2. Mr Vaughan Gething

MR VAUGHAN GETHING (affirmed).

Questions From Counsel to the Inquiry

Ms Blackwell: Thank you, Mr Gething, and thank you for the assistance that you’ve so far provided to the Inquiry. Thank you for coming to give evidence today.

Your witness statement is at INQ000187304. If we go to page 20, please, we can see that it was signed on 19 April of this year, and can you confirm, please, that it’s true to the best of your knowledge and belief?

Mr Vaughan Gething: Indeed, yes.

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

Now, dealing with your professional background, so far as it’s relevant to this Inquiry, in 2003 you were president of the Wales TUC Cymru, you were also a partner at the law firm Thompsons LLP. In May of 2011 you became a member of the Senedd for Cardiff South and Penarth. In June of 2013 you were appointed as Deputy Minister for Tackling Poverty, and in September 2014 as Deputy Minister for Health.

By May of 2016 you had become Cabinet Secretary for Health, Well-being and Sport, and you maintained that position when the name of that portfolio was changed in 2018 to Minister for Health and Social Services, and from May of 2021 you have been Minister for the Economy; is that right?

Mr Vaughan Gething: That’s correct.

Counsel Inquiry: Thank you.

So you held roles within the Ministry of Health in one way or another since September of 2014, but before October of 2016 is it right that you had not been presented with the fact that a pandemic was a significant health risk to Wales?

Mr Vaughan Gething: Well, I understood that if a pandemic happened it would be – it wasn’t, as it were, brought to my direct attention that it was something that I needed to be particularly prepared for. I had other priorities, not this.

Counsel Inquiry: So when did you become aware that a pandemic was a priority for Wales?

Mr Vaughan Gething: In the run-up to Exercise Cygnus with the briefing, I can’t remember which officially it was, but described the fact that there was a request for an exercise and for my attendance and participation, which obviously I undertook.

Counsel Inquiry: When you became Deputy Minister for Health, did you understand at that stage that pandemic influenza in particular was a Tier 1 risk for the United Kingdom?

Mr Vaughan Gething: No, it wasn’t the focus of my role as Deputy Minister for Health.

Counsel Inquiry: Well, did you understand that it was a Tier 1 risk? It might not have been a focus, but did you know at that time –

Mr Vaughan Gething: No, no, because pandemic preparedness would have rested with the Cabinet Minister for Health at the time. My role was very much on NHS performance and the link with social care in as far as it affected delayed transfers of care.

Counsel Inquiry: So until you became Minister, Cabinet Minister, you had no knowledge that pandemic influenza was a Tier 1 hazard?

Mr Vaughan Gething: No, not in the way it’s described now, no.

Counsel Inquiry: Becoming Minister in May of 2016, did it take five months for you to become aware of the pandemic threat?

Mr Vaughan Gething: So when I became the Minister, the Cabinet Minister, I received a briefing which did mention pandemic preparedness but there wasn’t an in-depth briefing, and it was in the – as I say, in the run-up to Operation Cygnus, the Cygnus exercise, that I was much better informed about the preparation for a pandemic and, indeed, the potential scale of it, and its relationship in the UK-wide risk register.

Counsel Inquiry: So before the briefing in October of 2016, what did you know? At the time that you became Cabinet Minister, did you understand that pandemic influenza was a Tier 1 risk?

Mr Vaughan Gething: Not in those exact terms, I think that would be wrong. I knew that we had pandemic preparedness, and I’d seen it and read my initial briefing, obviously, but not in the way it’s now described in the Tier 1 risk register. It would be wrong for me to try to tell you that I understood that it was in the Tier 1 risk register. That was definitely in the run-up to and the briefing for Cygnus.

Counsel Inquiry: So what did you know of it in May 2016, what did you know of pandemic influenza?

Mr Vaughan Gething: I knew that it was a potential risk. I’d obviously lived in Wales and so was aware that swine flu had been something that the government had had to deal with, so it was a much – much more general than the specific awareness of it being a Tier 1 risk in the UK-wide risk register.

Counsel Inquiry: As newly appointed Cabinet Secretary for Health, Well-being and Sport, didn’t you think that it was your business to understand what was the most pressing health risk to Wales?

