3. Ms Clara Swinson

MS CLARA SWINSON (affirmed).

Questions From Counsel to the Inquiry

Lady Hallett: I’m sorry you have been waiting for most of the day.

Ms Blackwell: Will you give your full name to the Inquiry, please.

Ms Clara Swinson: Yes, Clara Jane Swinson.

Counsel Inquiry: Thank you. Please keep your voice up and speak into the microphone – I can see you are adjusting them, thank you very much – so that the stenographer can hear you for the transcript. If I’m not clear in my questioning, please, by all means, ask me to repeat it.

First of all, Ms Swinson, may we have on the screen, please, both of your witness statements.

Firstly, INQ000182608. Can you confirm, please, that that is your first witness statement?

Ms Clara Swinson: Correct, it is.

Counsel Inquiry: And it’s true to the best of your knowledge and belief?

Ms Clara Swinson: It is.

Ms Blackwell: May we have permission to publish that, please, my Lady?

Lady Hallett: Yes.

Ms Blackwell: Secondly, INQ000212314. Thank you.

Is that your second witness statement?

Ms Clara Swinson: It is.

Counsel Inquiry: Again, is it true to the best of your knowledge and belief?

Ms Clara Swinson: It is, yes.

Counsel Inquiry: Thank you. We can take that down.

I’m going to begin by setting out briefly an overview of your career history as it’s relevant to the Inquiry.

Ms Clara Swinson: Okay.

Counsel Inquiry: You have been a senior civil servant since 2006, you are Director General within the Department of Health and Social Care, covering international health and domestic public health issues, and you have held that role since November 2016?

Ms Clara Swinson: Yes.

Counsel Inquiry: Since this appointment, you have reported to the Permanent Secretary, Sir Christopher Wormald, who has just given evidence?

Ms Clara Swinson: Yes.

Counsel Inquiry: You are a member of the DHSC executive committee and a senior sponsor for UKHSA, formerly PHE?

Ms Clara Swinson: That’s right.

Counsel Inquiry: Thank you.

You are responsible for three directorates, including the directorate on emergency preparation and health protection, to which we’ll turn in a moment.

Ms Clara Swinson: Yes.

Counsel Inquiry: You’re chair of the PIPP board, now newly renamed the Pandemic Preparedness Portfolio board, and you’ve been –

Lady Hallett: Why?

Ms Blackwell: Perhaps we’ll come to that, my Lady.

And you have been chair of the PIPP board since 2017, until it was re-formed under its new name in 2022.

You were also responsible for preparations for the EU exit?

Ms Clara Swinson: That’s right, and if I could just add, I’m responsible for more than three directorates that you said at the start. My responsibilities have changed a little bit since 2016, for exactly – but that is set out in my witness statement.

Counsel Inquiry: All right, thank you. You’re responsible for international policy, bilateral relationships and health work on a multilateral basis?

Ms Clara Swinson: Correct.

Counsel Inquiry: For example, at the World Health Organisation, G7 summit, et cetera?

Ms Clara Swinson: Yes.

Counsel Inquiry: Finally you are a UK senior official on the Global Health Security Action Group?

Ms Clara Swinson: I am.

Counsel Inquiry: Thank you.

I want, first of all, please, Ms Swinson, to deal with emergency preparedness and health directorate, and the EPRR function.

The directorate has day-to-day responsibility for pandemic preparedness, doesn’t it?

Ms Clara Swinson: That’s right, among other things.

Counsel Inquiry: All right. And what, specifically, does that entail in terms of emergency planning?

Ms Clara Swinson: Pandemic preparedness?

Counsel Inquiry: Yes, within the directorate.

Ms Clara Swinson: Yes, so that requires oversight of the health and care system responsibilities, so across the department, NHS England and Public Health England – as was, UK Health Security Agency now. It means preparing for any exercises there are, it also means with emergency planning being responsible for plans for non-pandemic threats.

Counsel Inquiry: Yes.

Ms Clara Swinson: That might be biological or they might be chemical or they might be terrorist attacks or so on.

Counsel Inquiry: All right.

It exists to respond, then, to a wide range of emergencies, including pandemic and infectious disease outbreaks, but isn’t limited to that, as you’ve just explained.

Ms Clara Swinson: Yes.

Counsel Inquiry: Is its role to support an emergency response?

Ms Clara Swinson: It would depend slightly on what the incident was. So we would stand up an incident team. That could be anything from, you know, a major cyber attack, it could be the Manchester Arena attacks, or it could be something that was health-specific, and it would depend exactly whose responsibilities – or whether for – so on, but it is – for whatever the impact is on the health and care system, it is to co-ordinate and oversee the response of the system.

Counsel Inquiry: All right.

Were you confident that the EPRR function, to be stood up in response to the risk from a pandemic, would be sufficient to meet the risk of a significant pandemic whilst you were in that role?

Ms Clara Swinson: So the function itself I’ve set out. In terms of – in a response phase –

Counsel Inquiry: Yes.

Ms Clara Swinson: – it would need to be scaled according to the incident.

Counsel Inquiry: All right.

Ms Clara Swinson: So that could be something that a small team could do, it could be something that we would need to expand.

Counsel Inquiry: Does the directorate and does the organisation have within it the capacity to upscale in the event of a large emergency?

