Transcript of Module 1 Public Hearing on 4 July 2023
(10.00 am)
1. Dr Andrew Goodall
DR ANDREW GOODALL (continued).
Questions From Lead Counsel to the Inquiry (continued)
Mr Keith: Good morning, Dr Goodall.
Dr Andrew Goodall: Bore da, good morning.
Lead Inquiry: Could we commence, please, with the issue of the Welsh Government’s corporate risk register. What are risk registers?
Dr Andrew Goodall: So I would say that we have two different risk registers which are associated in this area. We would have a National Risk Register, which would be in the arena of our hazards and threats, our emergency planning and preparedness, and there would be a route for reviewing those.
We would – we also have our corporate risk registers in the organisation, which tend to capture a much broader range of risk areas, issues which have to be addressed by the organisation. So that can include matters of workforce, matters of delivering government policy, but the running of the organisation. So I would say there’s a difference between those two approaches, but we use both.
Lead Inquiry: The first one, the National Risk Register, the Inquiry has heard evidence, in the main from Cabinet Office witnesses, in Whitehall, concerned with the production and maintenance of a United Kingdom risk register which sets out a number of risks, I think there are over 100 now in the NSRA, the latest variant of the National Risk Register, and the Inquiry’s also heard evidence from Scottish witnesses in relation to the maintenance of a Scottish risk assessment process.
Is there an analogue for Wales in terms of the risk register?
Dr Andrew Goodall: So we use the National Risk Register, and that would be consistent with the advice that you’ve had from Cabinet Office colleagues. There are risk registers which are used at the local resilience forum level and they are part of those local and regional arrangements. There is no intermediate Wales hazards and threats risk register which draws those together. The Wales risk – Wales Resilience Forum will oversee those arrangements but we try to allow that to be focused at the local resilience fora level deliberately, with our four fora in Wales.
Lead Inquiry: There are risk assessments and risk assessment plans at the local resilience forum level?
Dr Andrew Goodall: Indeed, yes.
Lead Inquiry: In the same way that there are risk assessment plans at the local resilience forum level in England?
Dr Andrew Goodall: (Inaudible)
Lead Inquiry: There happen to be more local resilience forums in England than there are in Wales, there are only four in Wales, but that is the local risk assessment process?
Dr Andrew Goodall: Yes.
Lead Inquiry: Focusing on the national level, risks which present themselves to the United Kingdom and England are not necessarily the same risks that may present themselves to Wales, because you might have a particular form of threat or hazard in Wales, I don’t know, a particular form of flooding or a particular locality which might be flooded, and therefore a different risk to that which may develop in relation to parts of England or the United Kingdom generally?
Dr Andrew Goodall: Yes, I would agree. The broad range of risks and threats would be consistent, but of course there would be some geographical differences in the Wales context. I think because we only had – we only have four local resilience fora, we didn’t feel that we needed to really work those through, although the Wales Resilience Forum does have a programme of work that will highlight those risks that emerge. But I would agree with you that – you know, where we are now, you know, we are introducing a Wales risk register, and it’s for the very points that you say, that irrespective of health areas and preparedness, there are some more unique issues. For example, coal tip safety in Wales, and some of the, you know, natural resource issues as well.
Lead Inquiry: I can’t recall when Scotland introduced its own Scottish risk assessment process, but on the premise that it was some time ago, has the Welsh Government specifically considered the merits of a Welsh risk assessment process over the ten or so years from the inauguration of the risk assessment process in Whitehall, which I think was 2010?
Dr Andrew Goodall: I think certainly with the transfer of responsibilities in 2018, I think that was in our thinking to look to convert it, but in some respects we were not looking to, at that point, duplicate some of those UK-wide areas, because it felt that they were providing the appropriate backdrop to the hazards and threats that we were facing at that time.
In terms of our current thinking, and indeed reflecting on our own lessons and actions that we’ve adapted, that is absolutely part of our thinking now that we do need to represent it in that way, so there is a Wales risk register in respect of those hazards and threats under review at this moment by the current resilience team.
Lead Inquiry: You refer to thinking; is there any guidance or paperwork to which we may refer ourselves where this issue has been specifically considered by the Welsh Government?
Dr Andrew Goodall: No. I would have expected that, as we absorbed those responsibilities in 2018, it would have formed a pattern of work to review, not because that was being pressed at that time, but the reality was, in 2018, our resilience attention had just switched and we weren’t able really to discharge some of those early expectations from sector assurance plans, so there is no documentation as such, but I know there had been some thinking over that previous time relying on, actually, the individual risk assessments that came up from the local resilience fora, and I said that was translated in document style into the programme of work for the Wales Resilience Forum.
Lead Inquiry: Dr Goodall, I’m sorry to press you, you say there was a pattern of work and thinking was done in a document style; was a document drawn up in which the issue of –
Dr Andrew Goodall: No.
Lead Inquiry: – a Welsh risk assessment was debated?
Dr Andrew Goodall: No, I’m just reflecting that there was no document at that time.
Lead Inquiry: Right. In hindsight, and it must surely follow because the Welsh Government’s position now is that there is a need for a Welsh-centric risk assessment process, that that was an error? It should really have been done at the time that the Transfer of Functions Order was made in 2018, so that there would be a risk assessment structure to which these new executive functions from Whitehall could be attached?
Dr Andrew Goodall: Yes, it helps the clarity of the functions and responsibilities that moved across, and that helps to clarify a change from support and de facto leadership arrangements into the co-ordination role. So, yes, I would agree. And as I’ve said, you know, our current thinking and experience and activities that are taking place are actually looking to produce an intermediate Wales risk register that reflects our own priorities in Wales.
Lead Inquiry: You’ve now used, if I may respectfully suggest, another euphemism: you’re “looking to produce”. Has the process started of –
Dr Andrew Goodall: Yes.
Lead Inquiry: – writing a risk assessment process for Wales?
Dr Andrew Goodall: Yeah, the resilience team is reviewing and has instigated arrangements to look at a Wales risk register.
Lead Inquiry: Has the decision been made to produce a Welsh risk assessment process and register?
Dr Andrew Goodall: Those arrangements haven’t been endorsed by ministers, but the resilience team have actually been producing a Wales risk register as one of our lessons learnt.
Lead Inquiry: Has that team made a decision on a piece of paper saying “The time has come to seek ministerial approval for the creation of a risk assessment process for Wales”?
Dr Andrew Goodall: The team has not done that, in line with your wording, so no.
Lead Inquiry: So that’s the first part, the National Risk Assessment process. The second part to which you made reference is the corporate risk register.
Dr Andrew Goodall: Indeed.
Lead Inquiry: Is that process in existence because the government, the Welsh Government, like commercial entities and other government bodies, is required to assess what risks may face that particular entity, the Welsh Government, and obliged to identify the steps that are required to mitigate the risk to ensure that the consequences that would normally flow from that risk developing can be addressed?
Dr Andrew Goodall: Yes, in respect of Welsh Government as an organisation, and in respect of capturing the risks and issues that the organisation is facing itself, yes.
Lead Inquiry: Could we have, please, INQ000128968.
Is this the corporate risk register for the Welsh Government in July 2014?
Dr Andrew Goodall: Yes, it is.
Lead Inquiry: If we could go to page 5 and row P5, thank you – so page 6 actually.
P5 says “Resilience (Major Emergencies):
“If we fail to provide leadership to ensure Wales is prepared for and resilient to the full range of national hazards and threats, including pandemic influenza, terrorism, major flooding, severe weather and currently the impact of the fire fighters’ industrial action, then there is a risk to the health and well-being of the citizens of Wales.”
Then if we could go back up to page 6 and the bottom half, the document sets out, does it not, mitigating steps, so things that need to be done in order to make sure that that risk doesn’t develop into reality? And the controls are: comprehensive governance structure; links with responder agencies, liaison; investment in facilities and communications; emergency contact arrangements; the existence of a pan-Wales response plan; ministerial agreement to strategies, in particular the 2011 document; and Welsh Government-led pandemic influenza group meetings.
So all, I suppose, the various moving parts of the Welsh Government and what it’s doing in relation to meeting the risk of pandemic influenza.
Can you tell from this document, Dr Goodall, what the overall view was of the state of those mitigating actions? So does the document tell you whether or not the Welsh Government believes that it has adequately addressed the risk by virtue of its mitigating actions? Is there a reasonableness or a critical review of the overall state of play in this document?
Dr Andrew Goodall: It sets out the initial assessment of the risk, which is the score of 20, that scale runs up to a maximum of 25, and it provides the score on the right-hand side after those actions have been deployed, which, allowing for the actions that are set out under the control section, gives that a residual score of 12. So whilst they don’t read across individually and directly to that number, they would be capturing a rounder view that there was a sense of assurance about the actions that were taking place at that stage, and this would have been in the run-up to some of the Exercise Cygnus-type arrangements at that time.
Lead Inquiry: Can you tell from the colour-coding on the right-hand side the degree of reasonableness of the actions that were being taken? So is this a category red, “Major risk, impossible to mitigate”, or an orange risk, which is, “That’s all right, we’ve identified reasonable mitigating steps and we think the risk has now reduced”, or is there some sort of other categorisation?
Dr Andrew Goodall: No, it would be your latter description, which would be indicating that there was a view that those mitigating steps would have reduced the overall risk assessment score.
Lead Inquiry: To what sort of level?
Dr Andrew Goodall: To –
Lead Inquiry: And –
Dr Andrew Goodall: – an amber level.
Lead Inquiry: What does amber mean?
Dr Andrew Goodall: Amber means that – need to keep it under observation, under consideration, it’s not at the highest level of escalation for actions.
Lead Inquiry: All right.
Can we now move forward, please, to the analogous entry for June 2019, just before the pandemic.
INQ000215558, please. If we could scroll in so that we may read it a little more clearly.
For quarter 1, 2019 to 2020, the risk is identified as a:
“Disruption Event, Affecting People, Places, Finances, Communications and IT.
“If there is a significant disruption event (whether an ‘act of god’ or planned attack/event) the Welsh Government may struggle to recover its operations quickly and effectively so that continuity of business critical activities is lost.”
The mitigating measures are now identified as: the existence of a “Business Continuity Plan”; in very broad terms, the disaster recovery plans are in place; the assertion that “Lessons are learned from disruption events”; and the claim that “Emergency response protocols are in place and are practised through desk top and live exercises”.
So a number of questions, please, Dr Goodall.
Firstly, why has the identification of the risk become so much more broad and opaque by 2019? There is no specific consideration of pandemic influenza being a risk and therefore no specific consideration of what mitigating measures might be necessary to meet that risk; why was that?
Dr Andrew Goodall: Yeah. So there was a change in the development of the corporate risk register, from the earlier version that you’ve showed as part of the evidence, through to, I think it was 2017, 2016/2017, when the risk register had been reviewed and set out more in the context of the specific issues that were relevant to the running and operation of the organisation, and this disruption event description was translated, therefore, into: could the organisation reassure that it was able to instigate its own arrangements, so its own internal business continuity plans, that it was able to have disaster recovery arrangements for IT, and became more internally focused in respect of a smaller range of risks that were set out in the risk register at the time.
From my personal experience, because I was the Director General for Health and Social Services, we had actually included pandemic flu and other health emergencies preparedness within the context of our group-based risk register, and I think rightly, whilst of course that would touch on some of those internal areas, because of our oversight of the system, we actually did need to make sure that we were covering off those pandemic flu risks in that arena, and they were consistently described in there. But there was a shift in the corporate oversight and the way in which the risk register was put together. So this is: can we set up the emergency co-ordinating centre? Do we have a rota in place? Do we have our own resilience plans internally? And looking at it for the internal operation of the organisation.
Lady Hallett: I’m sorry, Dr Goodall, I don’t follow. Wouldn’t a corporate risk register always focus on the operation and running of the business with specific issues relating to it? I’m not following what you mean by it changed, other than it obviously did change.
Dr Andrew Goodall: It changed to look at the way in which the civil service itself would step up in the emergency context, and also recognising that emergency planning and response over time had been limited to individual and almost rare events. We’d seen a pattern of requiring our contingencies arrangements to kick in much more often and using our internal co-ordinating arrangements. So there was a decision that was taken corporately reflecting on risk register arrangements and that decision was manoeuvred through. It was a much smaller list of corporate risks that were held at that level.
Mr Keith: Dr Goodall, can I ask you, as you answer, please, just to slow down a little.
Dr Andrew Goodall: Of course.
Lead Inquiry: You’re going very fast for the stenographer.
Dr Andrew Goodall: Of course.
Lead Inquiry: Dr Goodall, this is a risk register for the entirety of the Welsh Government, is it not? It is the Welsh Government corporate risk register?
Dr Andrew Goodall: Yes, it’s the Welsh Government risk register for the operation of the civil service of the organisation, yes.