Mr Vaughan Gething: In the briefing that I had, it described the fact there was work ongoing about pandemic preparedness, it described the fact that this was something the department was responsible for at the time of my appointment. In terms of the most pressing risk, the risk register I think describes if these things come to pass these are the biggest risks that can happen. My job, in terms of being the Health Secretary for all the risks I had in front of me, were the very standard things in a politically contested environment.

Counsel Inquiry: Can we take it that if you didn’t appreciate it was a Tier 1 risk, you didn’t read the National Risk Register or the assessment?

Mr Vaughan Gething: No, I did not read the National Risk Register.

Counsel Inquiry: Nor did you read any of the guidance and documents that we’ve been through during the course of this Inquiry so far? I’m going to describe it as a myriad of guidance and plans that were in force at the time dealing with civil emergencies in general and pandemic influenza in particular.

Mr Vaughan Gething: No. I’m aware you have gone through a range of plans with previous witnesses and I did not read those on my entry into the post.

Counsel Inquiry: When did you read them?

Mr Vaughan Gething: I’ve read some of them for the first time in preparing for this Inquiry, because as a minister, for some of those documents, they’re not actually read – for the minister to read, it’s about how the system, the overall system is prepared. I did obviously receive briefings on our pandemic preparedness from Cygnus onwards at various points in time, and they’re included in the documents before the Inquiry.

Counsel Inquiry: All right.

Lady Hallett: Just pausing there, sorry, Mr Gething, like me you speak very quickly and we have a struggling stenographer.

Mr Vaughan Gething: Okay.

Lady Hallett: So I have to train myself to try to slow down.

Mr Vaughan Gething: I will try to speak slightly slower.

Ms Blackwell: Thank you.

The Inquiry has heard much about the United Kingdom influenza preparedness strategy of 2011, and you will now be familiar with that document, Mr Gething.

Mr Vaughan Gething: Yes, I see it.

Counsel Inquiry: Yes. It doesn’t feature at all in your witness statement. When did you first read it?

Mr Vaughan Gething: I read it in advance – I read it and looked over it in advance of preparing for this Inquiry.

Counsel Inquiry: So whilst you were in post as Cabinet Office Minister for Health and Social Services, you hadn’t read the United Kingdom Influenza Pandemic Preparedness Strategy?

Mr Vaughan Gething: No, I’d received briefings on the strategy in advance of Cygnus and indeed briefings on our own strategies in Wales to try to implement those.

Counsel Inquiry: Were you aware during your time in office that the Welsh Government had implemented the strategy into their own planning?

Mr Vaughan Gething: Yeah, that was my understanding, yes.

Counsel Inquiry: All right. Does that mean that you were aware, then, of the Wales Framework for Managing Major Infectious Disease Emergencies?

Mr Vaughan Gething: I was aware of it insofar as I was briefed on it, but, as I say, that document isn’t written for ministers to run through and to read through. And I think it’s part of the point where you sit as a minister within the system and the choices you’re required to make. If I chose – if I read all of those documents and others within my brief, then I wouldn’t get to do anything else. It’s a choice about how ministers’ time is used.

Counsel Inquiry: There is no mention of that document in your witness statement. Can we take it from that that, although you might have been aware of it, you didn’t read it whilst you were in office?

Mr Vaughan Gething: That’s correct.

Counsel Inquiry: Were you aware of the planning assumptions that form the basis of both of those documents, the UK-wide and the Wales document?

Mr Vaughan Gething: Yeah, and that forms part of the briefing that went into Operation Cygnus and so it set out the point about the risk register, it set out the planning assumptions on an influenza pandemic being the most likely of the pandemics that could come. So those planning assumptions were part of that, and obviously they were part of how Cygnus was run as an exercise.

Counsel Inquiry: Did you ever question whether those planning assumptions were tolerable or whether they might be mitigated?

Mr Vaughan Gething: I didn’t question the assumption that an influenza pandemic was the most likely of the pandemic risks, and in terms of what was tolerable I think that comes into some of the things we went through in the Cygnus and some of the follow-on work, and then obviously we had to deal with those as very live issues during the Covid pandemic.

Counsel Inquiry: When you were in office, were you aware of the Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance of 2014?

Mr Vaughan Gething: I wouldn’t say I was aware of the detail of it. Again, I read that document, and looked over it more fully in preparation for this Inquiry, but I received briefings on the document and on the requirements in it around Cygnus and afterwards, and you’ll see it’s mentioned in a number of the documents that then come to me in the briefings I received from officials.

