3. Ms Jeane Freeman

MS JEANE TENNENT FREEMAN (called).

(Evidence via videolink)

Lady Hallett: I can see the witness.

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

The Witness: It’s Jeane Tennent Freeman .

Ms Blackwell: Thank you, and would you please take the oath or affirmation.

The Witness: Perhaps if you could speak a little louder?

Ms Blackwell: Can you hear me now clearly?

The Witness: I can, yes.

(Witness partly affirmed)

Ms Blackwell: I’m sorry, my Lady, the screen seems to have frozen.

Lady Hallett: A lot of time was spent over lunch trying to solve this, but …

Ms Blackwell: Yes. I’m just going to pause and see if our technical experts are able to solve the problem.

Lady Hallett: It’s just the last line of the affirmation to go, isn’t it?

(Pause)

Lady Hallett: I won’t leave, let’s just see how we go.

Ms Blackwell: Thank you, my Lady.

(Pause)

Lady Hallett: Do we know if she is coming from her home, an office, a government building?

Ms Blackwell: I’m unsure, my Lady, I don’t know where she is.

(Pause)

Ms Blackwell: My Lady, it doesn’t look like it’s necessarily going to be a quick fix.

Lady Hallett: I think it’s quicker if I stay here just in case.

Ms Blackwell: All right.

(Pause)

Lady Hallett: It’s not your fault, these things happen. Very well, tell me when you’re ready.

Ms Blackwell: I will.

Lady Hallett: Thank you.

(2.11 pm)

(A short break)

(2.16 pm)

Ms Blackwell: My Lady, I’m told that we are re-established and ready to go again.

Lady Hallett: Could we start the affirmation again, if you don’t mind, Ms Freeman.

The Witness: Not at all.

(Witness affirmed)

Questions From Counsel to the Inquiry

Ms Blackwell: Ms Freeman, can you hear and see me?

Ms Jeane Freeman: I can.

Counsel Inquiry: Great, thank you.

During the course of –

Ms Jeane Freeman: My apologies, I wonder if before we begin I could make two points, if I may?

Counsel Inquiry: Yes, please.

Ms Jeane Freeman: The first, as the first appearance of a Scottish Government minister to this hearing, I want to express my sincere condolences to everyone who has been affected by the Covid pandemic, both at the time and I know many still are.

I also want to thank our health and social care staff in Scotland in particular for their professionalism, their dedication, and their sheer hard work, which made such a difference to us working our way through the pandemic.

My second point, Lady Hallett, if I may, is to thank you for allowing me to give my evidence in this way on this occasion, notwithstanding our IT glitches. I very much appreciate your forbearance in that.

Lady Hallett: Not at all. Thank you.

Ms Blackwell: Thank you, Ms Freeman.

You have provided a witness statement. If we can have it on screen, please, it’s at INQ000182604. That’s the first page, and the final page is page 6. Thank you. We can see that there you have signed it on 19 April of 2023.

Can you confirm, please, Ms Freeman, that that is true to the best of your knowledge and belief?

Ms Jeane Freeman: It is.

Ms Blackwell: Thank you.

May we have permission to publish it, my Lady?

Lady Hallett: Certainly.

Ms Blackwell: Thank you, we can take that down.

If during the course of your evidence, Ms Freeman, the link becomes difficult or you can’t hear or see me, please let us know, and equally if you need a break at any time you will let us know as well.

Ms Jeane Freeman: Thank you.

Counsel Inquiry: In terms of your background relevant to this Inquiry, you were a Member of the Scottish Parliament between 2016 and 2021; you were Minister for Social Security from May 2016 to June 2018, you were Cabinet Secretary for Health and Sport from June 2018 until May 2021; and you are currently an ambassador for community engagement public health and innovation for the College of Medical, Veterinary and Life Sciences at the University of Glasgow.

Is that right?

Ms Jeane Freeman: It is correct up until the last part. My title now at the University of Glasgow is Dean of Strategic Communication and Economic Development.

Counsel Inquiry: Thank you.