Ms Clara Swinson: Yes. That would require resources across the department, as happened in the Covid-19 pandemic.

Counsel Inquiry: Right.

In terms of the pandemic preparedness programme, I want to ask you some questions about the UK influenza pandemic strategy of 2011, brought into force following the Hine review and the recommendations within Dame Deirdre Hine’s report, and largely untouched until the coronavirus pandemic hit. Because isn’t it right, Ms Swinson, that the coronavirus action plan published in March 2020 drew very heavily on the 2011 strategy?

Ms Clara Swinson: It is correct, yes.

Counsel Inquiry: Right.

Isabel Oliver, the interim Chief Scientific Adviser at the UKHSA, has confirmed – and this Inquiry has already heard quite a lot of evidence even so far about this – that the only pandemic scale plan in place at the time that Covid hit was the one set out in the strategy, that was for pandemic influenza.

Do you agree with that?

Ms Clara Swinson: The only plan in place, did you say?

Counsel Inquiry: Yes, the only plan in place, the only strategy to be followed and the only plan that was in place was –

Ms Clara Swinson: Yes. UK-wide. Obviously some other organisations had their own plans but, yes, UK-wide it was – the 2011 strategy was still existing.

Counsel Inquiry: Right. Do you think, knowing what you do now, that there was good reason for that plan to have been updated between 2011 and when the pandemic hit?

Ms Clara Swinson: So there were reasons to update it, for example, it was before the 2012 Act, to be clear about roles and responsibilities, and so on.

Counsel Inquiry: Yes.

Ms Clara Swinson: In terms of its overall approach in terms of the principles, the main areas, there would have been some things that were worth updating and refreshing –

Counsel Inquiry: Such as what?

Ms Clara Swinson: So, for example, you know, technology had changed since 2011, vaccine manufacturing and so on, but the basic premise of the plan, there was not a different strategy that was in place that we needed to publish. The basic premise of the principles is as set out in the 2011 plan.

Counsel Inquiry: What about the fact that it only dealt with pandemic influenza, what do you say about that?

Ms Clara Swinson: Yes, I mean, that is, it flows from the National Risk Register that you have been talking about today. We have reflected, and the new pandemic portfolio that you referred to in the opening is a recognition that now we are doing – we would like the strategy to be along all of the different routes of transmission, not just a respiratory pandemic.

Counsel Inquiry: So was that a mistake for it only to be limited to that? Do you think in hindsight, and knowing what happened in the intervening period, especially with other coronaviruses across the world, that perhaps that should have been drafted more widely?

Ms Clara Swinson: I think it was a reasonable decision at the time. I think it was in line with expert advice, and there was not a response to it saying it should have been extended. But clearly, knowing what we do now, as set out, we are changing our approach to cover all the routes of transmission.

Counsel Inquiry: All right.

I would like to look, please, at the witness statement of Professor Mark Woolhouse at INQ000182616. Thank you very much. Paragraph 10, which is on the previous page, I think. Thank you.

“In the event, our go-to response to Covid-19 became lockdown … Of itself, that highlights a striking deficiencies in the UK’s pandemic preparedness: we had no plans to implement lockdown at all. On the contrary [and here is the point] the UK’s 2011 pandemic influenza strategy document … states: ‘During a pandemic, the Government will encourage those who are well to carry on with their normal daily lives for as long as and as far as that is possible, whilst taking basic precautions to protect themselves from infection and lessen the risk of spreading influenza to others. The UK Government does not plan to close borders, stop mass gatherings or impose controls on public transport during any pandemic’. Lockdown was an ad hoc public health intervention contrived in real time in the face of a fast-moving public health emergency. We had not planned to introduce lockdown and this had two serious consequences.”

Which he goes on to deal with.

It’s right, isn’t it, Ms Swinson, that the 2011 strategy did not include any plans for mitigation measures such as lockdown, closing borders, stopping mass gatherings or controls on public transport?

Ms Clara Swinson: It’s true what it says here and elsewhere in the document, it says it’s the working assumption that there wouldn’t be restrictions on some of the things you’ve mentioned. It does say that there might be restrictions on some mass events and some school closures, but the working assumption is as set out, yes.

Counsel Inquiry: Other than mentioning those matters which you have just set out, there are no plans to mitigate, there is no discussion about the potential outcome of, for instance, controlling mass gatherings or closing schools, is there?

Ms Clara Swinson: There are a range of things to mitigate when one doesn’t have medicines or treatments, so there is advice to people if they’re unwell, for example, to stay at home, through to some of the more extreme measures that you’ve just mentioned. But yes, that is what is set out in the strategy.

Counsel Inquiry: All right. But there is no discussion of the impact of the imposition of those sorts of restrictions?

Ms Clara Swinson: There is no discussion of legally enforced stay at home, no.

Counsel Inquiry: What Professor Mark Woolhouse goes on to say is the lack of such measures is a striking deficiencies in the UK’s pandemic preparedness. Do you agree with him?

Ms Clara Swinson: I’m not aware of any country that had a lockdown plan. Obviously it’s what happened in the pandemic, and we, both in the department and across society, need to reflect on that. But it was not something that was in the UK plan or any other country that I’m aware of.

