2. Mr Duncan Selbie

MR DUNCAN SELBIE (affirmed).

(Evidence via videolink)

Questions From Counsel to the Inquiry

Ms Blackwell: Thank you.

Mr Selbie, thank you for the assistance that you’ve given to the Inquiry so far. You have provided a witness statement, which we can see at INQ000192268.

Now, that’s appearing on my screen. Is it also appearing on your screen?

Mr Duncan Selbie: Yes, it is now. It’s rather small, but yes.

Counsel Inquiry: All right. It’s being enlarged. Is that helping at all?

Mr Duncan Selbie: Yes, that’s better.

Counsel Inquiry: Excellent. Whenever I show a document to you, I’ll make sure that the document presenter makes it as large as possible for you.

Can you confirm, please, Mr Selbie, that that is your witness statement?

Mr Duncan Selbie: Yes.

Counsel Inquiry: Thank you.

We perhaps we don’t need to go to it but it is signed at page 14.

Is that statement, Mr Selbie, true to the best of your knowledge and belief?

Mr Duncan Selbie: Yes, it is.

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

I will ask you questions and I hope that all of them are clear and that you understand them. If you don’t, then please just let me know, and I will ask it again or try and rephrase it.

If you need a break at any time, Mr Selbie, please just let us know, and we will break for your convenience.

Please keep your voice as loud as you can so that the stenographer can hear you for the transcript.

Mr Duncan Selbie: Yes.

Counsel Inquiry: Can you also confirm, please, Mr Selbie, that you have read the witness statements provided to the Inquiry by Professor Dame Jenny Harries and also Professor Isabel Oliver?

Mr Duncan Selbie: Yes. Ms Blackwell, I’m terribly sorry, there was an interruption for about three seconds. I hope this isn’t going to happen.

Counsel Inquiry: So do I.

Mr Duncan Selbie: Could you repeat the question, please?

Counsel Inquiry: Yes, of course.

I was asking, Mr Selbie, if you can confirm that you’ve read the witness statements of Professor Dame Jenny Harries and Professor Isabel Oliver on behalf of the UKHSA?

Mr Duncan Selbie: Yes, I have.

Counsel Inquiry: Thank you very much.

Do you broadly agree with what has been set out in those witness statements so far as Public Health England is concerned?

Mr Duncan Selbie: Yes.

Counsel Inquiry: Thank you.

I want to begin by setting out your professional background and qualifications so far as they’re relevant to this Inquiry.

You have qualifications in health and hospital management and health and social care management. You held various NHS posts in Scotland and London between 1980 and 1986. Then in 1997 you became chief executive of South West London and St George’s Mental Health NHS Trust. In January 2002 did you became chief executive of the South East London Strategic Health Authority, and in November 2003 you worked for the Department of Health, initially as the director general of programmes and performance for the NHS, then as director general of NHS Commissioning.

In July of 2007 you became chief executive of Brighton and Sussex University Hospitals and then chief executive of Public Health England from July of 2012 to August of 2020.

Mr Duncan Selbie: Yes.

Counsel Inquiry: Thank you.

In her witness statement to the Inquiry, Professor Dame Sally Davies has expressed a view that UK public health institutes that deal with infectious disease outbreaks should be professionally led by a clinical scientist.

It’s right, Mr Selbie, that you don’t hold any medical or scientific qualifications, do you?

Mr Duncan Selbie: No, I don’t, and that is unusual for a national public health institute.

If I may, I should have said that I’m also the president of IANPHI, which is the International Association of National Public Health Institutes. It’s the world’s gathering of the Dame Jennies, if you like, in 115 institutes around the world, and I think I might have been unique in not being clinically or public health qualified.

Counsel Inquiry: Do you feel in any way that that hampered you in carrying out your role as chief executive of Public Health England?

Mr Duncan Selbie: Well, I’ve thought deeply about this, and, you know, with all genuine humility, no, I don’t think it did, because being a chief executive is not the same thing as being a clinical scientist or an academic. I think it could prove to be a great advantage, potentially, to have that background, but that’s not what a chief executive is there to do. And I’m very experienced as a chief executive, I’ve made lots of good decisions and lots of less good decisions, but I’m definitely very experienced, and that was the basis on which I was appointed. And I’ve never pretended to be otherwise.

You know, my interview included the Chief Medical Officer at the time and, as you know, it involved bringing together quite a complex set of bodies into a – and to create something new, something that hadn’t happened before in this country. So I’ll cease there.

Counsel Inquiry: All right. Thank you very much for that answer. Indeed, we have been through the extensive experience that you had of acting as a chief executive before taking up that post at Public Health England.

But I suspect that you may have been asked a similar question when you gave an interview in 2013 to The Lancet, because, asked about your experience in public health, your answer appears to have been:

“You can fit my public health credentials on a postage stamp …”

Is that right?

Mr Duncan Selbie: I did say that. It was a bit unkind of them. It was meant to be a light-hearted introduction, and I have had a lot of involvement with health inequalities in public health, because in my years as the director general of performance, I was instrumental in six priorities for the NHS, one of them being health inequalities, it was about the NHS, cardiovascular, cancer and so on. Then in my strategic health authority days I had a director of public health for the strategic health authority, and with mental health it was essentially a public health agenda, which we might talk about, but Professor Marmot I think would recognise that if you get it right for mental health you get it right for the public’s health.

So it was a little unkind, but if you read the whole of that interview it was balanced out, and I think the communications director at the time said, “I wish you hadn’t said that”, but it was meant to be light-hearted.

Counsel Inquiry: Thank you.

Mr Duncan Selbie: And respectful, it was meant to be respectful about what I didn’t know.

Counsel Inquiry: Yes. Well, thank you very much for that answer, Mr Selbie.

I know, because I’ve spoken to you before you took your affirmation and began to give evidence, that you were able to follow the evidence yesterday from Professor Dame Jenny Harries.

Mr Duncan Selbie: Yes.

Counsel Inquiry: So I’m able to take some of my questioning in short fashion with you today.

You will have seen that we covered evidence with Dame Jenny yesterday about the rather complex restructuring of public health in England bought about by the Health and Social Care Act of 2012 and the key differences between the HPA and PHE.

So we established the following: that the HPA was an executive non-departmental body, and was replaced by PHE, which was an executive agency of the then Department of Health; that PHE brought together, under the management of a single organisation, the previous distinct strands of public health, namely public protection, public health improvement, and healthcare, public health; that PHE worked with local authorities who were given new responsibility for improving the health of local populations, that role having been transferred from the PCTs; and that Public Health England also worked with the directors of public health who for England were employed by local authorities as strategic leaders for public health and health inequalities in local communities. We also looked at the various structural changes over time to the PHE local and regional teams.

