 2004. In fact, the Secretary of State –

Sir Christopher Wormald: Yes.

Lead Inquiry: – in the Department of Health and Social Care is the designated responder.

Can you just assist the Inquiry with the extent to which it is understood in a department what the extent of those obligations are under the Civil Contingencies Act? Is this an obligation which is placed on the Secretary of State personally, or is it an obligation that is discharged by the department as a whole?

Sir Christopher Wormald: Well, legally the department is an emanation of the Secretary of State, so in almost all cases the legal powers of the department are vested in the Secretary of State personally. Secretaries of state discharge those functions, normally via their department. So they are effectively indivisible. So if you asked people within the department, they would say that the department is a Category 1 responder, in the way that you describe.

Lead Inquiry: Every Secretary of State has any number of ministerial obligations, both by way of being in charge of a department, both by way of discharging obligations imposed on him or her under our constitutional structures, but also a fair few number of legal obligations –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – of the type to which I have just made reference under the Civil Contingencies Act.

So what extent are secretaries of state reminded or constantly informed that they are subject to direct legal obligations as well as their normal ministerial obligations?

Sir Christopher Wormald: You would normally be – have your legal responsibilities explained to you when you come into office. That would be the most important moment. And then obviously if you’re an experienced Secretary of State, you will largely be aware of what your legal responsibilities are.

Lead Inquiry: So as a department, but then directly as the Secretary of State, the department was under a legal obligation, as a Category 1 responder, to assess the risk of emergencies occurring, plan for contingency planning, put into place emergency plans and business continuity arrangements, make information available to the public, share information and co-operate with local responders to enhance emergency response co-ordination and efficiency measures.

So there was a fairly extensive list of specific obligations placed on the department –

Sir Christopher Wormald: Yes, that’s correct.

Lead Inquiry: – in this field of civil contingencies, by virtue of –

Sir Christopher Wormald: That’s correct, with one addition. The other responsibility of the department was to assure itself of the readiness of other Category 1 responders. In this context, mainly NHS England and Public Health England, as our two main delivery agents. And we discharge that function by having full-time permanent civil servants who work specifically on emergency response, which is in the directorate led by Emma Reed, who I believe the Inquiry is going to hear from directly.

So how those powers play out in practice is by the allocation of resources within the department of staff whose primarily responsibility is to act as that Category 1 responder. As we’ve put in various of our witness statements, there are a whole series of incidents in which they respond in that way.

Lead Inquiry: Indeed.

Sir Christopher Wormald: But the assurance piece is a very important addition to the list you read out.

Lead Inquiry: Do those legal obligations apply to all emergencies or just health-related? For example, pandemic emergencies.

Sir Christopher Wormald: Well, there are – it’s easy to oversimplify, but there are things which are clearly a health lead because the heart of the emergency is a set of health issues, for example the recent monkeypox outbreak I think would be in that category, and then there are a large number of things where health is one player in an emergency that is led from somewhere else. So something like a terrorist incident, obviously there is a health service response, but it’s led from elsewhere.

Now, I say it’s easy to simplify because, of course, the nature of emergencies means it’s not always that clear cut, so the Novichok poisonings, for example, would be an example where there was a clear security lead on the security aspects and then a huge health lead on the health consequences.

Lead Inquiry: My question related in fact to the legal duties under the Civil Contingencies Act. Those duties apply on a department, as –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – the Secretary of State, in relation to any emergency, do they not?

Sir Christopher Wormald: Yes.

Lead Inquiry: They’re not limited to a health emergency, but in practice, for reasons I’ll come on to in a moment, the Department of Health and Social Care is obviously concerned with health emergencies?

Sir Christopher Wormald: Yes, that’s correct.

Lead Inquiry: The reason it’s concerned particularly with health emergencies is that, under this governmental system of risk identification, risk ownership and departmental response to emergencies, the DHSC, and before it the Department of Health, was the lead government department relating to pandemic risks?

Sir Christopher Wormald: That’s correct, yes. Now, lead government department is – that’s an administrative designation rather than a legal designation –

Lead Inquiry: Yes.

Sir Christopher Wormald: – but yes.

Lead Inquiry: Therefore, as the lead government department, your department was responsible for leading the government’s work on risks which concerned you directly, and for which you had to be responsible?

Sir Christopher Wormald: Yes.

Lead Inquiry: To use a terrible word, risks which you owned?

Sir Christopher Wormald: Yes, that’s correct.

Lead Inquiry: That meant that you would be involved in the system of risk assessment in relation to pandemics, dealing with other government departments of course in relation to how they respond, dealing of course with how your own department would respond in the event of a pandemic, and, through various other parts of the government, ensuring – and I refer there to the Cabinet Office role and the role of the Resilience and Emergencies Division in the Department for Levelling Up, Housing and Communities – making sure that all the other parts of the government do what they’re meant to do?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: That’s part of the heavy burden of being the lead government department?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: Of course, in this pandemic which my Lady is inquiring into, your department was the lead government department?

Sir Christopher Wormald: Certainly in the planning phase and the initial response – I mean, obviously this becomes more of an issue for your second module –

Lead Inquiry: It does.

Sir Christopher Wormald: – obviously the onus of activity moved to a national scale in this particular crisis, as it does in many others.

Lead Inquiry: Yes. May we take it from your answers, therefore, Sir Christopher, that because of this legal obligation, because of the fact that your department was the lead government department, when it came to pandemic-related matters, risks, planned response, planned recovery, anything to do with pandemics, this was, during the ten years leading up to the pandemic, of core importance to your department?

Sir Christopher Wormald: Yes. I mean, obviously, as you said earlier, the department has many, many responsibilities across the health and care sector, which is of course a huge sector, but this is one of the very important responsibilities that we hold.

Lead Inquiry: In your department there is a directorate called the EPHP directorate, I think it’s the Emergency Preparedness and Health Protection Directorate?

Sir Christopher Wormald: Yes, it’s had a variety of names and acronyms, which I’m sure you have identified, but basically, yes, there is a directorate that is responsible for emergency preparedness and oversight of health protection, as you describe, pretty much throughout.

Lead Inquiry: Including pandemic preparedness?

Sir Christopher Wormald: Yes, correct.

Lead Inquiry: Obviously we’ve seen that there were a significant number of bodies and entities and boards and so on and so forth, both within your department and also connected to your department, arm’s length bodies and so on –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – which were focusing on pandemic flu preparedness?

Sir Christopher Wormald: Yes.

Lead Inquiry: So one of them, and we heard evidence of this last week, the Pandemic Influenza Preparedness Board, PIPP. Was that a DHSC-led programme or was that a cross-government programme?

Sir Christopher Wormald: That one is the DHSC-led programme. There was a second board, which I’m sure we’ll come on to, which was cross-government.

Lead Inquiry: Was that PIPP board chaired in fact by Clara Swinson, to whom you’ve referred, who was the then Director General for Global Health, and health protection, from whom we’ll be wearing perhaps later today, this afternoon?

Sir Christopher Wormald: Yes, from the point of her appointment, which I think was towards the end of 2016.

Lead Inquiry: That board first met in October 2007, you may recall?

Sir Christopher Wormald: Well, I don’t –

Lead Inquiry: Take it from me, Sir Christopher.

Sir Christopher Wormald: I’m told by the record that – yes.

Lead Inquiry: Another board was the Pandemic Influenza Preparedness board and, as we’ve heard in evidence, that was a board which was a cross-government board which was set up by order of the National Security Council THRC, Threats, Hazards, Resilience and Contingencies committee, chaired by the then Prime Minister Theresa May, in 2017?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: Was that a board on which the DHSC had a place –

Sir Christopher Wormald: Yes.

Lead Inquiry: – and which considered directly influenza planning?

Sir Christopher Wormald: Yeah, I mean, it was a – it was the part of the follow-up to the Cygnus exercise, and it was the main body charged with taking forward the learning and actions from that exercise, and it was co-chaired between the Cabinet Office and DHSC, recognising that there were recommendations that went directly into the health service and those for wider government.

Lead Inquiry: Within the internal management of your department, did the various individuals and employees who were contributing to these and other boards report up to, through you, a departmental board?

Sir Christopher Wormald: I’m not sure “report up to” is the correct terminology, so –

Lead Inquiry: Forgive me.

Sir Christopher Wormald: Well, no, I mean, this is a … I’m not quite sure what the right word – I’ll simply –

Lead Inquiry: Sir Christopher, will you allow me to rephrase the question?

Sir Christopher Wormald: Yeah.

Lead Inquiry: In your department, as part of its internal management structure, is there an overarching body called the departmental –

Sir Christopher Wormald: Yes, there is. Now, as I said earlier, all the legal powers are in fact vested in the Secretary of State, so departmental boards – and sorry, this is why I was struggling to find the correct words – they are not like the boards of arm’s length bodies or the boards of private companies or charities, in that they do not hold any decision-making or ficundary(sic) responsibilities. So they are, legally, purely advisory boards to the Secretary of State, who exercises all the –

Lead Inquiry: The legal powers?

Sir Christopher Wormald: – all the legal powers. So they are important, but they are important in that advisory function, as opposed to being a decision-making body.

Lead Inquiry: But subject to the legal powers vested in and imposed upon the Secretary of State personally, the departmental board is the most senior board or advisory group within the whole department, is it not?

Sir Christopher Wormald: Yes, but it’s very important to note that that does not mean it is the conduit of advice that goes to the Secretary of State in the vast majority of cases. As I think I set out in my first witness statement, the basis of departmental decision-making is the submission system to the Secretary of State. So what I don’t want to give the impression of is that Secretary of State decision-making is particularly advised by the board.

Lead Inquiry: No.

Sir Christopher Wormald: It doesn’t meet that often. But you are correct that it is the highest committee in the department.

Lead Inquiry: May I just observe that I didn’t suggest that it was a body for giving advice to the Secretary of State.

Sir Christopher Wormald: No, I’m sorry.

Lead Inquiry: It is, however, a body which addresses matters of the greatest import, of the greatest importance to the department as a whole, matters which could imperil the very existence of the department. For example, the major risks to its functioning, its operation, go to that level, do they not?

Sir Christopher Wormald: Yes, so the department’s risk register is normally a standing item of the board, and one of the board, and particularly the non-executive members of the board’s role is to critique what the department is doing on all those issues as a challenge function. As I say, decision-making sits elsewhere.

Lead Inquiry: Like many entities and boards, the board has a risk register which it has half an eye on –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – or a full eye, which tells it which risks pose the greatest threat to the whole entity, the whole department, which risks need to be focused upon by the board, and a register is of course kept of where the risks come in the general order of things and what is being done to mitigate those risks?