Lead Inquiry: Yes. Risk registers are meant to identify risks facing the particular body to which the risk register relates, namely the Welsh Government and its administration and governance. Influenza pandemic was generally regarded as the greatest risk facing the nations of the United Kingdom; it was a Tier 1 risk in the United Kingdom risk register. So why, if that is – if it is or was the greatest risk facing, generically, the Welsh Government, was the consideration of that risk, the detail of that risk, the proposed mitigation of the risk, the actions required to meet that risk, downgraded by virtue of being put into the Health and Social Services Group risk register – which is not the Welsh Government, it is one part of the Welsh Government, it is the health and social services part of the Welsh Government – and necessarily then taken out of the generic corporate risk register?
Dr Andrew Goodall: Simply, at the time the risk register was developed to be more generalised about the response, because of the pattern of experiences of other events happening and the need to step up the Wales resilience arrangements. So that was the decision that was taken at the time in development.
Lead Inquiry: Do you accept, Dr Goodall, that the inevitable consequence of that decision was that whilst the civil servants and ministers in the Health and Social Services Group part of the Welsh Government would have been thereafter focusing on the risk of pandemic influenza, because it was then in their risk register, nobody outside that group would have been required to focus for the purposes of the risk register on pandemic flu on the part of the Welsh Government, because it was no longer in the risk register?
Dr Andrew Goodall: I don’t feel that represents the position, because there was a lot of preparedness activity taking on. I know that Cabinet received updates in 2018 and in fact had instigated sector resilience plans from all of the sectors in Wales, which were explicitly on pandemic flu, and that would have reflected the seriousness and the high level of risk associated with it.
But there is a danger in looking at the risk register that whilst it covers a series of individual areas that you would lose some of that expectation within the organisation if you weren’t able to report up those concerns from the health group, I agree.
Lead Inquiry: You make, if I may respectfully suggest, a good point, which is that of course work and preparation continues by-the-by, but would you agree that if you take out of a formal quasi-legal document which is designed to ensure that the leaders of the Welsh Government focus on the greatest risks which face the government as a whole and the people of Wales, there will inevitably be a tendency to take your eye off the ball, because nobody is saying, “Right, what must we do? Our own risk register says this is the greatest threat or hazard that we face, we must focus specifically on what we’re doing to meet it”?
Dr Andrew Goodall: I’m concerned that it is possible that organisations would shift their attention. I would hope that the manner in which we continue to focus on the hazards and threats and that risk profile in terms of the oversight of the Wales Resilience Forum would have kept that attention, and certainly we continued with our preparedness activities through that period of time.
Of course I had the opportunity to raise any additional concerns from the Health and Social Services Group perspective because we were overseeing those arrangements within the detail of those plans as well where pandemic flu did feature.
Lead Inquiry: Mr Vaughan Gething, who was, firstly, Deputy Minister for Health and then subsequently, until 13 May 2021, Cabinet Secretary for Health, Well-being and Sport, has provided a statement to the Inquiry in which he says this:
“… preparedness was not a particular focus of interest or concern in government, the Senedd or outside, and I do not remember any significant questioning on the topic either in government, the Senedd, in the media or elsewhere.”
Elsewhere in his statement he says:
“… preparedness had not featured prominently before in my work, that changed when I had a part in Exercise Cygnus.”
That would tend to suggest, Dr Goodall, that at a high general level, whilst individual parts of the Welsh Government were getting on with doing what they felt they needed to do for preparing the Welsh people for the Tier 1 risk of a pandemic influenza, there was an absence of particular focus by the government on preparedness; would you agree?
Dr Andrew Goodall: I know the minister was very personally involved in Exercise Cygnus, but we would have taken some confidence and at that point the moderated scores, but I note the minister’s statement and we would have raised those issues with the minister if we had had significant concern about our response and preparedness at that time. But I know that he obviously had reflected, given his involvement in Exercise Cygnus, about its significance.
Lead Inquiry: Had the risk rating for disruption events, including pandemic influenza, gone up between 2014, the first chart we looked at, and 2019 to 2020?
Dr Andrew Goodall: The –
Lead Inquiry: The overall risk rating and whether or not the risk had been mitigated.
Dr Andrew Goodall: The overall risk score stayed at the same very high level.
Lead Inquiry: What about the risk score after the mitigating events are taken into account?
Dr Andrew Goodall: The mitigation score had dropped from 12 to 8 and, as I said, we had used that more in terms of the internal triggers for business continuity, so there was a different assessment, but the score had gone down from 12 to 8.
Lead Inquiry: What does that mean, that the score had gone down from 12 to 8?
Dr Andrew Goodall: It means that, in respect of the mitigations and that more general view, there was a view that those areas would give a degree of confidence about the responsiveness of the organisation and the triggers that we’d utilise internally in the organisation.
Lead Inquiry: May we be clear, please, Dr Goodall. The reduction from 12 to 8 signified an appreciation or acknowledgement by the Welsh Government that the mitigating features, the measures it had identified to meet that risk, were no longer as effective as they had been in 2014; their impact had been diluted. Is that not right?
Dr Andrew Goodall: The score here would mean that there would have been more confidence that the arrangements were working. That would have come back on experience of instigating some of these arrangements, like disaster recovery, over that previous time. So it’s a lower residual score, it was at that time showing a high level of assurance.
Lady Hallett: The risk has gone down from 8 out of 25. The state of preparedness has got better according to this risk register.
Dr Andrew Goodall: Indeed, yes, it had dropped from 12 to 8, yes.
Mr Keith: Was that in part because further actions were identified as having been – or actions were identified as having been put into place, a business continuity plan, generically disaster recovery arrangements were in place, lessons were being learned, and response protocols were in place? Is that why the overall risk had gone down, because those things were being done?
Dr Andrew Goodall: Yes, it was, and also, as I say, because of that broader use of it as being the internal trigger rather than a cross-Wales trigger.
Lead Inquiry: But the reality was different, was it not, because, as you agreed yesterday, the major civil contingencies planning documents, the communicable disease plan, the 2011 strategy, the Health and Social Services Group pandemic influenza response plan, none of them had been updated since 2014, the Transfer of Functions Order in 2018 had taken place, but the Welsh Government did not have the full resources, the capacity or the structural system to be able to accommodate those changes of executive function, not all the recommendations from Exercise Cygnus or Taliesin had been implemented, and the workstreams that did take place throughout 2018 and 2019 were significantly interrupted by Operation Yellowhammer?
So how can those control or mitigation measures have been properly advanced as a reason for mitigating the overall risk?
Dr Andrew Goodall: Yes, in hindsight on those scores, with the experience we went through, that residual score, despite those broader areas, should have been higher, but it wasn’t at the time.
Lead Inquiry: But, Dr Goodall, somebody compiling or somebody in the Welsh Government would have known when this risk register was being compiled that those mitigation measures were to a large extent chimera, they simply didn’t reflect the reality of the position on the ground, did they?
Dr Andrew Goodall: I think they were genuinely reflections at the time about the way in which we had worked through various internal arrangements, including business continuity. We’d had experiences around disaster recovery and it would have been demonstrating some assurance from the teams at that time, but I obviously can’t change the score that is there at that time.
Lead Inquiry: Do you agree that those mitigation measures were not accurately described in that risk register? At quarter 1 of 2019, those mitigating measures did not reflect the reality of the absence of work within the Welsh Government in terms of the updating of the planning, the guidance, the resourcing, the response to the exercises, or the capacity to meet the Transfer of Functions Order?
Dr Andrew Goodall: I think personally, in hindsight, that should have been a higher residual score, yes.
Lead Inquiry: Yes. Therefore those mitigating measures identified there are inaccurate, they were simply not an adequate reflection of the reality?
Dr Andrew Goodall: They are generalised statements, but they would have been –
Lead Inquiry: They are –
Dr Andrew Goodall: – business continuity arrangements that were referred to as part of that as well, but, as I said, the residual score in hindsight should have been higher at that time, I agree with you.
Lead Inquiry: Dr Goodall, they are either inaccurate or they are too general.
Dr Andrew Goodall: Yeah.
Lead Inquiry: Which is it?
Dr Andrew Goodall: I think they were too generalised, and that probably gave some inappropriate assurance on arrangements in there. Within the Health and Social Services Group plan, we were able to highlight some of the higher level of actions that were taking place on behalf of the sector, and I hope that that would have mitigated some of that in terms of the way we worked our way through those.
Lead Inquiry: Briefly turning to some of those plans and the guidance, do you agree that the 2011 strategy, the UK pandemic influenza strategy, was not updated before the pandemic struck, insofar as Wales was concerned, and that, as it happened, doctrinally, strategically, it contained, as the evidence now very plainly establishes, a number of flaws; would you agree with that proposition?
Dr Andrew Goodall: I agree it wasn’t updated, and I do agree, given the emergence of novel coronavirus pandemic, that there were a number of assumptions in there that directed us to not plan for a range of areas, and that might have included mass gatherings, non-pharmaceutical interventions. We would have been reliant more in a pandemic flu response for a series of opportunities to treat, to vaccinate, to use antivirals, almost as an initial response, and we simply didn’t have that within the coronavirus response. But I do agree that there were a range of areas in there which were not looking to contain mechanisms, and therefore more focus on those non-pharmaceutical interventions would have genuinely helped in the response.
Lead Inquiry: Were all the pan-Wales or Wales-centric health emergency pandemic influenza-related guidance documents all similarly tainted by that strategic error? So presumably the 2011 strategy, which was a UK document, was looked at by the Welsh Government, which would then rely upon it for the purposes of drawing up its communicable disease guidance, its Health and Social Services Group pandemic guidance, its civil contingencies guidance, its pan-Wales response plan, and so on, but they were all drawn, weren’t they, strategically from that original single United Kingdom document?
Dr Andrew Goodall: Yes, the UK document directed and was the framework that we all worked within. It set out the strategy, and that would have translated through. It would have been different with some of the arrangements like the outbreak plan for Wales, because, given the particular focus there, there would have been a focus on containment rather than the pandemic flu principle, which was an expectation that it would get to a level of community transmission.
Lead Inquiry: Therefore, because the 2011 strategy failed to recognise through the inherent unpredictability of respiratory viruses that there may be a non-influenza catastrophic outbreak with different incubation periods, different transmission levels, different viral load impact, none of those issues or the associated countermeasures that might have been drawn up to deal with those problems were addressed in any – as with Scotland – pan-Wales documentation?
Dr Andrew Goodall: Yeah, there was a strong focus on beyond the detection and assessment stage to be able to use, in a pandemic flu context, treatments and antivirals and to deploy those, and that was unavailable to us with the coronavirus pandemic.
On the updating of documents that you raised, we did update the pan-Wales response plan in 2019, we updated the health group response activation in 2019 as well, but it would be right to say that even if we had updated the plan back in 2018, I don’t feel that those underlying principles would have necessarily changed at that point. Of course, even if we had updated them in Wales, we would have updated them again because of a UK set of changes.
Lead Inquiry: Whatever the variants, whatever the updates, they were still harnessed to that strategic yoke from the original document?
Dr Andrew Goodall: Indeed.
Lead Inquiry: The inevitable consequence of all that was, wasn’t it, that in the early weeks of Covid – and I refer now to a statement from Mr Kilpatrick – it became absolutely apparent that the model which had to be drawn up from scratch in the early days of February and March 2020 simply didn’t align with the Public Health Wales Communicable Disease Outbreak Plan, which of course was the sole plan that Wales was relying upon for dealing with a communicable disease outbreak? It just didn’t help them at all.
Dr Andrew Goodall: Yeah, the outbreak plan would have tended to have been focused on outbreaks in a more local setting and would tend to be discharged within the local resilience fora setting, and obviously the translation to a national level would have been something different.
Certainly in, you know, reviewing the infectious diseases emergencies plan for Wales, that also was not really focusing on the broader sort of societal issues that were under review by the UK pandemic flu plan, and that, equally, would have needed us to step in differently at that kind of national level.
I mean, my view is that we were using the plans as the basis of our response, that it gave us foundations, and certainly that would be true of the pan-Wales response plan, but we had to adapt very quickly to the emerging situation and with the knowledge that was coming through very, very quickly at that time.
Lead Inquiry: All right.
Now, may we then turn, please, to plans – away from plans to exercises.
The two major exercises with which we need to be concerned are Exercise Taliesin and Exercise Cygnus, are we not?
Exercise Taliesin was in 2009. Was that a Welsh Government or a United Kingdom exercise?
Dr Andrew Goodall: That was actually a United Kingdom exercise. We discharged it very significantly, though, in Wales. I actually remember being part of that exercise at the time, because I was two years into being a chief executive.
Lead Inquiry: Was that an exercise which took place contemporaneously with the swine flu outbreak and therefore was able to pick up some of the lessons that were learnt necessarily from the outbreak itself?
Dr Andrew Goodall: Yeah, it almost immediately went into the early part of the swine flu outbreak, as the exercise was taking place, literally within 24, 48 hours.