Counsel Inquiry: So did you read that document whilst you were in office?

Mr Vaughan Gething: No, I didn’t read it in detail, because, as I say, I’d received a briefing on what’s generally required in the documents and how that then would affect the choices you might have to make as a minister.

Counsel Inquiry: Were you aware as part of your briefing to that document that paragraph 1.3 says that it will not be possible to stop the spread of the pandemic influenza virus in the country of origin or in the UK as it will spread too rapidly and too widely?

Mr Vaughan Gething: I’m aware that’s the planning assumption and, as I say, in the run-up to Cygnus the assumption of that exercise was that flu was already here and the challenge of dealing with an influenza pandemic, again the assumptions were it would already be here in numbers and it would be spreading. So that challenge was there. But I don’t want to – in terms of the specific paragraph and had I read that before, that’s not correct, but I was aware of the assumption, as you put it earlier, in planning terms.

Counsel Inquiry: Do you agree with the evidence that the Inquiry has heard from other witnesses that that was a flawed doctrine, that really there should have been consideration given to preventing the spread rather than accepting that influenza would spread and that mitigation of how to deal with the fallout from that was all that the plan related to?

Mr Vaughan Gething: Yes, I’ve heard the witness evidence from a number of people that it was a flaw to assume that it would be an influenza-type pandemic and it would already be here. There are, of course, questions you will come in to, I’m sure, about how far you could either prevent or contain something like that.

Counsel Inquiry: If you didn’t read these documents themselves and only relied upon the briefings you were given, would you have been aware of the absence in them of any guidance about the scaling up of contact tracing, or moving patients or quarantining or indeed lockdown?

Mr Vaughan Gething: Well, there’s a number of points there. So the guidance on a scaling up activity or moving patients, that was part of what we went through in Cygnus, so I did have an understanding that if you had a pandemic of that scale, then you would need to make uncomfortable choices that would require moving people around the system.

Counsel Inquiry: Yes.

Mr Vaughan Gething: And that would probably require stopping some things to allow more capacity to be created.

So there was a final part to your question as well?

Counsel Inquiry: Yes, contact tracing, moving patients around, quarantining and lockdown.

Mr Vaughan Gething: Yes. So on quarantining, I have heard the evidence of Dr Sandifer this morning and I did understand, because of particularly some of the localised outbreaks we had, that quarantining in community or family groups was entirely possible, but not at the scale that was envisaged and there was not a genuine consideration of the scale or the depth of the Covid pandemic, so there wasn’t then a consideration presented to me – and I think this evidence is common to all nations in the – UK, of the scale of the lockdowns that were then considered and implemented during the Covid pandemic. So in terms of preparation there wasn’t preparation that considered that scale of lockdown.

Counsel Inquiry: We’ll come to deal with Operation Cygnus in a moment, but just on the issue of your level of knowledge, did you as Minister for Health, commission any research, advisory papers or briefings to you as to what the evidence was telling the scientists in terms of this pandemic influenza hazard?

Mr Vaughan Gething: No, because I did rely on the briefings that I received, on the advice I received.

Counsel Inquiry: So nothing –

Mr Vaughan Gething: It’s hard to second-guess the advice you’re being given as a minister, whether you’re new or not, and to decide which areas you do want to try to second-guess on it, and I did rely on the advice provided and the provisions within it, and obviously in hindsight there are good reasons to question and to look afresh at what we do.

Counsel Inquiry: But nothing in the briefings that you received, nothing about the detail of the pandemic influenza threat caused you to request any further advisory papers or evidence gathering to take place in order to try to work out what Wales needed to do to mitigate this threat?

Mr Vaughan Gething: No, I had advice from officials who had expertise, and obviously you’ve heard the way our system is constructed with Public Health Wales and others within it, that advice was provided, and at the time I had no reason to go and to want to go behind it or to question it, so I did rely on the advice I was given.

Counsel Inquiry: You tell us in your witness statement that you first read the Pan-Wales Response Plan in January of 2020?

Mr Vaughan Gething: Yes.

Counsel Inquiry: Yes, did you know of its existence before that date?

Mr Vaughan Gething: I think, again, it was referred to and briefed in and around Cygnus, but I read it in the January, and that was after, obviously, the first indications about Covid in China.

