Transcript of Module 1 Public Hearing on 26 June 2023

(10.29 am)

Lady Hallett: Mr Keith.

Mr Keith: Good morning, my Lady. May I please call Emma Reed.

1. Ms Emma Reed

MS EMMA REED (sworn).

Questions From Lead Counsel to the Inquiry

Mr Keith: Could you please commence by providing your name.

Ms Emma Reed: My name is Emma Victoria Reed.

Lead Inquiry: Ms Reed, whilst you give evidence, could I remind you to keep your voice up – I don’t think there will be a problem – and also to make sure you speak clearly into the microphone so that your evidence may be properly recorded.

Have you kindly agreed to provide a statement to this Inquiry?

Ms Emma Reed: Yes, I have.

Lead Inquiry: May we have, please, INQ000195847 up, please.

Does that appear to be your statement?

Ms Emma Reed: It does.

Lead Inquiry: If we have the last page, you provided a signature and a statement of truth.

Ms Emma Reed: I did.

Lead Inquiry: My Lady, may that be published, please?

Lady Hallett: Certainly.

Mr Keith: Ms Reed, you have been a civil servant I think since April of 2003, and you’ve held a number of posts, not just in the Department of Health and Social Care but also the Cabinet Office and the Government Equalities Office; is that correct?

Ms Emma Reed: Yes, it is.

Lead Inquiry: Were you appointed to the senior civil service in April of 2013?

Ms Emma Reed: Yes, I was.

Lead Inquiry: From November 2014 until June 2015, were you one of the two deputy directors in the Department of Health and Social Care, leading on the response to the Ebola outbreak?

Ms Emma Reed: Yes, I was.

Lead Inquiry: Most significantly, are you currently director of the directorate in the Department of Health and Social Care which is the directorate of Emergency Preparedness and Health Protection?

Ms Emma Reed: Yes, I am.

Lead Inquiry: Have you been in that post since February of 2018?

Ms Emma Reed: Yes.

Lead Inquiry: Could you assist us, please, in broad terms, with the nature of the functions discharged within that directorate? We’ve heard a considerable amount of evidence about the various functions in the Department of Health and Social Care, and I therefore want to ask you what that particular directorate is concerned with. Is it, by way of commencement, the directorate that discharges or plays its part in discharging the duty on the Secretary of State for Health and Social Care by virtue of being a Category 1 responder under the Civil Contingencies Act 2004?

Ms Emma Reed: Yes, but allow me to set out broadly where my responsibilities in the directorate fall, and they broadly fall into two different areas. I have responsibility for health protection and health security policy –

Lead Inquiry: Can I come back to that, Ms Reed?

Ms Emma Reed: Of course.

Lead Inquiry: There is a method to my madness, I wanted you to set out generically the functions of the directorate before we look at health protection and health security.

So one of the major functions of the directorate is to discharge the duty on the Secretary of State by virtue of being a Category 1 responder under the CCA; is that correct?

Ms Emma Reed: It is, yes.

Lead Inquiry: Is another responsibility to discharge whatever functions are imposed on the DHSC by virtue of being the lead government department when it comes to health emergencies?

Ms Emma Reed: Yes, it is.

Lead Inquiry: Is it also part of your directorate’s functions to be concerned in that risk assessment process –

Ms Emma Reed: Yes, it is.

Lead Inquiry: – of which we have heard? And is it also your directorate which liaises with bodies such as the United Kingdom Health Security Agency and NHS England and the Department for Levelling Up, Housing and Communities, when it comes to assessing risk, managing risk, preparing for health emergencies?

Ms Emma Reed: Yes, it is.

Lead Inquiry: Importantly, given the extent of the burdens on you, is that why your directorate, the Emergency Preparedness and Health Protection Directorate, has led the DHSC’s response to all the major incidents to which you speak in your statement, monkeypox, the Novichok poisoning, the heatwave of 2022, and so on and so forth?

Ms Emma Reed: Yes, it is.

Lead Inquiry: All right.

So you’ve referred to health protection, and also to health security. What are they and what is the difference between them?

Ms Emma Reed: So health protection and health security policies form part of half of my responsibility. The types of policies that we have responsibility for in that area includes pandemic preparedness, emerging infectious disease, antimicrobial resistance. They are essentially about how the public health is protected but also what threats, under infectious diseases, emerging diseases and pandemics, may well be a risk to public health.

Lead Inquiry: So that’s all under health protection?

Ms Emma Reed: And health security.

Lead Inquiry: Ah, they’re together?

Ms Emma Reed: Yes, they are.

Lead Inquiry: All right. Your statement refers to the directorate having three branches, and you distinguish between health protection and health security, but are they in fact the same area?

Ms Emma Reed: They are very closely related to each other, and sit very closely adjoined.

Lead Inquiry: So which branch does the topic of pandemic preparedness fall under?

Ms Emma Reed: Predominantly under health protection.

Lead Inquiry: Right.

Is there, in your directorate, a third branch called the operational response centre?

Ms Emma Reed: Yes.

Lead Inquiry: What does that do?

Ms Emma Reed: So that covers the responsibilities you set out at the beginning of the questions which relate to the discharge of the Category 1 responder capability and is about how we prepare for threats and hazards that impact on public health, and how we respond also to those threats.

Lead Inquiry: So is it an emergency management centre? Does it deal with crisis management?

Ms Emma Reed: It does. It delivers emergency preparedness, resilience and response.

Lead Inquiry: Is the history, the etymology of the operational response centre, that it was first created within Health and Social Care to deal with the necessary preparations for the no-deal EU exit, but latterly it is now the crisis management centre in the Department of Health and Social Care that deals with all emergency preparedness, response and resilience issues?

Ms Emma Reed: That’s not quite right. The department has had a long-standing function that deals with emergency preparedness, resilience and response, and that was always part of the responsibility of this directorate and was part of my responsibility when I took the post in 2018.

In preparation for a no-deal exit we also developed an operational response centre that was focused on those particular capabilities for that threat, and following the exit from the European Union we merged both of those functions together to form what was then called the operational response centre, that brings in EPRR responsibility as well.

Lead Inquiry: I’m going to have to task you about your use of the word “function”. It’s a word that –

Ms Emma Reed: I apologise.

Lead Inquiry: No, no, there is no apology required. What do you mean when you say it had different functions? Do you mean there were different rooms, different operational response centres, different groups of people, or it was the same group of people just doing two different jobs?

Ms Emma Reed: It was – so by “functions” I mean a set of capabilities of – of – ways of working that we use a manage an emergency. In emergency response we had ones that dealt with broader threats, and in the operational response centre these were particular sets of products and ways of working that were specifically focused on no-deal exit.

Lead Inquiry: All right, so different jobs, but they were the same people, they were just dealing with, at different times, no-deal exit preparations or general EPRR responses?

Ms Emma Reed: No, they were different people. We maintained a capability to make sure that we were ready for any type of emergency as separate from the work we did to prepare for a no-deal exit.

Lead Inquiry: All right.

Ms Emma Reed: They were under – in the same part of my directorate, but they were different sets of people.

Lead Inquiry: Right, that’s clear, thank you.

My Lady’s heard evidence about the high level risk register that was held in the Department of Health and Social Care, and a departmental board meeting which held what was called a risk deep dive into major infectious diseases within the department, how the department would respond.

Could we please have INQ000022738 on the screen. This is a document, Ms Reed, dated 28 September 2016, so it’s before your time, because, as you’ve told us, you have been in post since February 2018.

If we look at page 2, please, would you just read the middle bullet point within the red box.

(Pause)

Ms Emma Reed: Thank you.

Lead Inquiry: At the time that you took up your position as director of the relevant directorate, to what extent did you understand that steps had been taken to address that plainly very serious and real concern? Were you told what had been done to raise awareness of the risk and to plan for the immediate mobilisation of a large number of staff in the directorate?