In terms of your experience of health in Scotland, as we have established, you were Cabinet Secretary for Health and Sport during the time that the Covid pandemic hit, and at paragraph 8 in your witness statement you tell us that:

“… one of the key lessons to be learned is to be more fully [integrating] and [resourceful of] … public health policies and delivery, both in terms of the overall delivery of health and social care in Scotland, and in the need to effectively tackle health inequalities, and in the resilience and emergency response structures at national, regional and local levels.”

So your principal lessons from the pandemic and the run-up to the pandemic are to integrate and resource public health and social care, address inequalities, and – is this right – to improve the EPRR structures?

Ms Jeane Freeman: Yes, I think that is correct. I think the pandemic (connection lost) criticality of the public health infrastructure, and became clear to me that we needed to do more to resource that structure.

Counsel Inquiry: From the time that you became Cabinet Secretary for Health and Sport, did any of those three issues and the need to improve them occur to you, or was it only from the Covid pandemic hitting that it became apparent to you that there needed to be improvements in those three areas?

Ms Jeane Freeman: I think it would be true to say that I have long-standing concern about health inequalities, prior to being the Cabinet Secretary, in previous roles. So I was very aware of the importance of being able to effectively tackle those across Scotland, and of the many initiatives that my – the government I was part of and previous governments had undertaken. But we were still faced with an intractable problem. Of course health inequalities are directly linked to economic inequalities, so it’s not an issue solely for health to try to resolve, but there is a critical importance there of what health might do.

Counsel Inquiry: When you came into office, were you aware of the United Kingdom influenza preparedness strategy that had been implemented in 2011?

Ms Jeane Freeman: I was.

Counsel Inquiry: Although it was before your time in office, were you aware that in fact before the swine flu outbreak in 2009 Scotland had had its own pandemic influenza strategy?

Ms Jeane Freeman: Yes.

Counsel Inquiry: Do you think that there were any drawbacks in Scotland aligning itself entirely with the United Kingdom wide strategy, given that it was, as we now know, implemented in 2011 and not updated over the following nine years and before the pandemic hit?

Ms Jeane Freeman: I think that would be fair, a fair assessment, if that had been the only thing that was informing our pandemic preparedness. But of course it wasn’t. It had been a number of exercises you and your colleague have covered with previous witnesses, there was the emergence and publication of the Scottish Risk Assessment, and various updated guidance as a consequence of some of those exercises, all of which came together to update and inform pandemic preparedness, but also resilience and preparedness across a range of other issues that might affect the country and the people who live here.

Counsel Inquiry: Well, in relation to the Scottish Risk Assessment, as we’ve established at the Inquiry this morning, although the Scottish Risk Assessment dealt with the population numbers relating to Scotland itself, there was very little additional alteration to the National Risk Assessment which was prepared nationally and for national guidance and in relation to which there was no additional Scottish input other than the population figures; do you agree with that?

Ms Jeane Freeman: By national, I assume you’re meaning UK?

Counsel Inquiry: Yes.

Ms Jeane Freeman: Yes. So whether or not the UK takes account, or the United Kingdom Government takes account of the Scottish Risk Assessment, which was published in 2018, is really for them to answer. What I do know is that it was a wide risk assessment, it gave a clear indication in terms of health issues along with others of an estimate of likelihood and impact and that would inform how the Scottish Government prepared itself for any future incidents which represented a threat to the proportion.

Counsel Inquiry: In relation to the UK-wide influenza preparedness strategy, was there ever any discussion during your time in office in Scottish Government that there should be an adaptation of that in order to make it more Scottish-centric?

Ms Jeane Freeman: Not that I’m aware of. What I do know is that the various exercises that have been touched on during the hearing so far did inform the work of what became Public Health Scotland but also the health directorate, and some of the guidance that was issued to regional and local – particularly regional – resilience partnerships.

Counsel Inquiry: Well, you tell us at paragraph 17 in your witness statement that your understanding is that the lessons which came from the exercises fed into your pandemic planning and preparedness. Can you tell us how the lessons fed into your pandemic planning and preparedness, please.

Ms Jeane Freeman: Yeah, if I could give you some examples of that. So one of those areas would be the –

(Connection lost)

Ms Blackwell: Oh dear. We were doing so well.