So I’m going to ask you, Mr Selbie, if you have any reflections on the impact of all those structural changes, in particular on the following issues: firstly, the clarity and understanding of EPRR roles and responsibilities. Was there, in your view, any confusion as a result of the – what I’m going to describe as rather complicated overlapping and/or blurred statutory responsibilities?

Mr Duncan Selbie: So I think initially there was a lot of learning to be done, because this was new for local government. Dame Jenny spoke yesterday about that being quite a difficult transition, and I agree with that, but it was about moving, if you like, from a place where directors of public health had been for many, many years to a place where they could make a bigger difference and could have a bigger impact. So I think it was very worthwhile, very brave and courageous of the public health directors to make that shift, but it did bring with it a whole lot of new relationships within councils, with colleagues, as well as with the health sector, and over time that became of some concern and the Health Select Committee asked us to look at this and to be more assured about these arrangements, and I think you’ve – you know, I’ve seen the – I have been reminded of the assurance exercise that we went through in 2016, which was quite positive, but it did involve still a lot of further training and bespoke interventions in different parts of the country.

So I don’t think – I think inevitably, because it was a big change, but it was a very worthwhile change, in my heart I will always say I believe that that was the right thing to do, but it did take time, and it did involve a lot of new learning for a lot of people.

Counsel Inquiry: In terms of funding, although ministers had promised to ringfence the public health budget for local authorities, we heard that the public health grant was reduced in real terms by 14% between 2015 and 2021. Were you aware of that at the time?

Mr Duncan Selbie: Yes, it was very disappointing and, you know, I spoke with the then Secretary of State, Jeremy Hunt, and then, as I say, with the ministers that were responsible for public health. It was – it was actually – it was a very disappointing time. In 2015, Mr Hunt managed to negotiate a lot more money for the NHS, but the Treasury made it a condition of that that Department of Health reduced its budget, and there was really only two places that the Department of Health could look for that. One was Health Education England, and of course we needed more doctors and nurses and we had to train more. So it was Public Health England. And I had a conversation with Mr Hunt where he asked me for 50% of the budget in order to fund the NHS, and obviously that wasn’t going to happen, because local government were then responsible for essential services, like school nursing and addiction services and most walk-in clinics, and all sorts of things that were terribly important, and of course – but there was a negotiation and the Treasury won that argument and there was an initial £200 million reduction. I’m afraid that then led to every year after that further reductions.

I might add one thing that Dame Jenny didn’t – or wasn’t – didn’t come out sufficiently. When this money was originally earmarked for local(?) government, it was essentially only what PCTs had been spending, and there was great variation across the country, and even though we had three attempts to try and get a good fix on what was being spent in the NHS, when we eventually settled it there was a seven-fold difference. We built inequality in from the outset.

The plan was that over time, through growth, we would even that out, and that was what was so terribly disappointing about what happened in 2015, because the ability to even that out was then taken – taken away.

Counsel Inquiry: So what was the practical effect of that consistent reduction in budget? How did that manifest itself within public health?

Mr Duncan Selbie: Well, again, Dame Jenny yesterday, and I definitely agree with this, says local government are the most fiscally able of all the public health services. They have managed to manage on less more than anyone else, and they are very good at that. But you’re talking very small amounts of money that have huge impacts locally. So £1,000,000 reduction in a year on a budget could mean that they couldn’t support a children’s centre or might not be able to continue to offer home support for people with long-term conditions, so a whole series of effects.

So, you know, the budget – the actual grant of £3 billion or so was a fraction of the spend in the NHS, so any reduction on that was going to have a bigger – you know, have a bigger impact.

I tell you, it was just depressing that this – because at that time it was so energising that we had this opportunity at a local level to bring together local knowledge, local leadership, with specialist support from Public Health England, lots of expertise, to try and do the right thing in a very sort of local way. But you have to fund that if you want to see that happen.

Counsel Inquiry: Yes. We’ve heard of a practice called “top slicing”, where local authorities would reallocate ringfenced public health budgets to other services. Do you know, for instance, Mr Selbie, whether or not pandemic planning or local risk assessments in relation to pandemic planning was one of the areas that was likely to suffer from the lack of funding? In other words, were local authorities in the business of taking money that might have been used for those matters and putting it elsewhere to more acute problems?

Mr Duncan Selbie: So there was a lot of concern that local government, under huge financial pressure, would want to use the public health grant. As small as it was, it was enabling of other things. And we instituted an arrangement with the National Audit Office where the use of the grant had to be approved by the director of public health and was signed off by the director of public health as having been appropriately used. This was to try and give some protection to directors of public health against directors of finance or chief executives who wanted to take the money.

What I can’t tell you is whether that affected EPRR in a significant way. I’d like to think not, because these were very small resources anyway, and they were all involved in local health resilience partnerships, where that sort of gap I think would become apparent.

Counsel Inquiry: All right, thank you.

I’m going to return later on in my questioning to the system of subsidiarity and local preparedness, but just touching upon directors of public health, was there a shortage of directors of public health due to retirements and recruitment problems?

Mr Duncan Selbie: It did fluctuate. In the early days – again, Dame Jenny made the point that quite a number of the more experienced, closer to retirement directors of public health took the opportunity to retire at the point of the change, and then there was a cohort involved that did move over that just didn’t find that it worked for them, it was such a different environment to the NHS they’d been used to, and they either went back to the NHS in some role or went on to do something else. So over time you saw – well, we paid a lot of attention, as Public Health England, to this in training, bringing on, professionally developing younger potentially future directors of public health, and I think it’s all in Dame Jenny’s statement about different programmes we put together.

We had about – well, we had exactly 152 local authorities. We had about 130 directors because small authorities used to share a director and that was perfectly normal. So I’m not up to date with the exact numbers, but I do think it was reasonably healthy, reasonably healthy, towards the sort of 2017, 2018, 2019 years.

Counsel Inquiry: Do you agree with the view that the links between NHS staff and public health specialists became fractured, which also affected community infection prevention and control?

Mr Duncan Selbie: Yeah, I think it became more difficult. And one of my greatest regrets was that in strengthening the relationship between public health – Public Health England but previously HPA – and the local government came at some expense of having removed that capability and that experience from the NHS, not just at PCT level, but at strategic health authority or whatever the management arrangements were at that time. And I was very concerned about that, and in 2018/2019 reintroduced directors of public health into the – what was then the seven leadership teams of the NHS, and there had been an interregnum of, what would that be, at least five years, so I definitely think that we lost our way about the NHS, and they were very, very glad to have this back.

Now, what did this mean for infection protection and control? I don’t have enough visibility on that. I would – I accept that it was, that the focus was diminished, that the sort of public health focus on this was, if you like, less – so it was more about what hospitals were doing, because they’ve always had a big focus on this. I know this to be true. But I think community services very much relied on their – their – when they had their public health responsibilities, for this.

But I genuinely – you’d have to ask NHS England I think, because they were actually responsible for this.