Sir Christopher Wormald: That’s correct, and –

Lead Inquiry: In a general sense?

Sir Christopher Wormald: Yeah, and as you correctly identified earlier, what the board does is it sits on top of a structure that assesses those risk and subcommittees that do so.

Lead Inquiry: So the board examines matters that are of the gravest importance to the department, and one such matter it examined by way of a risk deep dive was the issue of major infection diseases, which it did in September 2016?

Sir Christopher Wormald: Yes.

Lead Inquiry: Could we have, please, INQ000022738. “Departmental Board: Risk Deep Dive” dated, we can see, 28 September 2016, and then page 2, please, paragraph 1:

“In keeping with the departmental risk guidance, each quarter a risk from the Departmental High Level Risk Register is to be selected for a more in depth discussion at the Departmental Board. The aim of the discussion is … to consider in more detail the mitigations for a particular risk which might not otherwise be discussed. This quarter the risk of an outbreak of a major infectious disease has been selected for the first of these risk deep dives.”

Sir Christopher, it is self-evident that the risk selected for a deep dive will only be those risks which pose the greatest threat to the department, otherwise there is no need –

Sir Christopher Wormald: Yes, that’s correct, and as is shown in this presentation, there were in fact two risks that fell into this category, one which was the risk of an influenza pandemic, and one was what is known as the risk of a high consequence –

Lead Inquiry: Infectious disease.

Sir Christopher Wormald: – infectious disease.

Lead Inquiry: And at the bottom of the page we can see:

“The key question for the [departmental board] is how much money, time and effort do we want to invest in our insurance against these risks?”

And the blurb sets out how the national risk assessment, that’s no longer in existence because it was done away with and combined into the National Security Risk Assessment in 2019, to which my Lady has heard reference. It sets out a very severe reasonable worst-case scenario for pandemic flu. There is then the debate about the substantial expenditure on countermeasures. Then, at the second bullet point:

“In the event of a major disease outbreak the [Department of Health] …”

Because you were known as the Department of Health then. Then the directorate to which you’ve already made reference:

“… [EPHPP] Directorate would very rapidly be overwhelmed. Should we do more to raise awareness of the risk and to plan for immediate mobilisation of a large number of staff …”

And then this:

“The lack of a national forum to support and oversee planning and response in the social care sector poses challenges is there more that can be done to provide direction and strengthen co-ordination …”

So important serious issues were being raised in the department –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – for consideration by its highest level board in this deep dive, all related to, in broad terms, pandemic planning?

Sir Christopher Wormald: That is correct. I would say pandemic and high-consequence infectious disease planning, which are separate but related.

Lead Inquiry: Yes. That is the minute, or rather the presentation.

If we could just have a quick look at page 8, please, on the document. If you could zoom in, please.

Some figures were provided to the board on the likely consequences of a severe pandemic: 30 million people symptomatic; 300,000 to 1.2 million requiring hospital care; 75,000 to 300,000 requiring critical care; peak illness, 7.2 million people. Impact on the economy, massive. Lost working hours, huge. Societal disruption, extensive.

Could we have the minutes, please, of the meeting, INQ000057271.

This was a meeting dated 29 September, so one day later, at which these points were discussed:

“Departmental Board …

“Draft Minutes

“Present:

“Chris Wormald …”

That’s you, of course. And members of your team.

“Apologies:

“Jeremy Hunt, Secretary of State for Health.”

Could we have, please, page 1:

“Chris Wormald opened the meeting, noting apologies from members. There was no ministerial attendance due to the House of Commons summer recess and the upcoming party conference season.”

Then page 3, please, and the second bullet point:

“Members agreed that the effectiveness of the Board was linked to ministerial engagement, as much as it was to executive and non-executive engagement. It was thought that the balance between executive, non-executive and mistrial members was important, though there was a level of ambivalence amongst executive members at the proposed reduction in their membership. Some suggested it may be appropriate for them to attend the Board for the discussions on performance, risk and horizon scanning …”

Then the next bullet point, please:

“Members were concerned by the Secretary of State’s continuing lack of engagement with the Board. Chris Wormald explained to members that ministerial attendance at the Department for Education’s Departmental Board had been compulsory and enforced by the Secretary of State. He also advised that the Ministerial Code requires Secretaries of State to chair their Departmental Boards. On the proposal that the Secretary of State nominate a junior minister to chair in his absence, members noted that both David Prior and Philip Dunne had appropriate board-level experience.”

What steps did you take to ensure that the Secretary of State for your department attended future board members addressing matters of the highest importance, such as pandemic planning?

Sir Christopher Wormald: I don’t recall having a specific conversation with the Secretary of State on that point, and I don’t have a record of doing so. The Secretary of State would have been aware of the meeting and would also have been shown the minutes of the meeting, I assume, but, as I say, I don’t have a record of directly speaking to the Secretary of State about that matter.

Lead Inquiry: This was a board that you were the ex officio head of, at least by virtue of your name being first on the list of attendees. At that meeting members expressed concern about the Secretary of State’s continuing lack of engagement. Why was that not a matter that you brought to his direct and immediate attention in this issue?

Sir Christopher Wormald: It’s very difficult to comment on a negative. As I say, I don’t recall having a conversation. We undoubtedly had conversations about the board. I don’t recall discussing this particular board meeting, so we definitely had conversations about the board and ministerial attendance. As I say, I don’t recall raising this one specifically.

Lead Inquiry: It can’t be very usual, Sir Christopher, for members of a departmental board to express concern about their own Secretary of State?

Sir Christopher Wormald: No, I don’t think it – I don’t think it is.

Lead Inquiry: So why didn’t you bring it to his specific attention?

Sir Christopher Wormald: As I say, I don’t have a record of doing so, and I therefore cannot recall what was … what was my thought process at the time. I hesitate to guess what I was thinking, but I suspect I was thinking that I would deal with it in the general rather than the specific, but that is a … that is my post hoc rationalisation.

Lady Hallett: By which you mean?

Sir Christopher Wormald: Well, as I say, we were at – I remember having discussions with the Secretary of State about the board in general, and I suspect I was thinking that was the best way to address the issue, rather than a discussion about this specific board meeting. As I say, I don’t have a record of having done that, so I can’t claim that I did.

Mr Keith: Page 6, please. Then further down the page. Just a little bit further up, please – I’m sorry, too far down. Paragraph 24:

“The Department had been planning for a major outbreak or pandemic for many years, and the UK is recognised as one of the most prepared countries in the world: for example it had invested more in anti-viral stockpiles than most other countries.”

The antiviral stockpiles was, in the main, Tamiflu, the brand name for an anti-influenza pandemic antiviral; is that correct?

Sir Christopher Wormald: That’s my understanding, yes.

Lead Inquiry: So although it had invested more in antiviral stockpiles than most other countries, the stockpiles for antivirals was concerned only with providing a countermeasure to pandemic influenza?

Sir Christopher Wormald: In that case, yes.

Lead Inquiry: Yes:

“The Department is taking part in Exercise Cygnus, which would take place between 1 and 20 October … and be modelled on a pandemic scenario. It had been cancelled twice …”

We will come to Cygnus in a moment. One paragraph further down, please:

“It was more likely than not that even a moderate pandemic would overrun the system. At the extreme, there would be significant issues if it became necessary to track or quarantine thousands of people. A decision to fund high-end quarantine facilities had already been deferred by ministers.”

Sir Christopher, we will look in detail over the next two hours on what steps were taken by the department between now and 2016 and 2020 when the pandemic struck. Would you agree that by January of 2020 the system was not, even then, capable of dealing with even a moderate pandemic?

Sir Christopher Wormald: I would have quite a nuanced answer to that question.

Lead Inquiry: Well …

Sir Christopher Wormald: Sorry.

Lady Hallett: Let him try, Mr Keith. You can always come back with other questions.

Mr Keith: Please answer.

Sir Christopher Wormald: Sorry. I think a significant number of steps had been taken at the time. And this comes out in the paragraph that you emphasised before, we believed that we had good and very good, by international standards, procedures in place, and I believe that those were rational things to think, given the evidence, advice and resources that we had at the time.

If you ask me now, with the benefit of hindsight of having dealt with the pandemic, there are a – well, a large number of things that I would have wanted to have added, as it were, but that is with the benefit of hindsight. So I would distinguish between what we thought was rational at the time, which was, as I say, set out in the previous paragraph that you said, and what we would think now, based on what we now know.

The other thing I would add about this, and this may have been an error, but it was certainly what we thought, was an awful lot of our thinking, and the thinking that was in place when I arrived at the department, was focused on the Cygnus exercise, and that is where we expected all these questions to go, into that exercise, and the follow-up.

I’m sorry, that’s a sort of nuanced answer, but I’m trying to set out what I think we thought at the time and why, separately from what we now think is an appropriate way forward, if that is understandable.

Lead Inquiry: Sir Christopher, it forms no part of this Inquiry to examine with hindsight what other decisions could have been made or were made or were not made. But in 2016, this departmental board was warning in the clearest terms it was more likely than not that even a moderate pandemic would overrun the system. So there is no issue of hindsight here. That was a prospective warning that the system would likely not cope.

Sir Christopher Wormald: Yes, which is exactly why there was the proposal, and indeed the actuality, of Exercise Cygnus.

Lead Inquiry: Yes. Exercise Cygnus, paragraph 6 of its final report said this:

“… the UK’s preparedness and response, in terms of its plans, policies and capability, [were] … not sufficient to cope with the extreme demands of a severe pandemic that [would] have a [United Kingdom-wide] impact across all sectors.”

So Exercise Cygnus did not come in any way to relieve the problem that was identified in paragraph 25; it reported again that systemically the system would not be sufficient. So what was done after Cygnus to ensure that the system would be sufficient?

Sir Christopher Wormald: Well, there was a whole programme of work post Cygnus that we have mentioned already, led by the pandemic influenza preparedness board that we discussed earlier, the cross-government board, whose job it was to take forward the findings of the exercise.

Lead Inquiry: Could we have, please, paragraph 26:

“All decisions in response to an outbreak or pandemic would need to be made by the Department, as a department of state, though [arm’s length bodies] would have their role to play. There were, however, concerns about how resilient the somewhat fragmented system would be – especially in light of previous or future funding cuts.”

By January 2020, the system remained fragmented, did it not?

Sir Christopher Wormald: Its legal structure, as set out in the 2012 Act and the 2014 Care Act, the two governing pieces of legislation, hadn’t changed, no.

Lead Inquiry: The legal structure under that Act and the legal structure under the Civil Contingencies Act 2004 had not materially altered, had it?

Sir Christopher Wormald: Those – so the two Acts, which is, as it were, the governing acts of how we run the system, the 2012 Act and then the 2014 Act for health and then social care, remained in place, yes. And then, as you know, the Civil Contingencies Act hadn’t changed.