Counsel Inquiry: You tell us at paragraph 37 in your witness statement:

“My impression of the Plan, as a layman and someone without any previous experience or knowledge of pandemic preparedness, was that it was considered and reasonable. I do not think I first saw it [as we’ve established] until January 2020.”

Is it right, Mr Gething, to describe yourself as a layman when you had been the Cabinet Minister for Health since 2016?

Mr Vaughan Gething: I’m describing myself in comparison to, for example, the people you’ve already heard evidence from. I wasn’t the Chief Medical Officer or the Medical Director of Public Health Wales or the people involved in emergency planning, so in that sense it is a lay perspective, but obviously compared to the wider population I’ve got experience in government of doing a range of things.

Counsel Inquiry: Describing yourself as having no previous experience or knowledge of pandemic preparedness when you had been four years in post might be surprising to some people.

Mr Vaughan Gething: Again, I think if … I’m trying to be clear about the difference between myself and people involved in the detail of emergency planning. So compared to the general population, I certainly had more experience and knowledge, and I’m trying to be clear about that distinction rather than trying to go beyond it.

Counsel Inquiry: What level of contact did you have with the Chief Scientific Adviser for Health, Dr Rob Orford?

Mr Vaughan Gething: I saw Dr Orford on a number of occasions through the year. So in the pattern of that sort of engagement, I would have a regular meeting with the Chief Executive of NHS Wales, I’d have a regular meeting, normally at least monthly, with the Chief Medical Officer, sometimes sooner, and for some officials like Dr Orford I’d probably see them three or four times a year in set meetings. So, for example, some of the points that have been described around investing in our genomics capacity, some of that came from conversations with Dr Orford and Dr Atherton about what we needed to do. So I was – I knew who Rob was, I’d met him on several occasions before we get into the depths of the Covid pandemic.

Counsel Inquiry: Between you taking office in 2016 and the onset of the pandemic in 2020, were you aware that the Chief Scientific Adviser for Health had no involvement in pandemic preparedness planning?

Mr Vaughan Gething: No, I wasn’t aware of that specifically, no.

Counsel Inquiry: Does that surprise you?

Mr Vaughan Gething: In retrospect, it is, because he had such a role in giving advice to ministers when we actually had to deal with the scale of the pandemic.

Counsel Inquiry: Were you aware during your time in office of the Welsh Government risk register?

Mr Vaughan Gething: Yes, I knew we had a Welsh Government risk register.

Counsel Inquiry: Did you ever read it?

Mr Vaughan Gething: No.

Counsel Inquiry: Were you aware of the Health and Social Services Group risk register?

Mr Vaughan Gething: Yes, and I would discuss that from time to time as(?) it was raised with me by the Director General at the time, obviously who was Dr Goodall.

Counsel Inquiry: Did you read it?

Mr Vaughan Gething: No, I don’t think I did go through and read the risk register.

Counsel Inquiry: You tell us at paragraph 19 in your witness statement:

“My impression was that UK Ministers did not take ministers and officials from the devolved governments seriously.”

Is that how you felt all the way through your time as Cabinet Office Minister? Cabinet Minister, sorry.

Mr Vaughan Gething: It changed during the course of the pandemic, is –

Counsel Inquiry: Right.

Mr Vaughan Gething: So actually until that time, yes, that was my clear impression; and, with respect, I think the evidence of Mr Hunt confirms that.

Counsel Inquiry: Did you raise your dissatisfaction with how the UK ministers treated you as a devolved minister with any of the UK ministers at the time?

Mr Vaughan Gething: Well, that was challenging, because there was a choice about the lack of contact, which I go through in my evidence. Correspondence would either not be answered or take months to answer, as I set out. So it was one of the challenges, was that – the point about contact was a deliberate choice from the UK side, and my view has always been there is plenty of room for the political disagreement but there also has to be space made for pragmatic engagement because we always need to do business together on a range of things.

Counsel Inquiry: In your view, Mr Gething, did the strained ministerial relations hamper pandemic preparedness in Wales?

Mr Vaughan Gething: Yes, I do think they had an effect, I think they would have been better if we had had some form of ministerial engagement beyond the Cygnus exercise.