Counsel Inquiry: No, nor discussion of any of the other measures which we’ve set out. Other than mass gatherings and school closures, there is no discussion about any of the other mitigating impositions?

Ms Clara Swinson: In terms of social distancing?

Counsel Inquiry: Yes, in terms of closing borders, in terms of controls of public transport, that sort of thing; and what Mark Woolhouse is saying is the lack of that sort of information in the strategy is a striking deficiency. The question to you is: do you agree with that?

Ms Clara Swinson: The strategy did not have those things in it. I think that was reasonable at the time. It was not something – there was a consultation on this document, for example. Clearly, as the pandemic occurred, actions that were taken in other countries, and then in the UK, did lead to legal restrictions on daily life.

Counsel Inquiry: Do you agree that the 2011 strategy also didn’t plan for a whole-system effect, with wide-ranging impacts on society, the economy, public services, that sort of thing?

Ms Clara Swinson: Well, I believe it has a section on the whole-system effect, the fact that it would effect the whole of society, it would have societal and economic impacts, as set out in the strategy.

Counsel Inquiry: All right.

Thank you, we can take that down.

Jeremy Hunt in his statement to the Inquiry has said:

“… I believe with the benefit of hindsight that our preparations … were affected by an element of ‘groupthink’. By that I mean that the spread of many distinct types of virus could create a pandemic, yet our shared belief was that the most likely scenario was a pandemic flu.”

What do you say about that?

Ms Clara Swinson: So it’s true that our expert advice was that pandemic flu was and actually continues to be the biggest risk. You’ve talked at some detail today about the range of other pandemics –

Counsel Inquiry: Yes.

Ms Clara Swinson: – and I’ve explained how learning what – from what happened that we wish to take – setting out a different approach.

I think a number of witnesses, experts have also set out in their statements for you that they think flu was a reasonable scenario, but clearly there was not different expert advice before the pandemic. Expert advice and our experience would now show that we should plan for a wider group of viruses.

Counsel Inquiry: Do you think there is a need for more robust challenge and diverse expertise or perspectives in terms of what may happen?

Ms Clara Swinson: So in terms of expert advice and groupthink, yes, there are, you know, a whole range of advisory groups which we’ve set out in our witness statements.

Counsel Inquiry: Yes.

Ms Clara Swinson: You’ve got evidence from the chairs of some of those. Both in terms of expertise in the UK, our Chief Scientific Advisers, and in terms of learning from other countries, you know, I don’t think it was groupthink in a very small number of people, I think that is the case across the UK and for most of our European and American colleagues, or counterparts. Clearly, as Jeremy Hunt set out, learnings particularly from South East Asia and maybe expanding the expert input from what we’ve learnt now showed that there were some other ways of thinking about containment of a new novel disease and how to respond to it.

Counsel Inquiry: On that point alone, that could have been done, couldn’t it, at some point past 2016, when it was recommended from the fallout of Exercise Alice that South Korea, for instance, should have been contacted and the way in which they responded to MERS could be analysed and the UK could take from that indications of how best for them to react in a similar position, but that wasn’t done?

Ms Clara Swinson: I don’t know whether – I would be surprised if there was no contact between public health experts in this country and South Korea on MERS, for example, but in terms of the learning at the very extensive contact tracing and so on, that did not lead to a change in policy in this country.

Counsel Inquiry: All right. And are you aware of the analysis of contact tracing and precision lockdown and that sort of thing being carried out?

Ms Clara Swinson: I’m not, no.

Counsel Inquiry: No.

I’d like to turn now to the Pandemic Influenza Preparedness Programme, otherwise known as PIPP. Bearing on the Chair’s question, why has that now been renamed the Pandemic Preparedness Portfolio board?

Ms Clara Swinson: So that it covers in scope all the routes of transmission, not just respiratory viruses and, within that, not just influenza.

Lady Hallett: I still question whether it was necessary to change the name, but that’s probably for another time, Ms Swinson.

Ms Clara Swinson: The “I” stood for influenza, so –

Ms Blackwell: That needed to be removed?

Ms Clara Swinson: Yeah.

Counsel Inquiry: Right.

In any event, PIPP was the central DHSC led programme involved in organising, directing and managing pandemic preparedness amongst the DHSC and other bodies, and it worked together with Public Health England and NHS England; is that correct?

Ms Clara Swinson: That’s right. In my witness statement I set out 12 areas – and the corporate statement – of pandemic preparedness, but PIPP is one very important one of those.

Counsel Inquiry: All right, thank you. And it was in operation from October 2007 until July 2022.

In terms of the work of PIPP, was it initially shaped by the approach set out in the UK influenza strategy, or certainly since 2011?

Ms Clara Swinson: Since 2011, yes.

Counsel Inquiry: Yes, and you have been kind enough to provide to us a series of minutes from the PIPP board meetings. In July of 2017, we can see that a series of five workstreams were set out during the course of that meeting. I don’t think we need to look at the meeting notes themselves, but you’ll be familiar with them, Ms Swinson.

Can you confirm that the first four workstreams were as follows: surge and triage, community care, excess deaths, and sector resilience, and that those four workstreams were themselves derived from the findings of Exercise Cygnus?