Lady Hallett: I think I’m going to stay put this time.

Ms Blackwell: Yes.

Lady Hallett: Stay positive.

(Pause)

Ms Blackwell: I’m being told, my Lady, that they’re going through the same process that they did last time, so it may take about five minutes, but …

Lady Hallett: I’m staying.

Ms Blackwell: I’ll stay too.

(Pause)

Ms Blackwell: Ms Freeman, hello, can you see and hear me again?

Ms Jeane Freeman: I can, thank you very much.

Counsel Inquiry: Thank you.

We were discussing how the lessons learned from the exercises fed into your pandemic planning and preparedness, and I was asking you for details of how that took place.

Ms Jeane Freeman: Yeah, so if I could give you a couple of examples of that, one of which would be the NHS Scotland standards for organisational resilience published in 2016. There was guidance issued to our health boards on the back of the lessons learned from those exercises. Of course, Operation Cygnus or Exercise Cygnus was not specifically focused on the Scottish situation, but we did take their recommendations into account. And in terms of Iris, there were a number of specific actions that fed through from Iris, including the respiratory protective equipment survey which has been carried out consistently since 2015, and – I think as Ms Lamb indicated – the letter issued to health boards in 2019 asking them to ensure that their plans were updated with respect to the recommendations that had come out of the various exercises; and of course Health Protection Scotland which was a precursor to Public Health Scotland, did update its guidance on both SARS and MERS.

Counsel Inquiry: In addition to which there were several recommendations from the three exercises, Silver Swan, Cygnus and Iris, which by the time the Covid pandemic arrived had not been implemented, had they?

Ms Jeane Freeman: That’s correct.

Counsel Inquiry: So although you don’t cover this in any detail in your witness statement, I’m taking what I’m going to put to you now from the witness statement of the former First Minister, Nicola Sturgeon.

In relation to Exercise Silver Swan, still outstanding at the outbreak of Covid was an update to the pandemic guidance for the health and social care aspect of government, and she tells us in her witness statement that officials took the decision not to publish the guidance when the consultation had concluded in 2019, because that may have led to confusion in directing the Covid response.

Do you agree with that?

Ms Jeane Freeman: Yes, that’s correct.

Counsel Inquiry: Secondly, that there was a recommendation to continue the process of integrating health and social care partnerships into local pandemic planning, but that had not been successfully implemented at the time that Covid hit, had it?

Ms Jeane Freeman: It hadn’t, although they were part of local resilience partnerships.

Counsel Inquiry: Third, there was a recommendation to raise awareness of national PPE stockpiles and distribution, and that had not been successfully implemented, had it, by the time that Covid hit?

Ms Jeane Freeman: No, it hadn’t.

Counsel Inquiry: And, finally, getting more staff at NHS boards fit tested on PPE, which is an issue that Caroline Lamb helped us in relation to earlier today, and again although that was in the process of being organised, in fact that hadn’t been carried out, had it?

Ms Jeane Freeman: It hadn’t been completed, no.

Counsel Inquiry: No.

In relation to Exercise Cygnus, whilst you say that Scotland wasn’t an active participant in that exercise, nevertheless there were eight recommendations which covered the updating of pandemic guidance, operational aspects of co-ordinating a response, and also the expansion or optimisation of social care capacity, so similar themes to those that had been covered in Silver Swan.

Again, according to paragraph 21 of Ms Sturgeon’s statement, those matters had not all been implemented by the time that Covid hit. Do you agree with that?

Ms Jeane Freeman: I do.

Counsel Inquiry: May we display, please, INQ000103013, which is the report into Exercise Cygnus. This was, as we know, a tabletop exercise conducted in Scotland in March of 2018, and if we can go to page 14, please, second paragraph:

“The exercise identified 14 actions across a broad range of themes. Despite the breadth of discussion, there were no great surprises in the issues identified as priorities. In the event of a large scale crisis, Boards will appreciate strong, national co-ordination and clear guidance. Scottish Government and Health Protection Scotland should endeavour to ensure that relevant guidance is up to date and communicated effectively and that processes are in place for standing up and accessing national co-ordination structures and that these processes are widely agreed and understood. Amongst frontline staff there is unease at the lack of clarity on PPE availability, training and testing. This is a clear gap in Scotland’s preparedness for MERS CoV and other outbreaks and needs to be addressed as soon as possible.”