Counsel Inquiry: The Inquiry has heard that some parts of the English public health community have raised concerns about the extent to which Public Health England, as an executive agency of the Department of Health, was able to act as an independent advocate for public health and to set its own strategic priorities. Do you want to say anything about the lack of or perceived lack of independence of Public Health England from the government?

Mr Duncan Selbie: Well, I never felt constrained. I mean, there was never a moment when – in fact, there wasn’t a single occasion in the eight years that a politician of any – required a change to anything that Public Health England produced or published. We did negotiate about timing, and there were issues about, you know, other things going on at the time, but there was never a moment, not one moment where we were asked to, “Please don’t say that” or “Can you take that out” or “Can you redact that”.

In effect, when you look at the media about Public Health England over the years, I don’t think you’d have any doubt about our willingness to speak out and – you know, the libertarian end of politics in – in Britain wished we didn’t exist and, you know, they were always complaining about what we were advocating for.

So I don’t – I don’t think – I don’t think that, and Dame Jenny spoke yesterday about the particular protection that we had for our scientists and our public health professionals of all different forms. Although part of the civil service, they – we had a special code approved by the Treasury because the Civil Service code doesn’t allow civil servants to speak to the media without ministerial authority, and that did not apply to Public Health England. I was very proud of that. That was one of the early successes, to explain that actually our voice may not have been loud enough at times or we might not have got it right and others might have said that, you know, we should have been doing other things or concentrating on other things, but there was never any doubt in my mind that we were – you know, and I would have resigned, unquestionably. It was absolutely the heartbeat. We were independent to science and evidence, we were not independent of government, and that is often misunderstood. There’s not a national public health agency on the planet that is independent of its government, because you can’t separate politics from public health. But independence to science and evidence, definitely.

Counsel Inquiry: All right.

With such a broad public health remit, how did Public Health England under your stewardship as chief executive decide which public health strategies to prioritise each year?

Mr Duncan Selbie: So the heart of it was the global burden of disease which was the, if you like, health profile of the country, what was killing people, what was taking people away early in an avoidable way, and then Michael Marmot’s work was hugely instrumental about, well, that might be what people are experiencing but it doesn’t tell you much about why or what you can do about it.

So we tried to balance cross health improvement and health protection. You’ve heard from many that these are inseparable things, you can’t have a protected population unless you have a healthy one, and so we set priorities balanced across the wider determinants with the biggest priorities.

So, for example, we would tackle – of course we would tackle tobacco use and we would tackle obesity, but we also had HIV and TB, the start to life – that was Michael Marmot’s biggest advice to me that we should focus on, the beginning of life.

So it was a combination of those two sources of the best public health evidence that’s available that helped us to make these judgments.

We made those judgments with the Department of Health. You know, we didn’t just say and publish them. So we negotiated, we spoke to NHS England, we spoke to partners, the third sector, and of course with ministers, and with the Chief Medical Officers.

So the priorities were, if you like, agreed priorities but those were the two sources for how we came about them.

Counsel Inquiry: As you know, Matt Hancock gave evidence to the Inquiry this morning, and although he wasn’t asked about this in evidence, at paragraph 99 of his statement he talks about the conglomeration of different public health issues within Public Health England and, in his view, it was a mistake to create Public Health England as a body responsible for tackling non-communicable public health like obesity as well as communicable diseases and preparing for pandemics, because his view is that it was inevitable in those circumstances that the organisation, Public Health England, would spend more attention on tackling issues in front of it rather than worrying about the next pandemic.

Do you agree that more attention of Public Health England was spent on tackling non-communicable public health issues rather than pandemic preparedness?

Mr Duncan Selbie: So I’ve thought a lot about this, of course. I don’t think – no, I don’t believe that. Our first priority, beginning and end, was health protection. That was our raison d’être, it was what we did, 24 hours, seven days a week, and you’ve got the data about the thousands and thousands of outbreaks of – and the sort of big events that happened over those years, and Dame Jenny spoke about them, but I would have added others to them as well, that were managed by Public Health England health protection, with partners but very much with our expertise. At no point, not ever, did we compromise on that. I don’t say that with hindsight. I say that with – how could I describe it? It was our core purpose. But you cannot keep people safe unless you address the wider determinants, and you have witness statements, I thought the one from Richard Horton was particularly good, about how you can’t tackle health protection without tackling health improvement and inequalities, and so there are many different ways in which you can organise to best effect, and different countries approach this in different ways, some have separation, most are moving towards integration, but it’s not really that – for me, the question is: how do you deploy against the essential health functions set out by Geneva, which include all these different areas, in your context, in the way where you can get the best – if you like, the best from that investment? There’s not an answer that says, “And it is this”. But I do not agree with the prior Secretary of State that you can separate these. You have to find a way of bringing them together. That may be organisationally, or there might be other ways in which that might be done. But you can’t, frankly – anyway, I’m going on too much.

Lady Hallett: Mr Selbie, sorry to interrupt. Could you also try and speak a bit slower? Don’t worry, you’re not the first witness to speak too quickly. So if you could just try, I know it’s difficult.

Mr Duncan Selbie: I’m so sorry. Normally I spoke very slowly, so it’s just my – forgive me, I will try.

Ms Blackwell: I think maybe you’re getting a little bit animated, Mr Selbie, so it’s probably –

Mr Duncan Selbie: I shall turn it down.

Counsel Inquiry: I want to move on, please, to ask you about Public Health England’s responsibilities for preparing for and responding to pandemics, and remind you of what you say at paragraph 46 of your witness statement. You say:

“… in my view, [Public Health England] carried its emergency health protection work up to the point of January 2020 in the way that it was asked to do by Ministers. It is also my view that although [Public Health England] was not mandated or funded for at scale pandemic readiness and response, [it] did deliver on the tasks and responsibilities which were mandated by [Department of Health and Social Care] and the [Chief Medical Officer] throughout the first phases of the Covid-19 pandemic …”

What did you mean when you said that in your view Public Health England was not mandated for at-scale pandemic readiness and response?

Mr Duncan Selbie: So the big gap was mass testing, and mass contact tracing, because the flu plan didn’t ever envisage that that would be necessary, and all the thinking that – I know you’ve explored extensively, about MERS and the technical – the high-consequence infectious disease, if you like, none of that was – required a mass response. It required what we called in Public Health England a large-scale response, but the numbers were in the few hundreds, not what was eventually required, and there had never been any discussion, at any point, with anyone, in my discussions with the Secretary of State, the Chief Medical Officer, before and current, or in any place about the scale of pandemic that we faced.

So when I look at the budget for Public Health England, it is one quarter of 1%, it is actually 0.23 of 1% of the NHS budget. It doesn’t even add up to the cost of a small hospital. And for this, we ran amazing – I mean, I don’t wish – with – but, you know, gold standard science at Porton Down and Colindale and our regional laboratories and everything else that we’ve been speaking about this afternoon. It was just not ever part of the remit, you know, it was never part of what we were asked to do.