Ms Clara Swinson: I can. They were workstreams of the Cabinet Office/DHSC joint board, the Pandemic Flu Readiness Board, and so some of those were not purely about the health and care system –

Counsel Inquiry: Yes.

Ms Clara Swinson: – but the health and care system aspects, yes, were –

Counsel Inquiry: Were taken across and formed into the workstreams, thank you.

Ms Clara Swinson: Correct.

Counsel Inquiry: Can we look, please, at a paper prepared for a PIPP meeting regarding exercises in October 2018. It’s at INQ000023017. Thank you very much.

We can see page 1 sets out that this is an exercising paper and the first paragraph deals with background. I want to focus in, please, on the next paragraph which is headed “Principles”:

“To support in the development of future pandemic flu exercises and assist in the prioritisation of areas to exercise, this paper proposes the following principles:

“Exercises should be co-ordinated across DHSC, NHSE and PHE to prevent duplication;

“Exercises should test existing plans and strategies, rather than known gaps in knowledge;

“There should be a regular programme of tier 1 exercises to coincide with each new parliament and ensure continuity in preparedness;

“Where possible exercises should include Devolved Administration colleagues to ensure a joined up approach across the Four Nations (including in observer roles where active participation is not appropriate); and

“Lessons learned should be shared with other relevant Government departments to ensure continued cross-Government approach to pandemic flu preparedness.”

Now, I’d just like to return to number 2:

“Exercises should test existing plans and strategies, rather than known gaps in knowledge.”

Is it right that the exercises following on from this meeting in October 2018 were only to test existing plans rather than gaps in knowledge?

Ms Clara Swinson: Yes, in terms of the exercise programme.

Counsel Inquiry: Okay. How, then, did PIPP examine its known unknowns? How did it deal with matters that weren’t known at all or were barely known about if, as this principle suggests, the exercises should only test existing plans and strategies?

Ms Clara Swinson: Yes. So PIPP did exactly as you say and that was in response to the government strategy, the learnings from Cygnus. There are other elements of our pandemic preparedness, for example our research base or our clinical countermeasures, which could go wider, but there was not, in terms of a – there was not work to completely re-look at the plan or strategy. It was not something that our expert advice said in terms of going wider than flu, for example, and so in terms of the work we were doing, that was to test existing plans.

Counsel Inquiry: Should there have been, in your opinion, wider work done on the unknowns or the barely knowns?

Ms Clara Swinson: The unknowns in terms of pandemic preparedness are very great, and they would be – they are also set out in a large section of the 2011 strategy. Where there are unknowns, that’s about research and development, that’s about having flexible resources, it’s about scientific advice, all of those things. So there are other elements of the programme that – or the preparedness that would do that, but it is fair to say, looking back, that we now wish that scope to be wider.

Counsel Inquiry: Thank you.

Now, at some point during the life of PIPP, it began to create what are known as PIPP risk registers. You have been kind enough to provide to us the registers for 2016, 2017, 2018, 2020 and 2021.

The first question, Ms Swinson, is: why did this system only get going in 2016?

Ms Clara Swinson: I don’t know whether that’s the case. It certainly was from when I took over the board –

Counsel Inquiry: Right.

Ms Clara Swinson: – chair in 2016. So I couldn’t confirm whether – in fact, I’m pretty sure, in fact I know that those risk registers do include risks that were closed and go back before 2016.

Counsel Inquiry: All right.

Ms Clara Swinson: So I think they would have existed –

Counsel Inquiry: In some shape or form.

Ms Clara Swinson: – from at least 2011, yes.

Counsel Inquiry: All right, thank you. Are you able to say why there appears to be a gap in 2019?

Ms Clara Swinson: A gap of what, sorry?

Counsel Inquiry: Well, we haven’t been provided with the risk register for 2019. There is a two-year gap between 2018 and 2020. Is there a reason for that?

Ms Clara Swinson: So in 2019 there were planned to be two meetings each year. There was one meeting in 2019, one meeting was taken out of the schedule to allow for resources on Operation Yellowhammer, as you’ve discussed –

Counsel Inquiry: That was the EU exit?

Ms Clara Swinson: It was, apologies, the no-deal EU exit plans.

Counsel Inquiry: Yes.

Ms Clara Swinson: I would have to check the minutes of that meeting to see whether there was a risk register tabled or not.

Counsel Inquiry: All right. But it sounds very much as if its absence may have had to do with the Operation Yellowhammer planning?

Ms Clara Swinson: Possibly.

Counsel Inquiry: Yes. All right.

I’m not going to display the risk registers, they are extremely –

Ms Clara Swinson: They are detailed.

Counsel Inquiry: – large, aren’t they? They’re very wide and they have an enormous amount of information in them. But could you please, Ms Swinson, explain to the Chair –

(Alarm)

Counsel Inquiry: I’m just going to pause, my Lady. That may have been generated by the thought of putting the risk registers on the screen.

Ms Swinson, could you kindly explain to the Chair, please, what the purpose of the risk register is and the sort of information that they contained? And I will, as I think I’ve indicated to you, just take you briefly through the –

(Alarm)

Counsel Inquiry: I’m going to continue.

Ms Clara Swinson: Okay.

Counsel Inquiry: – the ongoing risk to health and social care systems and use that as an example. So with that in mind, please explain what they are.