Ms Emma Reed: I was not made aware of that particular commitment or issue raised in 2016.

Lead Inquiry: Were you not told by anybody, “Ms Reed, congratulations, you’re the director of the directorate, you need to be aware that the main departmental board for the entire department, the DHSC, stated two years before there was a very real concern that the entire directorate would be rapidly overwhelmed in the event of a major pandemic, and this is what we’re doing about it”?

Ms Emma Reed: At the point that I took over the post, we did think about the resourcing models and methods for escalating and scaling up our resource if it was needed, but that was never aligned to this discussion in 2016. It was part of our regular resourcing considerations.

Lead Inquiry: Could we have the minutes of that departmental board meeting at INQ000057271, please, page 6.

Again, I emphasise, before your time, but there are, on page 6 – I’m just going to refer you to them and then give you time to read them – paragraphs 25 and 26, these words:

“It was more likely than not that even a moderate pandemic would overrun the system.”

So not the department, in fact, but the system, the government.

“At the extreme, there would be significant issues if it became necessary to track or quarantine thousands of people.”

Then, at 26, concerns are expressed about how resilient the “somewhat fragmented system” would be, that is to say the government system for preparedness.

So would you just like to just reflect on those two paragraphs and then I’ll ask you some questions.

(Pause)

Ms Emma Reed: Thank you.

Lead Inquiry: Do you recall when you took up post anybody briefing you about the serious concerns expressed by the Department of Health and Social Care’s own departmental board about whether or not there were systems in place to track or quarantine thousands of people in the event of even a moderate pandemic?

Ms Emma Reed: There was no discussion with me about quarantining.

Lead Inquiry: What about track and trace, any discussion about that?

Ms Emma Reed: There was no discussion with me about track and trace.

Lead Inquiry: All right. Then, in relation to paragraph 26, did anybody at your very senior level in the department say, “Ms Reed, we’ve got concerns about how fragmented the system for preparedness in the United Kingdom has become, this is something that your directorate is going to have to grapple with”?

Ms Emma Reed: In the terms in which you set out, no. But the process for how the system would respond to a pandemic – and by the system I mean organisations in health and social care – was both a factor of our pandemic flu readiness programme but also one of the learnings from Exercise Cygnus, so the intent of that paragraph and the issue relating to system overload was something that I was aware of, yes.

Lead Inquiry: In essence, these concerns were being addressed because there were boards and systems and procedures otherwise in place to try to make sure the system was better prepared?

Ms Emma Reed: Yes.

Lead Inquiry: We’ll look then at those boards in a moment.

An important part of your directorate’s preparedness arrangements was its – and I’m now going to slip into the terminology – ownership of a 2011 pandemic influenza strategy, was it not?

Ms Emma Reed: Yes. Yes.

Lead Inquiry: Because that was a strategy dealing with influenza pandemic, a health emergency, and therefore, by definition, something within the reach of the Department of Health and Social Care?

Ms Emma Reed: Yes.

Lead Inquiry: Or the Department of Health, as it was then known.

Can you recall what you understood when you took up your post about the efficacy, the appropriateness, the adequacy of that strategy, whether it was a good strategy, whether confidence was placed in it, whether it needed refreshing, whether it needed updating or wholesale revision? Can you recall what the state of play was?

Ms Emma Reed: As I recall, the view was that the strategy included important component parts that would be used for a pandemic influenza, that it had been tested through Exercise Cygnus and there were elements of that that needed to be enhanced, and that there was a work programme under way through the Pandemic Flu Readiness Board to deliver that.

Lead Inquiry: Were you concerned by the fact that Exercise Cygnus itself had concluded that the UK’s plans, policies and capability for preparedness were not sufficient to cope with the extreme demands of a severe pandemic?

So you’ve referred to Cygnus and your answer is essentially, “Well, I understand that Cygnus, [which had taken place before your time] had addressed elements of the strategy”, but the Exercise Cygnus conclusion was rather more serious than that, wasn’t it?

Ms Emma Reed: It was very clear that there was a lot of work that the department needed to do to improve its readiness for a pandemic influenza. If the question you’re asking is: was I concerned about that? Yes, I was concerned about that, but I was also aware that by the time I’d started in my post in 2018, a programme of work had been established to address those concerns.

Lead Inquiry: It was therefore of central concern to you that those programmes should continue, because they were put into place for a good reason, namely to meet the serious concerns of this – of the departmental board’s observations, the outcome of Exercise Cygnus, and a clear understanding that the 2011 strategy needed at the least some work doing on it?

Ms Emma Reed: Yes.

Lead Inquiry: All right.

That 2011 strategy was the only pandemic-scale strategy, wasn’t it?

Ms Emma Reed: It’s the only one that was centrally run by the Department of Health, yes.

Lead Inquiry: Well, pandemic is a health emergency, it goes to the heart of your department’s functions. Who else would have an overarching health emergency-related strategy for pandemic influenza?

Ms Emma Reed: I would expect that key organisations responsible for delivering pandemic influenza response would also have thought through and have plans in place on how they would respond, so that would include NHS England, Public Health England and local delivery partners.

Lead Inquiry: In the event of a national crisis, in the event of, as it turns out, a catastrophic health emergency, the Department of Health and Social Care is the lead government department which drives forward what is required to be done to prepare for and, initially at any rate, respond to that crisis?

Ms Emma Reed: That’s correct.

Lead Inquiry: So what other strategies for dealing with a pandemic-scale catastrophe were there than this single document?

Ms Emma Reed: The Department of Health owned the single document for the strategy for pandemic influenza preparedness.

Lead Inquiry: Right. It was the only strategy document, was it not?

Ms Emma Reed: Yes.

Lead Inquiry: There was no strategy document for anything other than an influenza pandemic?

Ms Emma Reed: That’s correct.

Lead Inquiry: Could we have INQ000022708, page 14.

Three bullet points from the bottom, in paragraph 2.21, there is a reference to the intrinsic unpredictability of influenza pandemics.

Ms Reed, could you just have a read of that bullet point, please.

(Pause)

Ms Emma Reed: Thank you.

Lead Inquiry: You are not by training an epidemiologist?

Ms Emma Reed: No.

Lead Inquiry: Why did no one in the directorate, with an eye to that bullet point, ask himself or herself, “We have a strategy for dealing with influenza pandemic, but because influenza pandemics are intrinsically unpredictable, and because we may be struck by a pandemic that is not influenza but is another viral respiratory outbreak that is equally as unpredictable as influenza and therefore equally catastrophic, we need to have plans for that eventuality”?

Why was that question not asked?

Ms Emma Reed: The preparedness we developed for pandemic influenza was based on the reasonable worst-case scenario, so effectively every renewal of that risk assessment did ask whether – what the scenario would be that we ought to prepare for, and on successive risk assessments the risk assessment was the pandemic we should prepare for was a pandemic influenza.

Lead Inquiry: But those very same risk assessment processes referred, of course, to the possibility or the risk of a non-influenza pandemic, and those same processes stated in terms that there were inherent variabilities, that the next pandemic might or might not be influenza, it might have the same characteristics, it could be just as deadly or more so, it could have higher transmission or less transmission, it could be just as severe or less severe.

Where were the plans for dealing with those eventualities?

Ms Emma Reed: Well, the plans that we developed and the mitigations we built were based on the risk that we had been informed was the most likely risk, that experts advised me and colleagues that was the highest risk, and that was of an influenza pandemic.

Alongside the influenza pandemic is a risk that relates to emerging infectious disease, and in that risk scenario we had prepared messages and responses that would respond to that risk should that risk materialise.

Lead Inquiry: But you know very well, of course, that that risk, the emerging infectious disease risk, was predicated upon and assumed confinement to health setting outbreak, that is to say it wouldn’t extend probably beyond health settings, and that there would be a very small, relatively speaking, number of casualties and an even smaller number of fatalities?

Ms Emma Reed: Yes, that’s correct.