So this was in March of 2018. If we go over to the following page, please, we can see a series of 13 actions that were identified in Exercise Iris, and outstanding when Covid-19 struck were the following: Updating guidance on MERS CoV and incorporating various operational points in relation to care pathways and management of infected staff, NHS boards building in the potential impact of contact tracing and community sampling, and also continuing existing work to promote standard PPE requirements and the specific requirements of a high-consequence infectious disease.

Ms Freeman, can you still see and hear me?

Ms Jeane Freeman: I can still see and hear you. It dropped off for a minute, but I can see and hear you now.

Counsel Inquiry: So looking at the actions that were still outstanding from the three exercises at the time that Covid hit, and indeed at the time that you provided your witness statement in April of this year, do you still say that some of the lessons that were identified had been fed into your pandemic planning and preparedness, but would it be right to say that some of the lessons were yet to be fully actioned and completed?

Ms Jeane Freeman: Yes, I’d agree that that’s fair.

Counsel Inquiry: All right. Thank you. We can take that down, please.

I now want to look briefly, please, at three reports.

I think, my Lady, that these have already been referenced today, but I can deal with them shortly, I hope.

The first is the 2020 Audit Scotland report NHS in Scotland and it’s at INQ000148761. Thank you.

This is the one exhibit to your witness statement, Ms Freeman, and I’m going to read through some of the actions, please, that we see at page 20 to 21. Thank you.

“Not all actions from previous pandemic preparedness exercises were fully implemented”, as we’ve just established.

“The Scottish Government based its initial response to Covid-19 on the 2011 UK Influenza Pandemic Preparedness Strategy.

“41. In its consideration and assessments of risks to Scotland, the Scottish Government rated the risk of an influenza pandemic as highly likely to occur with a potentially severe impact. This aligns with the risk classification of an influenza pandemic in the UK National Risk Register of Civil Emergencies, 2017. However, the Scottish Government did not include an influenza pandemic as a standalone risk in its corporate or health and social care risk registers. This meant that there was not adequate corporate oversight of this risk, and it is therefore unclear how it was being managed and monitored.”

Ms Freeman, were you aware in the run-up to the pandemic that an influenza pandemic as a standalone risk had not been set out in the corporate or health and social care risk registers?

Ms Jeane Freeman: No, I wasn’t.

Counsel Inquiry: Do you agree that that meant that there was not adequate corporate oversight of that risk?

Ms Jeane Freeman: It may be the case that there was inadequate corporate oversight, but I do believe there was adequate health oversight of the risk.

Counsel Inquiry: “42. The Covid-19 pandemic was caused by a new virus with unknown characteristics. Initially there was insufficient evidence internationally to show how the virus behaved and was transmitted, who was at risk and what the incubation period was. The Scottish Government had no plan in place to manage this specific kind of outbreak so its response was informed by [the strategy that we’ve just referred to]. This was developed jointly by the four governments of the UK. The Scottish Government’s response was also informed by the 2017 Management of Public Health Incidents: Guidance on the Roles and Responsibilities of Incident Management Teams. The Scottish Government’s response to Covid-19 had to be adapted frequently as new information emerged.”

Then the audit report goes on to deal with the exercises that we’ve just covered, so we can skip over that, and on to the next page, please.

Here we see that the audit also covers the progress in addressing recommendations from pandemic preparedness exercises as being slow. Would you agree with that?

(Connection lost)

Lady Hallett: Frozen screen.

Ms Blackwell: Yes.

(Pause)

Ms Blackwell: I’m being asked how much longer I’ve got. I think I can wrap things up in about five minutes.

Lady Hallett: And I think I’ve given provisional permission to Ms Mitchell.

Ms Blackwell: I think so, yes.

Is it one discrete area, Ms Mitchell?

Ms Mitchell: It is one discrete area, and in fact half of what I was already going to ask has already been asked by Ms Blackwell, so I can narrow the focus.

Ms Blackwell: Thank you.