Lady Hallett: To be fair, I don’t think Mr Hunt said that he accepted that the UK ministers hadn’t deliberately contacted you or avoided you or treated you with disrespect, what he said was there was a difficult political relationship.

Mr Vaughan Gething: Again, I think that Mr Hunt’s evidence does not disagree with my evidence, he simply does not agree with the positive points that I make that it was a choice. We would request meetings. We wrote on a number of issues. We didn’t write every week, it wasn’t, “We’ll write a letter and see if we get a response”, when we wrote on real and serious issues we did not get a response or it took a very long time to get a response, and that isn’t an accident. They knew who I was and what I was writing for.

In no-deal Brexit preparation, I did not meet the Cabinet Minister for Health, whether it was Mr Hancock or Mr Hunt, and again that’s a choice. When you then have to deal with each other, as we did, you were starting relationships from anew with someone you’d never met, and I think that is suboptimal.

Lady Hallett: He did mention that there were good relationships between officials even if the politicians weren’t getting on, as perhaps most of us would like to think they would try to get on. In what way do you think things might have been different if the ministers had had the kind of contact one would hope and you were talking about?

Mr Vaughan Gething: When ministers talk and pragmatically agree, it always helps to speed up decision-making, and it can often help to highlight risks and opportunities. I see that in my current role as well as my previous one. So I do think that if there’d been ministerial engagement even only once after Cygnus it would probably have moved along preparedness for all of us.

I say in my own statement that I think that there were good relationships between officials, but, as I say, I think it would have been assisted if, despite the fact that we are politically very competitive, especially around the politics of the health service, there should always be room for some pragmatism and you have to do business. You don’t have to like the person on the other side of the desk, but you should from time to time meet.

Ms Blackwell: Thank you, my Lady.

Was it your experience as a minister, Mr Gething, that the public-facing political concerns set the agenda, and that was to the detriment of forward planning for things like a pandemic influenza?

Mr Vaughan Gething: So the public facing concerns definitely affected the agenda because every day something could happen that you would end up having to deal with as the minister. That’s life in ministerial office, especially if you’re a health minister.

At the start of the term, what we’re trying to do was to deliver a long-term plan for health and social care, and so I was trying to do that whilst dealing with the very headline issues as well. So, yes, it did mean that other issues had less attention. Antimicrobial resistance, for example, I know it was mentioned in evidence earlier today, that was an issue that got occasional attention between not just myself but in the animal health field, veterinary health field as well. Pandemic preparedness was never a subject of questions, never a subject of scrutiny within the Welsh Parliament, and I suspect that will change and that will be a change for the better.

Counsel Inquiry: Does that mean at the time that there was limited – it was given a limited priority by the government?

Mr Vaughan Gething: It didn’t have the same priority as those headline issues that did take up lots of the life and the energy of the government, and I know you’ve heard from other evidence that there was – preparedness was taking place but it wasn’t – it didn’t have the same intensity that trying to deliver a long-term plan had or responding to the latest very public challenges that our whole system, not just the minister, would have to deal with.

Counsel Inquiry: Do you think that there needs to be a check on what is appearing or coming down the line in the long term as well as the focusing of ministers’ attention on the here and now?

Mr Vaughan Gething: That’s the difficult balance to strike. So at the end of 2018 and into 2019 I was dealing with a maternity – a significant cluster of serious harm in maternity services in the Cwm Taf health board, so that was an issue that I wasn’t aware of until it was brought to my attention by officials. I then had a meeting where we then had to do a number of very difficult things, and that took time that – that was entirely appropriate and it was the right thing for my time to get directed at, but it meant that other things then needed to move.

So there is the challenge of what comes up, where you do need to shift your priorities, as well as your point about longer term priorities, and that’s definitely a lesson learning point, not just for people in the government but more widely as well I think.

Counsel Inquiry: I want to turn now to discuss with you your knowledge and involvement in the exercises that the Inquiry has heard so much about.

The Inquiry heard this morning in questions put to Dr Goodall about an exercise in April of 2009 called Taliesin. During your time in office, were you aware that that exercise had taken place?

Mr Vaughan Gething: It’s Exercise Taliesin, Welsh poet.

Counsel Inquiry: I do beg your pardon.

Mr Vaughan Gething: But no, I wasn’t aware, and of course 2009 is before I was elected.