My reflection about the – and I know it’s Module 2 – is that notwithstanding that I’m intensely proud of what Public Health England were able to do in those first few months, because everybody – everybody – had to pull together. And one of the benefits of Public Health England was that we had scale and allowed us to, say, draw on everyone to come together.

Have I answered your question? Please do come back. I may not have.

Counsel Inquiry: I think you have to a certain extent.

I want to ask you some questions about the UK Influenza Pandemic Preparedness Strategy of 2011, about which I know you will be familiar. Because whilst Public Health England may not have had any mandate from the DHSC in relation to mass testing or contact tracing, and indeed there’s no provision in that strategy for those levels of preparedness, the Inquiry has heard from several witnesses, including Mr Hancock this morning, that one of the major flaws in that strategy was doctrine that lay behind it, that it was based on a premise that it would not be possible to halt the pandemic and that the plan was really a clean-up plan rather than a plan to prevent the spread.

Do you agree, firstly, that that was a major flaw in the plan, in the strategy?

Mr Duncan Selbie: I’m not really qualified to say about what the doctrine might have been, because I would have looked to medical scientific colleagues to be able to respond to that.

What I would say is that – and I agreed with Dame Jenny on this – it was entirely sensible for the country to have an influenza pandemic plan. Even if that’s not what we then faced, it would have been negligent not to have had such a plan. And pretty much every country I think would agree with that.

But I never thought into: well, what happened – how do you prevent that, how do you prevent such a thing happening? And I – it’s definitely for discussion.

Counsel Inquiry: All right. The assumption that lay behind the strategy was that 50% of the population may well be infected. If one takes that assumption, what was Public Health England’s responsibility in terms of the assumption that lay behind the strategy? What plans and preparations and assessments was Public Health England expected to do?

Mr Duncan Selbie: So our plan was to – in the first phases, was the detection and the assessment phases, so first of all I do recognise the numbers, so our responsibility was to know what was coming through the surveillance systems that we had and then to develop the assay, the test necessary, adapt if necessary, and then roll that out to laboratories, principally in the NHS. Again, something we might want to explore, but in my statement – and I think in Dame Jenny’s – about the difference between public health microbiology and diagnostic microbiology, which is often misunderstood. And so our role, in addition to EPRR of course and supporting the whole – the country with guidance and the necessary sort of public health advice, was essentially and first of all knowing what was coming towards us and then being able to get a test out to the NHS so that they could do the diagnostics.

Counsel Inquiry: Was Public Health England in a position from 2011, when this strategy was in place, to ensure the capacity for testing up to 50% of the population, if this indeed took place?

Mr Duncan Selbie: Well, no, because you wouldn’t – my understanding is that you wouldn’t be testing 50% of the population. You would be testing for surveillance and research purposes. You would be testing just to know what was happening and you would be doing ongoing surveillance to be looking for any changes in the virus.

Counsel Inquiry: Yes.

Mr Duncan Selbie: So emphatically it wasn’t what we then faced, but … was that clear enough?

Counsel Inquiry: Yes. So is it your evidence, Mr Selbie, that in terms of the assumptions as set out in the strategy, Public Health England would have been in a position to provide that level of testing if the assumption that was set out in the strategy had come to fruition?

Mr Duncan Selbie: I sincerely believe that.

Counsel Inquiry: Do you agree that it was another flaw to the plan that it only dealt with influenza and, despite there being a line within the strategy suggesting that the plan had to be flexible, that in fact there was no advice as to how that flexibility should be practically employed, and that a better plan would have been a generic respiratory plan?

Mr Duncan Selbie: I do.

Counsel Inquiry: All right.

Finally, were you aware that during the course of the period of time that passed between 2011 and the onset of the Covid pandemic, that this plan was never updated? Were you aware of that at the time?

Mr Duncan Selbie: No, it didn’t really get past my consciousness. I know you heard yesterday about NIERP. NIERP?

Counsel Inquiry: Yes.

Mr Duncan Selbie: Which was our – and that was constantly updated, and that was, if you like, our agnostic response plan which, by 2016, incorporated ConOps, which I know you talked about yesterday, and was developed every year – sorry, refreshed every year from lessons learned exercises, all sorts of events that had happened. And we had assurance processes that I think were very good and were then sent up for external assurance to the Department of Health. But the actual flu plan, no, that never – it wasn’t conscious – on my conscience, no.

Counsel Inquiry: Is it right that the all threats plan NIERP had been exercised and updated from time to time but the pandemic influenza response plan set out in 2014 had not been updated since that was first published, as set out by Dame Jenny yesterday? Do you agree?

Mr Duncan Selbie: Yes, I recognise that. My point is that the NIERP was the operational plan that we could apply in any – and did, in many sorts of different scenarios. But the 2014 flu plan, because it reflected the 2011 DH plan, there was, I think, a sense that we would wait until – and then there were various things that happened over those subsequent years, not least Brexit, that I think just kept pushing that back.

If I could turn the clock back, and I wish I could on so many fronts, then, you know, obviously we’d just say, “Well, hold on, that just needs to be” – but it would have still been a flu plan. It would have still been a plan that didn’t assume what then happened.

Counsel Inquiry: Yes. You will be aware that we established yesterday with Dame Jenny that the flu plan was out of date in several respects, not only in relation to the structures within Public Health England which had changed between 2014 and the onset of Covid, but also the wrong description of the threats committee, which itself was abolished by 2019.

Are you concerned, Mr Selbie, that there was in place during your watch an important plan that was not updated in any respect over the six years between its inception and the Covid pandemic hitting?

Mr Duncan Selbie: Yes, of course, and I’m accountable for that.

Counsel Inquiry: All right. Thank you.

I’d like to move on now to look at some minutes from an oversight meeting which took place in October of 2017.

They are at INQ000179643, please. Can we go to the entry at 17/126, which I think is at page 5.

This is the PHE Emergency Response and EPRR Oversight Group. At 17/126 we can see this, that:

“The Group discussed the plans and raised several comments regarding the co-ordination with NHS plans. It was noted that engagement with [NHS England] was critical as they would be responsible for the patient pathway. There was also an issue with private laboratory testing where PHE is not notified of results.”

Then if we can go, please, a little further down to 127 and 128:

“It was queried how the plan fitted in with the work undertaken by the HCID programme. [somebody] noted that further discussions with [someone else] and Mike Jacobs (NHS) are needed urgently to ensure this plan fits in with HCID work to ensure there is no contradiction in plans.”

And:

“The meeting agreed the plan could be published as an internal draft to staff with the caveat that the document is interim and not to be shared outside of the organisation. DT to link with GD regarding wording for the draft release of the document to ensure staff are aware of its status.”

I hope that you were able to follow that, Mr Selbie.