Lead Inquiry: The whole system, having a lead government department, having local authorities and local resilience forums, being supervised and liaised with by the Resilience and Emergencies Division of the Department for Levelling Up, Housing and Communities hadn’t changed?

Sir Christopher Wormald: No.

Lead Inquiry: The Cabinet Office position hadn’t changed through its Resilience Directorate, it sought to exercise control by political persuasion and other means over other government departments?

Sir Christopher Wormald: A little more than political persuasion, but no, it hadn’t changed.

Lead Inquiry: The Department of Health and Social Care was responsible for the funding and the general guidance – funding of and general guidance for local authorities, but, of course, local authorities who are concerned with the adult social care sector fall outwith the direct functions of your department?

Sir Christopher Wormald: That’s correct. So the 2014 Care Act, which broadly maintained the previous arrangements for adult social care, sets out that it is a local authority-led and funded service, so it’s not correct we oversaw the funding, the funding is locally raised, and it gives a – quite a limited set of powers to central government, mainly through the inspection of care providers, not – not local authority commissioners, as I say, because that is something we have changed. So it was a largely locally-led system, with the department having responsibilities around the legal framework and around the inspection, as implemented by CQC.

Lead Inquiry: So, Sir Christopher, having therefore accepted that in no significant regard had there been any change to the fragmented nature of the system as at 2016, would you agree that the system remained similarly fragmented still by January 2020?

Sir Christopher Wormald: As I say, the legal position on all those matters had not changed.

Lead Inquiry: In this board meeting, Sir Christopher, concerns weren’t being expressed about the dry nature of the legal obligations being placed on the various parts of the government machine; concern was being expressed about how resilient the somewhat fragmented system would be, whether it would cope in practical terms. That wasn’t just an issue about legal obligations, was it?

Sir Christopher Wormald: No, no, I was answering the specific question you asked me.

Lead Inquiry: So there were no changes, were there, significantly, to how resilient the system would be between 2016 and 2020; it remained fragmented, didn’t it?

Sir Christopher Wormald: That’s true.

Lead Inquiry: Thank you.

Lady Hallett: You are accepting it was fragmented? I got the feeling that maybe you weren’t accepting, Sir Christopher, it was fragmented.

Sir Christopher Wormald: I don’t think there is any dispute that it was fragmented, and indeed the whole point of the 2012 Act was to reduce the level of central control over particularly the NHS and to run the system much more as a – and I apologise for using the jargon – as a quasi-market. So the idea of that Act was to have operational freedom within the NHS, and for the system to be based around a series of commissioners and providers, as opposed to a top-down system of direct control as had existed prior to 2012.

Now, whether you believe fragmented to be a good or a bad thing, I don’t think there’s any dispute that that was the purpose of that set of reforms.

Lady Hallett: Shall we pause there, Mr Keith?

Sir Christopher Wormald: In terms of – I want to cover social care as well.

Lady Hallett: Do finish the thought and then we’ll pause, break.

Sir Christopher Wormald: Yes – where, again, it’s not a matter of dispute that social care is a locally-run service and, therefore, divided amongst the top tier local authorities, as – again, you can debate whether that is a good thing or a bad thing, but I don’t think it’s in doubt that it’s a thing.

Mr Keith: And there we must leave it.

Lady Hallett: Well, unless you particularly wanted anything else on this topic.

Mr Keith: As it happens I had one more question on this document and then perhaps we can put it to one side. Paragraph 25:

“… there would be significant issues if it became necessary to track or quarantine thousands of people.”

Is this the position, Sir Christopher: that despite that issue, the important issue of quarantining, being raised in 2016, by January 2020, whilst there was and had been a continual debate as to how to isolate individuals in the event of a high-consequence infectious disease, there was – and – there never was any debate about mass quarantining, mass isolation, mass quarantining, was there?

Sir Christopher Wormald: Well, in the influenza plan, the basis of that is a series of voluntary what are known as NPIs, which would have included those issues. What there was not –

Lead Inquiry: Sir Christopher, I’m so sorry to interrupt. Quarantining is, as you know, of course, a mandatory thing. It’s a mandatory restriction. Was there any debate between now, the issue having been raised, and 2020, of mandatory quarantining of significant numbers of the population?

Sir Christopher Wormald: Not in the context of a pandemic.

Lead Inquiry: Well, we’re not really concerned with quarantining outside the pandemic in this Inquiry; so the answer is no?

Sir Christopher Wormald: Not in the context of a pandemic. I’m sure we will come on to, but there are important interactions between the strategy for high-consequence infectious diseases and the plans for a pandemic, which I’m sure we will discuss further.

Lady Hallett: I think you said the issue having been raised in 2020; I think you meant 2016.

Mr Keith: Thank you, I did.

Lady Hallett: Very well. We shall come back at 2.20, please.

(1.32 pm)

(The short adjournment)

(2.20 pm)

Lady Hallett: Mr Keith.

Mr Keith: Sir Christopher, may we now turn, please, to the risk assessment process to which you referred earlier.

As you’ve helpfully stated, the Department of Health and Social Care was the lead government department for pandemic risk and infectious disease, and so it was, in the nomenclature, the risk owner for those risks in the National Security Risk Assessment. It provided information and was part of the process by which those risks were identified, debated, described in the paperwork, and also what the impacts would be likely to be from those risks. The department owned all aspects of the debate concerning those two risks: pandemic influenza risk and emerging infectious disease risk.

Sir Christopher Wormald: That’s correct. I mean, the process of setting the risk and then agreeing reasonable worst-case scenarios and all those things I think has been described in other statements.

Lead Inquiry: Yes.

Sir Christopher Wormald: I mean, it’s an iterative process between the department and the centre.

Lead Inquiry: The Inquiry is aware that the department obviously received advice from both its internal scientists, its departmental Chief Scientific Adviser, or government department Chief Scientific Adviser, from a number of external advisers, external bodies – I mean, these risk assessments were pored over by a multitude of people and bodies –

Sir Christopher Wormald: Yeah, that is – that’s correct. So the process –

Lead Inquiry: We don’t need the full detail, would you just agree with the proposition that they were of course examined at great length by your department, which was responsible for them?

Sir Christopher Wormald: Yeah.

Lead Inquiry: And also with the assistance of internal and external advisers and scientists?

Sir Christopher Wormald: Yes, that’s correct.

Lead Inquiry: All right.

Now, we need to look, then, at the actual documentation, so we could please have INQ000147769. This should be the – what was then called the national risk assessment, and, my Lady, the government has kindly declassified parts of this internal National Risk Assessment for the purposes of this Inquiry.

That is why, Sir Christopher, it says “Official-Sensitive” at the top, but we are looking at it today.

Sir Christopher Wormald: Yeah.

Lead Inquiry: This is the 2016 version. It was the national risk assessment then, but in 2019 the two forms of the assessment, the national risk assessment and the National Security Risk Assessment, were brought together, were they not?

Sir Christopher Wormald: That’s my understanding, yes.

Lead Inquiry: All right.

Could we look, please, at page 7:

“The National Risk Assessment [towards the bottom of the page] is a strategic medium term planning tool. Risks captured within the NRA [the national risk assessment] are examples of civil emergencies that could plausibly affect the United Kingdom within its territorial boundaries in the next five years … It is crucial all risks are assessed using a consistent, evidence-based approach.”

What is an evidence-based approach?

Sir Christopher Wormald: I think it’s exactly what it says on the tin, so that it should be on the basis of expert opinion, modelling and the available evidence.

Lead Inquiry: An approach that isn’t based on available evidence isn’t much of an approach, is it?

Sir Christopher Wormald: Well, I mean, government is sometimes in the situation where it has to take decisions despite lack of evidence, so that does happen.

Lead Inquiry: All right.

Sir Christopher Wormald: But if you’re doing this kind of assessment, yes, you would expect it to be evidence based.

Lead Inquiry: “… each risk is considered on the basis of a ‘Reasonable Worst Case Scenario’ … [it’s] intended to provide an illustrative example of the worst plausible manifestation of the risk in question.”

And it’s based on two scores: impact, which determines the severity of the consequences; and likelihood – which is more concerned with non-malicious risks/hazards – or plausibility, which is concerned with malicious threats, “determining the expected recurrence rate of the risk over the next five years”.

If you go down a bit further on the page, please, we can see that we have the heading “Impact”:

“Impact is determined on the basis of collating information about the severity of economic losses …”.

And so on and so forth.

Page 9, please. There is a chart at the top of the page, and along the bottom of that chart we have Likelihood/Plausibility”. We can ignore likelihood. We’re concerned with plausibility, because we’re dealing with hazards, a pandemic, rather than, for example, a terrorist threat. On the left-hand side, “Impact”.

At the top we can see, for medium/high likelihood, but catastrophic impact, pandemic influenza. Thank you.

And for medium/high – with medium/high likelihood, and moderate impact, emerging infectious diseases. Is that correct?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: If we could scroll back out, please, and look at the bottom half of the page, you can see that there’s a second chart, and in relation to pandemic influenza risk, because it falls in the top part of the above chart, in the catastrophic range, there is a circled area in this chart called “High impact risks” in relation to which the “Government is expected to supplement generic capabilities with specific contingency plans”.

Scroll back out, please.

Because emerging infectious diseases was only a moderate impact as opposed to significant or catastrophic it didn’t fall within the shaded area for which the government was expected to produce a specific contingency plan; that’s correct?

Sir Christopher Wormald: Yes.

Lead Inquiry: All right.

Page 10, please. Planning assumptions were then drawn up. So once you’d identified likelihood and you’d identified impact and you could see where your risk came on the top chart, planning assumptions were then made on what the common consequences of a number of risks might be if they came to pass, so that everybody could understand the realistic worst-case scenario and plan accordingly. Is that correct?

Sir Christopher Wormald: Yes.

Lead Inquiry: So there is an example given at the bottom of the page, “Risks that could lead to mass casualties”, either an industrial accident or a terrorist attack or flooding or public disorder. If you group those risks together, the planning assumption would be therefore 1,000 casualties, because that’s the worst of those four particular risks which are grouped together. Do you agree?

Sir Christopher Wormald: Yes.

Lead Inquiry: All right.

Could we then, please, have page 23.

Page 23 gives us, for 2016, the likelihood – in the top chart – and impact of the two risks with which we’re most concerned: H23, which is, you agree, pandemic influenza, and, below it, H24, for moderate impact and medium likelihood, emerging infectious diseases?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: Then page 47, please. This is the more detailed description of the pandemic influenza risk, and we need to look at this in detail.