Ms Clara Swinson: Of course.

Counsel Inquiry: Thank you.

Ms Clara Swinson: So I think they’re quite usual programme documentation that would be recognisable to people working on programmes. It would set out the issue, the impact that would have if it occurred, a risk owner and a RAG rating – red, amber green – for how it was in the previous period and now, and where you’re hoping to get to.

Counsel Inquiry: And what was the purpose of the risk register? Who was going to use it once it was compiled?

Ms Clara Swinson: So it was brought to the regular PIPP meetings and it set out the actions, I should have added, that needed to be taken in order to try and improve the work against those risks.

Counsel Inquiry: All right, thank you.

So in 2016, there was a risk identified that the health and social care system may be unable to cope with an extreme surge in demand for services in the event of a pandemic. That’s right, isn’t it?

Ms Clara Swinson: Yes.

Counsel Inquiry: And are you able to remember without looking at the risk register what sort of action was taken away in order to try and mitigate that risk?

Ms Clara Swinson: Not from memory, no. There was work obviously arising from Cygnus in terms of NHS surge. The risk registers would also cover relative lower-level detail from teams in terms of funding, resourcing, business cases and so on.

Counsel Inquiry: All right. So once that risk had been identified and the rating had been given to it and an action had been raised –

Ms Clara Swinson: Yes.

Counsel Inquiry: – what would you expect to have taken place between the time that that risk register had been drafted and the following year when the next risk register was drafted? In other words, would any action that had been taken be carried forward to the next risk register in the following year?

Ms Clara Swinson: There should be, yes. It would depend obviously on resourcing and priorities across the department. I also note that the risk you pick up is a very large one that has been identified, you know, over many years and it’s not that two or three actions would be able to be taken forward in a six-month period that would completely resolve it. It would be completely normal that the risk registers were highlighting major issues that were red, or marked red, and would be very difficult things to change.

Counsel Inquiry: All right. Well, I think you know where I’m going: the same risk is present in 2017 and 2018, and in 2018 in relation to this it confirms that the plans have not been fully tested and that is still an issue.

Now, I’m going to skip over 2019 because, as we’ve established, we don’t have the risk register for that year. But in 2020, December 2020, that risk is still present: that the health and social care system may be unable to cope in the event of a pandemic.

What, if at all, is the interconnection between that being raised as one of the issues in the risk register and the recommendations that we see in Exercise Cygnus that there may be concerns about surge capacity particularly in health and social care? Is there a connection between the two? Did one formulate the other, or what?

Ms Clara Swinson: Yes, I – I think there’s a link between the two.

Counsel Inquiry: Yes.

Ms Clara Swinson: I mean, I think that risk, that probably existed before the recommendations of Cygnus. It’s a risk that I think, as I say, would never be completely mitigated with full confidence.

Counsel Inquiry: Are you able to say over the period of time between 2016 and 2020 what actions were completed in terms of mitigating that risk?

Ms Clara Swinson: The risk being NHS surge?

Counsel Inquiry: Yes, health and social care capacity.

Ms Clara Swinson: Sure.

So it would be made up of, you know, a whole range of things. There were some things that we did – for surge capacity, you both want to – or the options are both to decrease demand and they’re to increase capacity. So for example in their draft Pandemic Flu Bill, we prepared powers to have regulatory easements on the demand side, for example from CQC, the regular – the Care Quality Commission, sorry – and to increase capacity, so in order to bring – be able to bring back workforce who might have been recently retired or hadn’t kept up their registration.

Counsel Inquiry: Yes.

Ms Clara Swinson: So that those are two examples. You would need obviously, both on scale and number, to have, you know, a whole range of things, but that’s one example of the work that we did take forward on the draft legislation.

Counsel Inquiry: In terms of surge capacity of staff, apart from acknowledging that that was something which would need to happen in order to mitigate the risk –

Ms Clara Swinson: Yes.

Counsel Inquiry: – were there any practical arrangements made, as far as you are aware, that were in place by the time that Covid hit, relating to that surge capacity of staff?

Ms Clara Swinson: So I would say surge is a spectrum, there are things that the NHS does every year to surge; in winter to open new wards, for example, for parts of the year. Of course in terms of the overall funding and capacity of the NHS, that was something that was looked at in exactly the time period you’re talking about, in terms of the spending review, the funding, both for workforce and for beds and capacities. So there would have been things both on the large scale –

Counsel Inquiry: Yes.

Ms Clara Swinson: – in terms of overall capacity and, as I say, preparations, for example, on legislation.

Counsel Inquiry: Right.

Well, in relation to the progress of implementing the Cygnus recommendations relating to social care, could we look at, please, INQ000057522. Can we go to page 14, please. Thank you. If we look at the entry just below the mid-line, it’s LI18:

“A methodology for assessing social care capacity and surge capacity during a pandemic should be developed. This work should be conducted by DCLG, DH and Directors of Adult Social Services … and with colleagues in the devolved administrations.”

If we look at the column on the right-hand side, we can see it was identified as a two-year programme of work by the PFRB: year 1, to develop the policy options, and, year 2, to agree reporting routes.

A policy paper had been completed and, on community care during a pandemic, a draft strategy had been developed, but moving down to the penultimate paragraph there:

“Work to develop robust data and operational relationships with the social care sector did continue through EU exit preparedness work despite the pause in the PFRB programme.