Mr Duncan Selbie: Yes, yes.

Counsel Inquiry: This is a discussion of a group in relation to the MERS plan, wasn’t it?

Mr Duncan Selbie: Right, that’s what I wanted just to clarify with you.

Counsel Inquiry: Okay. I want to just explore with you the fact that these notes suggest that as of October 2017 this plan wasn’t finalised because there were some outstanding queries about how the plan fitted in with work undertaken by the HCID programme.

Are you able to help us with what those concerns were, looking at these notes now?

Mr Duncan Selbie: I’m afraid not. I imagine JH is Jenny Harries, and of course Mike Jacobs was the lead clinician for the HCID centre at the Royal Free, and was very involved – we were all very involved with each other over the Ebola outbreak, and so my sense of what you are saying is that there was a natural “We need to get this together, we need to make sure that it’s co-ordinated, that people – you know, that there’s alignment”. I believe it did actually work out because we used it in 2018 for the MERS case and we used it subsequently for other – monkeypox being the one that I can most remember. But I can’t remember the detail of at that time what the concern might be. But I’m satisfied as much as I can be that they were talking to each other, which is what I would hope for.

Counsel Inquiry: Yes. Whilst it’s laudable perhaps that there is an attempt to organise joined-up thinking with the High Consequence Infectious Disease Programme –

Mr Duncan Selbie: Yes.

Counsel Inquiry: – our understanding is that in fact this plan was never finalised, it remained as an interim plan and, although you suggest that it could have been utilised during the MERS outbreak in 2018, the information that the Inquiry has is that these discussions that were expected to be undertaken did not in fact lead to the plan being finalised. Does that accord with your recollection of what might have happened?

Mr Duncan Selbie: I regret I don’t, I can’t say, and I would – what I would be doing is be asking UKHSA if they could clarify that, because I’m surprised by that.

Counsel Inquiry: Well, that’s what we will do. But I think you’ve probably answered my next question: if this plan remained as an interim plan and had not been finalised between this discussion in October of 2017 and the onset of the Covid pandemic, that would surprise you, and that would be something which you would not approve of?

Mr Duncan Selbie: I wouldn’t approve of that, but I would say that my understanding is that it worked rather well, without – you know, in the sense that we practised it in 2018 and 2019 through actual lived experience of pathogens that were handled through that pathway. So my surprise is that it wasn’t finalised, and yes, I would be – I would not be happy that it had not been finalised.

Counsel Inquiry: Thank you.

I want to turn to ask you some questions now about the HCID programme. This was a network that was established in 2015/2016, at least in part due to the need to establish – need for it to be established during Ebola – specialised facilities around the UK where patients with highly infectious or transmissible diseases could be treated.

Mr Duncan Selbie: Yes.

Counsel Inquiry: Is it correct, Mr Selbie, that in the United Kingdom a high-consequence infectious disease is defined according to the following criteria: it’s an acute infectious disease that typically has a high case fatality rate, may not have effective treatment and is often difficult to recognise or detect rapidly, has the ability to spread in the community and within healthcare settings, and requires an enhanced individual, population and system response to ensure it’s managed effectively, efficiently and safely?

Mr Duncan Selbie: Yes, I recognise that.

Counsel Inquiry: Thank you.

Is it right that both SARS and MERS have been defined as HCID?

Mr Duncan Selbie: Yes, I believe so.

Counsel Inquiry: And it may seem like an obvious question, Mr Selbie, but why do HCIDs require a different response plan compared to other infectious diseases like influenza?

Mr Duncan Selbie: I think because it is – they are by definition rare, which is one of the criteria, that they are genuinely unusual, and this was one of the great strengths of Porton Down and Colindale is we had specific facilities to be able to quickly know what it is we were dealing with. Quick was really important because, you know, if you had something that was terribly violent, you needed to get the staff properly protected and fast. So these things don’t happen that often, but when they do the thing is to contain them and to manage them; read across for that what happened with, you know, C-19.

Counsel Inquiry: All right, thank you.

In an annual remit letter from the DHSC to PHE for the year of April 2016 to March 2017, there is this entry:

“Working with government and NHS England to develop a joint programme of work and production of plans for the public health system’s response to high-consequence infectious disease incidents. Expect to be completed in 2017 to 2018 with interim outputs throughout 2016 to 2017.”

Now, that suggests a clear intention for the system to be in place by 2017/2018, but the Inquiry understands that, as of March 2017, that work had not been completed and the system had not been set up. Is that something which you have personal knowledge of?

Mr Duncan Selbie: No, I don’t, but may I just quickly say that we had what you called a quarterly accountability meeting with the Department of Health where we would review progress against all the different elements of the remit letter: those of course on track, those that were ahead and those that were not, and what we were doing about those that were not. So I expect the Department of Health will have a record of that particular matter and what the – what was the story about that at that time.

It was Public Health England that asked for an EPRR element to those quarterly accountability reviews, because it was such an important part of our work. But may I – can I decline to say? I don’t know, I can’t say, but I do know who would know, if you like, and that would be the Department of Health.

Counsel Inquiry: Thank you.

Exercise Broad Street, which took place in January of 2018, was an exercise sponsored by the HCID programme board, and in it PHE and NHS England participated and an observer from DHSC also attended. It was a discussion-based exercise conducted at PHE Colindale in London to consider the future definitive HCID service in England and the challenges that an HCID incident could present professional partners with.

Do you remember that exercise taking place, Mr Selbie?

Mr Duncan Selbie: Well, only because I’ve read about it in the evidence pack.

Counsel Inquiry: Right.

Mr Duncan Selbie: But I wasn’t personally involved at that time.

Counsel Inquiry: You will have read, then, that one of the concerns raised during the exercise was that the total turnaround time for getting a diagnosis was 24 hours, which was considered to be too long, and the aim was to try and reduce that time to below six hours, which would improve the efficiency and cost effectiveness of the service.

One of the strongly featured comments was about getting patient samples from the point of sampling to the testing laboratory, and at that time it required a courier service, which was neither optimal nor consistent across England.

One delegate, you will have read, was quoted as saying “We recognised this for years. We need a common courier system that has capacity”.

A preference was also expressed for near patient sample testing because multiple sample testing –

Mr Duncan Selbie: Yes.

Counsel Inquiry: – locations could reduce transport time, thereby reducing total diagnostic turnaround times, and it was suggested that transferring samples to PHE Porton may not be optimal due to its geographical location, and that a northern and southern hub would be a more viable option.

Mr Duncan Selbie: Yes.

Counsel Inquiry: Dame Jenny Harries told us in her witness statement that the HCID programme was closed in April of 2018. Do you remember the closing of that programme taking place?

Mr Duncan Selbie: I – not at that time, but again I’ve read the – you included in the evidence pack the minute of the meeting that, if you like, recognised that decision.