Lead Inquiry: Could you describe for us, please, the width of that exercise, how significant it was in the general pantheon of exercises? Because it was in two parts, I think. The first part addressed the technical and procedural aspects of communications between local resilience forums, the four resilience forums in Wales, and the strategic co-ordinating centres, which deal with the response, as opposed to planning; and the second part of the exercise appears to have been – and it took place on a single day – with examining the strategic decision-making of the strategic co-ordinating groups. So it appears in general terms to have been addressing the mechanics and the working practices of that lower level in the civil contingencies structure, the local level. Is that a fair summary?
Dr Andrew Goodall: Yes, at the time I was a local health board chief executive and would have had involvement in those arrangements and through, you know, my organisation at the time. But, yes, it was looking to test the resilience of those local agency relationships and absolutely in the context of the local resilience fora structures as well. Of course that was up through the co-ordination mechanisms up at the Welsh level as well.
Lead Inquiry: So the exercise didn’t address directly the workings, in fact, of the central Welsh Government, so the workings of the Cabinet of the First Minister or the directorates, including Health and Social Services, or that part of the government, but of course they were the bodies that would receive whatever information was coming from the local resilience forums and the strategic co-ordinating groups?
Dr Andrew Goodall: Well, I would say “and”. I think they were absolutely focused on ensuring that those local resilience arrangements worked and responder organisations were part of it, but in the context of working in Wales, the structures would have come together at the national level as well, and there would have been involvement at that time from the Health and Social Services Group, its equivalent.
Lead Inquiry: Could we have, please, INQ000128976, which is the report from that exercise. Exercise Taliesin/swine flu structured debriefing report, it took place in the Emergency Coordination Centre on 18 November 2009, although there was an earlier day, as I suggested, I think, in April where –
Dr Andrew Goodall: There was.
Lead Inquiry: – there was an exercise from 8 till 8 in the evening for the strategic co-ordination groups and local resilience forums. It was prepared for the Wales Resilience Partnership Team, and if we could go, please, to page 13, I think we’ll find the recommendations or conclusions. If we could scroll back out, please, at the bottom of the page:
“The following conclusions are based on the issues raised at the workshop for swine flu and Exercise Taliesin …
“In spite of pandemic flu being known as the highest risk and with considerable investment being made in recent years to ensure that the UK is prepared to cope with such an event, a number of gaps were exposed in plans which need to be addressed ahead of a more serious pandemic. These issues in particular are …”
Then if we could – could we scroll back out so that we can get our steps in relation to – our bearings in relation to the particular areas: excess deaths, social care, schools and early years settings, and – over the page – information gathering, cultural approach based on the worst-case scenario, and overall the response to swine flu did not fully test the plans in place.
So there were some quite serious issues arising out of Exercise Taliesin on the areas which I’ve identified.
To what extent were those areas still the focus of concern at the time of Exercise Cygnus held in Wales for Wales alone in 2014, four years later? So were all these issues addressed or did they continue to pose concern by the time of Cygnus?
Dr Andrew Goodall: Yeah, whilst actions had taken place on those areas, looking at the list – I haven’t got the whole list in front of me at this stage, but there were still concerns expressed about clarity of school closure proposals, as I’ve already indicated that is something that would also go back to some of the founding principles of the 2011 pandemic flu strategy. The social care responsiveness and capacity in there, albeit that there would have been actions aside from emergency planning that we would have undertaken to have an understanding of capacity in social care. It’s not line managed like the NHS, so it’s a different flow of information. And on the excess deaths, whilst I know that there was work that took place at that time, it still seemed that with Exercise Cygnus we still needed to provide clarity, and a lot of that was around the changing assumptions or the challenge to some of the assumptions about potential deaths as well. So I think that was always a point of modelling that seemed to be asking for more assurance in the system as well, and that was repeated for Exercise Cygnus.
Lead Inquiry: If we look at the Cygnus recommendations, they are in INQ000107136.
This is the recommendation document that came, as I’ve suggested, from that first part of Exercise Cygnus; when the United Kingdom adjourned or delayed its own Exercise Cygnus, Wales went ahead with its part of Cygnus in 2014. We can see that the first paragraph refers to the fact that a Tier 1 UK exercise was meant to be held in October 2014 with three phases. There were initially 11 scheduled – local resilience fora scheduled to participate in England, but they didn’t, of course, because that was put off, while Wales had all four of its local resilience forums agreeing to take part.
If we could scroll back out, please.
Strategic objectives were identified and then “Exercise Play”, the workshop, is identified, and then right at the bottom of the page we can see that the main cross-government element scheduled for the week commencing 13 November was postponed.
Could we then go to page 2, please.
“Exercise Outcomes”, a number of issues were raised dealing with excess deaths, so that was still an issue by the time of Exercise Cygnus, as you’ve just rightly acknowledged.
“Communication – information demands and situation reporting needs to be centralised to reduce duplication … There needs to be consistency of messaging across the board …”
Does that mean communication in the sense of media and dealing with the public, or communication between the moving parts in the civil contingencies structure?
Dr Andrew Goodall: Your latter point, the moving parts of the structures.
Lead Inquiry: That’s an important issue, is it not?
Dr Andrew Goodall: It’s an important issue.
Lead Inquiry: If they don’t communicate, then the system isn’t likely to perform very well in terms of responding to whatever emergencies present themselves?
Dr Andrew Goodall: Indeed that’s true, and whilst different arrangements require different data flows, yeah, the importance of having enough data but also making sure that there is enough time to be acting on the back of that evidence and data as well.
Lead Inquiry: Regulation we needn’t be overly concerned with.
“Resources – There needs to be a national stockpile of resources made available.”
School closures, still an issue. Demands for data collection, still an issue. National pandemic flu service, one SCG, strategic co-ordinating group, expressed concern.
Then over the page, the recommendations – sorry, at the top of the page:
“Vulnerable People – Concerns were expressed over the capacity and readiness of privately owned care homes to have robust contingency plans.”
Then recommendations were made.
So is this the position, Dr Goodall: a number of features which had come out of the earlier exercise had still not been addressed by the time of Exercise Cygnus, and some of them were of considerable importance and went to the centrality of the civil contingencies health response as a whole? These were significant matters.
Dr Andrew Goodall: Yes, some of those would have continued, and I would say that there were activities taking place to understand and address those areas, but they continued to feature. You know, I know, for example, that we were able to take assurance back from local resilience fora on their views of being able to manage excess deaths on modelling numbers, which took place back in, I think, 2018. But I still don’t feel that the work was fully completed even by that point on the back of the Cygnus recommendations.
Certainly on care home understanding of capacity, having clarity on the local government responsibilities and their local business continuity plans for homes was important, and to seek that assurance, but at the national level – and this for me was beyond just the emergency planning response, we did need to have more understanding of simple issues like the numbers of beds available across Wales. So in my Director General role we did commission an exercise to understand that capacity, just to try and have a similar understanding to the way in which we would use some of our NHS data as well, but it was still not to full resolution, I agree.
Lead Inquiry: The issue of the capacity of the adult care sector to cope with the demands of a pandemic was perhaps the most significant failing identified at the time of Exercise Cygnus in 2014, was it not?
Dr Andrew Goodall: Yes, I would agree that that was still an area of concern.
Lead Inquiry: It was the most significant area of concern because it directly went to matters of life and death in the care home sector; would you agree?
Dr Andrew Goodall: Indeed, and it was a serious issue for local authorities and their discharge of their responsibilities, and it was important to keep that focus up. As I said, it’s why we wanted to have a broader understanding of those numbers.
Lead Inquiry: In 2016 the delayed United Kingdom exercise took place, and it was an exercise which Wales participated in because the original Exercise Cygnus in 2014 had only been fairly limited, hadn’t it, and therefore it was obviously desirable that the Welsh Government took part in the adjourned exercise in 2016?
Dr Andrew Goodall: Yes, I agree.
Lead Inquiry: The recommendations from that, insofar as Wales was concerned, were contained in a document, a Wales debrief report, at INQ000128979.
October 2016. Exercise Cygnus had taken place earlier in October 2016, so this is obviously the debrief report.
If we could go, please, just scroll through the first – well, let’s have a look at the first page.
We can see there that the references to the nature of Exercise Cygnus:
“… a Tier 1 UK pandemic flu exercise with full ministerial participation. In Wales, the Exercise began on the 14th … continued on [the] 18th …”
It involved, again, multi-agency groups from all four local resilience forums.
There was a – the main exercise was on the 19th and 20th, with the CMO leading COBR officials at a meeting, leading officials at a COBR meeting, and the Cabinet Secretary for Health, Well-being and Sport, that would be Mr Vaughan Gething, and the Minister for Social Services and Public Health participating.
There is then a reference to the NHS workshop on the 14th, and how the local resilience forum pandemic planning checklist and various injects were considered for the purposes of the exercise.
If we could go forward to the next page, there is a reference to countermeasures awareness workshop. Then if you would bear with me one moment, Dr Goodall.
(Pause)
Lead Inquiry: We’ll go straight to the recommendations page. While we wait for that to come up, is it right that the overall position was that there were – there we are, thank you very much indeed, very sharp attention by our brilliant technician.
Page 4:
“Recommendations
“… 1 – All organisations were asked to review their pandemic plans …
“Recommendation 2 – All organisations to ensure there is sufficient awareness … of what is … within the Welsh National Stockpile.
“Recommendation 3 – All organisations to review their local delivery points and antiviral collection points …”
If we could just scroll further forward one page, we will see if there were any more recommendations, and there weren’t.
So insofar as Wales was concerned, only a small number of the recommendations from the overarching exercise were relevant?
Dr Andrew Goodall: There were more recommendations than that, I think, if you scroll –
Lead Inquiry: Ah, is that because the recommendations were split up –
Dr Andrew Goodall: In sections.
Lead Inquiry: By reference to particular parts of the exercise.
Dr Andrew Goodall: Particular parts.
Lead Inquiry: All right, yes, there we are, page 7. We have recommendations 4 and 5.
I believe there were 12 in all?
Dr Andrew Goodall: There were 12 within the Welsh context. There were 22 obviously when the overall Exercise Cygnus recommendations came through, and I would say that they also remained relevant to us, of course.
Lead Inquiry: Of the 12 recommendations of the overall 22 recommendations, the 12 that were relevant to Wales, how many of those recommendations concerned issues which had still not been addressed from the earlier Taliesin exercise and the earlier Cygnus exercise?
Dr Andrew Goodall: Because of our particular use of this exercise, we hadn’t quite gone into all of those arrangements in that way, but certainly the broader Exercise Cygnus recommendations and the 22, they would have continued to show some consistent concerns that even if plans or activities were taking place they still hadn’t come to the best outcome that would give resilience in those arrangements as well. So we took the Wales recommendations and drew them into the Exercise Cygnus recommendations just for ease of access.
Lead Inquiry: The reality was, wasn’t it, that the concerns about the adult social care sector had not gone away two years later, the communication issue had not gone away, but, in addition, by the time of the Exercise Cygnus report in 2016 there was then additional concerns being expressed about countermeasures, the stockpiling; is that correct?
Dr Andrew Goodall: There was a wish to understand the level of provision that had been made to have assurance on those countermeasure arrangements, but, as part of the Welsh response at the time, we had particularly wanted to test and exercise that, so it didn’t mean that we didn’t have stocks or countermeasures in place, it was just making sure that they were going to be appropriate for the modelling data that was emerging through Exercise Cygnus as well. So that was an intention for us to try and focus particularly on those countermeasures.
Lead Inquiry: Was it at that point that the Welsh Government set up the Wales pandemic flu task and finish group about which you debated the merits of – with my Lady yesterday? Was that the task and finish group that was put into place to try to address such concerns as were coming out – finally out of Exercise Cygnus in 2016?
Dr Andrew Goodall: Yes, they were the practical arrangements. And of course we reached out to the pandemic flu UK arrangements as well and were observing in part of those arrangements and participating.
Lead Inquiry: That task and finish group, as you said yesterday, wasn’t able to finish its work, because, although it identified the tasks, it never finished them?
Dr Andrew Goodall: Also, as I said yesterday, we ended up moving our resilience activity and focus on to other matters.
On the Exercise Cygnus arrangements, 15 of the actions were completed, seven of them were still not marked as complete and under consideration. I can describe how on some of those measures I think that they actually had more significant activity. As an example, there was a draft communication strategy that had been worked on and was available, but it hadn’t been issued. We had worked through a draft extreme surge guidance plan, but at that point it wasn’t issued, it was only in draft and under consideration, so there were a number of areas that we hadn’t finalised or completed, as I said yesterday.
Lead Inquiry: It may be thought, Dr Goodall, that in the event of a disease outbreak in a pandemic, two of the most vital concerns would be the ability to surge your provision of health services, and a second would be your ability to be able to provide adequate care and resource to vulnerable people, particularly those in the care sector, in order to be able to deal with the terrible consequences of a pandemic.
It was those two areas, the surge planning and the guidance and the arrangements for the protection of the adult social care sector, that were not addressed by the task and finish group after 2016, even though those were areas which had been flagged up as long ago before as Exercise Taliesin; correct?