You see, Sir Christopher, on the top left the overall assessment is very high, is it not?

Sir Christopher Wormald: Yes.

Lead Inquiry: Is that because, in the top right-hand corner of the page, the chart for pandemic influenza provides that the reasonable worst-case scenario, which is that star, is right up at the top of the page with medium to high likelihood but catastrophic impact?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: Therefore, because of the medium/high likelihood and the catastrophic impact, together an overall assessment is made of it being very high?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: What does the arrow under the star signify?

Sir Christopher Wormald: Now, that I couldn’t tell you.

Lead Inquiry: All right. That’s easy then. In that case I won’t pursue that particular point with you.

Then in the wording you can see there is a general description of the pandemic influenza risk, a novel flu virus emerges, up to 50% of the population may experience symptoms, 750,000 fatalities in total, absenteeism could reach 20%, and then these words, in the sixth line:

“Each pandemic is different and the nature of the virus and its impacts cannot be known in detail in advance.”

That is a description which falls in this page under the heading of “Pandemic influenza”, but it is applicable to any pandemic, or any viral respiratory disease, because they all differ, and the nature of the virus and its impacts can’t be known in detail in advance.

So my question to you is this, please, Sir Christopher: the risk assessment approach acknowledged that the pandemic influenza risk could be different in each case, its characteristics could vary, depending on transmission, severity, incubation period, available countermeasures and the like, and the impacts couldn’t be known in detail in advance; why was that same approach not applied to a non-influenza pandemic, which is equally – could be – a virus or a coronavirus or some other type of infectious disease?

Sir Christopher Wormald: Well, I mean, as you have discussed with other witnesses, this is, of course, one of the great questions. Now, how it was discussed within the department while I have been in it, and this may have been a wrong approach but it was undoubtedly what people said to each other, was you had to have a basis for planning and influenza was the most likely, most dangerous and identified risk, and the approach …

Lead Inquiry: I’m sorry, Sir Christopher –

Sir Christopher Wormald: I’m sorry, I lost my thread slightly.

And the approach taken was essentially “ready for flu, ready for anything”, would be the summary of what was – what was thought. And this was built in, as I’m sure you know, to the original 2011 flu plan, which mentions the possibility of other respiratory diseases, and that was certainly the thinking that was going on at the time, that you had to specify a risk, and influenza was chosen on that basis, and that then, were some other type of unpredictable pandemic break-out, you would adapt the flu plan based on that approach.

Now, as with some of my previous answers, obviously we have learned a lot, and in terms of our learning from the pandemic we are in a different place, but in terms of what was thought at the time and the answer to your question, that was the approach being taken.

Lead Inquiry: In the next paragraph it says:

“There is no known evidence of association between the rate of transmissibility and severity of infection, meaning it is possible that a new influenza virus could be both highly transmissible and cause severe symptoms.”

What your own departmental risk assessment – you owned this assessment – was saying. Dealing with pandemic influenza, there is no known evidence of association between transmissibility and severity, which means just because something is high transmissibility doesn’t mean to say it’s going to be necessarily low severity or high severity. They’re two different issues.

So it stands to reason that any disease, viral disease, could be both highly transmissible and very deadly?

Sir Christopher Wormald: That is what it says, yes. I mean, you’d need to – you have lots of them before the Inquiry – you would need to ask our epidemiologists for the science behind that, but that’s undoubtedly what it says on the page.

Lead Inquiry: But that is a statement of known evidence which applies to all infections, all viral respiratory diseases, not just influenza. So why didn’t any single person in the plethora of individuals and entities who addressed this risk assessment, say, “Well, hang on, if an influenza disease, a pathogen, can vary quite significantly in its characteristics – incubation period, transmissibility, stuttering or high transmissibility, asymptomatic, not symptomatic – and therefore you just can’t say what characteristics it’s likely to have, surely that applies equally to non-influenza pathogens?

Sir Christopher Wormald: In that –

Lead Inquiry: Because it’s based on the characteristics of a virus?

Sir Christopher Wormald: Yeah, and the Chief Medical Officers’ witness statements cover these points in detail.

Lead Inquiry: Do you agree that it was open to anybody reading that paragraph to ask that question: surely this applies to non-influenza viruses as well?

Sir Christopher Wormald: Well, as I say, that was the thinking at the time, that you wrote a plan for flu, and that if you got another type of pandemic then you would be adapting the plan that you had for flu for the disease that did occur and, as I say, as is covered in the Chief Medical Officers’ statement, a lot of that has to be done when you know what the disease you’re facing is. That was, as I say, the thinking at the time.

Lead Inquiry: All right. Page 48, the next page, please.

So we’re still in 2016. We’re now dealing with emerging infectious diseases. The overall assessment, top left, is high, not very high; correct?

Sir Christopher Wormald: Yes.

Lead Inquiry: In the top right in the chart, for likelihood/plausibility – again we’re only here concerned with likelihood – the reasonable worst-case scenario star reflects a medium/high likelihood, same as pandemic influenza, but the impact is moderate rather than catastrophic; that’s the difference, isn’t it?

Sir Christopher Wormald: Yes, though, as I was saying before the break, and perhaps this is the moment to talk about it, there isn’t a hard and fast distinction between high-consequence infectious diseases and then pandemics. Indeed, one can become the other. So the heart of this strategy across those two things is you can have an emerging infectious disease which you seek to contain. Where you fail to contain, it has the possibility to become an epidemic or a pandemic. And that is of course what happened, exactly what happened with Covid. It was originally defined as a high-consequence infectious disease and then declassified as it became a pandemic.

Lead Inquiry: The arrows on this page, page 48, signify, do they not, that because little may be known about the particular characteristics of the emerging infectious diseases, and because viral infections may differ radically in terms of their incubation period, transmissibility, severity and so on and so forth, there was actually a chance that the impact could be greater than the reasonable worst-case scenario, and that is why the top arrow is in “Significant” – the row for “Significant”?

Sir Christopher Wormald: Yes, I think I’ve understood the arrows, now. That presumably is the bands of –

Lead Inquiry: Of possibility?

Sir Christopher Wormald: – around the reasonable worst-case scenario.

Lead Inquiry: Right. So, actually, whoever drew up this chart was recognising that because with emerging infectious diseases, like all viruses, it’s impossible to know in advance with any degree of certainty what the characteristics may be and therefore how deadly or how transmissible the disease would be, it was important to identify the possibility that it could be more significant than the reasonable worst-case scenario?

Sir Christopher Wormald: Yes. And as I said, you have to – and this is, as I understand it, how it has always been thought about – think about those two strategies in parallel. So we had one strategy, this one, which covered a wide range of possible diseases, those classified as HCIDs, a number of which have the possibility, as was the case with Covid, of becoming a pandemic, most of which – and as I’m – as you’ll know from several of the witness statements, we have had a number of HCID incidents, the vast majority of which don’t.

Lead Inquiry: Yes.

Sir Christopher Wormald: So on the question that I know this Inquiry has been looking at, did we only have a plan for flu, that is not correct. We only had a pandemic plan for flu to be used in the way I described, adapted in the light of the pandemic that you had, and then a wider strategy, a lot of which flowed from the response to the Ebola crisis that you were describing earlier, about high-consequence infectious diseases, and I take the upper arrow in this case, that is the transmission from one category to the other, that would be a disease that would be on its way to being –

Lead Inquiry: Yes –

Sir Christopher Wormald: – pandemic, likewise the one going downwards the other way.

Lead Inquiry: Thank you, Sir Christopher. So the short answer is, if I may say so with respect, or suggest to you with respect, is that there was a specific pandemic plan for influenza –

Sir Christopher Wormald: Oh, yeah.

Lead Inquiry: – but no specific pandemic plan for anything that wasn’t influenza?

Sir Christopher Wormald: No, well, I mean, that is clearly factually correct, for the reason that I described earlier –

Lead Inquiry: Yes.

Sir Christopher Wormald: – which I fully, fully appreciate may have not been the right approach – and, as I say, we’re taking a different approach now, but just in terms of what was the approach –

Lead Inquiry: We will come to now in a moment.

Could we scroll back out, please, from page 48.

If you look at the middle of the page there is then a reference to the fact that there had been more than 30 new or newly recognised diseases over the past 30 years, and there is a reference then to SARS and then to MERS and Ebola.

Sir Christopher Wormald: Yeah.

Lead Inquiry: So the author of this document plainly recognises that there are a significant number of new or newly recognised diseases out there –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – and there had been over 30 years, and the arrows indicate properly that there was a risk of something worse happening than the reasonable worst-case scenario, because we are dealing here with a generic description trying to be applied to a specific future disease –

Sir Christopher Wormald: Yes.

Lead Inquiry: – the nature of which you don’t know?

Sir Christopher Wormald: Yep. That is correct.

Lead Inquiry: All right.

Could we look, please, at 2019, which is INQ000185135, on the eve of the pandemic. INQ000185135.

“Emerging Infectious Disease”. The risk picture changes, does it not, between 2016 and 2019?

Sir Christopher Wormald: Yes.

Lead Inquiry: Because the chart now, top right-hand corner, has the top arrow for possible catastrophic outcome of emerging infectious disease two rows above the reasonable worst-case scenario.

Sir Christopher Wormald: Yeah, and I think I would say that is a more accurate picture of the risk than the 2016 one, as was demonstrated in the pandemic that we did suffer. So clearly, and, as I said, a high-consequence infectious disease can be on the way to being a pandemic –

Lead Inquiry: Catastrophic in terms, Sir Christopher, of –

Sir Christopher Wormald: Oh, yeah.

Lead Inquiry: – massive fatalities – well, huge numbers of people infected, work absence, impact on economy, and the like?

Sir Christopher Wormald: Yes. Yes.

Lead Inquiry: Right.

Sir Christopher Wormald: So in the translation between something that begins as a high-consequence infectious disease and becomes an epidemic or pandemic, yes, then it would have the same risk profile as our pandemic risk, it has effectively become that, and, as I say, that is in practice what happened with –

Lead Inquiry: With Covid, right.

Sir Christopher Wormald: – with Covid, yeah.

Lead Inquiry: Could we scroll back out, please.

Towards the bottom of the page, you will see a reference to a reasonable worst-case scenario, and a description of how the infection would likely develop outside the United Kingdom.

Could we scroll back out, please. And in the middle of the page there is a debate over means of transmissibility and so on.

Could we go forward one page, please, to page 2. There is then a description of:

“What the [reasonable worst-case scenario] described above could lead to …”

Increased demand on specialist intensive care. Localised disruption to routine healthcare activities if outbreaks occur in hospital settings.

Just emphasise, please, mentally, Sir Christopher, the reference to hospital settings.