Lady Hallett: Ms Mitchell, I appreciate we all get connection problems on occasion, but is this a networking problem common to Glasgow? I gather she is at a university.

Ms Mitchell: I think I’ll probably just say no comment, my Lady.

(Pause)

Lady Hallett: Ms Freeman, can you see and hear us?

Ms Jeane Freeman: I can. Thank you.

Lady Hallett: Thank you.

Ms Jeane Freeman: I apologise again, I think it’s the internet at our end that keeps going down.

Ms Blackwell: Ms Freeman, I was asking you if you agreed with the audit that the progress in relation to the recommendations from the various exercises and the implementation of what was being advised had been slow?

Ms Jeane Freeman: I think my response to that would be that in some areas it was not slow, and in some areas there was important work done, not least the Scottish standards in terms of resilience and the risk assessment that I mentioned earlier. But it is fair to say that not all of the recommendations had been implemented or completed by the time the Covid pandemic struck.

Counsel Inquiry: There was no plan to respond to any other pathogen than influenza, was there, in Scotland?

Ms Jeane Freeman: No, there wasn’t. There was certainly an understanding of different pathogens but, as you said, the Covid-19 was a novel virus, so its exact characteristics and how it would perform and transmit was unknown internationally, and so information and clinical assessment of that was being updated regularly and frequently.

Counsel Inquiry: But there was no plan to respond to any emerging infectious disease, was there, Covid or otherwise?

Ms Jeane Freeman: But there was the plan to respond to flu, to a flu pandemic –

Counsel Inquiry: Yes, but not to any emerging infectious disease other than influenza?

Ms Jeane Freeman: Well, there had been updated actions in response to both MERS and SARS, and in terms of H1N1, but there was no specific plan for other pathogens, as you say.

Counsel Inquiry: Was the capacity and capability within social care in Scotland a fundamental problem in the run-up to Covid hitting?

Ms Jeane Freeman: So we were – we had information through our Care Inspectorate which requires residential care for adults to be registered with them, and the Care Inspectorate inspects those establishments so we had information about the scale of the residential provision, and we understood from our local authority colleagues adult social care provision to people in their own homes. So we had no reason to think that the scale of provision was inadequate and, because of the inspection regime, had a basis for believing that basic infection prevention and control measures were understood across both in-home adult social care and residential social care.

Counsel Inquiry: Was there problems with capacity and capability within the NHS services in Scotland leading up to the pandemic?

I’m thinking in particular of those issues that were identified in the Auditor General NHS in Scotland 2020 report, my Lady, to which Caroline Lamb referred during the course of her evidence.

Ms Jeane Freeman: So there were of course, as there always are, pressures on NHS capacity, and there had been clear recommendations from previous exercises about the importance of NHS staff understanding PPE requirements, which includes not only the PPE equipment to use but also the donning and doffing of PPE, and there had also been recommendations around the redeployment of staff in response to any particular health emergency. But there were capacity issues because Scotland at that point was also trying to reduce its waiting times, for example, for specific procedures, and also improve its performance in other areas of hospital-based healthcare as well as primary care.

Counsel Inquiry: I just want to take you up on two points that you’ve made there, Ms Freeman. The report from the Auditor General states that Covid-19 has exacerbated the existing financial and operational challenges in the NHS; do you agree with that?

Ms Jeane Freeman: Yes, I think that’s true, but additionally what has exacerbated the challenges is, of course – I believe it has been explained to the hearing before me – how the Scottish budget is devised and therefore decisions of the United Kingdom Government in terms of public spending have a direct impact on the Scottish budget, and the Scottish Government of course cannot borrow and cannot run in deficit.

So the impact of the United Kingdom Government decisions in about the previous ten years, where they undertook a policy of what has been described as austerity, had a direct impact on the Scottish Government budget. Notwithstanding that, the health budget and the budget for social care had increased year on year, but not necessarily increased sufficiently to meet with additional demands but also with other cost pressures around pharmacy, inflation and so on.

Counsel Inquiry: The second issue is PPE. Why, if the issue of stockpiling, providing and fit testing of PPE had been raised in three consecutive exercises, had the Scottish Government not acted upon the recommendations?