“Plans to issue guidance to the Adult Social Care sector are linked to a wider refresh of the guidance and strategy documentation for a future influenza pandemic.”

So it looks as if work had been done but that the whole of the methodology and the implementation of that was still being worked upon at the time that the pandemic struck; is that fair?

Ms Clara Swinson: That’s fair, yes.

Counsel Inquiry: Thank you. We can take that down now.

Before we leave Operation Cygnus, it’s come to the attention of the Inquiry that the report itself from the exercise was not published until very recently. You’re nodding your head. You’re aware of that, of course?

Ms Clara Swinson: Yes.

Counsel Inquiry: Are you able to explain why that report was not published until fairly recently?

Ms Clara Swinson: Yes. I mean, it was made available to all the participants and it was also put on ResilienceDirect, which is the website for all of the local resilience fora and wider, that’s led by the Cabinet Office. So it went out widely –

Counsel Inquiry: Sorry to interrupt. Was that in an unredacted form?

Ms Clara Swinson: There might have been some names redacted, for example, but yes, that was the report that went out. In terms of publishing it so that anyone could access it on a website, that was not done. We also – I think that is common or was common across all of the exercises through the tier 1 programme, not just health, partly because they’re – for reasons about it being, you know, going to the people who most needed to know, I think that is one thing that in terms of transparency, in terms of a forward programme – and I think this will be in the minutes of one of the more recent boards from me – that there ought to be a presumption to make these things widely public to a wider audience.

Counsel Inquiry: Thank you.

I’d like to look, please, at one of the ORC lessons learned reviews, it’s at INQ000087227. Can we go to page 6, please, and paragraph 6.4. Thank you.

“We have identified four specific areas where respondents indicated that action would help stand the Department in a stronger position ahead of any future health emergency.”

Going down to the second paragraph headed “Preparedness of the Adult Social Care Sector”, we see this:

“Some commented that emergency planning had assumed that care providers would be responsible for their own response, and a centralised government role had not been anticipated. Initial government expectation stemmed from the complex and largely private nature of adult social care in the UK.

“Though contingency plans were in place and tested, some respondents stated that the pandemic highlighted glaring omissions in strategic direction of integration and preparedness meaning that the social care system was not able to respond to a major health emergency.”

Ms Swinson, do you accept that there were glaring omissions in strategic direction of integration and preparedness which meant that the social care system could not respond?

Ms Clara Swinson: There were certainly – I mean, this is a report of what people said from the team.

Counsel Inquiry: Yes.

Ms Clara Swinson: We were not self-congratulatory about everything going well. We wanted to learn from wave 1 for wave 2, and it reflects –

Counsel Inquiry: Which is to be commended, yes.

Ms Clara Swinson: – it completely reflects that feedback.

Of course, in terms of understanding about adult social care data and the national system, that was the legal and regulatory system that was set up, since in the 2022 Act there are additional powers the government has taken, it was not something that in terms of data sharing, for example, in the legal system that was in place in 2020. It was not a system that was a nationally directed one. Social care is managed through local authorities and responsibility of upper tier local authorities.

Counsel Inquiry: So do I summarise your evidence in this way: you wouldn’t use the phrase “glaring omissions”, but you do accept that those involved in the system acknowledged here that there were difficulties in strategic direction of integration and preparedness within the system?

Ms Clara Swinson: I think that’s – that’s fair, and the social care system not being able to respond to a major health emergency –

Counsel Inquiry: Yes.

Ms Clara Swinson: – is obviously – you know, there are very many different providers and that would be varied, but I think how you have explained it is fair.

Counsel Inquiry: Thank you.

Moving finally, then, on to clinical countermeasures and PPE. This will of course form part of a future module, but I just want to ask you some questions, please, about your responsibility and involvement in the provision of stockpiles and for you to explain to us really how Public Health England managed stockpiles relating to pandemics.

Ms Clara Swinson: Okay.

Counsel Inquiry: So you’ve provided your evidence on the review of countermeasures for pandemic influenza and infectious diseases. Now, that’s a document – we don’t need to put it up, and we can take down the one that’s currently on the screen, please – but that’s a document which opens with the following:

“The Covid-19 pandemic has shown clinical countermeasures held for an influenza pandemic have limited applicability to non-influenza pandemic threats.”

That is something which you would accept, and that the PPE stockpile has been designed with influenza in mind, restricting its utility for other infectious diseases.

Beyond pandemic influenza, what is the current position regarding stockpiles for HCIDs, and what is the planning in terms of a future pandemic?

Ms Clara Swinson: Yes, so we are bringing together an assessment with our Deputy Chief Medical Officer that looks at obviously what was already in place before the pandemic for some things that are still there, for example for flu, where stocks have been used through the Covid pandemic and where there are different stockpiles, for example antibiotics, for a whole range of things.

So we are reviewing those countermeasures, both kind of the wind-down from Covid ones, we’ve got Covid treatments and antivirals now as well, to say what is the – what are the countermeasures we wish to keep on an ongoing basis, compared to the wider scope of not just flu but pandemics. And, indeed, on the points you raise, for example on PPE, that is also relevant for chemical or biological non-pandemics but other high-consequence infectious diseases, as you’ve mentioned, and other major threats that could be chemical, biological, radio, nuclear.