Lead Inquiry: Yes.

Could we look at page 57 in this document, please. The 2011 strategy assumed – and we can see at paragraph 7.5 – that “staff absence is likely to be significantly higher than normal across all sectors”, levels of absence may vary due to the size, and then if you could scroll back out, please, and in the middle of the page, 7.4:

“… the Government will encourage those who are well to carry on with their normal daily lives … The UK Government does not plan to close borders, stop mass gatherings or impose controls on public transport during any pandemic.”

Any pandemic.

Between 2011, when this strategy was first made, Ms Reed, and 2020, when the non-influenza pandemic struck, are you aware in the Department of Health and Social Care of any person at any time questioning that statement, “the UK Government does not plan to close borders, stop mass gatherings or impose controls”? Was there any debate about the possible necessity of border closings, self-isolation, quarantine, mass quarantine, mandatory quarantine, or anything of that sort?

Ms Emma Reed: I’m not aware of any conversations on those areas of mitigation, no.

Lead Inquiry: Could we have INQ000023131, please.

This is a pandemic preparedness meeting dated November 2019, so on the eve of the pandemic, Ms Reed, but about a year and a half after you had taken up your post.

It’s a meeting of a – well, of, in fact, the Department of Health and Social Care, so it’s not, I think, a – it wasn’t a PIPP meeting or a PFRB meeting, we’ll come back to those in a moment, it’s just a departmental meeting.

Page 5, I’ll read out the relevant bit and then give you a moment to find the part on the screen.

On the right-hand side – don’t, please, scroll in, because I’ll lose my way – but on the right-hand side there is a heading “Areas of Work not Prioritised for the Next 6 Months:

“Adult Social Care – The briefing paper which outlined plans to augment adult social and community care during a pandemic, was agreed by the former CMO [Professor Dame Sally Davies], CSA and CNO in July 2018. DHSC policy and social care team to work with [National Health Service England and Improvement] to agree next steps.

“Pandemic Influenza Public Health Communications Strategy – The content was signed off … but needs further work … a Concept of Operations … document to outline the … command structure and the responsibilities of Departments … needs to be developed.

“Refresh of UK Pandemic Influenza Strategy – Update the content of the … Strategy to ensure that UK Pandemic Influenza preparedness and response policy is accurate and up to date.”

Ms Emma Reed: Thank you.

Lead Inquiry: These areas of xwork which were not prioritised were of fundamental importance, were they not, to the United Kingdom and the Department of Health and Social Care’s ability to be properly prepared for a pandemic?

Ms Emma Reed: They were important pieces of work in the pandemic flu readiness programme, yes. They were not the areas of priority.

Lead Inquiry: Are you suggesting, Ms Reed, that the bringing up to date and making accurate of the United Kingdom’s sole strategy for influenza preparedness was not a matter of very considerable importance?

Ms Emma Reed: No, sorry, allow me to clarify. These pieces of work were important as part of the pan flu readiness programme and they were important pieces within that programme. However, as I am happy to expand, at that period of time, in readiness for the potential disruption of a no-deal exit, my view at that time was preparing for a no-deal exit took precedent(sic) over completion of some of these pieces of work for a short period of time.

Lead Inquiry: Did you or anybody else when confronted with – and it was a Cabinet direction, wasn’t it?

Ms Emma Reed: Yes.

Lead Inquiry: Work must be – to use the etymology, the terminology, work must be prioritised, the euphemism for the cessation or interruption or complete stopping of other workstreams in order to be able to focus on preparations for a no-deal EU exit, that came from the highest level, did it not?

Ms Emma Reed: It did, yes.

Lead Inquiry: It did.

Did anybody in the Department of Health and Social Care, which bore the primary responsibility for getting the country ready for a health emergency, say, “These important” – you used the word vital, “These vital parts of pandemic preparedness cannot afford to be stopped”?

Ms Emma Reed: If I recall the process at that time, I was asked to look at which areas of work we would prioritise and de-prioritise in order to prepare for a no-deal exit, and in thinking through which areas of work I would de-prioritise and prioritise, I recall a submission going to ministers to set out which areas of work I would recommend that we prioritised and deprioritised.

On the case of adult social care particularly, I think it may be helpful to add that my concern about the impact of adult social care as a result of a no-deal exit, a real and credible threat to that sector, was that that sector needed to prepare for and ready itself for a no-deal exit over the risk of a pandemic preparedness.

Lead Inquiry: The concern that flowed from not being ready for a no-deal EU exit in the adult social care sector –

Ms Emma Reed: Yes.

Lead Inquiry: – was that there would be an interruption of services, that’s to say the availability of staff to work in the sector, because of problems with employment and the ability of individual members of the workforce to work in the United Kingdom after an abrupt and traumatic no-deal exit; also the supply of medicines probably?

Ms Emma Reed: That’s correct.

Lead Inquiry: So the two areas were workforce availability and supply chains?

Ms Emma Reed: I would say they’re two of the areas of concerns.

Lead Inquiry: What were the others?

Ms Emma Reed: I think financial stability of that sector was a particular concern before a no-deal exit, and at that time we weren’t certain what additional financial would be on the sector as a result of a no-deal exit, so that was an additional concern.

Lead Inquiry: Was it ever seriously considered by anybody in your department that one of the consequences of an unprepared no-deal EU exit would be the deaths of very large numbers of inhabitants of care homes?

Ms Emma Reed: I think that the human aspect and risks associated with that relating to a no-deal exit were considered. I don’t have the details of what the risk assessment said of a no-deal exit, but the risk of harm to the public was absolutely a consideration.

Lead Inquiry: In the risk assessment process, and the procedure was updated, as you know, in 2016 and then 2019, what was the assumed outcome of a severe influenza pandemic on the United Kingdom in terms of fatalities?

Ms Emma Reed: If I recall, I believe the number to be about 8 – 800,000, I think, but I’m recalling, I might have that number incorrect.

Lead Inquiry: Around 800,000 deaths?

Ms Emma Reed: (Witness nods)

Lead Inquiry: Of which, if the pandemic were to be particularly dangerous to the elderly, a significant proportion of those deaths would be in the care home sector, would they not?

Ms Emma Reed: I would believe so, yes.

Lead Inquiry: Yes. So let me put the question again: in terms of the balance between the possible outcomes of an unprepared no-deal EU exit and the appalling loss of life attendant upon a pandemic for which no preparedness had been carried out, why did no one say “We cannot afford to stop the pandemic preparedness”?

Ms Emma Reed: I think in response to your question, there’s a couple of points I think are important to make.

The first one is that the adult social care sector had done some work in pandemic preparedness prior to the pausate of the work.

Secondly, I think the work that was done for Operation Yellowhammer was of benefit to our preparedness for a pandemic influenza.

Then the third point I’d make is that, in considering where to allocate resources, what I consider is: what is a real and present and credible threat versus the risk of a threat? And to try to strike the balance of where resources are allocated, I retained teamwork on pandemic preparedness, but I also allocated resources to deal with the real risk of a disruption through a no-deal exit.

Lead Inquiry: All right. May we then look briefly at the NSRA process to which you’ve referred.

Can you recall what role you had in the republication of, the re-issue of the NSRA process in 2019?

Ms Emma Reed: The National Risk Register’s reassessment comes to my team to lead the process for reviewing whether the risk is still the same risk. One of my team led the work on developing that risk assessment. I was aware of the work at the time, that was led within my team.

Lead Inquiry: Not all the risks, indeed only a very small number of the risks, fall within the reach of the Department of Health and Social Care. Of course, disease is one of them, perhaps the main one.

Ms Emma Reed: The department has a number of risks on the risk register. Not all of the department’s risks are – fall within the confines of my directorate’s work. We deal with emerging infectious disease risk and we deal with pandemic risks, but there are risks that sit outside my team in the other parts of the department.