Counsel Inquiry: Yes, I understand that, but the result of that exercise and one of the recommendations being consideration given to the social care sector, that wasn’t something that was brought to your attention?

Mr Vaughan Gething: Not in pandemic preparedness and planning terms, but the social care sector was very important to me in terms of running the whole health and social care system, that’s why we had a long-term plan for health and social care, but not in the specific context of pandemic preparedness and planning.

Counsel Inquiry: The first Exercise Cygnus, in 2014, which was held in Wales, were you aware of that exercise at the time? I think you might have been Deputy Minister for Health at the time that that took place, or indeed shortly afterwards.

Mr Vaughan Gething: Yes, so I started in September 2014 as the Deputy Health Minister, but I wasn’t aware of the Wales-only Exercise Cygnus operation.

Counsel Inquiry: All right. One of the recommendations that this Inquiry has heard fell out of that exercise was the concerns around the capacity and readiness of privately owned care homes to be able to cope with the likes of a pandemic and having their own contingency plans in place. So that wasn’t brought to your attention?

Mr Vaughan Gething: Not that specific – in relation to the pandemic. The broader points, though, about the future of the sector were much more in my mind. And, as the deputy minister, delayed transfers of care is definitely an area where you can’t resolve that without health and social care working together, but that’s not the same as looking at it through the lens of pandemic preparedness.

Counsel Inquiry: Whilst you were in the role of Deputy Minister for Health, were you aware of Exercise Dromedary that took place in 2015?

Mr Vaughan Gething: No.

Counsel Inquiry: That was a Public Health Wales multi-agency exercise dealing with the outbreak of one case of MERS CoV coronavirus, in which surge capacity wasn’t tested but was mentioned. That’s not something that was on your radar as Deputy Health Minister?

Mr Vaughan Gething: No, and essentially my role as a Deputy Health Minister was virtually everything that had a target on it, that had a number, was then my responsibility, including all of the media that went with it. So it wasn’t actually part of the role that I had as the Deputy Health Minister.

Counsel Inquiry: You don’t mention Exercise Alice in your witness statement, which we know was delivered in February of 2016 by the Department of Health. Was that something that was within your knowledge when you became Cabinet Minister?

Mr Vaughan Gething: No. So when I became the Cabinet Minister in 2015, and then in 2016 I am now aware that Exercise Alice has taken place, but I think it was a Public Health England led exercise, so I wasn’t aware of it, no.

Counsel Inquiry: Yes. In your briefing for Exercise Cygnus later on in 2016, were these previous exercises, and in particular I’m going to highlight the issues that they raised with social care, not brought to your attention?

Mr Vaughan Gething: Not in the sense of pandemic preparedness. So around the exercise and the briefing and the conversation that takes place, then actually social care is part of the system-wide challenge that you’re trying to understand and run an exercise for.

Counsel Inquiry: Did you have any direct involvement in Exercise Cygnus in October 2016?

Mr Vaughan Gething: Yes, I attended ministerial meetings on both days as requested. My deputy at the time also attended some of those exercises as requested. So on both of the days when ministerial attendance was requested we both attended and participated.

Counsel Inquiry: It was a huge exercise, wasn’t it?

Mr Vaughan Gething: It was, it involved a range of people. I remember having the briefing with Dr Atherton and I remember sitting down in the basin of Cathays Park in the control centre where it was run from and participating in those meetings.

Counsel Inquiry: Was it important to you that all relevant learning from Exercise Cygnus was carried forwards and incorporated into Wales pandemic planning?

Mr Vaughan Gething: Yes. And as I think I describe in my statement, I understood there would be lessons learning, there would be an officials route(?), both within Wales as well as with other partners, and I expected that the learning from that would then be implemented. My own impressions from the exercise were that there were positives and there were things that I would expect to be worked on.

Counsel Inquiry: The way in which you describe it in your witness statement at paragraph 67 is:

“I was advised that learning points had been identified and would be implemented … either in whole or in part, or that there was a delay in implementation. For that reason, I assumed, absent any advice to the contrary or questions in the Senedd, that the lessons of Exercise Cygnus had been applied.”

Did you read the Exercise Cygnus report, Mr Gething?

Mr Vaughan Gething: I can’t recall which report are you referring to, because there are a number of notes that come after it and there is then the briefing I receive from officials, so let’s be clear about which report.