Dr Andrew Goodall: Whilst the extreme surge guidance hadn’t been issued, it was available as a draft, and ultimately we were able to use that when we were responding very quickly to the coronavirus pandemic. But as I indicated, it wasn’t issued.
In respect of the care home resilience arrangements, it was really important to maintain a focus on those arrangements, absolutely, and to make sure we were able to take assurance from the sectors and the systems reporting in to us.
Lead Inquiry: In addition to this incomplete task and finish process, did the Welsh Government, following something called the Pollock review a few years before, which had been a review specifically commissioned to address why it was that lessons weren’t being learnt from reviews and inquiries, set up something called the Joint Organisational Learning strategy, a body called the Wales Learning and Development Group, and then ultimately the Wales Pandemic Flu Preparedness Group, to also look into why learning was not being properly put into place following exercises?
Dr Andrew Goodall: It did do that, and it also led to the arrangements put in place first of all with training, which had been instigated back in 2008, but also the pattern of the annual conferences, both generally for civil contingencies and also for the health sector, that allowed us to be able to draw in those mechanisms with the organisations and the first responder arrangements as well. So they also allowed us to have an understanding of the focus of those activities over that time as well.
Lead Inquiry: But that additional – and I’m sorry, I’ve described it repeatedly as labyrinthine – process itself wasn’t able to ensure that all the recommendations and the learning from the various exercises were put into place, was it?
Dr Andrew Goodall: No. As I said yesterday, there were actions that were incomplete.
Lead Inquiry: In particular, as a result of resourcing problems, we looked at this through Sir Frank Atherton, the strategic decision taken to await work from Whitehall before getting on with doing work in Wales on the pandemic flu preparedness group workstreams, and also because of the diversion of attention away from civil contingencies planning towards the necessary preparations for a no-deal EU exit, those workstreams were never completed?
Dr Andrew Goodall: Yes, you’re right, and we obviously talked about Operation Yellowhammer yesterday, and the way in which it needed to take resources within the organisation, although that did give us some insight into sector resilience plans more generally as part of that process.
Lead Inquiry: Standing back, in relation to the areas of concern expressed after Cygnus, one of the key issues during Cygnus was, as I’ve suggested to you, healthcare demand, the surge in demand for critical care, that work was still being finalised in 2018, but it never reached fruition, did it?
Dr Andrew Goodall: It was still in draft at that time. There had actually been guidance issued on critical care surge earlier, I think back in 2012.
Lead Inquiry: It was never updated, was it?
Dr Andrew Goodall: It wasn’t, no, I do agree with that, although it had been worked on with colleagues and experts within that particular system, but I agree that it hadn’t been updated by that point, but there was critical care surge guidance.
Lead Inquiry: The consideration that it was thought necessary to give to reviewing and amending the pandemic influenza framework for local authorities and social services providers was never complete?
Dr Andrew Goodall: It wasn’t completed, but we did, through our resilience arrangements, take assurance from local resilience fora on their preparedness and also from local authorities as first responders on their arrangements. So there was an assurance link through to whether those organisations felt that their plans were sufficiently resilient or robust.
Lead Inquiry: There was no national resilience structure, assurance structure, put into place in the way that there is in England and in respect of local resilience forums in England, there was no national resilience standard process put into place, a national resilience assurance process by which local resilience forums could be checked put into place either, was there?
Dr Andrew Goodall: There was a self-assessment process for them within the responsibilities the Welsh Government had before 2018, before it had the legal duties. It didn’t have the performance and assurance role, but from 2018 it would have allowed us to start discharging those assurance roles, and there was a sector resilience assurance exercise that was undertaken in 2018, and it was in the context of pandemic flu.
Lead Inquiry: Was there any non-self-assessment, any external assurance process for checking the validity, the worth, the merit of the plans that were being put into place to deal with a pandemic influenza?
Dr Andrew Goodall: It was generally a self-assessment process for LRFs and also for individual organisations. We had used some peer review examples where Welsh local resilience fora would look at each other’s progress and make assessments.
Lead Inquiry: There was in 2018 an understanding that following the Transfer of Functions Order there needed to be a review generally of the civil contingencies structure in Wales; is that correct?
Dr Andrew Goodall: Yes, I agree. We needed to understand how we were going to properly and fully discharge those responsibilities.
Lead Inquiry: What happened to that general review of civil contingencies following the Transfer of Functions Order?
Dr Andrew Goodall: Whilst we had done the sector resilience oversight and we had expanded the team with the new responsibilities coming over, our attention and activity had simply moved across to Operation Yellowhammer and the EU exit arrangements, and that meant that the resilience team was embedded in that work as well as a very large part of the organisation as well. So the discharging of those responsibilities as we intended was put on pause, even though we were using and deploying the civil contingency mechanisms for EU exit.
Lead Inquiry: The inability to carry out that review, of course, an inability which existed prior to Wales being struck by the pandemic, has been described by one of your own ministers as “extremely disappointing”. You’ve seen the reference in Mr Kilpatrick’s statement.
Even after the pandemic struck, when the review of civil contingencies in Wales took place in 2023 – it did earlier this year, did it not –
Dr Andrew Goodall: It did.
Lead Inquiry: – did it then become apparent that there were still flaws in the civil contingencies system, in particular in relation to leadership capacity, effective and continuous training and exercising, a system for the systematic capture of lessons from exercises, the need for an establishment of minimum standards for competency, skills, qualifications, training and development?
Dr Andrew Goodall: Yes, indeed. They remain the themes in those areas and that work is under way to make sure that they are resolved. There is a system that captures the lessons learned now, which is held on an all-Wales level by Public Health Wales, and that is a new introduction since 2017, but we do need to make sure that we embed those arrangements and deal with the actions as well as the culture and behaviour around those issues as well.
Lead Inquiry: So, Dr Goodall, would you agree that, given that many of those issues had been raised consistently, continuously from 2012 onwards, that is an egregious example of locking the stable door after the horse has bolted?
Dr Andrew Goodall: We’ve had to learn many lessons and adapt and, you know, we need to ensure that we keep addressing the issues, from our planning and also from our recent experiences as well.
Mr Keith: I’ve no further questions.
My Lady, you’ve given permission for three areas of questioning to be advanced by Covid-19 Bereaved Families for Justice Cymru.
Lady Hallett: Thank you.
Questions From Ms Harris
Ms Harris: Good morning. I’m Bethan Harris. I appear on behalf of Covid-19 Bereaved Families for Justice.
I have three questions, Dr Goodall, and I have ten minutes, so I’ll be keeping an eye on the time.
Yesterday Sir Frank Atherton, when he was giving his evidence, was referred to a document which had been produced for the Health Protection Advisory Group.
For the reference that is INQ000177362.
I won’t take you to that document, but I’d just like to read, first of all, what he said in evidence.
He was taken to the document and it was introduced to him as a paper prepared for the committee, that’s the Health Protection Advisory Group, in July 2019, six months before the pandemic struck, and the document contained within it this statement:
“The current microbiology/infection services in Wales are fragile and are struggling to deliver on a day to day basis the prevention, early diagnosis and frontline support that professionals and the public require.”
He was asked whether that was not a major concern, and he agreed it was a major concern.
I’d like to ask you about a document that you’ve referred to in your witness statement that you’ve exhibited, and if it could be brought up on the screen, please. The number is INQ000177552.
You’ve referred to it in your third witness statement at paragraph 128.
Hopefully that can be brought up on the screen. Thank you. I think it’s there.
This is a ministerial advice. You see it, Dr Goodall?
Dr Andrew Goodall: Yes, I can, thank you.
Ms Harris: Thank you. It’s addressed to the Minister for Health and Social Services. It’s dated 2 September 2019:
“Subject: Strengthening and improving the National Health Protection Service in Wales.”
Box 1:
“What is the issue you are asking the Ministers to consider?
“This advice summarises the current health protection challenges faced in Wales and sets out the investment needed to meet this challenge and to strengthen and improve our National Health Protection Service.”
Then it goes on to refer to the actions which are being recommended, which are to increase the revenue that’s necessary, and indeed we heard Sir Frank Atherton refer to the request for additional revenue in this area when he gave his evidence yesterday.
I’d like to refer you to what is stated with regards to the context, which is on the next page, if we could kindly go to that on the screen, please, headed “Advice”:
“4. Context – What is the situation that has led to this advice?”
First of all, the “recent terrorism incident in Salisbury” is referred to, uncertainties caused by EU exit, growing threat posed by antimicrobial resistance, increased threat of high-consequence infectious disease, such as Ebola, and then goes on to refer to:
“International and domestic events demonstrated fragilities in all the respective national health protection services operating within the UK, which the responsible authorities in all four nations are seeking to address.”
Then it goes on to say:
“Response to these threats relies on the same physical and human infrastructure which is currently under pressure to deliver basic health protection services. Health professionals in Wales are not confident that they could at all times provide an effective response to high consequence infections or other chemical and biological threats.
“The National Health Protection Service in Wales is fragile; and the service today is confronted by a number of challenges. These include …”
Then, first of all, it refers to UK-wide shortages of trained staff and then:
“- laboratory estates on many sites which are no longer fit for purpose …”
The next bullet point:
“- the need for increased ward-based clinical services and services in the community to support both infection prevention and antimicrobial stewardship.”
It then goes on to say:
“Although microbiology is a shortage speciality UK wide, recruitment to Wales is particularly challenging when the laboratory estate on many sites is not fit for purpose, and a lack of investment in new technologies and redeployment of scientists means microbiologists are unable to spend time on the frontline supporting professionals …”
I’m going to skip the next paragraph. Then finally that:
“Health protection professionals in Wales consider that, adequately resourced, there is much more they could contribute in the prevention, diagnosis and management of infection and in guiding prudent use of antibiotics.”
So that, as I say, is a document that you’ve exhibited, and what I’d like to ask you about is, first of all, do you agree that the document that I initially referred to, the one that Sir Frank Atherton was referred to yesterday, and this particular document, in September 2019, they imply that there was a very real need to improve on infection prevention and control services in Wales at that time in 2019?
Dr Andrew Goodall: Yes, I remember not just the document but the discussion at the time. It was a very honest assessment that had come through that group, also on the advice and expertise of Public Health Wales, and it was really important that we were responding to those concerns about fragility, and the decision was made to support that. In fact the previous year we had actually made some additional financial investment in Public Health Wales in this arena as well.
Ms Harris: Do you agree that, in terms of pandemic preparedness and being prepared for the Tier 1 risk that everyone across the UK, including in Wales, was aware of, that there would need to be capacity to meet a significant increase in need for infection prevention and control services?
Dr Andrew Goodall: Yes, indeed. I mean, the NHS faces day-to-day pressures whilst it’s discharging many activities and supporting its communities. The day-to-day pressures of the service, you know, would need to have some resilience built in to be able to deal with those extra responsibilities as well. So yes, the existing service was under pressure, which was why we were addressing it, but we were also trying to build in some resilience into the system with the investment as well.
Ms Harris: Going to what I think you are saying, and I’ll ask you to confirm, were the two or two of the main pandemic preparedness planning documents – I’m going to ask you whether they actually reflect the importance of infection control and prevention.
First of all, if you can perhaps confirm that the Wales Framework for Managing Major Infectious Disease Emergencies, October 2014, was one of the main preparedness guidance documents that was current in Wales from 2014 onwards, right up to when the pandemic hit?
Dr Andrew Goodall: Yes, it would have covered responsibilities and maybe not gone into all of the detail. Certainly the outbreak plan for Wales would have really dealt with some of the very specific issues in terms of discharging that on a local level.
Ms Harris: Yes, thank you. So that’s one of the documents. It’s right, isn’t it, that that document, the Wales Framework for Managing Major Infectious Disease Emergencies, you may be familiar with its content without me needing to take you specifically to the document, but I’d like to refer you to a passage in it, and it was indeed a passage that was highlighted yesterday, again in Sir Frank Atherton’s evidence. Paragraph 11.1:
“All hospitals need to establish ways of caring for large numbers of infectious patients on a scale outside their normal experience, including those requiring high dependency care.”
So just to confirm, that document clearly recognised the importance of infection control in the context of being prepared for a pandemic?
Dr Andrew Goodall: Yes, I agree.
Ms Harris: Indeed.
The other document is the Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance, again another one of the major preparedness guidance documents, 2014, that remained in force throughout up until the pandemic hit; yes?
Dr Andrew Goodall: Yes, indeed, yeah.
Ms Harris: Thank you.
Dr Andrew Goodall: We’d hoped to review it in 2018, but it was the document in 2014 that was an important response document for us, yes.
Ms Harris: That one referred to the meticulous use of infection control procedures being part of preparedness and part of what would be needed in the event of a pandemic?
Dr Andrew Goodall: Yes.
Ms Harris: That’s familiar to you. Thank you.