Lead Inquiry: Do you accept, as Ms Hammond on behalf of the Cabinet Office – and of course the Cabinet Office and the DHSC co-chair the Pandemic Flu Readiness Board – would you accept in relation to the DHSC, as Ms Hammond accepted in relation to the Cabinet Office, that the DHSC would have been better prepared for a pandemic if – had the reasonable worst-case scenario been closer, a lot closer to the realities of Covid than it was?

Ms Emma Reed: Yes, I think it stands to reason that we would have built a different set of responses and plans had the risk that we were dealing with been a Covid risk.

Lead Inquiry: There is evidence before my Lady that Dame Deirdre Hine in her review of the swine flu pandemic in 2009 had expressed some concerns about the adequacy of the RWCS, the reasonable worst-case scenario model.

Within the DHSC, as far as you’re aware, were there concerns ever expressed about the adequacy of the RWCS model, and in particular the risk that by focusing on the assumed worst-case scenario it could lead to a tendency to stop thinking about how to prevent that worst-case scenario from actually happening?

Ms Emma Reed: In the way in which you ask, nobody had raised with me a concern about the process for developing the reasonable worst-case scenario or that risk that we don’t do work on the lead-up to that risk occurring, and I believe that with the emerging infectious disease risk, we had complementary capabilities in two different sets of scenarios which would have – which would have addressed where those risks would have taken us.

Lead Inquiry: But of course, as you now accept, the scenario for new infectious disease was predicated on a very limited outbreak with relatively very limited consequences?

Ms Emma Reed: Indeed, and the mitigations that we had in place for managing that had been adequate for the outbreaks of those emerging infectious diseases I experienced over the five years of my appointment.

Lead Inquiry: Putting it another way, because the reasonable worst-case scenario for a non-influenza outbreak was described in such very limited terms, confined to health settings, relatively small number of casualties, an even smaller number – tragic though they are – of deaths, much less was required of the department to mitigate for that risk, because the risk, of course, had none of the terrible catastrophic consequences that the Covid pandemic resulted in?

Ms Emma Reed: Sorry, I –

Lead Inquiry: Yes. You didn’t have to do very much by way of mitigating the new and emerging infectious disease risk, because the risk was described in a very limited way. It didn’t have the catastrophic or national consequences that a severe influenza pandemic would have or as Covid had.

Ms Emma Reed: I wouldn’t agree with the statement that there was less for us to be concerned with, with relation to a high-consequence infectious disease risk. They are extremely serious, and we worked very closely with NHS England and Public Health England to ensure that the plans were in place for managing that risk.

Lead Inquiry: I didn’t suggest that you were less concerned. I said what you had to do practically by way of mitigating the risk was a great deal less than what you would have had to have done had you been mitigating for a severe national pandemic?

Ms Emma Reed: I think it’s true to say that our work on pandemic influenza was a greater responsibility for the department, yes.

Lead Inquiry: That work was framed by that 2011 strategy which said in terms: you don’t need to worry about things like borders or quarantining or self-isolation or mass test and trace. Because none of it was envisaged, was it?

Ms Emma Reed: I would say that – I wouldn’t necessarily say that it was framed by that. It was – the work that we did on pandemic influenza was framed by a series of documents, by Exercise Cygnus, by the risk registers across that period of time. So it was a number of different documents, including the 2011 strategy.

Lead Inquiry: When Mr Hancock MP became Secretary of State for your department in July 2018, that was after you had been appointed to your post as director of the EPHP directorate. He was provided with a document.

INQ000181825, please.

Ah, I’ve got the wrong reference, that’s his witness statement.

Could we have INQ000184105, instead, please. “Introduction to Emergency preparedness, resilience and response”. So this was a paper which was prepared for him, I think at his request, he wanted some more information, about the – well, England’s emergency preparedness, resilience and response.

Could we go down, please, to paragraph 12:

“Following a national-level exercise in 2016 and a subsequent National Security Council (Threats, Hazards, Resilience and Contingencies) meeting in February 2017, a cross-Government Pandemic Flu Readiness Board … was established to develop and manage the UK’s preparedness for a flu pandemic … The first year of the programme included the following work streams …”

Then over the page, please:

“- Response of the adult social care and community healthcare system.

“- Coping with excess deaths …

“- Communicating legal, moral and ethical considerations.”

That led to the MEAG committee being set up.

“- Keeping different sectors working with reduced staff numbers.”

If that could be shrunk, please.

Then, at paragraph 13, reference to “‘mass casualty’ planning”.

Do you recall assisting in the process by which Mr Hancock was briefed in relation to the general state of preparedness?

Ms Emma Reed: I am not familiar and cannot recall specifically adding to this briefing. I can say, and can recall, that when new ministers arrive I do support Clara Swinson in producing an assessment of the very current situation of risks and threats that the department faces as part of new ministerial briefing, but I can’t specifically recall contributing to this particular one.

Lead Inquiry: At paragraph 12, the first few words are:

“Following a national-level exercise in 2016 …”

Would that have been a reference to Exercise Cygnus, do you think?

Ms Emma Reed: Looking at the reference to the Pandemic Flu Readiness Board, I would assume it was in relation to Exercise Cygnus and not Exercise Alice.

Lead Inquiry: Yes, because it was as a direct result of Exercise Cygnus that the then Prime Minister directed in the NSC(THRC) meeting that a board be set up and a programme of work devised for the Pandemic Flu Readiness Board?

Ms Emma Reed: That’s correct.

Lead Inquiry: Looking back, are you surprised that there is no reference in this paragraph to the conclusions of Exercise Cygnus, which you described earlier yourself as being concerning, to the effect that the UK’s preparedness and response in terms of its plans, policies and capability were not sufficient?

Ms Emma Reed: No, I wouldn’t say that I was surprised that it didn’t go into more detail in this note. From my brief reading of this note, my assessment is that this was a very early briefing given to our Secretary of State to set out the range of threats and hazards that the department faced.

In 2018 there had been a series of challenging incidents over the last five years of my role, 32 major incidents, not including anything relating to Covid. So it’s very important at the very start of a secretary of state’s tenure that they’re clear about our risk assessment and their Category 1 responder requirements. I would have expected reference to the high-level risks on pandemic influenza and emerging disease, but in the context of the wider threat landscape.

Lead Inquiry: What was the highest risk in the entirety of the government’s risk assessment procedures?

Ms Emma Reed: When it came to hazards, it was pandemic influenza.

Lead Inquiry: What was the lead government department for pandemic influenza?

Ms Emma Reed: The Department of Health and Social Care.

Lead Inquiry: So are you not, therefore, somewhat surprised that there was no reference to the fact that the greatest hazard risk in the entirety of the government’s book of risks was a pandemic influenza and that the national level exercise of Exercise Cygnus, which dealt with the possibility of an influenza pandemic, had reached the conclusions that it did in such serious terms?

Ms Emma Reed: I would not have expected that document at that time to have included more information on that risk than it did. It is also useful to recognise that there had been a poisoning in Salisbury, there had been breast cancer screening incidents, so it was in a context of a number of different incidents that had occurred. I would expect the risk register to have been referred to, as it was in this document.

Lead Inquiry: May we then discuss in a little more detail some of the exercises. You were concerned, because you were one of the two deputy directors within the department leading on the response to the Ebola outbreak, so you were concerned very much with how the country – the department did respond?

Ms Emma Reed: Yes.

Lead Inquiry: To what extent – and I should say that – was that outbreak 2014/15, so not when you were director of the EPHP, you weren’t appointed to that post until February 2018, it was whilst you were in a different post?

Ms Emma Reed: That is correct.

Lead Inquiry: All right.

To what extent were you concerned with taking on the recommendations in the report on the Ebola outbreak once the outbreak was over?

Ms Emma Reed: Are you talking about at the immediate time or in my current post?

Lead Inquiry: No, at the immediate time. So following the outbreak obviously there was a certain amount of learning and reports were produced dealing with the outbreak and what could be learned from them, and making recommendations as to the future. To what extent were you concerned with that process?