Counsel Inquiry: Well, I’ll put it on screen.

Mr Vaughan Gething: Thank you.

Counsel Inquiry: It’s INQ000022792, please.

So this is the report following the three-day exercise in October of 2016.

Can we go to page 6 and paragraph 3, please. Under “Key Learning”, thank you:

“The analysis of the evaluation reports from the organisations participating in the exercise indicate that the UK’s command & control and emergency response structures provide a sound basis for the response to pandemic influenza. However, the UK’s preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic that will have a nation-wide impact across all sectors.”

Let’s just pause there. Do you remember reading that in October of 2016?

Mr Vaughan Gething: No.

Counsel Inquiry: Had you read it, would that have caused you some concern?

Mr Vaughan Gething: If I had read this, and with respect I think it was produced after October 2016, I’m not sure of the exact date, but whenever, if I had read that paragraph, then I – I almost certainly would have asked extra questions about what was then taking place, and there is definite learning from that about – again, I made the point earlier about where ministers’ time is used. If I had read that I think that I almost certainly would have asked more questions and asked for more assurance about what was happening.

Counsel Inquiry: Can we take it that you didn’t read the report?

Mr Vaughan Gething: No, I didn’t. I did not read this report. I recognise the front now in preparation for it.

Counsel Inquiry: Did your advisers feed back to you the fact that there were real concerns about the capacity of the United Kingdom preparedness and response?

Mr Vaughan Gething: My advisers fed back, and you’ve got the documents, that there was a need for improvement, there was a need for learning to be applied, and I received briefings on the progress of those during 2017, 2018 and 2019, and I know you’ve got some of the email trains around that as well.

Counsel Inquiry: What steps did you take, then, to satisfy yourself that Wales would be prepared for the next pandemic?

Mr Vaughan Gething: Well, I engaged with the briefings I received from my officials, and you’ll know that at various points I have asked about follow-up from different parts of the sector, and I know you’ve also been through, for example, the improvements, the investment in microbiology, a range of other things that happened. So there were different decisions that I made.

Looking back, I think it is fair to say that if I had put more ministerial time into this, then I may well have sped up preparedness.

Counsel Inquiry: Was social care on your radar as Cabinet Minister?

Mr Vaughan Gething: Yes. I’ve set out earlier that social care was part of the departmental responsibility, and at the start of the term my deputy and I at the time invested fairly significant time and then through the rest of that period in not just having the long-term plan to cover both health and social care but actually direct time with local government and with partnership boards bringing health and the third sector together, because we knew that you can’t have a long-term future for the health service without social care being part of the answer.

Counsel Inquiry: Did your advisers bring to your attention that, as part of Exercise Cygnus, the local resilience forums had expressed concerns that it was not possible to collate an accurate picture of social care capacity because much of the capacity lay with private providers?

Mr Vaughan Gething: Not specifically in those terms, but I’m obviously aware of the structure of social care and how it has changed significantly over the last few decades.

Counsel Inquiry: You will be aware now that that concern is something that was raised as far back as Exercise Taliesin, and nothing appears to have been done about it in the meantime; is that a concern that was ever brought to your attention when you were Cabinet Minister for Health?

Mr Vaughan Gething: Not in those specific terms. Like I said, the concerns about social care were broad and not simply focused on pandemic preparedness, it was much more about the stability of the sector, given the demands that it faces. And the structure of it is part of that too.

Counsel Inquiry: Did you cause for any research, briefings, action to be taken as a result of what you knew to be the problems with social care during the time that you were Cabinet Minister?

Mr Vaughan Gething: Yes, we invested in social care, it was part of our plan for the future. I made deliberate choices to put parts of the NHS allocated budget into partnership space that had to be used by health and social care working together through the seven regional partnership boards that we’d created. So social care was definitely part of what we were concerned about, and wanted to invest in its future, and that did also take into account the structure of the service, what improvement could look like, and the broader vulnerability within the sector as well.

So you’re thinking about different models for social care so it’s more sustainable, who the new actors are going to be. There are lots of relatively small family-run homes that give you different vulnerability. If people retire, that home can go and you potentially have a number of residents who may not be able to carry on. So that was a challenge, and the way that it’s commissioned and funded is also a key risk as well. And all those challenges, in the way I’ve described them, would still exist now, but we’re in a better position now than when I started, and I expect we’ll be in a better position in the future, because, you know, social care is essential for the future of the health service and it’s part of our – it’s part of our success story that lots of us can expect to live to be older and there is a need to plan for and to deliver against that.