Counsel Inquiry: Has there been an improvement, do you think, in the systems that are now in place in terms of the provision of PPE both in stockpiles and the range of PPE which is now being considered?

Ms Clara Swinson: Yes, I think that is fair. It is now managed by the NHS supply chain.

Counsel Inquiry: Yes.

Ms Clara Swinson: In terms of countermeasures, there are things that are used in day-to-day health and care, and so it is about having a stock that you can rotate and use. There’s another set of things for how they’re stored and how we should approach them where you would not expect to use it day-to-day, it is actually an insurance policy against a threat that may or may not happen. So there’s both what to stockpile –

Counsel Inquiry: Yes.

Ms Clara Swinson: – on what expert advice, how to hold it, and what is rotated through normal use in the NHS.

Counsel Inquiry: Thank you.

Professor Banfield of the BMA has told the Inquiry in his witness statement at paragraph 33 – no need to display it, please – that the government’s actions meant that PPE at the time was not available to suit a diverse range of facial features, including for smaller, often female face shapes and for staff who wear a beard or hair covering for religious reasons.

Do you accept that there is a need to consider sufficient supplies of PPE to fit a wide range of face shapes and sizes, and that that wasn’t perhaps adequately considered as part of pandemic planning prior to Covid-19?

Ms Clara Swinson: Yes, I do.

Counsel Inquiry: Was that foreseeable and should it have been done?

Ms Clara Swinson: In terms of the assumptions about PPE, before the pandemic there were a number of assumptions that turned out not to be the case. It was never the case that the assumption was that it would be above business as usual volumes, so it would be an additional stockpile for people to draw on, but that business as usual stocks would continue.

Clearly, because of the global demand and in fact the pandemic starting in China and there being lockdowns there, and that’s where a lot of the manufacturing was, that the overall supply chain collapsed.

So that was one assumption.

The behavioural use and the fact that the other – a second assumption is that PPE would be used just for symptomatic patients.

Counsel Inquiry: Yes.

Ms Clara Swinson: Actually very much more was needed in Covid-19, as we’ve set out I think in Chris Wormald’s statement number 6 or 7, as it is now – it was used in the pandemic for asymptom – for all health and care, and so the volumes were very, very much greater than we had ever assumed.

Counsel Inquiry: Was one of the problems in planning in this way a lack of data? The reason that I ask you that is, returning to the ORC lessons learned review which we have already touched upon, there is a statement in there as follows:

“There was insufficient data available to consider equality issues around PPE provision. A retrospective equality impact assessment is now being undertaken and will help address these concerns.”

Ms Clara Swinson: Yes, and my apologies, because you asked about the different types of face masks –

Counsel Inquiry: Yes, yes.

Ms Clara Swinson: – that is something that definitely came out in wave 1. Kevin Fenton from Public Health England –

Counsel Inquiry: Yes.

Ms Clara Swinson: – carried out a review. It was evident in the first few months that that is something where there were not enough different types of face mask, and that is something both in business as usual and in our stockpiles of course we need to make sure are covered in future, now and in the future.

Ms Blackwell: Right. Thank you very much.

Those are all the questions which I have for Ms Swinson. Would you excuse my back, my Lady.

(Pause)

Ms Blackwell: In the usual way, I think my Lady has provided a provisional consent for certain questions to be asked, and I will turn to Ms Munroe King’s Counsel to ask those questions if, my Lady, that is appropriate.

Lady Hallett: Yes.

Ms Blackwell: Thank you very much.

Lady Hallett: Ms Munroe, thank you.

Questions From Ms Munroe KC

Ms Munroe: Thank you.

Good afternoon, Ms Swinson. My name’s Allison Monroe and I represent Covid Bereaved Families UK. Just a few questions.

In relation to the World Health Organisation research and development blueprint reports, we don’t need to have these brought up, but for reference, my Lady, they are found – the 2017 report is at INQ000149108.

Just to contextualise those reports for you, Ms Swinson, the 2017 and the 2018 reports, the WHO Research and Development Blueprints, as they’re called, determined that there was an urgent need for research and development into MERS and SARS and other highly pathogenic coronaviral diseases.

The 2018 Blueprint report also prioritised Disease X, and both reports noted the importance of cross-cutting research and development which would help to address a range of different pathogens or diseases at the same time.

Finally, Professor Sir Peter Horby of NERVTAG and Dr Miles Carroll of the PHE were members of these prioritisation committees.

Now, at the time of their publications, would you have read those reports?

Ms Clara Swinson: I had not read those reports, no.

Ms Munroe KC: You’ve not read them.

Ms Clara Swinson: I have, they were in – the 2017 I think was in my witness bundle, I’m aware of what it is and aware of some of the work flowing from it, but I don’t think that I had read that at the time.

Ms Munroe KC: Would any of the information in those reports have been brought to your attention at the time?

Ms Clara Swinson: So, in terms of the research that the UK would do, that isn’t just my job, but in terms of the department, and in fact the Foreign and Commonwealth Office, where we would prioritise research funding, that would definitely be brought to the government’s attention, and indeed the government took some actions that I think do link back exactly to the research and development blueprint.