Ms Emma Reed: I was involved in the lessons learned processes, there were a number of different lessons learned processes post the Ebola outbreak, and I moved to different roles that were unconnected in this area in the intervening period. So the work was continued by my colleagues.

Lead Inquiry: So you were involved in the lessons learned processes but only for a while?

Ms Emma Reed: Some of the lessons learned processes. There was a number of lessons learned processes.

Lead Inquiry: Right. You said the work was continued by your colleagues because you moved to different roles. To what extent were you concerned? For how long were you involved in the lessons learning process?

Ms Emma Reed: I’m recalling that some of the lessons learned processes were operational lessons learned, and some of them were more detailed lessons learned, a series of sessions. I was not involved in the more formal lessons learned processes, if I can recall.

Lead Inquiry: The reason I ask, Ms Reed, is that, as you will no doubt recall, one of the lessons, lesson 8, from the Ebola report was that appropriate levels of PPE should be maintained for ongoing infectious disease preparedness. A second lesson, lesson 16, was that consideration needed to be given to the development of the relevant powers to allow stepped interventions from port through to community, so, in a sense, social restrictions or closing of borders or management of people and gatherings.

Can you recall what steps were taken to pursue those issues, to draw up further papers or develop the thinking on PPE and social interventions?

Ms Emma Reed: So thinking about the PPE aspect of your question, PPE and appropriate levels of PPE were part of the mitigations that were recommended on the back of the emerging infectious disease risk. Ebola is an emerging infectious disease, it’s a high-consequence infectious disease, and would therefore have been dealt with under the mitigations for that particular risk.

Lead Inquiry: Can I just pause you there?

Ms Emma Reed: Yes, of course.

Lead Inquiry: Is that a reference back to what you said earlier, which is that of the two risks, health or disease-related risks in the risk assessment process, you’ve got influenza pandemic, with its assumed catastrophic consequences, and then you’ve got the much narrower new and emerging infectious disease risk, with the assumed much narrower consequences, and therefore reference to PPE would be a reference to the PPE required in a health setting or in a much narrower way?

Ms Emma Reed: That is correct. Ebola would have been classed as an emerging infectious disease and would have been treated as an emerging disease with the mitigations that would be appropriate for the management of high-consequence infectious disease. And with that, your question around PPE, is that PPE advice that would be given to us would be based on how you have that intensive treatment regime for a high-consequence infectious disease and what would be the appropriate PPE required to manage those diseases.

Lead Inquiry: What about lesson 16 and the consideration of powers that might be required to adopt interventions in the community, so restrictions on movement or public gatherings or border controls and so on? Do you recall what work was done on those issues?

Ms Emma Reed: I don’t recall the work that was done on those issues. I am aware that there was a view that border restrictions wouldn’t be the appropriate response for an emerging infectious disease or pandemic influenza.

Lead Inquiry: Of course, that’s why it was the lesson in the report. But was this not something that, at least subsequently, as the director of the directorate, you would have seen the outcome of the work done to put that recommendation into place?

Ms Emma Reed: I’m aware of work that Public Health England and latterly Health Security Agency have been doing around border measures. I’m not aware of any work that was done to restrict border access.

Lead Inquiry: Exercise Alice was in 2016, wasn’t it, and it was an assumed large-scale outbreak of MERS coronavirus?

Ms Emma Reed: Yes.

Lead Inquiry: That’s correct. Was that an exercise in which the Department of Health and Social Care was a participant, an organiser, or just an observer?

Ms Emma Reed: The exercise was run by Public Health England and the Department of Health and Social Care participated in that. I wasn’t in post at the time.

Lead Inquiry: But there were a number of recommendations made as a result of the report following on that exercise, were there not?

Ms Emma Reed: That’s correct.

Lead Inquiry: Those recommendations included issues such as developing plans for or at least considering the need for quarantine, self-isolation, the collection of data from contacts, an enlarged process of community sampling – of course, again, this was regarded as a high-consequence infectious disease, it was a more limited outbreak – do you know what happened with those lessons and the putting into place of practical measures to give effect to them?

Ms Emma Reed: Yes. There were two piece – bodies of work that were set up to lead pieces of work on how to respond to those actions. One was developed by NHS England, they set up a high-consequence infectious diseases programme. The Department of Health was a participant to that piece of work. And Public Health England set up a programme of work to also respond to the recommendations and the work on high-consequence infectious disease.

As I understand it, NHS England’s board continues, and we still play an active role on that, and PHE’s commitments have been embedded within their programme of work at UKHSA.

Lead Inquiry: Both those workstreams, Ms Reed, were clinically related, weren’t they? They were to do with how the NHS clinically would deal with the impact of a high-consequence infectious disease outbreak and how Public Health England would deal, I suppose, semi-clinically, with the outcome of an outbreak.

Where was the work done by the DHSC by way of plans for quarantine, self-isolation, enhanced community sampling and collection of data?

Ms Emma Reed: I would say that the recommendations were both clinical and operational, and that the clinical and operational elements of them were led by NHS England and Public Health England, with bodies that we were on to support. In your – answer to your question about where the work on contact tracing was led, that was within Public Health England.

Lead Inquiry: Did the DHSC, as far as you are aware, take forward, produce papers or policies or guidance or spend time thinking about any of those issues within its own department?

Ms Emma Reed: So the advice on clinical and operational matters would be the responsibility of NHS England and Public Health England, so we would look to those bodies to provide us with advice. I am not a clinician and I’m not well placed to write those papers. I would seek advice from colleagues across the health and social care organisations that can.

We were very aware of the level of readiness in the health and social care system to deal with an emerging infectious disease. There were, at – off memory, approximately eight or nine in the five years of my appointment, and so I was very aware of the response capability to high-consequence infectious disease and had run a number of incidents to see how that operated in practice.

Lead Inquiry: Those recommendations were not formulated by way of directions to NHS England or Improvement or to Public Health England, they were generic recommendations or lessons: X, Y or Z must be done.

So, given that it wasn’t the NHS England or the PHE who were told to respond in their own way, within the limits of their own functions, to these areas of concern, why wasn’t the DHSC itself responding, doing what it could to improve the overall system of preparedness for a health emergency by addressing these particular issues?

Ms Emma Reed: I would say that it is within the remit of those organisations to lead the response that was required to those recommendations. That is set in the remit letters and the responsibilities that those organisations hold to deliver adequate preparedness to an outbreak of an infectious disease and a response to public health. That is enshrined within the responsibility of those two bodies to do.

Lead Inquiry: Exercise Cygnus.

Ms Emma Reed: Yes.

Lead Inquiry: You’re aware, because we’ve been debating it, that the overall outcome of Exercise Cygnus was that the UK’s plans, policies and capability were not sufficient to cope with the extreme demands of a severe pandemic. How often, as far as you’re aware, was that conclusion considered within your department once you took up post

Ms Emma Reed: Sorry, could you repeat the question?

Lead Inquiry: Yes. How often was active consideration given to whether or not that general conclusion from Exercise Cygnus was being dealt with? How often were meetings held where employees in the department would say, “Right, well, that was the serious conclusion from the exercise. How well are we doing in terms of addressing those concerns, of making sure that the plans and the policies and the capability are now sufficient”? How often was active consideration given to making sure that that worrying feature was being adequately addressed?

Ms Emma Reed: I would say on a regular number of occasions in different ways. That – the concern that was raised in Cygnus was a feature of our risk and our risk register. That was discussed at every level of the department on a quarterly basis. We had boards that were looking at the readiness of the health and social care system to respond to that, that was chaired by my Director General, Clara Swinson. We had quarterly conversations to look at cross-government readiness and whether we were addressing the recommendations of that report.

So – and also regular meetings with our permanent secretary. So I think the question about how months later? we were responding to our state of readiness was asked on a regular occasion.