Further down the page, “Specific Assumptions and strategic context”. There is a likely high case fatality rate, for MERS it would be about 35%, there is no effective treatment, the main control measure is the implementation of effective infection control.

So the approach taken on this page is to say in terms: because the reasonable worst-case scenario – that star – only has medium impact, not catastrophic, even if we assume there is no antiviral, there is no vaccine, that there is a very high case fatality rate, 35%, the impact is not going to be of the same order as an influenza pandemic, it’s of moderate impact, you’d be dealing with disease in health settings, healthcare settings –

Sir Christopher Wormald: Yeah.

Lead Inquiry: – the possibility of infection there, but it’s not going to run amok through the whole population, killing 35%?

Sir Christopher Wormald: No, that is the – you have put your finger on the difference between a high-consequence infectious disease, where you are dealing with small numbers and you’re seeking to contain it –

Lead Inquiry: Where the greatest risk is in hospital settings, because doctors and nurses have to be able to treat people who are infected and there is a greater risk of transmissibility there?

Sir Christopher Wormald: Yes. Now, I’m only – I’m only cautious on my answers because you will get much better answers –

Lead Inquiry: It’s all right.

Sir Christopher Wormald: – a number of other witnesses in terms of the epidemiology. But in terms of the concept, the high-consequence infectious disease strategy is, as I say, for where you have small numbers and the intent is to contain and get it to zero, and a pandemic is effectively where contain has failed – or, sorry, an epidemic, where contain has failed and you are into the question of: how do you mitigate something that has gone beyond your ability to contain it?

Lead Inquiry: We are focusing on for the moment on the risks, not how you deal with a pandemic once it’s out there.

Sir Christopher Wormald: Well, the only thing I would say is those are at – that question of: can you contain it and drive it to zero is central to the question of what the risk is, as it were.

Lead Inquiry: Well, Sir Christopher, the reason why it can be controlled and reduced to zero is because this risk assumption assumes that it is not highly transmissible, that it’s not going to run amok through the population and it can be controlled.

Sir Christopher Wormald: Yes –

Lead Inquiry: Correct?

Sir Christopher Wormald: – and that is the difference –

Lead Inquiry: Indeed.

Sir Christopher Wormald: – between the two categories.

Lead Inquiry: Could we go forward, please, one page further to page 3. There is then more debate about MERS and SARS. Then in the middle of the page, or two-thirds of the way down the page:

“The emergence of new infectious diseases is unpredictable but appears to have become more frequent. This may be linked to a number of factors such as climate change, the increase in world travel …”

And so on and so forth.

So there is a clear recognition there, isn’t there, that new infectious diseases are unpredictable and have become more frequent; correct?

Sir Christopher Wormald: Yes.

Lead Inquiry: Yes. Can you scroll back out, please?

Then, at the bottom of the page, “Recovery and long term implications”.

Could we go forward one page again, please, to page 4.

There is a description of variations, again a description of Ebola and reference to MERS and SARS.

Then, please, page 8.

The consequences of this particular risk, broadly identified as it was:

“Likelihood … There is significant uncertainty about the frequency with which an emerging infection may develop the ability to transmit from person to person.”

So there is a risk, is there not, recognised in this document that a non-influenza emerging infectious disease may be a high transmissibility pathogen, it may travel human to human readily?

Sir Christopher Wormald: Yes.

Lead Inquiry: Scroll back out, please. But the fatalities, the number of people which were assumed in this document to result from this disease, is put at – under “Fatalities”, 200, no notice and excess deaths.

Then further down the page, please:

“Casualties (UK)

“Total number

“2,000

“No notice and excess casualties.

“- Using the upper bounds, 20 no-notice, 1,800 excess.”

So even though the arrows signified a risk of a catastrophic outcome to a non-influenza pandemic, or a non-influenza pathogen, even though the document recognised that there could be human-to-human rapid transmission and, by implication, that the disease could spiral out of all control, it concluded only – and I apologise for using this language – a relatively few deaths by comparison to the 820,000 deaths assumed in an influenza pandemic?

Sir Christopher Wormald: Now, I think we’re in a slight danger of getting lost in the terminology, so …

Lead Inquiry: Well –

Sir Christopher Wormald: As I –

Lead Inquiry: Sir Christopher, are you able to answer that question, why did – those things being recognised, being apparent on the face of this document, was such a relatively limited conclusion reached in terms of impact?

Sir Christopher Wormald: Because of the interrelationship between those two identified risks, and so that’s the reason why the two risks are on the National Risk Register. So if you are successful at containing a disease via your HCID mechanisms, then you would be containing the risk at these sorts of level –

Lead Inquiry: But, Sir Christopher, I apologise for interrupting, if the emerging infection does develop the ability to transmit rapidly human to human, as those arrows identify, as that paragraph under the heading “Likelihood - confidence assessment” states, there will be no question of containment, will there, because it won’t be –

Sir Christopher Wormald: Oh, no, until you are into your epidemic/pandemic risk, with the kind of reasonable worst-case scenarios identified for that – sorry, that’s what I mean by –

Lead Inquiry: So why, why, why, were the number of deaths put at 2,000 not 820,000?

Sir Christopher Wormald: Well, sorry, this is where I think we may be at risk of becoming lost in the terminology. Then you have two identical risks. You have effectively two epidemic/pandemic risks –

Lead Inquiry: For which the outcomes will be the same: massive loss of life?

Sir Christopher Wormald: Yeah.

Lead Inquiry: Collapse of the economy? Huge – millions of people infected?

Sir Christopher Wormald: Yes, and, as I say, and –

Lead Inquiry: That is not this outcome on page 8, is it?

Sir Christopher Wormald: No, because, as you correctly identified, these would be the outcomes if you have successfully contained the disease. The outcomes if you have not successfully contained the disease would be in the reasonable worst-case scenario that we had identified for pandemic influenza, ie the disease in that case would have translated – as Covid did – from one being managed as an HCID, with these sorts of implications, into something that was in the pandemic risk category with those sorts of implications.

Now, as I say, I don’t – I’m not trying to get lost in the terminology, what I’m trying to do is explain the translation between those two.

So your point, I think, is entirely correct, but it’s the way it’s reflected in the risk register is how I have described it, it’s the translation of a disease from one category to another category.

Sorry, I’m not sure I’m explaining myself very well.

Lead Inquiry: Sir Christopher, in your own witness statement you accept that any new pathogen transmitted by the respiratory route is likely to share characteristics with influenza, in that it may spread rapidly via close proximity –

Sir Christopher Wormald: Yes.

Lead Inquiry: – can travel rapidly and there are few easy intermediate countermeasures?

Sir Christopher Wormald: Yes.

Lead Inquiry: If that is so, then there is not likely to be any control. As you correctly said, the non-influenza virus will react and be apparent in just the same way as an influenza pandemic: widespread, devastating, deadly. But that is simply not on the face of this page, is it?

Sir Christopher Wormald: No, it’s not on this page, but it is –

Lead Inquiry: Is it on any page, Sir Christopher, that you know of?

Sir Christopher Wormald: Well, it’s in the – as I say, I’m not sure I’m explaining myself terribly well – but that is in the pandemic scenario. So if you look at the –

Lead Inquiry: Is it in any –

Lady Hallett: Mr Keith, let Sir Christopher finish.

Sir Christopher Wormald: Yeah. So if you look at the types of diseases discussed in this risk, MERS, SARS, Ebola, et cetera, the ones that you quoted, they all were contained in the HCID category. Now – and I have already pointed to this may have been a flaw in the approach, and you have heard this from other witnesses, but that was the thinking, that you have a risk that is about: can you contain the disease? Then you have a risk about a disease that you have not contained, which you would manage in the same way as an influenza pandemic.

Now, as I say, it may have been incorrect thinking that “ready for flu, ready for anything”, but that was how we were – or how it was being thought about, the relationship between these two things, between the thing that you want to contain and you try as hard as you can to contain and is the policies and procedures that flow out of this risk, and then what you were doing to try to mitigate the effect of a disease for where these approaches of containment have not worked.

Now, my final point –

Mr Keith: Please.

Sir Christopher Wormald: – I do, and as we’ve discussed this within the department, I think there is a very key issue for us about the threshold between those two things. So there has been a lot of discussion, rightly, of some of the countries that handled Covid extremely well, such as South Korea. Effectively what they had was a much higher threshold of containment for HCID than we were able to do, and that was the key difference.

So I do think what we are talking about points to some of the key issues about the management of the disease, of diseases. I don’t actually think the risks were identified incorrectly, and I do think those two stages of you try and contain a new disease so that it doesn’t lead to a pandemic, and then if it does you try and mitigate the effect so that the impacts on society are as small as possible, I do think that is the right thinking. I do think in retrospect the questions about what the thresholds are between those two things is a very important thing.

Lead Inquiry: Sir Christopher, just a few moments ago you said “there was a flaw in the [thinking]”.

Sir Christopher Wormald: Erm, well, so in that we have changed our thinking, as I think our KC set out in our opening statement. I will continue to distinguish between what we thought was reasonable at the time and what we think now with the light of experience. We have changed our approach on some of these issues, so it is only fair that I reflect that.

Lead Inquiry: Well, my Lady will always ensure that the process is fair.

Sir Christopher Wormald: Sorry, that was not the implication, that it was not. No, I chose my words badly. That we have changed our thinking in the light of what we have learned in the pandemic, I think I am supposed to say when that is the case. And almost by definition, as we have changed our thinking based on our learning, that causes us to ask questions about our previous approach.

Is that a better way of framing it? I wasn’t trying to suggest anything about fairness.

Lead Inquiry: Well, happily, Sir Christopher, in this process, I ask the questions, so I can’t answer your question, I’m afraid.

Sir Christopher Wormald: Sorry. I’m sorry.

Lady Hallett: Happily for you, Mr Keith.

Mr Keith: Happily for me.

Sir Christopher, one last question on this topic. You have accepted now there was a flaw in the thinking. Those three or four pages that my Lady has looked at show quite clearly that on the one hand it was well recognised that a non-influenza pathogen would be unpredictable, potentially with catastrophic consequences, that you couldn’t say in advance what the incubation period would be, what the transmissibility would be, what the severity would be, that there was a risk that it would be as deadly as an influenza pandemic.

Sir Christopher Wormald: Yes.

Lead Inquiry: Was not that thinking obvious? You say it’s now flawed, but it was obvious at the time, wasn’t it?

Sir Christopher Wormald: No, so let me be very clear indeed.

So the bit of this where we have adapted our thinking is what I said earlier about the piece of orthodoxy, which was “ready for flu, ready for anything”, as it were. So, as I say, the thinking at the time was: you made a plan for influenza as the most likely risk, and still one of the most dangerous risks, and then you adapted that plan for what was in front of you. And that is some of the things it says in the original 2011 version, that this would be adapted for a SARS-like disease.