So what I want to ask you is: do you accept that, when we look at what we had in September 2019, in the document I referred you to, which you’ve exhibited, and we look at those documents in 2014 and what they flag up in terms of needs, in terms of infection prevention and control, that there just wasn’t a robust enough process of following up on what the Welsh Government’s own guidance said, that there wasn’t a critical review as to whether things were actually put in place that had been stated in the documents?
Dr Andrew Goodall: We would have worked with individual health boards in Wales who would have used their funding for a variety of areas. Public Health Wales, of course, would have made its assessment, and when it came forward with its national plan we were very happy to support it.
I mean, certainly, and I speak from personal experience as a local health board chief executive, we had tried to ensure that new hospital builds were supporting an infection control outlook, including single room arrangements, for example, but that was not available to all of the estates, and they were certainly possible with new build arrangements in Wales, but we would have worked with individual organisations on their proposals and plans and they would have been able to make some local decisions on that infrastructure as well.
Ms Harris: Right. So you’re saying things were done, but do you accept it wasn’t enough?
Dr Andrew Goodall: When we were receiving that national protection proposal, that was showing that we needed to invest more and have more flexibility and capacity, yes.
Ms Harris: Thank you.
I’m going to just deal with a second question very briefly, because I know that I’m running out of the time that’s allocated. Thank you for those answers.
I’d like to ask you a question on PPE, and perhaps putting to one side matters of what the arrangements were with regards to how much PPE was stockpiled and what was the extent of the actual availability of PPE that was planned and put in place.
The distribution system for accessing PPE and distributing it, was the resilience of that system in Wales adequately tested in advance of the pandemic?
Dr Andrew Goodall: The PPE stockpiles, where we were making sure that we had about 15 weeks’ worth of supply available, were well tested. When we were in the coronavirus response, we really had to utilise the excellence of the national procurement service arrangements to change the distribution model quite quickly.
But to your question, I don’t think that they were rigorously tested. They may well have featured as part of the procurement service’s own resilience proposals. But certainly we adapted very quickly to ensure we could distribute the PPE at least out to the regional centres before they needed to go through to the frontline staff and services.
Ms Harris: Just finally, obviously this module is not looking at what actually transpired and how things played out on the ground in any detail, but do you acknowledge that there were problems with distribution?
Dr Andrew Goodall: We ended up having to change our distribution model, rather than to 11 centres to literally get to hundreds of sites in matters of days, so it was a very different response that was required at the time.
Ms Harris: Right. In retrospect, would it be right to say that there hadn’t been sufficient scrutiny of the resilience of that distribution system in advance of the pandemic?
Dr Andrew Goodall: We were assured on the existing arrangements, but at the scale, the severity and the duration of the arrangements, we would have needed to have done more work based on the experience that we had to the coronavirus pandemic.
Ms Harris: Thank you.
Thank you, my Lady, those are my questions. Thank you very much.
Mr Keith: My Lady, I omitted to ask about one particular area which I know has been of concern to my Lady.
Lady Hallett: The stenographer has been going for a long time. Is it important to deal with it?
Further Questions From Lead Counsel to the Inquiry
Mr Keith: Yes, it’s about the Chief Scientific Adviser system in Wales, and I wanted to ask two questions in relation to that, if I may.
Dr Goodall, it is this: it appears from material that the Chief Scientific Adviser for Health in Wales – a man who is actually, I think, a Mr Rob Orford – because he is concerned with being the Chief Scientific Adviser for Health is not part of the UK Chief Scientific Adviser system; and secondly, do we have it right that, for whatever reason, the Chief Scientific Adviser in Wales and the Chief Scientific Adviser for Health in Wales are not at the centre of the Welsh civil contingency structure, so they don’t actually give advice on civil contingencies to the Welsh Government? Have I summarised the position correctly?
Dr Andrew Goodall: Yeah, you’ve summarised those correctly. There were some changed arrangements put in place during the pandemic itself to access those, but they were – certainly Rob, as the CSA Health, was involved in the pandemic response, but they had traditionally not been directly involved in the preparedness.
Mr Keith: Thank you.
Lady Hallett: Thank you very much, and I shall return at 11.40.
(The witness withdrew)
(11.22 am)
(A short break)
(11.40 am)
Lady Hallett: Ms Blackwell.
Ms Blackwell: My Lady, may I please call Dr Quentin Sandifer OBE.
DR QUENTIN SANDIFER (sworn).
Questions From Counsel to the Inquiry
Ms Blackwell: Dr Sandifer, thank you very much for the assistance you’ve so far given to this Inquiry, and also thank you for coming to give evidence today.
You have prepared a witness statement which we see at INQ000192266. Your signature appears at page 83.
There we are.
You signed this statement on 27 February this year. Can you confirm, please, that it’s true to the best of your knowledge and belief?
Dr Andrew Goodall: Yes.
Ms Blackwell: Thank you.
My Lady, may we have permission to publish it, please?
Lady Hallett: Yes.
Ms Blackwell: Thank you.
We can take that down, thank you.
I’d like to begin by establishing through you, Dr Sandifer, the creation of Public Health Wales. It was formulated in 2009 by the Minister of Health and Social Services, following a review of public health functions undertaken in 2006; is that right?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: Thank you.
The functions of Public Health Wales are three-fold: it provides data and science-based leadership, specialising in public health expertise and co-ordination and advice, and is a delivery of key public health services; second, it works closely with public health boards, local authorities and other partners, including education and housing; and, third, it protects and improves the health and well-being and seeks to reduce health inequalities. Is that right?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: Thank you.
The structure of Public Health Wales has a senior management team that has changed in certain respects since its incorporation in 2009, but the chief executive since 2014 has operated a corporate level business executive team structure, where collective decision-making at a corporate level is a key feature, in addition to each director having clear accountability and responsibility for a specific portfolio; is that right?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: The second key role is that of National Director of Health Protection and Screening Services and Medical Director, a title which was previously known as the Executive Director of Public Health Services, Medical Director.
Dr Andrew Goodall: That’s correct, and I held that latter title from October 2012 until December 2020.
Counsel Inquiry: Thank you.
In your role at executive level responsibility, which we’ll go into in more detail throughout the course of your evidence this morning, is it right that you have now become a consultant adviser for pandemic and international health for Public Health Wales?
Dr Andrew Goodall: Yes, following my retirement in December 2020, I returned in 2021 and undertook that contracted consultancy role on a part-time basis.
Counsel Inquiry: Thank you.
I want to turn for a moment to deal with the funding of Public Health Wales, and to confirm with you, please, Dr Sandifer, that there are two main sources of funding for the organisation: funding from the Welsh Government and other National Health Service Wales organisations who provide remuneration for the provision of services delivered by Public Health Wales?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: You tell us at paragraph 41 in your witness statement that:
“In exercising its role as functions, Public Health Wales was not held back in any way by the funding made available by the Welsh Government.”
And that, in your view:
“There are no examples of insufficient funding curtailing the ability to fulfil Public Health Wales’ role and functions in a timely manner in relation to the pandemic.”
Is that right?
Dr Andrew Goodall: That’s right.
Counsel Inquiry: Public Health Wales funding increased dramatically from 2009 to 2010, when it was set at £41.5 million, to £152.9 million by the time we reached 2019 to 2020.
What was the cause of that dramatic increase in funding, and why was it made?
Dr Andrew Goodall: Well, the figure that you started with, the £41 million, reflected a half year position, because the organisation was established at the beginning of October 2009. The full year figure, which is reflected in the 2010/2011 accounts, was around £81 million.
The principal reason for the expansion in funding was partly as a result of some transfers of functions that were discharged in other bodies in Wales, transferring in to Public Health Wales, with the funding attached to those, and also in part as a result, likewise, of some service transfers, for example our diabetic retinopathy service was transferred in from a local health board into Public Health Wales and brought with it a substantial amount of financial resources.
Then there were some other additional investments made by Welsh Government during the course of the ten years, including in health protection, but also in other areas like policy, research, international health development.
Counsel Inquiry: Thank you.
Can you confirm, for the purposes of the Civil Contingencies Act of 2004, Public Health Wales is a Category 1 responder?
Dr Andrew Goodall: Yes, it is.
Counsel Inquiry: So as well as having health protection and microbiology responsibilities, it also had an EPRR function, didn’t it?
Dr Andrew Goodall: It did.
Counsel Inquiry: In terms of the allocation of budget for emergency preparedness, resilience and response functions, that increased from 2014 to 2015 and £387,000 to 2020 to 2022, £884,000. Can you explain why there was such a dramatic increase in that part of the budget, please.
Dr Andrew Goodall: Yes. I think it’s fair to say it’s very difficult to tease out what exactly were the financial elements attached to EPRR, because of course EPRR is a function delivered by the whole of the organisation, and in particular from our health protection and microbiology services. But I do recognise those figures, and the reason why there was such an increase is that following the Ebola outbreak in Wales in 2014 to 2016, and on the back of reviews that we undertook both to our emergency planning and business continuity arrangements, we introduced some changes in 2017/2018 including, for example, expansion of our emergency planning support workforce, the appointment of a lead manager, and all of those appointments attracted the need for further investment.
Counsel Inquiry: Right.
Did you think at the time, in 2014 to 2015, that the EPRR budget was sufficient?
Dr Andrew Goodall: I think Public Health Wales discharged its EPRR functions within the resources available to it, but in doing so, at that time, it should be said that the EPRR function was located in our Health Protection Team, and it is probably true to say that it was subsidised by the Health Protection service.
Counsel Inquiry: Well, you tell us at paragraph 196 in your witness statement that “the health protection services in Public Health Wales were under-powered”. What did you mean by that?
Dr Andrew Goodall: So that paragraph refers to our assessment of the initial phase of the coronavirus response.
So, if I could just summarise, perhaps, to help the Inquiry understand the pattern of investment: between 2010 and 2019 there had been no budget cuts and there had been an increase in both the financial resources and the workforce in the health protection and microbiology services, which is where most of the EPRR functions were based and from which they were delivered.
Counsel Inquiry: Right.
Well, just before we leave the issue of finance and budgets, you also tell us at paragraph 78 that in February 2019 the Welsh Government confirmed additional funding for the National Health Protection Service and that there was £1 million capital funding in that year to directly support the automation of the laboratory services across Wales and £0.6 million minimum revenue for the continued development of the Pathogen Genomics Unit. Is that right?
Dr Andrew Goodall: That’s correct, and that reflected, in fact, a series of investments that had been made since 2014 in our health protection and our microbiology services.
Counsel Inquiry: Dr Tracey Cooper, your successor in post, tells us in her witness statement that that funding facilitated enhancements to the microbiology laboratory network and infrastructure, but that those improvements were still being made and implemented at the time of the pandemic; do you agree with that?
Dr Andrew Goodall: If I could just gently correct, Dr Tracey Cooper’s the chief executive of Public Health Wales and had been so since June of 2014, and remains still the chief executive.
Counsel Inquiry: Thank you.
Dr Andrew Goodall: But to your point, yes, that is correct.
Counsel Inquiry: All right. She also told us that that funding was only a part response to the need raised by Public Health Wales for the strengthening of the health protection system across Wales, so she appears to be saying – and please correct me if I’m wrong – that a plea had been made for further investment, and the investment in terms of the laboratory services that was received was only a part response; do you agree with that?
Dr Andrew Goodall: It was. We began our discussions with Welsh Government in the second half of 2017 about what we regarded as the additional investment required to strengthen our National Health Protection Service. This also coincided with what we believed was some necessary investment, such as you referred to, the capital investment, in particular technologies, molecular diagnostics and genomics sequencing in particular. But – and we were grateful for the investment that we did receive, but we had still anticipated and therefore made the case for further investment, which then came through later in 2019.
Counsel Inquiry: Is that partly because in 2017/2018 the organisation identified to the Welsh Government in particular the need to strengthen the health protection system and what Dr Cooper describes as a particularly fragile microbiology service?
Dr Andrew Goodall: Yes.
Counsel Inquiry: All right. Do you agree that at the time and before that investment was made, the microbiology services were particularly fragile?
Dr Andrew Goodall: Yes, that fragility was created in 2015/2016 with the retirement of a number of senior microbiologists and difficulties that we had recruiting to those posts. And the investment that we referred to, the fragility and the investment we referred to, was accompanied actually also by some internal actions we took to strengthen the model for the delivery of microbiology at the same time.
Counsel Inquiry: To what extent did Public Health Wales provide advice to the Welsh Government on its pandemic preparedness?
Dr Andrew Goodall: So Public Health Wales has throughout its existence provided specialist advice and direct support systems leadership to Welsh Government and the wider health, social care and local government system in Wales in respect of EPRR, and so, yes, that included specific advice to Welsh Government on its pandemic planning arrangements, learning and development, exercising and training.
Counsel Inquiry: What level of representation did Public Health Wales have on scientific advisory bodies such as SAGE and NERVTAG?
Dr Andrew Goodall: So Public Health Wales has never been a member – or at least, I’ll put it the other way around. Representation from Public Health Wales, there has been no representation from Public Health Wales on NERVTAG. Likewise, we’ve not had a seat on SAGE pre-pandemic.