Lead Inquiry: How many recommendations came out of Exercise Cygnus?

Ms Emma Reed: 22, and four learning recommendations.

Lead Inquiry: By June 2020, how many of those recommendations did the DHSC itself identify had not been fully completed?

Ms Emma Reed: Off my recollection, I would say that eight of them had not been fully completed – had been partially completed, and about six of them had not been completed at all.

Lead Inquiry: That was, you’re quite right, the conclusion of a DHSC meeting, workstream, another workstream, to consider to what degree the department or to what degree the recommendations from Exercise Cygnus had not been completed, and that was a conclusion reached in June 2020, was it not, Ms Reed?

Ms Emma Reed: That sounds about the right date, yes.

Lead Inquiry: All right, take it from me then.

Lady Hallett: Can I just ask what you mean by not fully completed, not completed at all?

Completed means done, completed. So I would have thought not fully completed means work had started but it hadn’t finished. Not completed at all, I don’t understand.

Ms Emma Reed: Okay, allow me to expand. Some of the recommendations had different component parts to them, and so there may be an element of a part that had been completed. So, for example, we had completed some work on surge guidance, and that had been completed, but the second half of that, around socialising that with – or testing that with health and social care organisations, that part of it was not completed.

Lady Hallett: But that would come under the category of not completed.

Ms Emma Reed: I think that’s a fair conclusion to reach, yes, my Lady.

Lady Hallett: So what do we mean by six were not completed at all? Do we mean no work had started?

Ms Emma Reed: No, I wouldn’t say that no work had started. Work had started on all of the recommendations, but there were some elements of those that had been completed.

So I would agree with your conclusion that they weren’t completed, but work had begun on all of them.

Lady Hallett: Or they hadn’t got very far?

Ms Emma Reed: It varies across the recommendations, my Lady.

Lady Hallett: If you have a recommendation that says “We must get more PPE, this is a highly infectious disease, it’s got terrible consequences, we must get” – whose responsibility is it to get the PPE?

Ms Emma Reed: I would suggest that that would be my responsibility.

Lady Hallett: Who would ensure that your responsibility was carried through, apart from you?

Ms Emma Reed: That would be the responsibility of my permanent secretary and the departmental board.

Lady Hallett: So after Ebola you had a recommendation for more PPE, was it?

Ms Emma Reed: I can’t recall the recommendation from Ebola, my Lady.

Lady Hallett: I think there was one in relation to PPE.

Ms Emma Reed: If there was a recommendation that related to PPE being acquired for an emerging infectious disease, as I understand it the PPE stockpiles for emerging infectious disease have been adequately built, I haven’t had anything to tell me to the contrary. So I’m not – it’s – unfortunately before my time I can’t confirm whether or not and how the recommendations for Ebola’s PPE were delivered, but I can say that that hasn’t been raised to me as an issue, that there isn’t adequate PPE for an emerging infectious disease.

Lady Hallett: Thank you.

Mr Keith: Can I assist you, Ms Reed?

Lesson 8 from Ebola was that further work would be required between the Department of Health, NHS England and Public Health England to determine the most appropriate levels of PPE that should be maintained for ongoing infectious disease preparedness.

But for the reasons that we have been debating, namely that the assumed consequences of infectious non-influenza disease were set so low, were so narrow, in terms of being confined to healthcare settings, and very low levels of casualties and fatalities, not very much PPE was required to meet what was thought to be necessary for a high-consequence infectious disease. But no consideration was given at all to the need for PPE for a non-influenza pandemic.

That’s the sum of it, isn’t it?

Ms Emma Reed: The risk assessment we were building our mitigations for were a pandemic influenza and emerging infectious disease, and in both of those cases, with advice from experts and specialists, we were advised what PPE we needed for both of those risks. If you start from the premise of the risk you’re mitigating, you build the appropriate mitigation for those risks. So it is the case that we had appropriate PPE for those two scenarios, but not for a Covid pandemic, which was not the risk we were managing.

Lead Inquiry: Going back to the recommendations, the recommendations from Cygnus, 14 of which had not been fully completed, whatever that means, eight partially, perhaps six not fully, fully completed, that was not a situation in June 2020 which took anybody by surprise, was it?

Ms Emma Reed: No. The recommendations that hadn’t been completed were part of our ongoing programme of work, and, as I mentioned earlier, some elements of our programme needed to be paused, and so there were elements of those programmes that hadn’t been completed.

I would also say that there are a number of recommendations in Cygnus that it’s not really conceivable for us to say that we have ever fully completed. So the first recommendation is that our emergency preparedness must follow best practice. Well, by definition we never complete that, because the process is about continuous learning. So I’d never feel comfortable being at the point of saying that we’ve absolutely completed that activity. The way that some of the recommendations were phrased were such that they were about ongoing work and continuous development. So I think it would be difficult for us ever to get to the point that we’d say all 22 of those had been completed.

Lead Inquiry: The point, Ms Reed, though, is this, isn’t it: as at June 2020, the body that was looking at how many of the recommendations were implemented couldn’t have been taken by surprise, it must have been apparent to everybody who was responsible for implementing the implementations, from 2016 through to 2020, that the recommendations were not being implemented; it just was not being done, for a variety of reasons, which you’ve attempted to explain? It just wasn’t done.

Ms Emma Reed: There were a number of recommendations that weren’t completed, that’s absolutely correct.

Lead Inquiry: You knew that the recommendations were not being implemented. 2016 was four years before this committee reported as to the number which weren’t being implemented.

Ms Emma Reed: That’s correct.

Lead Inquiry: If we could have, please, on the screen INQ000022792, which is the report into Exercise Cygnus, page 6. At 1, amongst the recommendations which were never implemented in full was this one:

“The development of a Pandemic Concept of Operations …”

Correct?

Ms Emma Reed: That’s correct.

Lead Inquiry: Page 8, at 3, work to be done on how the public would respond to a pandemic, that is to say whether it would self-isolate, whether it would cope with the demands of mandatory quarantining, how it would respond to social restrictions; correct?

Ms Emma Reed: I can’t say with certainty whether any of the work was done on this particular recommendation. I don’t think it is concluded.

Lead Inquiry: Now, the only thing that was done, Ms Reed, wasn’t it, was that a committee was set up called MEAG, of which my Lady has heard, the Moral and Ethical Advisory Group, which would give advice in the event of a pandemic on some of the moral and ethical questions that might arise?

Ms Emma Reed: Yes.

Lead Inquiry: But the work done, the behavioural work done as to how the public would deal with social restrictions and non-pharmaceutical interventions and how in practice the country would be enabled to deal with the consequences of a catastrophic pandemic were not addressed at all, were they?

Ms Emma Reed: No.

Lead Inquiry: Page 9:

“An effective response to pandemic influenza requires the capability and capacity to surge resources into key areas, which in some areas is currently lacking.”

The NHS did put into place, at your department’s urging, plans for surge capacity, and we saw that of course when the pandemic struck, but very little work was done in relation to how the adult social care sector would cope with a mass influx of patients in a pandemic.

Ms Emma Reed: I wouldn’t agree that there was no work done in that space. There was a lot of engagement with LRFs and some guidance was issued to adult social care providers in May of 2018 that addressed the question of surge. I would not say that that work was completed, and I would be very clear to say that there was more that we needed to do about community surge. But it was not the case that no work was done.

Lead Inquiry: Page 11, there was some feedback in the course of Exercise Cygnus from local resilience forums to the effect that there are just “too many plans” and “there is a question about how up to date all the plans are and whether there are contradictions between [them]”.

What was done in order to rewrite the plans? To produce something, perhaps in a single document, something that was coherent and clear to the LRFs? Was that ever done?

Ms Emma Reed: No, it wasn’t completed.

Lead Inquiry: Page 12, some of the feedback was to the effect that LRFs, the local resilience forums, “would have difficulty operating their plans and capabilities at this scale [of response]”.