Can I say that I agree with all of that, about the need to have probably a small number but geographically sensible capability around the country so that it wasn’t all dependent on getting a sample into Wiltshire.

I do know, as you know, that we do have these laboratories in – I’ll get it wrong, but Manchester, Bristol, oh, Birmingham. Anyway, a memory test. But it’s therefore with –

Counsel Inquiry: Four centres, I think, yes.

Mr Duncan Selbie: – that capability, I’m sure. I’m sure with that. I knew about the number, about where the – in Cambridge as well.

So, and I’m very surprised it would take 24 – these days it would take 24 hours to do anything of that nature.

Counsel Inquiry: What I want to ask you about, Mr Selbie, is what happened to this particular issue, as well as other matters that were raised during the course of the programme about community sampling and diagnostic testing and guidance when the programme was shut down, who took over those issues, partly raised in this exercise and partly part of the workstream that was created during the course of the HCID programme.

Mr Duncan Selbie: So I’m afraid I can’t help with why was the programme closed. Dame Jenny Harries was what we called the SRO, which meant she was responsible for making sure that any actions that flowed from that – hadn’t been completed – was put into what we might call business as usual, being picked up through the EPRR oversight and the delivery team supporting, brought up to – and the management team as necessary.

I never had any cause for concern or raised with me at any point that there was a need for my intervention. I was con – I mean, I was supported by an exceptional, talented team. I mean, I’m not going to talk through all of them, but of course Jenny was one of them. But I had many Jennies who were professionally at the height – you know, so if – and they were all very capable of coming to me and saying if they were concerned about an outstanding action or some investment that they needed. No, to my memory, no such concern was raised.

Counsel Inquiry: Given what we’ve just seen about concerns raised over the timing of testing –

Mr Duncan Selbie: Yes.

Counsel Inquiry: – did you, during your stewardship of Public Health England, ever look into contacts with private laboratories to assist with surge testing?

Mr Duncan Selbie: No. No. We did lots of work through, as you talked yesterday with Dame Jenny, about our income that we generated commercially and, you know, providing that was within health protection, you know, it was like skills and capabilities that we had or wished to develop, then we would work with whoever wanted to work with us, and that would include the private sector, but there was never any discussion in those years about using the private sector in that way.

Counsel Inquiry: Do you think that there should have been?

Mr Duncan Selbie: No, not particularly. There was no – there was no – I mean, Public Health England didn’t regulate or accredit or in any way constrain the private sector or any academic provider of laboratory science from doing what they wished to do, provided they could meet the standards set by the Health and Safety Executive.

So of course there’s lots of private laboratory work, but it wasn’t necessary in that context at that time for public health microbiology. We had sufficient capability, sufficient capacity for the – for what was asked of us.

I mean, I love the private sector, they’ve got so much to offer, they’ve got so much to give, but in that context in that setting it wasn’t a necessary – it wasn’t necessary.

Counsel Inquiry: But looking at the PHE pandemic flu strategy of 2014 and the UK pandemic flu strategy of 2011 –

Mr Duncan Selbie: Yes.

Counsel Inquiry: – wasn’t it obvious that a huge expansion of testing would have been necessary if that had come to fruition, and that the existing capability that Public Health England had over those years was not sufficiently scalable?

Mr Duncan Selbie: No, that was not my understanding. If we had had an influenza pandemic, Public Health England was genuinely perfectly capable of doing the detection assessment, the creation of the test, and the roll-out of that. The assumption was that the go-to for clinical diagnostics was the NHS, and if you look at healthcare systems around the world, it’s the healthcare system that provides the clinical diagnostics, not the public health system. To my knowledge, there is not a public health agency that does clinical diagnostics anywhere in the world. CDC US, the China CDC, from Pakistan to Ethiopia, the clinical diagnostics is a healthcare responsibility.

So there was never any requirement – what public health microbiology does is research, surveillance and … oh, forgive me, but the initial diagnostic of the – what the pathogen is, and then making sure people know what they need to do. But it would not – it is not right that there was ever any assumption that Public Health England would require mass testing capability for the influenza strategy.

Counsel Inquiry: I want to –

Mr Duncan Selbie: Sorry, it was reference capability that I was searching for.

Counsel Inquiry: Reference capability, thank you.

Mr Duncan Selbie: Reference, surveillance and research.

Counsel Inquiry: Yes.

Moving back, please, to the system of subsidiarity, what were Public Health England’s responsibilities so far as local risk assessment and local pandemic planning were concerned?

Mr Duncan Selbie: Well, this was principally through something created – again I’ll try and be brief – the local health resilience partnerships created in 2013 which were a creature based on local resilience forums that had preceded for, you know, quite large geographical areas and they covered the same areas that the police and the fire service and others covered. But there’s lots and lots of partners in health, as you have gathered, so the local health resilience partnership was a way of, like, vocalising that at a local level, and that was jointly chaired between a local authority within the area, so a director of public health, and NHS England.

Public Health England advised, attended where possible, but essentially local risk assessment was – and the management of and response – was through the local health resilience partnerships. I’m trying to remember my acronyms. And there was a very powerful contribution from Public Health England about expertise and the sharing of sort of good practice and so on, but that was handled locally between the NHS and local government.

Counsel Inquiry: So would Public Health England provide expertise to the local resilience forums or the local authorities in terms of their own assessment locally of pandemic risks and that sort of thing?

Mr Duncan Selbie: Yes, yes, and in 2018 we produced, with the Association of Directors of Public Health, good practice guidance for – jointly for local authorities and the NHS.

Counsel Inquiry: Did Public Health England ever assess whether or not the local resilience forums or the local authorities were themselves performing acceptable risk assessments and had in place adequate and responsible plans for a pandemic hitting?

Mr Duncan Selbie: Yes, we did, and we were asked to do that by the Health Select Committee – I mentioned this earlier – and so we were, if you like, detailed by the Department of Health to undertake such an exercise. It was quite sensitive, because local government are not national government, they are government in their own right, and they’re quite protective of who comes along and audits what it is they’re doing. So it took us a short while, but we did agree an exercise with local government and with the NHS which was completed in 2016. It was anonymised for the purposes of the – what got published, but everybody got to see their own results, and then there was discussion that went on between the centre of the region of Public Health England, the local area team or whatever they were called at the time in the NHS, and with local government. That was published by the Health Select Committee, I think in 2018. There was a plan to refresh that assessment in 2020, which then never happened because of Covid.

Counsel Inquiry: And did the pandemic preparedness and planning that fell to local authorities include plans for social care?

Mr Duncan Selbie: Yes, well, local government are largely responsible for social care, and so yes. Yes. To the extent that they did, I don’t – you know … I can almost imagine what you’re going to ask me next.

Counsel Inquiry: Well, I’d like to put to you something which Matt Hancock told the Inquiry this morning, which was: when the pandemic struck, he was told that local authorities were required to have pandemic preparedness plans and, when he asked to see them, his Minister for Social Care found out that there were only two local authorities which had reported to have these plans in place, which he considered to be wholly inadequate.