Now, that is thinking that we have moved on from. I don’t actually think that the difference between an HCID – sorry, a high-consequence infectious disease – that you are trying to contain and a disease that you are trying to mitigate, I don’t think that is flawed thinking.

I do think the question of what’s the top of what you try to contain, as opposed to mitigate, that is a clear lesson of the pandemic, and from some of the countries that you correctly quoted in some of your opening statements about who we should – who we should learn from, one; and, two, the other area where I think your questions are right on the button are on the levels of uncertainty about the emergences of these diseases.

So the question is asked: were we overreliant on an influenza plan? My view is we were overreliant on plans, period. Our thinking now is much more in terms of: what are the flexible capabilities that allow you to put together the correct type of response, given the type of disease that happens to be in front of you? As opposed to: can we write a plan for a specific outcome and then identify it? And then, second, as has been discussed with a number of your witnesses already, and I’m sure will come up a lot more: what is the underlying resilience of your system?

Lead Inquiry: All right. Sir Christopher, I’m going to interrupt, I’m afraid, just to try to allow you to draw breath. It’s a very, very long answer.

Sir Christopher Wormald: I’m sorry it’s long, but we have thought about this quite a lot – as you would expect – and what I’m describing does flow out of the questions that you are correctly – correctly asking about these types of strategies.

So I do think your questions get us to those questions. I don’t draw exactly the same conclusions as you, which is perhaps unsurprising, but I do think we get to those sorts of – the sorts of learning that I have just described.

Lead Inquiry: All right, Sir Christopher, you made a reference in the course of that answer to the 2011 document.

Sir Christopher Wormald: Yes.

Lead Inquiry: Do I take it you mean the 2011 United Kingdom influenza pandemic strategy?

Sir Christopher Wormald: Yes.

Lead Inquiry: This was a strategy which was designed, was it not, by your department?

Sir Christopher Wormald: Yes.

Lead Inquiry: It was a strategy, as it says in the title, for dealing with an influenza pandemic strategy?

Sir Christopher Wormald: Yes.

Lead Inquiry: And, as you’ve rightly acknowledged, if I may say so, there was, perhaps, too great a dependency upon plans and, as we’ve discovered, too great a dependency upon an influenza pandemic plan.

Was that strategy in 2011, which formed the basis for this risk assessment thinking, ever updated?

Sir Christopher Wormald: As in a new one published? No. There was a plan to, but the pandemic struck before it was. So –

Lead Inquiry: Was that –

Sir Christopher Wormald: So –

Lead Inquiry: Was the plan not published because of the pandemic, Sir Christopher, or some other reason?

Sir Christopher Wormald: The work was not finished. So –

Lead Inquiry: Sorry, the work was not finished?

Sir Christopher Wormald: The work was in flight at the time. Now –

Lead Inquiry: No, Sir Christopher, I’m so sorry, what do you mean “the work was in flight at the time”?

Sir Christopher Wormald: Right, so we – I’m getting confused around the word “plan”.

Our intention in 2019 was that we were working on an update of the – and a refresh of the influenza plan, not a wholesale rewrite. There was not proposals for new strategic thinking, but a refresh of the plan. Those plans had not finished – sorry, those – that work had not finished at the time that the pandemic broke out.

Lead Inquiry: Sir Christopher, is the answer correctly to my question this: the 2011 document was never updated or refreshed, and the reason why it was not refreshed in 2019 was nothing to do with the pandemic, which is what you said a few moments ago, but because your department’s work was significantly interfered with by the diversion of resources to dealing with a no-deal EU exit?

Sir Christopher Wormald: Oh, yeah. Yes. No, and I think we’ve been explicit about this, that this is one of the areas of work that we paused while we were looking very specifically at the consequences of a no-deal Brexit.

Lead Inquiry: So the work was not in flight, as you said, and the work was not interrupted by virtue of the pandemic, as you said?

Sir Christopher Wormald: Well, it was delayed by the work on Brexit and then the pandemic broke out, more specifically. Sorry, I’ve chosen my words badly there.

Lead Inquiry: Did the 2011 strategy, the sole strategy for dealing with the detailed plans for a pandemic, pay any regard to overseas experience, from the experience of the other countries to which you made reference a few moments ago, who had dealt with MERS and SARS?

Sir Christopher Wormald: Well, the plan makes an explicit reference to SARS. I think it is correct that in the 2011 plan and in the substantial work that was done post that, we were not looking at the examples of some of the countries that you mentioned in your opening statement.

Lead Inquiry: So if I may suggest, the correct answer is that whilst there was a reference to SARS in the 2011 strategy, there was no reference at all to how other countries had coped with SARS?

Sir Christopher Wormald: There certainly wasn’t in the 2011 plan, and you are correct that our plans were what you might describe as in the European and western mainstream. We were not looking at the examples that – particularly of the countries you reference. That’s simply a fact.

Lead Inquiry: But the countries which had dealt, in your own words, perhaps more efficiently and appropriately with Covid were the countries that had dealt with SARS and MERS to which that very risk assessment makes reference, there were repeated references to SARS and MERS.

Sir Christopher Wormald: Yeah.

Lead Inquiry: So why was there no reference or thought given to the experiences of other countries who had been there before us?

Sir Christopher Wormald: Well, and I am … in terms of 2011, I am partly hypothesising, because obviously this was before my time, but –

Lead Inquiry: Have you read the document?

Sir Christopher Wormald: Yes – no, well, as I say, I’m quite happy to comment, I am merely setting out.

So I think this comes into the conversation we were having about the management of high-consequence infectious diseases versus the management of pandemics.

So in terms of MERS and SARS, and including Exercise Alice, which was for a high-consequence infectious disease, we were looking at those sorts of containment and elimination strategies.

What South Korea and some other countries very successfully did in Covid was apply those to much more widespread diseases than SARS and MERS, and that was the thing – and a number of people have pointed to this – that we had not built a system to do, was to do that sort of containment at the sort of scale that they did.

So, as I say, the difference is not: were one set of people thinking about containment and the other not? It was the scale to which they were – and I’d say very successful and everyone is correct to point to them on – the scale at which they were able to carry that out compared to the much lower scale of containment that was based in our plans.

Lead Inquiry: You said earlier and you say in your witness statement at paragraph 96:

“… the capabilities developed for an influenza pandemic are often the most transferable for use in response to other pandemics, should that be required …”

And the point you made earlier and the point you make in your statement is: well, all right, as a country we didn’t prepare for a coronavirus pandemic, we had only a generic plan for emerging infectious disease, it failed to have regard to the likely or possible characteristics of such a disease, namely that it would be as devastating as an influenza pandemic, but that’s all right, the capabilities developed for an influenza pandemic can be transferred in use – in response to other pandemics.

Could you please itemise, shortly, list the capabilities which can be transferred for use in other influenza pandemics?

Sir Christopher Wormald: There was one – before I do, I don’t think it’s the case that we only had a generic plan for high-consequence infectious diseases, we only required to have a generic plan by the National Risk Register, but there was in fact an extensive programme of work led by the NHS on how you deal with high-consequence infectious diseases. So I don’t think that word is correct.

We used quite a lot of the flu plan in Covid. We used the legislation, we used the surge capacity of the NHS, we used the response function that we had built up, we used the thinking on public communications, and the voluntary versions of non-pharmaceutical interventions. And absolutely crucially, and very successfully, we used the investments that had been made in vaccines, via the UK Vaccine Network, which provided the platform technologies that turned into the Oxford/AZ vaccines.

So there were a whole series of things from the influenza plans and the work flowing from it that we used.

There were then some things that we didn’t use, as your question points to.

Lead Inquiry: The stockpile of personal protective equipment for an influenza pandemic had a duration of about three months. Was that a capability which was transferred to Covid or did we run out?

Sir Christopher Wormald: It was undoubtedly transferred in that we used the pandemic stockpile that we had built up for influenza in the early months –

Lead Inquiry: Did the stockpile run out, Sir Christopher?

Sir Christopher Wormald: We never nationally ran out of PPE. We were very short and we had significant logistical issues. The – so the stockpile that we had built up was (inaudible) useful in the pandemic. Was it big enough for the pandemic that we had? It would have been much better were it to have been larger.

Lead Inquiry: Were the –

Lady Hallett: Can I just interrupt there?

Mr Keith: Yes.

Lady Hallett: I think a lot of medics would be surprised at your comment “we never nationally ran out of PPE”.

Sir Christopher Wormald: Yes, and I chose my words very carefully, and it’s a debate we have had before. There were huge pressures on PPE and we had, as I said, significant challenges getting PPE to the right place. So the department has never said, and it would not be true to say, that in individual places there were shortages of PPE and people having to use not the right PPE. That’s different from it having run out nationally. So, in terms of all the reports people make of the struggles with PPE and the right PPE in an individual place not being available, that was clearly true.

Mr Keith: Sir Christopher, the stockpile which existed on 1 January 2020 ran out. Obviously further PPE had to be procured –

Sir Christopher Wormald: Yes.

Lead Inquiry: – but the stockpile for an influenza pandemic was not sufficient, was it?

Sir Christopher Wormald: Well, the –

Lead Inquiry: Was that stockpile sufficient, Sir Christopher?

Sir Christopher Wormald: The stockpile was never intended to cover the whole of a pandemic, it was supposed to create a buffer while you ramp up production –

Lead Inquiry: But you’re the one who said the capabilities developed for influenza are transferable for use?

Sir Christopher Wormald: Yeah, and the stockpile was transferred.

Now, I did not, and this was a very deliberate answer to your question, I did not put PPE on my list of things that we transferred. While the stockpile we had was useful, and prevented us from running out of PPE at various points, there was a clear difference between the PPE we needed for this type of pandemic and the one we had built up, which is why I didn’t put it on my list of transferables.

Lead Inquiry: The antiviral medicine Tamiflu was a capability developed for influenza pandemic. Was that of any use at all in a non-influenza pandemic?

Sir Christopher Wormald: No. And again, that is why I didn’t put it on my list.

Lead Inquiry: I believe that you’ve answered the question.

Sir Christopher Wormald: Okay.

Lead Inquiry: You’ll have an opportunity in a moment, no doubt, of answering other questions on this.

Sir Christopher Wormald: I’m sorry.

Lead Inquiry: In relation to contact tracing on a mass level, or of quarantining, or of lockdowns, or any of the more severe social restrictions, were those capabilities that were designed in relation to an influenza pandemic?

Sir Christopher Wormald: So wide-scale contact tracing was never part of the influenza plan, and lockdowns, as in legal lockdowns, they were not what we had planned for.