Counsel Inquiry: Right. Do you think that Public Health Wales deserved a place on NERVTAG and SAGE?
Dr Andrew Goodall: I do think that it would be beneficial for Public Health Wales to be on NERVTAG. I recognise that SAGE is established in specific circumstances –
Counsel Inquiry: Yes.
Dr Andrew Goodall: – and that government representation would be the most appropriate sitting outside of government. We didn’t presume that that would include us but we would of course always be happy to support Welsh Government had we been asked.
Counsel Inquiry: In terms of responsibility at a local level, Public Health Wales’ duties and responsibilities, and its obligations indeed under the Civil Contingencies Act, meant that it worked closely with local resilience fora; is that right?
Dr Andrew Goodall: Yes, we had representation on four – all four local resilience fora in Wales.
Counsel Inquiry: Did Public Health Wales also chair the Wales Risk Group?
Dr Andrew Goodall: We did. One – the senior manager for our combined – in 2017/2018, we combined our business continuity and emergency planning arrangements. Our business – our manager for that service did lead that group from January 2018 till November 2020.
Counsel Inquiry: What, if any, discussion was there during the meetings of that group about the National Risk Assessment?
Dr Andrew Goodall: So what that group did is it took the National Risk Assessment and then, with Welsh Government and with representatives from the four local resilience fora, considered how that risk assessment applied within Wales and the steps and actions that should be taken, including the inclusion of the risks in local resilience fora, community risk registers.
Counsel Inquiry: Did that also involve an assessment of any gaps in preparedness that might exist at the local level?
Dr Andrew Goodall: We also, as I’ve already said, had representation at the local level, and our representation at the local level included liaising with each of the local resilience fora about their assessed risks and advising them accordingly.
Counsel Inquiry: So how did Public Health Wales have the necessary arrangements in place to effectively support and enable the local resilience fora to make their own rapid and effective responses to the pandemic when it struck?
Dr Andrew Goodall: So Public Health Wales’ Health Protection Team, together with the microbiology service, used our emergency response plan as the basis for our initial response to the pandemic in 2020, and in doing so we were aware that the local resilience fora in turn were standing up their strategic co-ordinating groups, as it appropriate, as a response.
Counsel Inquiry: What is the Wales Resilience Forum and how does Public Health Wales contribute to that?
Dr Andrew Goodall: Wales Resilience Forum is a structure within Welsh Government that is chaired by the First Minister and includes representation from all multi-agency partners at a strategic level to consider the risks across the piece, so not confined only to health, and I represented Public Health Wales as a member of that group.
Counsel Inquiry: How does that sit with the Wales Resilience Partnership Team?
Dr Andrew Goodall: The Wales Resilience Partnership Team was a group underneath the Wales resilience fora, in part providing secretariat functions, and in part tasked with the operationalisation of some of the activities that had been discussed at the Wales Resilience Forum.
Counsel Inquiry: Did you also sit on the Wales Resilience Partnership Team?
Dr Andrew Goodall: I didn’t, but our emergency planning and business continuity manager did.
Counsel Inquiry: Right, thank you.
All right, now having established the body that Public Health Wales became in 2009 and its functions and responsibilities, I’d now like to look at some of the plans that were in place over the course of the Module 1 time period.
First of all, please, can we look at INQ000089558, which is the Public Health Wales Emergency Response Plan.
We can see that this version is version 2, created in September of 2018, and if we go to page 2, please, we can see that under the heading “Sponsoring Executive”, you appear as the sponsoring executive.
What does that mean in terms of this particular document?
Dr Andrew Goodall: What that means is that, as the executive lead for public health emergency planning in Wales, this document was endorsed by me and commended by myself to our board for consideration.
Counsel Inquiry: What was the purpose of this document? How was it intended to be used?
Dr Andrew Goodall: So this document, as it says at the top, provides the specific arrangements for our strategic and tactical response to emergencies, incidents and outbreaks.
It’s the top level document of a suite of documents also that sit with this. It is an internal document, but it has been written very much in the spirit of the Civil Contingencies Act, was shared with and therefore deliberately made known to our local resilience fora partners.
Counsel Inquiry: So they had access to this?
Dr Andrew Goodall: They and Welsh Government had access to this document.
Counsel Inquiry: Thank you.
Can we go to page 9, please, and look at paragraph 1.1. Thank you. We can see here under the heading “Introduction” that:
“The Public Health Wales Emergency Response Plan details the organisation’s response arrangements to any emergency, incident or outbreak that impacts on, or requires the mobilisation of, public health resources and capabilities. The Emergency Response Plan provides a framework to establish, create and improve resilience.”
Did this document replace an earlier iteration, and if so, when was that first created, please?
Dr Andrew Goodall: So this document replaced an earlier version which had been approved by our board in November 2016, and indeed it was about the fifth – I’d have to just remind myself, we had a plan in 2009, 2012, 2014, 2016 and, yes, this would have been the fifth iteration of the plan in 2018.
Counsel Inquiry: It wasn’t updated, was it, until 2022, I think?
Dr Andrew Goodall: That’s simply because events overtook us. At the beginning of 2020, which is – I mean, we review our plans annually anyway. The plan was still, we considered, relevant at the beginning of the outbreak of the pandemic, but we, during the course of the pandemic, recognised that the plan would need updating and at the earliest appropriate time we did so.
Counsel Inquiry: Thank you.
Can we go to page 10, please, and have a look at the roles and responsibilities. We can see that, third row from the bottom – can we just scroll out, please, here we are:
“Facilitate epidemiological follow-up of affected populations and communities as necessary.”
To what extent did Public Health Wales achieve this? What was this intended to represent?
Dr Andrew Goodall: So in an incident, an emergency, particularly in an outbreak, what we always sought to do was to assess the impact of that on the populations affected. We did this during the Covid response, a wide range of assessments were undertaken, including epidemiological assessment. But an example would be: had there been a chemical release from a factory with a cloud of gas discharged and floating over a local population, we would follow – after that event had been resolved, we might well follow up with the affected population to see if there had been any longer term impact.
Counsel Inquiry: Do you agree that within this document, the EPRR information largely focuses on command and control measures and doesn’t include any specific detail on how to handle a coronavirus outbreak, and it doesn’t go into any plan for non-pharmaceutical interventions?
Dr Andrew Goodall: So I think I should explain that this plan, which is an all-hazards plan, it’s a generic plan, was written in the context of Public Health Wales as a Category 1 responder, being able to demonstrate that it was fulfilling the requirements of the Civil Contingencies Act and the duties and responsibilities, including statutory and non-statutory guidance, and that is how this document has been written.
Counsel Inquiry: So is your answer that you wouldn’t have expected that level of detail to be involved or incorporated into a document such as this?
Dr Andrew Goodall: I would expect that information to be in other documents.
Counsel Inquiry: Right. Well, we’ll move to look at other documents in a moment. But before we do – we can take that down, please – I would like to ask you about the Health Protection Advisory Group. That is a group that had been or indeed has been in existence for many years, hasn’t it?
Dr Andrew Goodall: It has, yes.
Counsel Inquiry: And it was – it involved the CMO, the Chief Medical Officer for Wales, but you tell us in your witness statement that there was a period of abeyance of the group before it was re-established in May of 2018. Why was the group put into abeyance, which required it to be re-established in May of 2018?
Dr Andrew Goodall: So the group is a non-statutory advisory group to the Chief Medical Officer, and in 2014 the then Chief Medical Officer retired and the group therefore ceased to meet. The current Chief Medical Officer came into post later in the year, and then, at the beginning of 2018, he decided that he would like to re-establish the group.
Counsel Inquiry: What was the involvement of Public Health Wales in that group?
Dr Andrew Goodall: Public Health Wales has always been a member of the Health Protection Advisory Group.
Counsel Inquiry: To what extent was pandemic preparedness discussed during those group meetings?
Dr Andrew Goodall: So, the group looked at the whole breadth of public health threats and hazards, and Public Health Wales advised and supported the group, for example by preparing technical documents and papers for it to consider, and influenza pandemic preparedness had been one of the subjects of discussion in the group.
Counsel Inquiry: What was discussed about it?
Dr Andrew Goodall: So we had been aware that in 2016, or 2014, as has been discussed already, there had been an exercise in Wales and that there had also been an exercise at the UK level that Wales had participated in, and that had generated recommendations and outputs which needed to be followed through.
Counsel Inquiry: So did Public Health Wales become involved with the recommendations that fell out of Exercise Cygnus and the other exercises that ran before that, which we’ll turn to look at in a moment?
Dr Andrew Goodall: So when Exercise Cygnus took place, Public Health Wales had two representatives observing. When the report was published in July of 2017, we obviously received a copy of that report and, as was shown yesterday, a Wales influenza pandemic preparedness group was convened, meeting first in September that year, and Public Health Wales was represented on that group.
Counsel Inquiry: All right. Well, we’ll come to look at that in a moment.
Before we do, let’s just have a look at a set of meetings from this group, from 17 December of 2019, when the Health Protection Advisory Group met, and we can see from the first page that Public Health Wales were represented by Andrew Jones.
You sent your apologies for that meeting. We can see that halfway down the page. But no doubt you will have been filled in by – what took place during the course of the meeting and any recommendations that came out of it?
Dr Andrew Goodall: Yes, I was on annual leave. Andrew Jones is my deputy.
Counsel Inquiry: Thank you.
Can we go to page 4, please, of these meeting notes, and look at paragraph 5.2. Thank you.
We can see that the:
“CMO acknowledged [that] there were significant questions around the preparedness of NHS Wales to deal with a similar situation and to be able to manage an infected case at one of our acute hospitals for at least 24hrs. It was agreed that whilst a key work stream of strengthening the National Health Protection Service would look at an all-Wales system for dealing with high consequence infections more urgent action was necessary to provide reassurance.”
To what does this relate, please?
Dr Andrew Goodall: So this relates to discussions that were taking place at the time about the development of a high-consequence infectious diseases unit in Wales.
Counsel Inquiry: Yes.
Dr Andrew Goodall: At that time, it was necessary for any patient that had a high-consequence infectious disease to be transferred to a designated unit in England.
Counsel Inquiry: Yes. Right. Well, if we look at the bottom of this paragraph, we can see that action 23 was for the:
“CMO to write to health boards, [Public Health Wales] and WAST requesting their plan/pathway for dealing with a high consequence infectious disease (deadline for [which was] March 2020).”
Do you know whether or not that was done?
Dr Andrew Goodall: So in January 2020, as it became clear to us in Public Health Wales the novel coronavirus represented a very serious threat, we as an organisation entered into discussions with Welsh Government and – with one of our local health boards, to discuss how we could establish very quickly a high-consequence infectious disease unit at that hospital, in advance of and in readiness for potential patients if novel coronavirus came to Wales.
Counsel Inquiry: We can take that down now, please.
I would like to look at the Emergency Planning and Business Continuity Group and look at the terms of reference for this group which are at INQ000089648.
Thank you.
We can see that’s the front page there. These are the terms of reference.
If we turn to page 2, please, we can see in the top third of the page that again you are the sponsoring executive, as the executive director of public health services, and medical director.
Can you tell us when this group was established and what the purpose was for the group being brought into force?
Dr Andrew Goodall: So the group was established in August 2018. The story behind it is we had conducted a review of our business continuity arrangements in 2016, and that review had recommended that we should bring together our business continuity and emergency planning arrangements under the leadership of a single executive. They were at that time under different executives within Public Health Wales.
It also recommended that we should establish the role of the business continuity – sorry, the executive – the emergency planning and business continuity lead, the manager that I have already referred to.
Counsel Inquiry: Yes.
Dr Andrew Goodall: So all of that was accepted in 2017, and in 2017 we brought – started to bring these entities together, and that was finally completed and formalised in the first half of 2018.
Counsel Inquiry: If we look at the bottom part of this page, we can see that under the heading “Updates and amendments” that there is a blank table. Has this document, these terms of reference, ever been updated or amended?
Dr Andrew Goodall: I don’t know the answer to that question to the current time.
Counsel Inquiry: All right. Well, if we need to establish the answer for that, then we will formally ask.
Is it right that the Emergency Planning and Business Continuity Team was steered by the local resilience forum?
Dr Andrew Goodall: The Emergency Planning and Business Continuity Team effectively provided the operational leadership for the implementation of the emergency preparedness planning and response arrangements of Public Health Wales, and that necessitated engagement with a wide range of partners, Welsh Government, local government, the health boards, the local resilience fora.
Counsel Inquiry: Well, let’s look at the Emergency Planning and Business Continuity Work Plan, please, 2018 to 2020, which we can see at INQ000183523. Was this document the work plan for the group?
Dr Andrew Goodall: It was.
Counsel Inquiry: You sponsored this document as well, didn’t you?
Dr Andrew Goodall: I did.
Counsel Inquiry: Which was approved in July of 2019.
Could we look at page 2, please. Thank you.