“More focus and co-ordination on pan flu preparedness [is] needed nationally, departmentally and within Resilience and Emergencies Division Operations Centre itself.”

Now, of course you don’t speak for the Resilience and Emergencies Division of the Department for Levelling Up, Housing and Communities, nor for the Cabinet Office, but was that focus and co-ordination carried out, as far as you were aware?

Ms Emma Reed: I am aware that the Ministry for Housing engaged extensively with local resilience forum around their readiness in pandemic influenza. I’m aware the Cabinet Office engaged extensively with local resilience forums on their resilience standard and their level of preparedness.

Of course it’s also important to note that NHS England and Public Health England are represented on the local resilience forum, so I also engaged with the health system that sits on local resilience forum. It was not co-ordinated and that was definitely one of the recommendations that we were – we didn’t deliver, which I regret, around that co-ordination and the bringing together of advice. But we did engage with local resilience forums and at the local level.

Mr Keith: My Lady, is that a convenient moment?

Lady Hallett: Certainly. I shall return at 12 o’clock.

(11.45 am)

(A short break)

(12.00 pm)

Mr Keith: Ms Reed, what are health sector security and resilience plans?

Ms Emma Reed: They would be plans that organisations who are Category 1 responders and have responsibility under the Civil Contingencies Act need to have in place to ensure that they can discharge that duty.

Lead Inquiry: So they are plans which you put into place to make sure that everyone can know or you can be assured that your preparedness and continuity arrangements are in order, as they are obliged to be under the Civil Contingencies Act 2004, as a Category 1 responder?

Ms Emma Reed: Yes.

Lead Inquiry: Can we have INQ000187694, please, which is the 2016 plan, page 3, paragraph 1:

“Within the health sector, there are generally good levels of resilience, with good preparedness and business continuity arrangements in place.”

Ms Emma Reed: Yes.

Lead Inquiry: At paragraph 5:

“The health sector can be impacted by the majority of risks in the National Risk Assessment … it is essential that within the health sector, national planners are … planning against the common consequences … Given the diversity and interconnectedness within the health sector, and the extent to which it needs to respond to the consequences of emergencies in other sectors, emergency preparedness, resilience and response planning … adopts an ‘All Risks’ approach.”

So this is the DHSC saying “We have measured ourselves against a security and resilience assurance, these are our plans for preparedness and continuity, we [going back to paragraph 1] think there are generally good levels of resilience, with good preparedness and business continuity arrangements in place”, it’s you signing off on how you’re doing, paragraph 1?

Ms Emma Reed: Yes, but this is not a – this is not a static status, it is something that we continually look at, the health and social care sector’s resilience for emergency preparedness.

Lead Inquiry: Of course, so this is just for 2016?

Ms Emma Reed: Yes, I’m not familiar with this document.

Lead Inquiry: All right.

So every year or every two years these plans are put into place or these documents are prepared, and they’re not static, are they, they take account of whether or not there is good resilience and whether there has been an outbreak or whether there has been an exercise and whether you’ve responded to an exercise or whatever it might be. They’re not fixed, set in place. They take account of the reality of how well the department is doing.

Ms Emma Reed: The department and its delivery organisations.

Lead Inquiry: Arm’s length –

Ms Emma Reed: Yes.

Lead Inquiry: And its arm’s length bodies?

Ms Emma Reed: Yes.

Lead Inquiry: Could we then, please, have 2017/18 health sector resilience plan, INQ000105273. Page 3.

So, Ms Reed, this health sector security and resilience plan was after Exercise Cygnus. The first one I showed you was before the report in Exercise Cygnus.

Could you go, please, down to the bottom of the page – or, rather, halfway down the page. There we are, stop there.

So this plan, a year and a half later, from the earlier plan, is after Cygnus has reported in the terms that it did about the systemic insufficiency of the plans, policies and capability in the health sector, amongst others, to cope with the extreme demands of a severe pandemic, but the wording in this plan is identical:

“… there are generally good levels of resilience, with good preparedness and business continuity arrangements in place.”

The identical words to the plan 18 months before. So it wasn’t static – sorry, it was static. The plan uses the identical wording from the earlier plan. So how could it possibly have taken account of that severe conclusion from Exercise Cygnus, and the fact that the workstreams which came from Cygnus were not by and large being pursued through to their fruition?

Ms Emma Reed: I’m not familiar with this document and this document was produced before my time in the organisation, so I cannot – I cannot make an assessment of the decision to draft that sentence as it is. Looking at this document for – for what I can see it to do, is it is looking across the totality of the threats and hazards landscape, so all of the threats that are captured in the National Security Risk Assessment, I think that my perception would be that at that time the concern of pandemic influenza was in a state of readiness, but this is looking at general levels of resilience and preparedness across all the risks in the National Risk Register.

Lead Inquiry: Ms Reed, in the field of health emergency, in the field of the Tier 1 risk faced by the United Kingdom, there had been since the earlier sector resilience plan, Exercise Cygnus, which had concluded in the way with which you are very familiar. How could a proper, adequate sector resilience plan conclude in this way using the identical wording that its earlier plan had used before Exercise Cygnus had reported?

Ms Emma Reed: I can’t comment on the drafting of this paper –

Lead Inquiry: Because this was before your time?

Ms Emma Reed: – it was not – before my time. I would not say that in the specific risk of pandemic influenza we were fully prepared or that there was good levels of resilience. I would say generally across the threat and hazards landscape there is a good level of resilience and a good degree of preparedness.

Lead Inquiry: Was there a sector resilience plan prepared by you, however, after you were in post?

Ms Emma Reed: I don’t believe there was, no. I don’t recall producing one, no.

Lead Inquiry: All right.

My Lady, there’s a document which we have on our system which hasn’t in fact been disclosed for a variety of reasons, I’m not quite sure why, to core participants and to the witness, and therefore I’m not in a position to be able to bring it up on the screen, and it’s not right that I should because it will take everyone by surprise.

But I want to ask you, Ms Reed, do you recall a sector resilience plan for 2018 and 2019 being prepared whilst you were and remain in post?

Ms Emma Reed: I don’t recall a plan being produced, no.

Lead Inquiry: All right.

If that plan were to use these words “there are generally good preparedness and business continuity arrangements in place”, that would seem to indicate that the wording had still not been materially altered, even by 2018/19, when you were in post?

Ms Emma Reed: I can’t comment on the text, I’m not familiar with the document. If the text is the same as the previous versions, that would imply that it hadn’t been changed. That would not be my view of the pandemic risk, but it would be my overarching view of our state of readiness for wider threats and hazards.

Lead Inquiry: All right.

The Pandemic Flu Readiness Board, we’ve covered the workstreams which were meant to be addressed by the Pandemic Flu Readiness Board. Bringing those threads together, the board was established in –

Ms Emma Reed: 2017.

Lead Inquiry: – in March, following Exercise Cygnus. It was established by order of the National Security Council Threats, Hazards, Resilience and Contingencies committee in the order of the then Prime Minister?

Ms Emma Reed: Yes.

Lead Inquiry: It had a number of workstreams, some of which were completed?

Ms Emma Reed: Yes.

Lead Inquiry: Some were part completed, some were not completed at all. We needn’t go into the detail of it. But that Pandemic Flu Readiness Board, which was a board chaired jointly by your department and the Cabinet Office, didn’t sit at all, did it, between November 2018 and November 2019?

Ms Emma Reed: That’s correct.

Lead Inquiry: You’ve already explained and other witnesses have explained that that was because of the necessary preparations for a no-deal exit, Operation Yellowhammer interfered in this process. But why did the fact that the particular workstreams were in some places being paused or not completed mean that the board itself didn’t have to meet between November 2018 and November 2019? Why was Operation Yellowhammer a sufficient explanation for why the board didn’t meet as opposed to why some of its workstreams were not being seen through to their conclusion?