Lead Inquiry: No.

Exercise Alice, to which you’ve referred –

Lady Hallett: Sorry, just before you go on, was there anything else you wanted to add earlier, Sir Christopher?

Sir Christopher Wormald: Just on antivirals, obviously you can only stockpile antivirals that exist for diseases that you know about. So in that case I would absolutely defend stockpiling, where you do have antivirals that are relevant to a disease – well, you can’t stockpile, as I say, an antiviral that doesn’t exist. So there were no antivirals for coronavirus, just like there was no vaccine, so the choice to stockpile it never arose. I don’t think that should – I don’t think we should take the lesson that we should therefore not stockpile antivirals that we can use were we to have a flu pandemic, was my point.

Mr Keith: Sir Christopher, with respect, has anybody suggested that we shouldn’t stockpile antivirals?

Sir Christopher Wormald: No.

Lead Inquiry: The question to you was because you said “There are capabilities for a pandemic influenza that may be readily transferred to a non-influenza”, I was asking you about what capabilities –

Sir Christopher Wormald: Sorry, yeah.

Lead Inquiry: – could not be transferred.

Sir Christopher Wormald: I’m sorry if I misunderstood.

Lady Hallett: Exercise Alice.

Mr Keith: Exercise Alice.

There were a number of recommendations made in the Exercise Alice, and in light of the time I’m not going to take you through them, but lessons or actions 5, 7, 8 and 9 were concerned with producing a briefing paper on the South Korea MERS outbreak to consider the policy relating to port of entry screening.

Action 7: produce an options plan using extant evidence and cost benefits for quarantine on a mass scale.

Action 8: community sampling.

Action 9: develop a live tool or system to collect data from MERS coronavirus contacts.

I appreciate this is a very broad question, but can you say, in general terms, whether or not any of those actions were actually pursued by your department following the conclusion of Exercise Alice?

Sir Christopher Wormald: Yes, some of them were partially, but you are correct that not all of them were completely. I should say that was, of course, a test of our HCID mechanisms, not our pandemic mechanisms.

Lead Inquiry: You referred to the experience of Asian countries. In a lessons learned report after the pandemic, in September 2020, do you agree that your own department stated that it would have benefitted from a fuller understanding of the response by Asian countries, which might have enabled us to start building testing systems earlier in January 2020?

Sir Christopher Wormald: Yes.

Lead Inquiry: Could we please have up INQ000057430.

This is a memo dated 27 March 2019 to Professor Sir Chris Whitty, the Chief Scientific Adviser, from your department, or the DHSC, headed “Pan flu preparedness & high-consequence infectious disease policy …”

If you look at paragraphs 1, 2 and 3 they say this:

“You are aware that, following reorganisation and re-prioritisation of DHSC work due to EU Exit no deal planning, pan flu preparedness and high-consequence infectious disease … policy has moved to your portfolio of responsibilities on a temporary basis.”

Then there is a reference to corporate memory in paragraph 2.

Then in paragraph 3:

“… Emma Reed and Clara Swinson agreed a range of work related to pan flu and HCID that would be scaled back or paused before this policy area transferred across to you.”

Then may we have, please, page 3.

This is an annex, annex A:

“Pan flu preparedness and HCID policy. Area of work continuing, slowing or pausing as a result of EU Exit prioritisation.”

Sir Christopher, would you cast your eye down, please, the left-hand side of that document, the column “Work area”, and broadly identify how many areas were either stopped, reduced or paused, just broadly?

Sir Christopher Wormald: Quite a lot.

Lead Inquiry: In your statement at paragraph 416, could we have, please, INQ000184643, page 79:

“While it is a matter of judgement, the Department’s view is that the UK was better prepared for health-related emergencies as a result of the work conducted on EU Exit. For example, on supply, the Department had a far deeper understanding of global medical supply chains and stronger relationships with industry, heightened stockpiles of critical medicines and medical products which provided an increased buffer … and an improved emergency response function, including provision for emergency logistics to mitigate disruption …”

So there is a reference there to supply chains and emergency response function.

Do you agree that that sentence, those sentences in that paragraph, if we could go back, please, to the phrase “UK was better prepared for health-related emergencies”, is a proper and correct reflection of that annex and the number, sheer number of workstreams for pandemic planning that were paused or stopped?

Sir Christopher Wormald: Yes. Now, as I made clear in my statement, this is entirely a matter of judgement, I could not, you know, arithmetically prove. However, what we – essentially happened – and I should say this was not – this was not a plan or a strategy, I’m merely trying to assist with what happened. We stopped a whole load of work which was about enhancing the flu plan and taking forward chunks of the flu plan, and we – and that’s clearly a negative, I’m not trying to imply that that is not a negative – and we added a whole series of generic capabilities that we then used in the Covid response, and my reflection on that is that the capabilities that we built up as a byproduct of our no-deal Brexit work were extremely valuable to us in the pandemic.

So, as I say, and just to be very clear, I am not trying to suggest that reducing the work that you showed earlier in some way enhanced us, it clearly didn’t, it was – clearly in an ideal world, if you had all the resources you want, you would do both, I am simply saying, in the balance of weighing up, those capabilities that I quote in my witness statement turned out to be, in my judgment, more valuable than more work on the influenza plan.

Lead Inquiry: Do you agree that the Exercise Cygnus report concluded that the United Kingdom’s preparedness and response in terms of its plans, policies and capability were not sufficient to cope with the extreme demands of a severe pandemic?

Sir Christopher Wormald: Yes, that is what it found and, as I said earlier, there was then a programme of work that followed Cygnus.

Lead Inquiry: You must have been very concerned when you read the Cygnus report and its conclusion at paragraph 6 that the preparedness and response, both in terms of plans and policies and capability, were not sufficient to cope?

Sir Christopher Wormald: I thought Cygnus had done its job properly –

Lead Inquiry: Were you concerned, Sir Christopher?

Sir Christopher Wormald: Yes, and this was an area where I took specific meetings and reports in the follow-up beginning in late 2017, which I haven’t done for similar subjects. So …

Lead Inquiry: But many of the workstreams which you ultimately put into place as a result of Cygnus were not, ultimately, actioned, as we have just seen, because of the competing demands of Operation Yellowhammer, the plans for a no-deal exit, and many of the workstreams were never finished or only partially completed, were they not?

Sir Christopher Wormald: Yes, no, I mean, that is correct. I think a lot of progress was made after Operation Cygnus, but you are completely correct that not all actions were completed and that we changed our departmental priorities at the point that it says.

Lead Inquiry: So where between 2018, when Operation Yellowhammer was first conceived, the planning for EU exit no-deal, and the end of 2019, when it became apparent there would be no no-deal exit, do you express your continuing concerns that the workstreams to make the United Kingdom compliant with that core recommendation from Exercise Cygnus were not being completed or had been stopped and that our country’s system for preparedness and response was imperilled?

Sir Christopher Wormald: I’m sorry, I’m not quite sure I understood the question.

Lead Inquiry: Did you express in a way that mattered your continuing concern that the outcome of Exercise Cygnus was not being addressed because the workstreams designed to address it were being interrupted or had been stopped altogether?

Sir Christopher Wormald: Well, they were decisions that were not taken lightly at all, and our intention all along was, once we had come out of the period when we had to plan for EU exit, that those things would continue. I couldn’t point you to a thing I wrote on that subject, but that was our expectation.

Lead Inquiry: Exercise Cygnus was a multi-phase exercise, a Tier 1 exercise, was it not?

Sir Christopher Wormald: Yes.

Lead Inquiry: It took place over two days, it was preceded by another exercise, Exercise Cygnet, it involved more than 950 people, it was a serious test of the United Kingdom’s response capacity, and it largely failed, did it not?

Sir Christopher Wormald: No, I don’t think that’s –

Lead Inquiry: The outcome, Sir Christopher, in paragraph 6, was that our systems, plans, policies and capability were not sufficient to cope with a severe pandemic.

Sir Christopher Wormald: Well –

Lead Inquiry: The country failed that test, did it not?

Sir Christopher Wormald: The point of exercising is to identify where your plans are already strong and where they need enhancing.

Lead Inquiry: And they were not strong, because the Cygnus report was to the effect that, whether in terms of policies or capability, the system was not sufficient?

Sir Christopher Wormald: There was work to do on the system, yes, and the purpose of the exercise is to identify those.

Lead Inquiry: The preparedness and response of the United Kingdom was not sufficient, Sir Christopher?

Sir Christopher Wormald: Yeah.

Lead Inquiry: Do you agree?

Sir Christopher Wormald: I mean, that is what the report says, yes.

Lead Inquiry: So, over the subsequent three years, the workstreams that were put in place to deal with Cygnus and that conclusion about the systemic lack of capacity, preparedness and response, were then themselves paused, interrupted or stopped.

Where is your expression of concern that we were, therefore, by the end of 2019, in largely no better a position than we had been in 2016, October?

Sir Christopher Wormald: Well, I don’t think that is correct, because a number of workstreams did go forward, and, as I said earlier, I couldn’t point you to a piece of paper that I wrote expressing those concerns.

Lead Inquiry: Workstreams continued in relation to the ability to deal with just the fact of excess deaths and the sheer number of deaths that might be anticipated; correct?

Sir Christopher Wormald: Well, that was one of the workstreams.

Lead Inquiry: Workstream continued in relation to how a severe pandemic might impact on prisons?

Sir Christopher Wormald: Yes.

Lead Inquiry: Work continued on how the health sector, the NHS, would cope with the surge demand of a severe pandemic?

Sir Christopher Wormald: Yes.

Lead Inquiry: But in every other regard, whether it was to do with the adult social care sector, to do with public health measures, to do with a central repository of information for how to deal with a severe pandemic, for dealing with the loss of institutional memory, for dealing with the plans relating to dealing with a pandemic, that list in annex A, no further work was done in the main by December of 2019, was it?

Sir Christopher Wormald: Between the point that we paused it and that date, yes. A number of actions before that date had taken place. So if you take the example of social care, the follow-up, in terms of further discussions and seminars with local authorities that my colleagues at MHCLG carried out took place, as did the commissioning of guidance from the Association of Directors of Social Services for the social care sector, which was created and published in 2018.

So it is not correct that nothing was taken forward between 2016 and 2020. It is correct, as your exhibit correctly identifies, that a number of things were paused in mid-2018, for the reasons that we have set out.

Lead Inquiry: By June of 2020 your department reported, after the pandemic, that 14 lessons of the 22 recommendations had not been completed; is that correct?

Sir Christopher Wormald: Yes, that’s correct.

Lead Inquiry: 14 of 22?