I’d just like your reflection on that evidence.

Mr Duncan Selbie: Well, so would I, if that was the actual case, but I’ve just – I’ve just said, you know, in 2016 we assured that these local health resilience partnerships, all 36 of them, had plans, that they were assessed against, I think, 13 criteria – I can’t tell you if social care was one of them – but they were then, if you like, peer reviewed, externally assured and published and followed through.

But – I didn’t listen to the Secretary of State this morning, the former Secretary of State, but I would definitely concur that we – you know, social care was just not on our radar, and there’s no getting away from that.

Counsel Inquiry: To what extent did Public Health England engage with other public health agencies in the devolved nations?

Mr Duncan Selbie: Oh, regularly. We had very regular – we had networks for health protection, so I had Professor Sir Paul Cosford – who, you know, late died, a very profoundly senior and much loved director of health protection – and he would co-ordinate the colleagues in the four nations. We talked about lots of other things. I went personally to Cardiff and Edinburgh and Belfast on quite a regular basis and we – and we basically, we, you know, we cared for each other, you know, there was no – there was no – you know, we shared openly. And Public Health England was, like, you know, the mother ship for, you know, certain capabilities that you wouldn’t be able to replicate everywhere, very available to the four nations.

Counsel Inquiry: I want to turn now to ask you about public health resilience and health inequalities. You’ve already made reference to Professor Sir Michael Marmot, who, as you probably know, has given evidence to this Inquiry, together with Professor Clare Bambra, on the issue of health inequalities.

Mr Duncan Selbie: Yes.

Counsel Inquiry: The Inquiry has also received, as you know, a statement from the editor-in-chief of The Lancet, Richard Horton, who talks in his witness statement of the fact that the science that has guided government responses has come mostly from infectious disease specialists and epidemic modellers, who understandably frame the health emergency in terms of their two disciplines. But he talks about the fact that what happened with Covid was not really a pandemic but was twin epidemics clustered together, because Covid-19 itself was very challenging but, when you take that into account in terms of the state of the health of the nation, then that made it even more difficult to cope with.

Do you agree with that?

Mr Duncan Selbie: I do. He actually used the phrase “syndemic”.

Counsel Inquiry: Syndemic, yes.

Mr Duncan Selbie: And I know my academic qualifications are marginal, but I did publish in the last year with the Deputy Director-General of the WHO on this issue, on: it wasn’t a pandemic as such, it was a syndemic, for all the reasons that are set out by Michael Marmot. And I said earlier I was very taken by what Richard Horton had to say, because he’s right, you know, you have to take account of all of these if you want to truly make a difference; you can’t just say, you know, “We’ll do something about cardiovascular disease or cancer” if you’re not doing it for those that are most vulnerable, the people at most risk.

So I won’t get back on to my … but essentially I completely and utterly agree with that.

Counsel Inquiry: Thank you.

I’d like to display, please, document INQ000211268, which is a report of the inquiry panel on health equity for the north of England chaired by Margaret Whitehead. It’s entitled, “Due North: The report of the Inquiry of Health Equity for the North”, and it’s dated September of 2014.

If we could look, please, at page 6, which explains why the report was commissioned, it says this:

“Life is not grim up North, but, on average, people here get less time to enjoy it. Because of poorer health, many people in the North have shorter lifetimes and longer periods of ill health than in other parts of the country. That health inequalities exist and persist across the North of England is not news, but that does not mean that they are inevitable.

“While the focus of the Inquiry is on the North, it will be of interest to every area and the country as a whole.”

Then it talks about the fact that the inquiry was commissioned by Public Health England.

Do you remember this inquiry being commissioned?

Mr Duncan Selbie: Oh, yes, very much.

Lady Hallett: Sorry, forgive me for interrupting. Roughly how long more?

Ms Blackwell: This is my final topic. I do know that permission has been provisionally granted to Covid-19 Bereaved Families for Justice to ask about one topic.

Lady Hallett: I’m wondering if it might be sensible – I gather the stenographer is having a tough time. Not surprised.

Ms Blackwell: I’m sorry.

Lady Hallett: Given we’ve got about five or ten minutes left, a five-minute break, or longer?

So remember that question, Ms Blackwell.

Ms Blackwell: I will, I’ll keep it in my mind.

Lady Hallett: I’ll be back in five minutes.

(3.10 pm)

(A short break)

(3.15 pm)

Ms Blackwell: Thank you, my Lady.

Mr Selbie, can you see and hear me again?

Mr Duncan Selbie: Yes, I can.

Counsel Inquiry: I think there’s a slight delay between the picture that we have of you and the sound, but I’m going to carry on because I only have so few questions left now. I think it might have caught up now in any event.

Could we display page 30, please, of this report, which we hope will show us two maps of the life expectancy amongst males and females by local authority between 2009 and 2012, females on the left, males on the right, and we can see that the red areas show the lowest life expectancy on both maps, and they are pretty much mirrored one to the other.

Mr Duncan Selbie: Yes.

Counsel Inquiry: The actual findings as to the causes of health inequalities are at page 74. Can we have a look at that, please. We can see on the left-hand side that the Inquiry’s overarching assessment of the main causes of the observed problem of health inequalities within and between north and south are:

“Differences in poverty, power, and resources needed for health;

“Differences in health damaging environments, such as poorer living and working conditions and unemployment;

“Differences in the chronic disease and disability left by the historical legacy of heavy industry and its decline; [and]

“Differences in opportunity to enjoy positive health factors and protective conditions that help maintain health, such as good quality early years education; economic and food security; control over decisions that affect your life; social support and feeling part of the society in which you live.”

Now, the Inquiry recognises that some of the recommended actions in this report could only be taken forward by central government, but if we look at recommendation 4, which is at page 19, there were specific actions identified for Public Health England. Thank you. To:

“Conduct a cumulative assessment of the impact of welfare reform and cuts to local and national public services;

“[to] Support local authorities to produce a health inequalities risk mitigation strategy;

“[to] Help to establish a cross-departmental system of health impact assessment;

“[to] Support the involvement of health and well-being boards and public health teams in the governance of local enterprise partnerships and combined authorities;

“[to] Contribute to a review of current systems for the central allocation of public resources to local areas;

“[to] Support the development of a network of health and well-being boards across the North of England with a special focus on health equity;

“[and to] Collaborate on the development of a charter to protect the rights of children.”

Now, I don’t seek to ask you, Mr Selbie, to deal with each of those recommendations individually, but given that these were present in a report in 2014, are you able –

Mr Duncan Selbie: Yes.

Counsel Inquiry: – in broad terms to explain what action Public Health England took to reduce these health inequalities in the north of England after these recommendations were received?