Ms Munroe KC: Right. But in terms of your role and in the course of your role as Director General in the DHSC, how important would those documents, those reports – because they talk about prioritising –

Ms Clara Swinson: Absolutely.

Ms Munroe KC: – in particular MERS and SARS.

Ms Clara Swinson: Yes. So the Chief Scientific Adviser in the department is the DG level responsible for our research and development. I think these are very important documents for all countries, because they list the diseases where there could be a major public health international event and where there is not a pipeline or incentives on industry currently to have – to develop vaccines, therapeutics or diagnostics. So that would have been, I’m sure, within our Chief Scientific Adviser and our Foreign Office, Chris Whitty, through the chair of the UK Vaccine Network, for example, had prioritised a list – which was not identical to the WHO one but had similarities – for where to invest research into vaccines.

Ms Munroe KC: From those answers, am I to gather, then, that in terms of the work and strategies of your own department, a prioritisation in terms of research and development of MERS and SARS and Disease X would not be something that you would have done or prioritised?

Ms Clara Swinson: No, I don’t think that’s correct. The UK Vaccine Network prioritised a vaccine into MERS that became the Oxford/AZ platform. I think most of the research would be funded by overseas development assistance money, ODA money, and that is – there is some in the Department of Health and also in the Foreign and Commonwealth Development Office.

Ms Munroe KC: I’m more thinking at the time of their publication, though, 2017 –

Ms Clara Swinson: Yeah.

Ms Munroe KC: – and 2018 in terms of research and development and particularly this question of prioritising those diseases. Was that part of the strategy of your department at all?

Ms Clara Swinson: It was, in terms of prioritising research and development, where there are very substantial budgets across government, both in the Department of Health and in the Foreign and Commonwealth Office and DfID, yes, that would have been taken into account.

Ms Munroe KC: Right.

These reports also agreed on the value, where possible, of developing countermeasures for multiple diseases or for families of pathogens.

What, if any, action did your department take in relation to this and how was that monitored?

Ms Clara Swinson: So I’ve given one example, which is the research and development funding that went to Oxford on the MERS vaccine. We would have to look further for others. As I say, that would be through our Chief Scientific Adviser, both in the department and the network across government.

Ms Munroe KC: Can you assist on this, please: what, if any, action was there taken to update the UK’s list of high-consequence infectious diseases to include Disease X or highly pathogenic coronaviral diseases following those reports in 2017 and 2018?

Ms Clara Swinson: So the high-consequence infectious disease list is kept under review by groups or the Chief Medical Officer, the Medical Director of the NHS, and the Advisory Committee on Dangerous Pathogens. It’s not a static list, it does change. It is pathogens that actually exist, and there’s quite a long list.

Disease X, as you have put in your question, is the idea of a novel pathogen that would arise. Clearly you need to do research into a whole – have flexible research in order to be able to respond to a pathogen that doesn’t yet exist.

Ms Munroe KC: In terms of the findings from those two reports from 2017 and 2018, to what extent were they considered or reflected in the national risk assessment, in particular, again, going back to this point about the prioritisation of SARS and MERS?

Ms Clara Swinson: Yes. So for the high-consequence infectious diseases, the risk that you were discussing earlier on an emerging infectious disease, obviously was based – or the scenario was a SARS or MERS type of coronavirus. But in terms of other threats listed there, there would be some that would be very relevant for the UK; there would be others on that list that would be much more likely to have – to occur in other bits of the world, and I think Sir Chris Whitty’s statement sets out those diseases in part of his statement.

Ms Munroe KC: But the question was: how were they reflected in the national risk assessment?

Ms Clara Swinson: So they would have – so the type of diseases which had a potential for international spread, a public health event of emergency concern, as the WHO calls it, would be reflected in the emerging infectious disease risk that went on a Covid/SARS/MERS scenario.

Ms Munroe KC: Finally, was NERVTAG asked to comment on the blueprint at any point, either the 2017 or the 2018 WHO blueprint reports?

Ms Clara Swinson: So those reports were, and the process was run by the World Health Organisation, they brought together an expert group to do so. I think it was from individuals rather than groups, so I don’t think NERVTAG themselves would have been asked, but that would have been up to the World Health Organisation.

Ms Munroe KC: But from your perspective within your department, obviously there are individuals such as we mentioned at the beginning Professor Horby, who was a member of NERVTAG, who is also part of that prioritisation committee for the research and development blueprint.

So following from that, he is a member of that committee, he is a member of NERVTAG; would NERVTAG, as a group themselves, be discussing the findings and the observations of the report?

Ms Clara Swinson: You would have to check with NERVTAG themselves.

Ms Munroe: All right. Thank you very much, Ms Swinson.

Thank you, my Lady.

Lady Hallett: Thank you, Ms Munroe.

Ms Blackwell: That concludes the questioning for Ms Swinson, and indeed today’s business.

Lady Hallett: Thank you very much indeed.

Thank you very much for your help, Ms Swinson, sorry again for the delay.

(The witness withdrew)

Lady Hallett: We will start again tomorrow at 10 o’clock.

Ms Blackwell: Thank you, my Lady.

(5.05 pm)

(The hearing adjourned until 10 am on Tuesday, 20 June 2023)