We can see at the top that:
“[The] document outlines the Emergency Planning and Business Continuity actions for [the time period]. The actions address the legal requirements on Public Health Wales in its role as a Category 1 responder …”
Can we go to page 9, please.
We can see it that this sets out the emergency planning activity under the integrated emergency management system, and if we could just scroll through the next few pages we can see that there are the six phases that we’ve seen before.
Thank you, if we can carry on.
Ending with – next page, please – response and recovery.
There are no references to pandemic or influenza in this document, although there are references to bomb threats and Brexit health and other such matters. Do you agree with that?
Dr Andrew Goodall: I do agree with that.
Counsel Inquiry: Why were references to the threats or hazards of pandemic influenza and matters of that nature not contained within this document?
Dr Andrew Goodall: So the reason why Brexit was included, because it was a live issue at the time. Pandemic influenza was not included because we were having – those were set out in the other documents, that no doubt we will come to, the documents that have already been referred to, and that this therefore took a strategic approach to how we discharged our responsibilities under the Civil Contingencies Act in respect of any incident, outbreak or emergency that might take place. But it didn’t explicitly refer to the development of pandemic influenza planning.
Counsel Inquiry: Were you aware when you sponsored this document that the National Risk Assessment had assessed the hazard of pandemic influenza as being at the first tier, so it created the most serious threat?
Dr Andrew Goodall: Yes, we did.
Counsel Inquiry: So do you still say that it wasn’t necessary or appropriate for it to be mentioned in this work plan for emergency planning?
Dr Andrew Goodall: As I say, we recognised that pandemic influenza was at the top of the National Risk Assessment and we were fully engaged throughout the period of Module 1 in direct discussions with Welsh Government and with our local resilience fora to prepare and respond to influenza pandemic.
Counsel Inquiry: But that’s not really an answer to the question. Didn’t it deserve a mention in this document?
Dr Andrew Goodall: In hindsight, yes, I can see that it could, but at the time, having just established this group, we didn’t include it.
Counsel Inquiry: Does the fact that it’s not included demonstrate that pandemic influenza was not in the forefront of the mind of Public Health Wales and other organisations who were involved in the creation of this document?
Dr Andrew Goodall: No, I don’t agree with that. As I prefaced my previous answer, Public Health Wales has had a full and active involvement in support of and advising Welsh Government and partners in the development of our pandemic influenza plans.
Counsel Inquiry: Public Health Wales did sit on the Wales Pandemic Flu Preparedness Group, didn’t it?
Dr Andrew Goodall: It did.
Counsel Inquiry: I’d like to look now, please, at a set of minutes from the meeting of that group in January of 2018.
We have them at INQ000187219. Thank you.
Now, we can see who was present. David Goulding, who was the Welsh Government health emergency planning adviser, and other members of the Welsh Government, and then we know that Public Health Wales was present, although the name of the person attending has been redacted. So that wasn’t you on this occasion?
Dr Andrew Goodall: No, it wasn’t, but I do know who it was.
Counsel Inquiry: All right. Well, perhaps that doesn’t matter, and if it does we’ll come back to it.
Could we have a look, please, at the second paragraph, which is I think on page 2. Thank you. Here we see under the heading “UK Pandemic Flu Review and Work Plan”:
“DG discussed the PFRB High Level Work Plan, advising that the Review Board had agreed to extend the time period into a second year to address ongoing deliverables. [He] asked if there were any questions regarding the Work Plan, none were asked and added that the next UK Pandemic Flu Readiness Board would meet at the end of February. WP alluded to the difficult timescales for some areas being set centrally.
“The meeting discussed the importance of operational delivery, through the UK review some key pandemic influenza strategic policies and guidance are updated notably the UK Pandemic Influenza Framework 2011 and the Cabinet Office Pandemic Influenza Guidance to LRFs.”
Now, is it right that three of the four LRFs were not in attendance at this meeting?
Dr Andrew Goodall: You would have to re-show the first page for me to be certain.
Counsel Inquiry: All right. Can we go back to that, please. At the bottom paragraph here we can see:
“It was noted with disappointment that three of the four LRF Chairs” –
Dr Andrew Goodall: Yes.
Counsel Inquiry: – “were not in attendance. WP confirmed that the LRF chairs had been invited and that no apologies had been received from them. Reference was made to LRF engagement with being taken forward by the DCLG in England and the need for Welsh Government to also engage with the LRFs in Wales. DG emphasised the importance of having the LRF chairs on the group and asked that this be re-enforced with them.”
Does this chime with any concern that you had about the engagement of LRFs in this particular group?
Dr Andrew Goodall: Until I saw these minutes recently, I had not remembered that only one of the four LRFs had been in attendance. My memory of our LRFs is that they were active and full participants in pandemic flu preparedness, and I’ve noted which health board was in attendance. So I share this disappointment of the chair, and fully agree with his sentiment that they should be reminded of the importance of attending.
Counsel Inquiry: But was this a common theme?
Dr Andrew Goodall: No.
Counsel Inquiry: Was this a problem, that the LRFs were not engaged in this particular group?
Dr Andrew Goodall: No, as I said at the preface to the last answer, my experience was that the LRFs were active participants with us in all areas of emergency planning and response, including pandemic flu.
Counsel Inquiry: Is your recollection at the time that these meetings were taking place – and these minutes, I remind us, were at January of 2018 – that the Wales Pandemic Flu Preparedness Group was an effective group?
Dr Andrew Goodall: The … so I was aware that there were a range of workstreams which had made limited progress, as has been discussed already.
Counsel Inquiry: All right. Well, I’d like to look, please, again at page 2 and at paragraph 3, and the first paragraph there:
“WP advised that it was the perception at a UK level that Wales and other devolved governments are lagging slightly behind England in some areas such as legislation and health and social care surge planning due to a lack of resource.”
Were you aware of that at this time?
Dr Andrew Goodall: I was, and I recognise those issues.
Counsel Inquiry: All right. What was done about it?
Dr Andrew Goodall: So, as I understand it, Welsh Government were undertaking work on healthcare surge planning, particularly in the area of critical care. I wasn’t familiar with the detail of the progress with the social care surge planning.
Counsel Inquiry: All right. We can take that down, please.
The Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance we see at INQ000089573.
This was issued, as we see, by the Welsh Government Department of Social Services, Health Emergency Preparedness Unit in February of 2014, and this was really the Welsh response to the United Kingdom 2011 guidance, wasn’t it?
Dr Andrew Goodall: It was.
Counsel Inquiry: Yes. You will be familiar with this document, Dr Sandifer?
Dr Andrew Goodall: Yes.
Counsel Inquiry: Yes, and you can confirm then, without us having to go into the detail of it, that in general terms it relied upon the planning assumptions that had been established in the UK 2011 document?
Dr Andrew Goodall: Yes.
Counsel Inquiry: All right.
This guidance deals with stockpiles of a range of consumable products, including eyewear, aprons, gowns and gloves. We don’t see that level of detail in the UK document. Did Public Health Wales have any involvement in providing the additional guidance in relation to those particular areas of stockpile?
Dr Andrew Goodall: So the Welsh Government led on countermeasures stockpiling, including PPE. Our infection prevention control lead did occasionally provide advice to Welsh Government if any specific questions were raised, but we had no other direct involvement.
Counsel Inquiry: Could we go to page 13 of this document, please. Thank you.
Now, we can see here the co-ordination arrangements for major infectious disease emergencies in Wales. If we familiarise ourselves with this, we’ve got the National Security Council at the top, SAGE to the right. Then, going from left to right on the second level, the Department of Health organisations and the devolved administration health departments. In the middle we’ve got the Wales Civil Contingencies Committee and the DH&SS Health Response Team, and to the right the strategic co-ordination groups.
Then on the third tier, left to right, we have the health boards, the NHS trusts and there, in the right-hand corner at the bottom, Public Health Wales.
Now, is that co-ordination arrangement familiar to you?
Dr Andrew Goodall: It is.
Counsel Inquiry: There would appear from this chart to be no direct contact or line of contact between Public Health Wales and, for instance, the SAGE group that we see at the top right-hand corner. Do you think there should have been?
Dr Andrew Goodall: So, as I said earlier, no, there was no direct connection between us and SAGE. We expected that Welsh Government would be invited to join SAGE at both ministerial and official level, and if it was thought appropriate by Welsh Government for Public Health Wales representation in support of their minister or officials, then we would have been pleased to provide that.
Counsel Inquiry: All right.
Could we go to page 31, please.
Now, in relation to community care, we can see that the guidance here is that:
“As demand for hospital care increases, patients discharged home may require a greater level of care than they would do normally. Social and community care services may face particular challenges that include …”
There are a series of bullet points there.
Just moving down below the bullet points:
“Care of individuals in the community therefore presents a diverse and complex challenge at a time when staffing capacities are likely to be reduced. Close working relationships across health and social care organisations, the independent sector and voluntary groups will be essential to sustaining services during a pandemic.”
Do you agree, Dr Sandifer, that this plan should have included more guidance around when someone should be discharged from hospital and what should happen on discharge back into the community, for example guidance on sending tested or untested patients to care homes or back into the community?
Dr Andrew Goodall: Obviously that became an important issue during the coronavirus pandemic, and I can see that that could have been helpful to the health boards, and incidentally it was the health boards and the local government overseeing social care services that would have been the principal beneficiaries of that guidance.
Counsel Inquiry: All right.
Do you agree that there is also a failure or a gap in this guidance to include advice in terms of when lockdowns or social distancing measures of any description could or should have been implemented?
Dr Andrew Goodall: Well, on lockdowns, I think it’s fair to say from my own professional experience I hadn’t envisaged circumstances where we would have locked down a whole society or, indeed, a whole country in the way that we did in March 2020. Of course self-isolation of individuals or perhaps a family unit, or quarantine of a small defined population, are established principles in public health infectious disease control. But lockdowns took us into completely unchartered territory.
Counsel Inquiry: But there’s nothing in this document about any social distancing measures of any severity, from mixing with people within your community and that being restricted to the other end of the spectrum, which is lockdown; is that a mistake?
Dr Andrew Goodall: I would expect our health boards, working through their local resilience fora, to be familiar with the basic tenets of social distancing as a regular or a normal practice in reducing community transmission. So at the – if you like, that end of the spectrum, I’m not sure that that needed formal guidance. But of course lockdowns I don’t think were anticipated in the way that they were implemented, and that is the reason why they don’t appear.
Counsel Inquiry: All right.
Well, before we turn away from plans and guidance, I’d just like to look at two more documents, please.
The first is at INQ000089572, and this is the Welsh Government’s Wales Framework for Managing Major Infectious Disease Emergencies.
I know that the Inquiry has already looked at this document. It’s dated October of 2014. We can see at the bottom left-hand corner it’s issued by the Health Resilience Branch of Welsh Government.
I would just like to look at paragraph 1.1 on page 5, please, and 1.2 as well, if we could zoom in, please, on those two paragraphs.
We know that:
“This Framework sets out generic arrangements for the management of major infectious disease emergencies by health services in Wales and should be considered in the context of the principles set out in …”
Then there’s four more pieces of documentation and guidance: the NHS Wales Emergency Planning Guidance, the Cabinet Office statutory guidance Emergency Preparedness, and the non-statutory guidance Emergency Response and Recovery, and the Pan-Wales Response Plan.
“The Framework is supported by the following guidance …”
We’ve then got five more pieces of guidance:
“The Communicable Disease Outbreak Plan for Wales …
“The UK National Framework for responding to an influenza pandemic …”
Which we’ve already mentioned.
“Guidelines for Smallpox Response …
“Wales Health and Social Care Influenza Pandemic Preparedness & Response Guidance …”
Which we’ve just looked at.
And:
“NHS Wales Guidance Mass Casualties Incidents – A Framework for Planning.”
This was a complicated business, wasn’t it?
Dr Andrew Goodall: It was.
Counsel Inquiry: Did you, in your role at the time, find it unhelpful that there were so many different pieces of guidance and planning documentation that would need to be assessed and considered in the outbreak of a pandemic?
Dr Andrew Goodall: I was very conscious that you had to have a good understanding of the range of organisations and guidance to be able to navigate your way through this.
Counsel Inquiry: Right. Far better, do you agree, Dr Sandifer, to have a slimmed down, simplified set of guidance and plans for everybody to be able to understand and follow?
Dr Andrew Goodall: There’s absolutely no doubt that the principle of consolidating and simplification is a good idea, would have been helpful, but I think it’s just worth recognising the context of a couple of these plans.
The Communicable Disease Outbreak Plan for Wales, which we haven’t discussed yet, that was really a plan for responding to local outbreaks, whilst this framework was for responding to infectious disease threats that might affect the whole of Wales.
So I think it’s important to recognise that there was some need for distinguishing between a plan to deal with something at a local level, between something at a national level, but the general premise of simplification would have been helpful.
Counsel Inquiry: All right, thank you.
Well, let’s look, please, finally, at the Communicable Disease Outbreak Plan for Wales, which is at INQ000089575. Thank you.