Sir Christopher Wormald: Not been completed. A large number of those were ongoing.

Lead Inquiry: Yes, they had not been completed by the time six months before the pandemic had struck, had they?

Sir Christopher Wormald: That’s correct.

Lead Inquiry: And in relation to social care policy implications, one of the objectives of Exercise Cygnus, objective 5, was to develop plans for the social care facilities to be used to support clients who were discharged from hospital as part of the sector’s surge capacity, and whilst there were meetings held in relation to that important workstream, that was one of the workstreams that was not completed, was it?

Sir Christopher Wormald: No, that wasn’t completed, no.

Lead Inquiry: Sorry?

Sir Christopher Wormald: That was not completed, no.

Lead Inquiry: In relation to another recommendation, that adult social care should be better integrated into all aspects of the DHSC’s emergency response system, was that completed?

Sir Christopher Wormald: It wasn’t completed, although work was done on that subject, as I have just –

Lead Inquiry: Some meetings were held, were they not?

Sir Christopher Wormald: Well, and guidance produced by the Association of Directors of Social Services.

Lead Inquiry: Was the system for adult social care better integrated into the department’s emergency response?

Sir Christopher Wormald: Well, in the light of what happened in the pandemic, I couldn’t, hand on heart, say yes. There was, as I’ve described, a programme of work post Cygnus, but, as I think is well known, this is one of the areas where we adapted our approach most during the pandemic and we were most challenged in how we dealt with that sector. So I think I couldn’t – I couldn’t say in the light of what happened that that had been successful.

Lead Inquiry: I think you’ve accepted, and a number of bodies have said this in the clearest terms, including Care England, that some social care providers did run out of PPE. Do you agree?

Sir Christopher Wormald: Yes, and, as I was describing earlier, we had two levels of challenge: one was the national supply, where it was exceptionally tight, but at no point did we actually run out; and two was the logistics of delivering to a much larger number of settings than we had anticipated, which was a huge, huge struggle, as your witnesses have pointed to.

Lead Inquiry: Your own departmental conclusion was, in December 2020, the Covid pandemic has shown that the clinical countermeasures, including PPE, held for an influenza pandemic had limited applicability to non-influenza pandemic threats.

Is that a way of saying that the PPE held for influenza pandemic was of little assistance to the coronavirus pandemic?

Sir Christopher Wormald: No, it was of – it was of assistance. What it was not designed for, and I know you’ve discussed this with other witnesses, was for a disease with a significant amount of asymptomatic transmission, which required us to provide PPE into a lot more settings than had been planned for. So yes, I recognise that conclusion.

Lead Inquiry: NERVTAG, the committee for New and Emerging Respiratory Virus Threats Advisory Group, you say in your own statement – the seventh statement, at paragraph 76 – recommended to DHSC that surgical gowns be stockpiled and they did so in advance of the pandemic.

Were surgical gowns stockpiled?

Sir Christopher Wormald: The process of scoping the procurement was under way at the point when the pandemic broke out. So that had been accepted, but the procurement was not complete at the time that the pandemic broke out.

Lead Inquiry: In relation to the just-in-case contracts which the department had been involved in or had arranged, and which of course was a basis of one of the workstreams post Exercise Cygnus, did the just-in-case provision of stockpiles and supplies meet the demands in January 2020?

Sir Christopher Wormald: No, they didn’t, and I think you reference the report, those contracts didn’t work largely because other countries introduced bans on the exports of PPE, and we were therefore – and I’m sure we will cover this in much more detail in other modules – forced to go to the general market at considerable expense.

Lead Inquiry: Did your own departmental briefing paper for oversight and assurance in July 2020 report that the respirators which had been provided for frequently fitted white faces but the ones which were better off for black staff were purchased in much smaller quantity and there had been no provision for that in the post Exercise Cygnus pre-pandemic planning?

Sir Christopher Wormald: Yeah, that is a finding that the department found during the pandemic and acted on during the pandemic, that is correct.

Lady Hallett: Mr Keith, sorry to interrupt, but I was asked to break at about half past or 25 to.

Mr Keith: That’s a convenient moment.

Lady Hallett: Thank you very much. I shall return at 3.55.

(3.40 pm)

(A short break)

(3.55 pm)

Mr Keith: Sir Christopher, it appears to be common ground that, insofar as your department considered, when planning for a pandemic, the potential impact on protected groups, ethnic minorities, vulnerable sectors of society, the marginalised, the position was that plainly a pandemic would have different impacts but that those impacts would be of a clinical nature, so a pandemic would affect those who have heart disease or diabetes or some other comorbidity in a different way to a healthier member of the population; is that correct?

Sir Christopher Wormald: Yes. So when we’ve looked at what we did on equalities beyond what we did for legal compliance, the focus was exactly as you say, it was on the clinical elements of inequality and how those would be impacted by a disease, that is correct.

Lead Inquiry: It follows, does it not, that neither your department, nor, in fact, any pre-Covid exercise, considered the issue of how a pandemic in reality, or as part of a test, would impact vulnerable people or those with health inequalities or related factors, other than insofar as they may be impacted clinically?

Sir Christopher Wormald: Yes, there is obviously a very large overlap between the two, as you heard from other witnesses.

Lead Inquiry: Yes.

Sir Christopher Wormald: There was a lot of thinking in the department, and still is, about the issues that you point to. They were, as you say, not thought of directly in the context of pandemic preparation. So there was lots of work on those areas, but I couldn’t point you to specific parts of pandemic preparation.

Lead Inquiry: Well, you say, “There was a lot of thinking in the department, and still is, about the issues that you point to”. There was no thinking, was there, in the department, or as part of any single exercise between 2007 and 2018, Exercise Pica, about the impact of plans or the pandemic or the response to the pandemic, planned for or tested on vulnerable people, ethnic minorities or any sector of the population other than insofar as they may be affected clinically; is that correct?

Sir Christopher Wormald: In the exercise programme, yes, I think that is correct.

Lead Inquiry: So it’s not right to say there was a lot of thinking about these issues then. There was no thinking about these issues then?

Sir Christopher Wormald: Oh, sorry, I’m not explaining myself correctly. In wider health policy, there is a lot of thinking –

Lead Inquiry: Of course.

Sir Christopher Wormald: – about health disparities, was my point. As I said, what there wasn’t was that specifically in pandemic preparation.

Lead Inquiry: My Lady’s Inquiry is not into healthcare, it is into the planning for pandemics?

Sir Christopher Wormald: Yeah, sorry, I –

Lead Inquiry: Yes.

Sir Christopher Wormald: As I say, I chose my words badly. I apologise.

Lead Inquiry: It follows also, doesn’t it, that at no time did the department ever obtain specialist advice on health inequalities and the implications of health inequalities on pandemic planning impacts and mitigation strategies?

Sir Christopher Wormald: No, I don’t think we ever commissioned advice on that, until actually during the pandemic, when of course we did a lot.

Lead Inquiry: A bit late, Sir Christopher?

Sir Christopher Wormald: Sorry, I’m not – I am merely setting out – I’m sorry, I’m merely setting out what happened.

Mr Keith: I’ve no further questions, thank you.

Would my Lady give me one moment?

(Pause)

Mr Keith: My Lady, in relation to the Rule 10 process, I believe that whilst a number of questions were posed by one core participant, you have not provisionally indicated that any of them should be posed, and therefore, in light of that provisional indication, now that we’ve actually heard Sir Christopher, are you minded to confirm your provisional indication and not allow any further questions to be asked?

Lady Hallett: Unless there are any further submissions, yes, I am.

Mr Keith: Thank you very much.

Questions From the Chair

Lady Hallett: May I ask a couple questions, please, Sir Christopher?

Sir Christopher Wormald: Yes.

Lady Hallett: Roughly how many staff did you have to allocate to Operation Yellowhammer and the Brexit no-deal?

Sir Christopher Wormald: I believe in total we allocated, in the process we were talking about earlier, approximately 70. I will have to go and confirm that, but I think it was about 70.

Lady Hallett: That happened across government departments ? Everyone was told: you’ve got to provide a number of staff?

Sir Christopher Wormald: Well, no, this was the internal re-prioritisation going on within DH –

Lady Hallett: So this is not the general response to a no-deal Brexit, this is the health department’s response?

Sir Christopher Wormald: Yeah, so we had a number of workstreams of which we were responsible, by miles the biggest of which, and our biggest worry, was about the supply of pharmaceuticals during the – during a no-deal Brexit, and particularly the number that came through the short straits. So we owned a number of workstreams. And when Yellowhammer, as I set out in my statement, became the principal focus of government, departments re-prioritised within. There was also a re-prioritise across government as a whole, but the one here which affected our pandemic preparations was the internal DHSC exercise, if that’s clear.

Lady Hallett: Thank you.

You said that, as a result of the pandemic, there are things that you would have done differently, with the benefit of hindsight and whatever other element of judgement you may want to use. Can you give some practical examples of what you would have done differently if you had known what you know now?

Sir Christopher Wormald: Yeah, so obviously the report done by the Chief Medical Officer and the Government Chief Scientific Adviser gives a very comprehensive list of the learnings from the pandemic. When we’d discussed this within the department, it comes down to five things.

The two biggest ones I’ve mentioned already, which is the focus on capabilities and underlying resilience, as opposed to plans and systems.

Third is what’s become known as the pathogen agnostic approach to planning, which is moving away from the “ready for flu, ready for anything” philosophy I was describing earlier towards a “Let’s look at the roots of transmission”. That’s the third one.

The fourth is a focus on surge capacity, which was clearly a big problem for us at the beginning of the pandemic, getting from the initial response phase to the when you’ve deployed the full armaments of the state, focusing on that phase.

Fifth, as I think has been widely reported, and I think Government Office for Science also made this point, we were short of testing, we did not have the testing capacity that some of our European or other counterparts had.

So, in terms of how we’re thinking about pandemic preparation going forward compared to what I have described, it’s those five areas which we see as the biggest ones.

That’s obviously not an exhaustive list, and it’s not a complete list, in that of course the government will – well, it set up this Inquiry because it wishes to get to lessons learnt, so we’re not trying to finalise what we think, but in terms of where our thinking is, it is those five areas that we think would make the biggest differences in our approach to planning.

Lady Hallett: Thank you. That’s all I ask.

Mr Keith: Thank you, my Lady.

Lady Hallett: Thank you very much indeed, Sir Christopher. Sorry you have been so long in the witness box.

(The witness withdrew)

Lady Hallett: Yes, Ms Blackwell.

Ms Blackwell: My Lady, the next witness is Clara Swinson, who I understand is in the process of being brought into the witness box.

(Pause)

Ms Blackwell: Thank you, Ms Swinson, would you like to take the oath, please.