Mr Duncan Selbie: So this is one of actually a number of reports signed(?) by Public Health England direct looking at the health of the nation, and the issue about the north is not that it possesses – it’s about intensity. There are inequalities everywhere, but the intensity is greater.

I remember very well, it does feel like a long time ago, that we had regional response, because we had a regional director for the north, who worked with Margaret and local authorities who had a lot of the influence here with the city – thinking about Andy Burnham in particular for Manchester, but there were other mayors, Liverpool, that we were speaking to about the sort of expert advice and support that Public Health England can provide.

This is ultimately an issue of resources. I – you know, we were not able to make the sort of investments happen that would make the biggest difference here. It’s a … it’s evident that, you know, these inequalities remain as tough and may be widening, if Professor Marmot is right about this.

Public Health England was not in a position to direct resources, but we were in a position to highlight and make transparent, if you like, bring visibility to this, and about, you know, the actions that might make the greatest difference.

I’m trying very hard not to rumble along, but we did produce all sorts of evidence about what would make the biggest difference for those that were in these circumstances that Margaret Whitehead describes.

Counsel Inquiry: Thank you.

I think I know the answer to this question, but do you agree with Professors Marmot and Bambra that over the course of the ten years preceding the Covid pandemic that life expectancy, and in particular healthy life expectancy, worsened for those who were living in poverty?

Mr Duncan Selbie: I think that’s a very reasonable position.

Counsel Inquiry: And so during the life of Public Health England, do you believe that it succeeded in its mission to reduce health inequalities?

Mr Duncan Selbie: Evidently not. But what we did do was draw – make it transparent, bring it into consciousness, we produced evidence, reviews, we gave advice, we tried to get government to focus on the things that would make the biggest difference. We made good progress in certain areas like TB and HIV and Hep C, we made less good progress in areas like childhood obesity, but it wasn’t for the want of Public Health England. We made advice available on all sorts of areas that this report speaks to, including air quality and gambling and pretty much everything in between.

But in my witness statement I make the point that politics and public health are inseparable, that you simply can’t get these sorts of things addressed without political commitment. Not just about money, but about the commitment to do difficult, and difficult is difficult for governments, it’s been particularly difficult for this government, and we’ve seen …

So I would say evidently inequalities have not improved and therefore we have not succeeded in our mission, but I would not accept that it wasn’t for want of trying and for drawing out the evidence about: if you did this, you could expect to see this impact.

And, finally, people publish things, they say things, they go out and they say what they care about, but these days I’m not interested in that, I’m interested in: show me your budget and then I’ll know what you care about. Don’t show me your strategy and don’t tell me that you care about health improvement and inequalities; show me a budget and then I’ll know whether you do. And I’m afraid that I would say that there has not been a sufficient interest and focus, because the spending does not reflect that.

Counsel Inquiry: Thank you, Mr Selbie.

My Lady, that completes my questioning and, subject to my Lady confirming that Covid-19 Bereaved Families for Justice do have permission to ask a question around the Chief Nursing Officers’ meeting of October 2014, then I will hand over to Ms Munroe King’s Counsel.

Lady Hallett: Ms Munroe.

Questions From Ms Munroe KC

Ms Munroe: Thank you, my Lady.

The question is in fact – that was yesterday’s question.

Lady Hallett: I was going to say –

Ms Blackwell: Oh, I’m so sorry.

Lady Hallett: – I thought I was having déjà vu, that’s why I looked over to you.

Ms Blackwell: I was wondering how it was going to be relevant. I’m so sorry.

Lady Hallett: Don’t worry, she didn’t mislead me, Ms Munroe.

Ms Munroe: Thank you.

Mr Selbie, can you hear and see me?

Mr Duncan Selbie: Yes, I can, Ms Munroe.

Ms Munroe KC: Thank you very much. I ask questions on behalf of Covid-19 Bereaved Families for Justice throughout the country.

It is in relation to a document that you have already been referred to today, the MERS plan. I wonder if we could have that on the screen, please. It’s INQ000179069. Can you see that, Mr Selbie?

Mr Duncan Selbie: I can, yes.

Ms Munroe KC: Ah, that’s actually the meeting. It’s the document itself. I’m told it’s INQ000 –

Mr Duncan Selbie: I can see the document.

Ms Munroe KC: You can see the document?

Mr Duncan Selbie: Yes, I can, yes.

Ms Munroe KC: Thank you. It’s entitled “Public Health England Response Plan for Possible, Presumptive and Confirmed [MERS] cases”, and the purpose of – it’s a guidance, and the purpose is that it’s an internal document to be used by PHE “to inform planning for potential MERS cases”.

Mr Duncan Selbie: Yes.

Ms Munroe KC: Now, this was from 2017, it’s during a period of time of your tenure with PHE. Would you agree, Mr Selbie, that that particular plan sets out in some considerable detail matters such as infection control guidance and management of both symptomatic and significantly asymptomatic MERS patients and healthcare workers?

Mr Duncan Selbie: Yes.

Ms Munroe KC: Would you also agree, Mr Selbie, that when – and again we don’t need to bring it on the screen because it’s a guidance you’re familiar with, but for reference purposes, my Lady, it’s page 14 of the guidance – it includes measures within this guidance that we all became very familiar with during the course of 2020, and they include isolation and self-isolation in the community, contact tracing, communications and restricting interactions between those affected and the wider public, such as transport restrictions, prohibitions of attendance in public spaces, et cetera; that’s all part and parcel of the guidance, isn’t it?

Mr Duncan Selbie: Yes.

Ms Munroe KC: Now, appreciating, Mr Selbie, what you have said this afternoon in answer to questions from Ms Blackwell about this MERS plan, that there needed to be clarification with UKHSA, that notwithstanding, given that Covid-19 was initially classified as an airborne HCID, would you have expected the MERS plan to have been utilised in some form for Covid-19, as it had been for MERS and monkeypox, as you’ve referenced, and are you able to say whether it was in any form utilised?

Mr Duncan Selbie: Yes and yes. So what you were describing would be regular health protection activity at a scale that we were well used to dealing with. It is my understanding that the HCID pathway was in fact utilised for the early cases of Covid, yes.

Ms Munroe: Thank you very much, Mr Selbie.

Thank you, my Lady, those are my questions.

Lady Hallett: Thank you very much, Ms Munroe.

Ms Blackwell: My Lady, that completes the evidence of Mr Selbie, and the evidence for today.

Lady Hallett: Thank you very much, Mr Selbie. I don’t want what the time difference is, but I hope we haven’t affected your day too disastrously. Thank you very much for your help.

The Witness: Thank you. Thank you.

(The witness withdrew)

Lady Hallett: 10 o’clock tomorrow?

Ms Blackwell: Thank you, my Lady.

Lady Hallett: 10 o’clock tomorrow. Thank you.

(3.31 pm)

(The hearing adjourned until 10 am on Wednesday, 28 June 2023)