Ms Jeane Freeman: So you understand that in Scotland we have a single organisation, National Services Scotland, which operates as the procurement arm for our National Health Service, so we have a single procurement approach. So they had their own pile or stockpile or volume of PPE, and in addition they managed the Scottish share of the national stockpile. Now, I think the key question was whether or not both of those resources were widely understood within health, or within social care; and in terms of social care, up to the pandemic the provision of PPE in primary care and in social care was the responsibility of primary care organisations, be they opticians or GP practice, and in social care, whether that was local government in the provision of adult at-home social care or residential care homes, where the owners of those care homes were responsible themselves for PPE provision.

So there was sufficient PPE at the start of the pandemic, obviously there were serious challenges throughout that, and although it’s fair to say we came close on some occasions, we did not run out of PPE in Scotland.

Counsel Inquiry: In terms of the fit testing of PPE amongst NHS staff, the recommendation to ensure that that was carried out adequately was raised in 2015. We know from the witness statement of Nicola Sturgeon that, at the time that Covid hit at the end of 2019, beginning of 2020, that had not been dealt with sufficiently. Is that the fault of the government and, if it isn’t, where does the fault lie for the failure to implement that recommendation over that period of time?

Ms Jeane Freeman: So the responsibility for ensuring that those recommendations are delivered sits with government. There’s no question of that. Government and health boards and others were under severe pressures, of course, throughout that period, and it is possible that in the prioritisation of resources and effort then this did not feature high enough up in those priorities. There were staff who had been fit tested, but that was not of a sufficient number to meet the demands of Covid when it arrived.

Counsel Inquiry: Lessons hadn’t been heeded, plans hadn’t been updated, assumptions remained unchallenged, and Scotland was not as prepared as it could have been, was it, Ms Freeman, when Covid hit?

Ms Jeane Freeman: There were certainly areas where Scotland could have been better prepared, in terms of the underlying structure and the delivery of all those recommendations, but Scotland, like other countries throughout the world, was dealing with a virus which was unknown and new, so in that sense I don’t believe there is a plan that would have been possible that would have been able in and of itself to cope with Covid-19. What we had was an infrastructure, including our resilience infrastructure – which you’ve heard of – which was the architecture, if you like, that we could rest upon whilst we came to terms – often on a daily basis – with what the impact of Covid meant in terms of health and social care provision.

Ms Blackwell: My Lady, that’s all I ask. I’m going to hand over now to my learned friend Ms Mitchell.

Lady Hallett: Ms Mitchell.

Questions From Ms Mitchell KC

Ms Mitchell: I would like to ask about one issue, which is about the preparation and preparedness of Scotland in relation to PPE, and my learned friend has just touched on the matter, and you have responded:

“So there was sufficient PPE at the start of the pandemic, obviously there were serious challenges throughout that, and although it’s fair to say we came close on some occasions, we did not run out of PPE in Scotland.”

And I think that’s reflected at paragraph 14 also of your Inquiry statement.

I’d like us, please, to turn to the document for the Auditor General report, that’s INQ0001484761, and I would like us to go to page 11 of that, that’s at paragraph 14.

Do we see there that it is stated in this document, put short at paragraph 14:

“There has been a huge global demand for personal protective equipment (PPE) since the start of the pandemic.”

Then reading short, going to the last two lines:

“Therefore, the pandemic PPE stockpile was not enough to fully meet the demands of the NHS. For example …”

There are three examples which have been given which I will just pick from quickly. The first there is:

“Some NHS boards reported shortages of certain items of PPE early in the pandemic.”

That seems to be in contrast to the evidence that you’ve given to the Inquiry today.

Also:

“In a survey of Scottish members carried out in late April 2020, the … (BMA) reported that some doctors did not have access to correct and sufficient PPE. This was highlighted as the most concerning issue for 16% of respondents. Those working in higher risk areas reported shortages of a number of items of PPE, including full-face visors [that being] 29%, and long-sleeved disposable gowns [that being] 16%.”

Finally:

“The Royal College of Nursing surveyed its members in Scotland in April 2020. It found that of those respondents working in high-risk environments, 25% had not had their mask fit tested and 47% [almost half] were asked to reuse single-use equipment.”