Can we go to page 2, please.
Now, we can see under the preface, written in April of 2014:
“In recent years, there have been multiple plans in Wales for the investigation and control of communicable disease. All these have contained very similar guidance. Whilst it has been recognised that each individual plan was robust and fit for purpose, the presence of several plans for use in outbreaks has caused confusion as to which plan should be followed. Therefore, at the request of the Welsh Government, a multi-agency working group was convened in 2008 to draw the plans together into one generic template.”
So just pausing there, this is a reaction in April of 2014 to multiple plans for the investigation and control of communicable diseases, so this was an effort undertaken in 2008, to simplify things, but, as we’ve just seen, in fact, although this one response deals with this particular area, when you look more widely there were still multiple pieces of guidance and planning documentation that was still in existence?
Dr Andrew Goodall: That’s correct.
Counsel Inquiry: Can we move down, please, to look at the full page. Thank you. If we can go over to – oh, in fact, before we do that, can we just highlight what we can see in bold in the middle of the page, please. Because when we look at what was used to create this plan, we can see that it’s an amalgamation of a major outbreak of food poisoning plan, an emergency framework for health-related incidents and outbreaks in Wales and Hertfordshire from contaminated drinking water, and then, finally, the model plan for the management of communicable disease outbreaks in Wales.
So, so far as this Inquiry is concerned, that is the model plan upon which this document was able to draw?
Dr Andrew Goodall: Yeah, if I could just clarify something about the development of this plan. We had a series of plans – highlighted in bold here – in the early noughties, which we recognised caused confusion, as the first paragraph states. The work began in 2008. The first version of the Wales Communicable Disease Outbreak Plan was actually published in 2011, and then we kept it under review and this plan reflected an updating of the 2011 communicable disease outbreak plan in April 2014.
Counsel Inquiry: All right. Well, I want to look further back, please, because the Management of Communicable Disease Outbreaks plan upon which this was based, taking into account what you’ve just said about there being an interim plan in 2011, was first written in 1995; is that right?
Dr Andrew Goodall: As I understand it, yes.
Counsel Inquiry: And not updated until this plan was brought into force, although we can see that there was a draft update in 2007.
Dr Andrew Goodall: So there was a draft update in 2007, and then that plan, together with the other two plans, consolidated into the 2011 plan that I’ve just referred to.
Counsel Inquiry: Yes.
Why was the Management of Communicable Disease Outbreaks plan not updated between 1995 and 2011?
Dr Andrew Goodall: I don’t know the answer to that. It pre-dated my time in office.
Counsel Inquiry: Do you think that by 2011 the 1995 plan was massively out of date?
Dr Andrew Goodall: Well, the 1995 plan had been updated, but it was in a draft form –
Counsel Inquiry: Well, according to – I’m so sorry, Dr Sandifer, but according to this note, although a draft update was in force in 2007, from what you’ve told us, that wasn’t formalised until 2011.
Dr Andrew Goodall: That’s right.
Counsel Inquiry: All right.
Dr Andrew Goodall: But I would anticipate that our communicable disease specialists would have been working to the most updated plan, even if it was still in draft format.
Counsel Inquiry: But why wasn’t it updated between 1995 and the draft update of 2007?
Dr Andrew Goodall: I don’t know the answer to that question.
Counsel Inquiry: Does that concern you?
Dr Andrew Goodall: It is a very long time, and I would have expected our plans to have been reviewed and updated in a period of 12 years, at least once or twice.
Counsel Inquiry: Yes. So does it concern you that it wasn’t, according to this note?
Dr Andrew Goodall: If I – yes, I mean, it’s a concern that 12 years elapsed between updating of a plan.
Counsel Inquiry: Again, I have to ask: does the fact that the communicable diseases outbreaks plan was in abeyance, I’m going to suggest, demonstrate that this was not a subject at the forefront of those who should have been thinking and planning about it?
Dr Andrew Goodall: I don’t think that’s a fair characterisation of the people who were responsible for discharging communicable disease control during that period. It is a fact, and I’m not disputing that, for a period of 12 years it would appear that this plan was not updated, and I don’t have information to explain that.
Counsel Inquiry: All right. Well, I’d like to go back, please, just for a moment to the emergency response plan that we’ve looked at briefly, the Public Health Wales Emergency Response Plan, which is at INQ000089558, because I’d just like to for a moment concentrate on what level of consideration was given by Public Health Wales in this emergency response plan to vulnerable people.
We can see that consideration at page 25:
“Public Health Wales is required to give special consideration to those who are made vulnerable as a result of the emergency or who are less able to help themselves in the circumstances of an emergency.”
And we see at 14.5:
“Those who are vulnerable will vary depending on the nature of the emergency. For planning purposes the Cabinet Office Guidance … states that there are broadly 3 categories that need to be considered …”
Then we have those with mobility problems, those with mental health or learning difficulties, and dependents such as children.
So it rather looks as if Public Health Wales were taking their lead as to who would qualify to be described as vulnerable from the Cabinet Office guidance at chapter 5 of the emergency planning – Revision to Emergency Preparedness document?
Dr Andrew Goodall: Yes, I would accept that.
Counsel Inquiry: Do you think that that was an extensive enough description of who should be categorised and considered as vulnerable?
Dr Andrew Goodall: Well, in hindsight and reflecting from today, no, I don’t.
Counsel Inquiry: Because it doesn’t contain any mention of the elderly or those with comorbidities or those suffering from health inequalities, does it?
Dr Andrew Goodall: No, it doesn’t explicitly refer to those, but the way I would expect this section of the plan to be implemented is that the – in the circumstances of an emergency, a risk assessment would be undertaken. The populations most at risk in the course of that incident would be identified, and the responders would pay due attention to those. But – and that could be a very, very long list, but this does reflect what the chapter 5 says in the guidance.
Counsel Inquiry: Has that narrow definition now been expanded?
Dr Andrew Goodall: So Public Health Wales recognises that it needs to take a more, to quote Alexander and Mann, “people-centred approach” to its emergency response planning, and the current guidance plan that was recently published takes us some way toward that but acknowledges that there is still further work to be done to address that issue.
Counsel Inquiry: Is that plan that you’ve just mentioned, the updated plan, an update of this?
Dr Andrew Goodall: It is.
Counsel Inquiry: What’s the date of it, please?
Dr Andrew Goodall: May of 2023.
Counsel Inquiry: So the current position is that, as you’ve just told us, Dr Sandifer, the definition has been broadened but on reflection now it needs to be broadened even further?
Dr Andrew Goodall: So it has been broadened and in very particular way to take account of inequalities, recognising the particular impact inequalities had during the coronavirus pandemic. But it’s my view that that plan represents a stage in a process that still needs further development, and I understand that my successor has had conversations with his strategic partners to signal the need for us to continue that work.
Counsel Inquiry: Do you know when that will be completed?
Dr Andrew Goodall: I don’t know when that work will be completed. The plan has just been approved and I would envisage that Public Health Wales will attend to that now.
Counsel Inquiry: Are you able to help us with the detail of how that current definition still requires to be extended?
Dr Andrew Goodall: Well, this definition is still within the guidance. These groups are still relevant categories –
Counsel Inquiry: Yes.
Dr Andrew Goodall: – in any future plan. I would envisage that the plan as it develops might move away from the expression of “vulnerable persons”, although that is generally recognised within the EPRR community, and set out more broadly the wider range of vulnerabilities in the population that the plan should consider.
Counsel Inquiry: So I’m going to press you on this. What isn’t contained in the current 2023 guidance that needs to be contained within it?
Dr Andrew Goodall: Well, the guidance does refer to inequalities, but I think it could go further and expand on what that means in terms of different population groups, minority ethnic groups, for example, who were particularly vulnerable during the coronavirus pandemic.
Counsel Inquiry: For whatever reason that level of detail has not yet found its way into the 2023 guidance?
Dr Andrew Goodall: That, I think, is simply a reflection of the scale of work that Public Health Wales is still engaged in, in the transition of Covid-19 into an endemic and the recovery work associated with that.
Ms Blackwell: All right. Thank you very much.
Those are all my questions for Dr Sandifer.
I understand, my Lady, that you’ve provisionally provided permission for Bereaved Families for Justice Cymru to have five minutes of questions on particular topics.
Lady Hallett: I have, thank you.
Questions From Ms Shepherd
Ms Shepherd: Thank you, my Lady.
Dr Sandifer, I ask questions on behalf of Covid-19 Bereaved Families for Justice Cymru.
I want to look at an exhibit in your witness statement. If we could have up on the screen, please, INQ000089594.
So this is the report to inform policy on airborne isolation rooms in major acute hospitals, and it’s the Report of the airborne Isolation Rooms Review Working Group on behalf of Welsh Government.
If we have a look at the date, it’s 18 October 2017, and we can see the purpose and summary of the document at the bottom.
If we look now, please, at page 2, in the introduction, and it’s the top paragraph, it says here:
“Since 2006 NHS Wales Shared Services Partnership – Specialist Estates Services … have surveyed and produced an annual report on all airborne isolation rooms in major hospitals across Wales. Every year the reports have concluded that many of these airborne isolation rooms are inadequate for the purpose intended when assessed against current best practice.”
Then the rest of that introduction just outlines why there needs to be a working group to look at this.
If we then look, please, at page 3, next, these are the recommendations and this is an indicative list of the organisms requiring airborne isolation facilities. Subparagraph (f): “SARS like infections and MERS CoV”.
If we have a little look down at the bottom of the page there are some recommendations. Recommendation 2:
“Every hospital in Wales with a 24-hour Emergency Unit must have at least one Negative Pressure Suite located within that Emergency Unit.”
Then the recommendation below:
“Every Health Board in Wales must have at least one Negative Pressure Suite able to accommodate a case requiring respiratory isolation …”
If we have a look now, please, at page 13 of this document –
Lady Hallett: Ms Shepherd, just before you go on, can you alert me to which is the question I have given permission for you to ask.
Ms Shepherd: Yes, my Lady, you gave me permission to ask why there hadn’t been an update to the airborne isolation facilities in accordance with this document.
Lady Hallett: Sorry, I must have lost it. Anyway, okay.
Ms Shepherd: If we have a look at page 13, the very bottom bullet point of this page, it says:
“Current building structures do not support safe management of patients with infectious diseases, pose significant threats to the capacity of the hospitals following admission even of suspected cases, pose a threat to the well-being of healthcare staff …”
So that was the case as at 2017. Ms Blackwell KC put to you earlier some meeting minutes from 2019 when the CMO, Sir Frank Atherton, had raised the issue with ability to deal with HCID infection. Was that still the case as of January 2020?
Dr Andrew Goodall: Yes, I expect it was. I certainly raised it as a concern, an ongoing concern, in July of 2019 with the Chief Medical Officer. I fully recognise this report and I fully agree with the content of this report.
I should state here for clarity: the responsibility for ensuring that there are safe isolation facilities on the healthcare estate rests with the health boards in Wales.
Ms Shepherd: Could we have a look, finally, please, in this document, at page 14, in the very top bullet point:
“None of the Health Boards are designed to deal with such threats and there is no hospital in Wales currently that has a facility to manage emerging infectious threats at an optimal level.”
So since 2006 this has been raised, it was raised in this document in 2017, and it was raised again by the CMO Frank Atherton in 2019, we get to January 2020 and still nothing has been done to address this; do you agree?
Dr Andrew Goodall: I agree that this was a significant area that, yes, had not yet been adequately dealt with over a very long period of time.
Ms Shepherd: Does that reflect that there was a lack of urgency in Wales to address this issue and lessons were not learned?
Dr Andrew Goodall: I can’t speculate on the precise reasons for that. As I say, Public Health Wales has flagged this as an issue over the years, but the issue clearly was not fully addressed by the time Covid-19 came along.
Ms Shepherd: Does that reflect a lack of urgency to deal with infection control generally in hospitals?
Dr Andrew Goodall: Again, our health boards, who have responsibility for the hospitals in Wales, also have a responsibility for healthcare-associated infections and antimicrobial resistance, and again that was a journey that they were still on. Public Health Wales had worked with them over the years to address the performance and generally progress had been made, some had made better progress, but we were not yet where I would have liked by the time we reached the end of 2019.
Ms Shepherd: Thank you, my Lady.
Lady Hallett: Thank you, Ms Shepherd, I did find the question in the end. Thank you.
Ms Blackwell.
Ms Blackwell: Thank you, that concludes Dr Sandifer’s evidence.
The Witness: Thank you.
(The witness withdrew)
Lady Hallett: I think the suggestion is I should take a shortened lunch break because we’ve got quite a heavy afternoon.
Ms Blackwell: Yes, my Lady, would you consider perhaps sitting again at quarter to? Thank you very much.
Lady Hallett: Very well, quarter to. Thank you.
(12.58 pm)
(The short adjournment)
(1.45 pm)
Lady Hallett: Ms Blackwell.
Ms Blackwell: Good afternoon, my Lady. May I please call Vaughan Gething.