Ms Emma Reed: I would say that the reason for that is that our prioritisation of resources in working on pandemic flu were prioritised at the delivery of key elements of the programme rather than in the secretariating of a board. So I prioritised our work on the Bill and on work to do with excess deaths and MEAG rather than board secretariating functions. So the work continued but we didn’t run a board.

Lead Inquiry: You were the prime civil servant, along with Ms Hammond, on that board?

Ms Emma Reed: Yes.

Lead Inquiry: You effectively co-chaired it?

Ms Emma Reed: Yes.

Lead Inquiry: You knew the board was not sitting and did not sit for a whole year.

Ms Emma Reed: That’s correct.

Lead Inquiry: Did you not think to yourself, “The risk of a pandemic has never gone away, these are important workstreams which the Prime Minister ordered to be done, they are things that matter, they reflect the conclusions of Exercise Cygnus, they are important aspects of getting this country ready for the Tier 1 risk, the greatest risk in the entire risk assessment process, I think we should be sitting”?

Ms Emma Reed: I – no, I don’t. I think that what I took as a judgment was, firstly, that resources were needed to support the response to the real threat of disruption from a no-deal exit and, secondly, that I prioritised work that needed to be completed on capabilities that actually were used in the Covid situation, which included the Pandemic Flu Bill. Those pieces of work could continue outwith a board structure.

Lead Inquiry: Now, there are a number of things that the board did see through to fruition. There was the drafting of a Bill –

Ms Emma Reed: Yes.

Lead Inquiry: – which was the draft pandemic Bill, which became the Coronavirus Act.

Ms Emma Reed: Yes.

Lead Inquiry: Only in relation to the emergency regulations in England was that Act used, was it not, when Covid struck, because Scotland, Wales, Northern Ireland all used earlier emanations of the Public Health Act, did they not?

Ms Emma Reed: I would have to check my records to see which piece of legislation –

Lead Inquiry: All right.

Ms Emma Reed: That would be an issue for the devolved administrations.

Lead Inquiry: MEAG –

Ms Emma Reed: Yes.

Lead Inquiry: – was put in place, the Moral and Ethical Advisory Group, and that gave valuable assistance, of course, during the pandemic on the moral and ethical issues.

Another piece of work that was done was the board authorised, drafted and prepared and published something called the National Resilience Standards. That was a standard, a test, a check, if you like, for local resilience forums, so that they knew to what standard their own preparedness plans had to be judged by?

Ms Emma Reed: Yes.

Lead Inquiry: I put it to Ms Hammond, but I ought to put it to you because I think the National Resilience Standards for Local Resilience Forums came, at least in part, from the Department of Health and Social Care, did they not?

Ms Emma Reed: If I recall, it was a piece of work that was led by the Cabinet Office working in partnership with the department responsible for local government, but we will have supported that work.

Lead Inquiry: All right. Are you aware that until 14 November 2019, just before the pandemic struck, the National Resilience Standards for Local Resilience Forums across the entirety of England and Wales made no reference to any need to judge their work by reference to the plans that might be required for an influenza pandemic?

Ms Emma Reed: That would be a matter for the Cabinet Office and the department for housing and local government.

Lead Inquiry: All right.

The PIPP board or the PIPP programme, what was that?

Ms Emma Reed: That was a programme that was led by my Director General, Clara Swinson. The responsibility of that body was to look at the delivery of the health and social care elements of pandemic preparedness. So it was a more internal health and social care-focused programme.

Lead Inquiry: Was there a long period during which it did not meet, or at least the board for the Pandemic Influenza Preparedness Programme did not meet?

Ms Emma Reed: As I recall, it also did not meet during the period of end 2018 to 2019.

Lead Inquiry: Again, because of Operation Yellowhammer?

Ms Emma Reed: As I understand it, yes.

Lead Inquiry: Do you agree that no pre-pandemic exercise in which your department was either an observer or a participant and no outbreak report and no DHSC policy or guidance paper considered the issue of the vulnerabilities and inequalities of parts of the community and how they might be affected by the plans that you were drawing up for a pandemic influenza?

Ms Emma Reed: No, I wouldn’t agree with that statement. I think there was consideration taken for the impact to vulnerable people of a pandemic influenza.

Lead Inquiry: Clinical vulnerability, Ms Reed, it was clinical vulnerability, it was obviously, in the event of a pandemic, the pandemic and our responses to the pandemic will have an impact clinically on those who are at greatest risk from the disease. Was there any consideration of anything other than clinical vulnerability?

Ms Emma Reed: I believe that there were considerations of wider inequalities of – for those individuals who would potentially find it difficult to access health and social care systems.

You mentioned earlier also the moral and ethical committee that considered issues around concerns from different faith groups about the approach to vaccination and shielding, so there were areas where thinking about protected characteristics were a consideration in our planning and preparing.

There was no systemic assessment of protected characteristics impact, but individual work programmes were considering impacts on vulnerable people.

Lead Inquiry: The work programmes to which I now understand you may be referring, was that the work done to ensure that if individuals want treatment, clinical treatment, steps needed to be taken to mitigate differential impact by ensuring that health communications will be available in a range of languages?

Ms Emma Reed: There was work undertaken to think about how we reach communities where English is not the first language. I would say that it is writ within the principles of how we deliver our work that we consider health inequalities at a national and local level and so communications would, in themselves, think about people who may not be able to access information where English isn’t their first language.

Lead Inquiry: Ms Reed, other than the obvious point that some people may be more clinically vulnerable to a pandemic, the only consideration in this whole ten-year period given to the position given to members of ethnic minority groups or vulnerable sectors of society, by way of your pandemic planning, was making sure that health information would be available in a range of languages; is that the sum of it?

Ms Emma Reed: I don’t believe that to be true, we considered equality impact assessment as part of the – as the 2011 strategy, we considered an impact assessment as part of the pandemic Bill preparedness that you mentioned earlier. In guidance that went to local resilience forums they talked about people who would struggle to access mainstream healthcare, which included those who were homeless and disenfranchised. So there was work to do that. It wasn’t systemic – systematic, I apologise, but there was work to consider vulnerable people.

Lead Inquiry: The work that was done, and you’ve just referred to it, was a consideration – there was a paper called the Equality Duty paper, which came out around about the same time as the 2011 strategy, there was nothing thereafter, which considered the legal obligation imposed on the government generally under the Equality Act 2010, known as The public sector Equality Duty. Is that the duty to which you’re referring?

Ms Emma Reed: Yes.

Lead Inquiry: Right. That was a broad omnibus consideration of the power or the duties of the government under the Equality Act. Where was a single paper referring to what the impact would be on the particular parts of society to which I’ve made reference of either a pandemic or your planning?

Ms Emma Reed: There was no single piece of paper with that on it.

Lead Inquiry: Right. Do you accept from me, evidence through me, evidence from the government’s own Equality Hub, and its director, Mr Bell, who has given a witness statement to my Lady, which says:

“Reasonable and proportionate searches have been conducted … I can confirm that this department was involved in no work related to the United … government’s response to civil emergencies, including a pandemic. There was no contribution to the design or preparation of any policy response on behalf of the United Kingdom government in the event of a pandemic.”

Just no work was done on this topic at all, was it?

Ms Emma Reed: There was no overarching assessment of the impact of the pandemic preparedness strategy on inequalities since the publication of the strategy in 2011.

Lead Inquiry: Thank you.

Ms Emma Reed: Had there been a revision, we would have done that.

Mr Keith: All right. Those are all my questions, thank you.

My Lady, that concludes the evidence of Ms Reed.

Lady Hallett: So no Rule 10?

(Pause)

Mr Keith: There were applications but permission has been denied.

Lady Hallett: Thank you very much.

Thank you, Ms Reed, thank you for your help.

The Witness: Thank you.

(The witness withdrew)

Ms Blackwell: My Lady, good morning. The next witness is Rosemary Gallagher MBE. May she be sworn, please.