So, in light of that, what are we to understand by your phrase “we never ran out of PPE in Scotland”?

Ms Jeane Freeman: So in my answer I need to be clear that I’m not seeking to undermine those surveys at all or what the members of those organisations (connection lost) them. But there is a difference between supply and distribution and, as I said in my previous answer, there’s a couple of important things to understand about how we entered the pandemic and what we had to do in response to the pandemic.

The first of those is that that single procurement arm, NSS, was a procurement arm primarily for NHS hospitals, and that’s how it distributed its PPE. It became very clear very early on that those other parts of health and social care which (inaudible) prior to Covid were their own suppliers of PPE through their own separate contracts, mainly because they are private businesses in many instances, albeit they’re providing a service to the NHS. But because their volumes were small, in the global demand for PPE, they were frankly losing out in that. And so we took a decision that our single procurement arm would procure and distribute PPE to all those places: to primary care, to social care, both care at home and residential care, to opticians, dentists, GP practices. That meant we had an introduce a number of new both ordering and distribution channels, which we did at pace – and my thanks to NSS and to others for enabling that to happen – but what that also meant was that distribution within hospitals also had to change.

If I could give you one example, I operated a practice throughout the pandemic whereby individuals could get in touch with me directly if they believed they had any problems, particularly on PPE, and we had a very specific PPE phone line which was staffed and instances of shortage or unavailability were addressed.

On one occasion I had a very senior clinician from a hospital in Edinburgh contact me to say that he was in the Accident & Emergency Department and they didn’t have the PPE they needed. The daily report that I received from National Services Scotland showed me the volume of each item of PPE that we had in stock, and so I couldn’t understand why he was without what he needed. Investigation that evening revealed that it was there, but it was in a particular cupboard and nobody had told him that cupboard and where it was. So we resolved it.

So I give that example as an indication of a distribution between the volume of PPE that you might hold and the efficacy of how it is distributed out to those who need it, and it was largely in the distribution that we had to constantly update how we did that and improve it, often in response to those surveys and those individual members but also to others using our dedicated PPE helpline.

Ms Mitchell KC: Can I just ask: are records taken of the phone lines?

Ms Jeane Freeman: I believe they were. Certainly what happened was that I was given information each day and one of my ministerial colleagues assisted me in picking up all the issues that were raised and then trying to resolve them and fix any problems that were arising, in real time, so that we weren’t having people trying to work in very difficult circumstances without the protective equipment that they needed.

Ms Mitchell KC: Would you, finally, accept then that not running out of PPE under your definition still meant that many frontline Scottish medical staff didn’t have correct and sufficient PPE and caused, for example, 47% of Scottish nurses being asked to reuse single-use equipment?

Ms Jeane Freeman: Well, I’m in no position to gainsay what that survey says, what I can – and I wouldn’t wish to do so. But what I can say is that where issues were raised, either through the PPE helpline or directly with me or any of my colleagues, we acted in real time to resolve those; and what I know, given that every single day I received an update from NSS on each item of equipment, how much we had, what was on order, whether there were concerns about ordering coming in, and that with another ministerial colleague we invested to set up a domestic supply chain of PPE in those circumstances of high global competition, then I know that we had enough PPE. But clearly we encountered issues around distribution both to where it was needed but also within those locations to the individuals who needed specific PPE.

Ms Mitchell: Thank you, my Lady, I’ve got no further questions.

Lady Hallett: Thank you very much indeed, Ms Mitchell.

Ms Blackwell: My Lady, that completes the evidence of Ms Freeman.

Lady Hallett: Thank you very much indeed, Ms Freeman. We got there in the end, thank you for your help.

And that I think completes the evidence for today.

Ms Blackwell: It certainly does.

The Witness: Thank you.

Lady Hallett: Thank you.

(The witness withdrew)

Lady Hallett: So tomorrow at 10 o’clock?

Ms Blackwell: 10 o’clock, please, my Lady.

Lady Hallett: Thank you.

(3.05 pm)

(The hearing adjourned until 10 am on Thursday, 29 June 2023)