Counsel Inquiry: Did you take any action on this recurring issue that there appeared to be no register of private care homes in terms of the contingency plans for a pandemic or for any sort of outbreak that they might have? Did you take any action on that?

Mr Vaughan Gething: No, not on that specific point.

Counsel Inquiry: Are you aware, Mr Gething, that following Exercise Cygnus there was a group created called the Wales Pandemic Flu Preparedness Group?

Mr Vaughan Gething: Yes.

Counsel Inquiry: Did that group ever report directly to you?

Mr Vaughan Gething: I received briefings from that group. The named individual who provided those briefings is David Goulding, and he is referred to in the papers.

Counsel Inquiry: Were you aware that during a meeting of that group, the following was discussed:

“Adult social care and community healthcare.

“NR advised that there was currently an issue around who would be the SRO for the social care workstream within the Department of Health. He added that within Wales he was trying to establish where there was social care capacity but the task was extremely difficult as most of the care provision was provided by independent companies.”

So, in other words, there was a restatement of the problem, knowledge of private social care?

Mr Vaughan Gething: Yeah, and that – that’s part of what you’re looking at across the whole system, regardless of the purpose, because understanding who’s providing the care, understanding the commissioning arrangements that are largely led by local government and understanding the variety of different homes in each of the 22 authorities is part of the challenge we have, and had, when it came to dealing for this in very real terms.

Counsel Inquiry: Were you able to watch the evidence of Frank Atherton from yesterday or have you been able to receive a briefing on what that might have contained?

Mr Vaughan Gething: I’ve seen some of it. We had Cabinet yesterday so I wasn’t able to absent myself to watch all of it.

Counsel Inquiry: All right. Are you aware, then, that in an email trail from July 2018 there was concern expressed about the pace of development of the review and guidance which needed to be exposed to ministers, according to Mr Atherton, along with resource issues? In fact I think it might have been Mr Kilpatrick who sent the first email, but there was a chain, I think, referred to during the evidence of Mr Atherton which indicated that this concern needed to be brought to the attention of ministers?

Mr Vaughan Gething: Yes, I’m aware of the email exchange that was referenced yesterday.

Counsel Inquiry: Yes. Was that brought to your attention?

Mr Vaughan Gething: Not specifically in terms of that exchange, but I know you’ve heard other evidence about some of the other steps that were taken, but, for example, I didn’t then get at that briefing saying, “We need you to intervene, Minister, because we’re not making enough progress”. And there are times where you intervene and you say, “I want to know what’s happening”, or, “I want to meet officials”, and it does accelerate progress and provide renewed focus, but I don’t recall ever being briefed on that particular exchange or its outcome in relation specifically to, “We want you to be more engaged in pandemic preparedness to make sure that we accelerate the work that we’re doing”.

Counsel Inquiry: One of the concerns expressed in that email train was the fact that the Welsh Government appeared to be waiting for the Department of Health to issue guidance before it could assess and review its own plans and guidance. Do you consider that to be a problem for Wales, reactive rather than proactive?

Mr Vaughan Gething: Well, I think it’s always part of the challenge when you want to work across the four nations about where and how you do that, and to do that in a way where you can have your own plans to do what you want to in Wales, whereas in the pandemic scenario you know it’s likely to affect all four nations and so you want some deliberate consistency. Or if you’re going to do things differently, to understand why. And because England is a much bigger block within the UK, and it’s likely that if you have a future pandemic it will come through England first – that’s just the reality of travel patterns and population size – that you would want to have that come through. So, again, if that was put in front of me as a minister, I would – and it goes back to, I think, my Lady’s questions about what could be helped – if I’d had a briefing that said, “We haven’t got this in the Department of Health in England, it would be really helpful, and we also need to make sure that we have a greater focus in the Welsh Government”, one of the things you could have done as a minister would be to say, “I want to know more about this, I want to know what has happened within a certain timescale”, and often that is something you do, say, “I want to know within three months what’s happening, and I want to have the officials in front of me”, that kickstarts people to do things within a timescale, and you could have written or asked for a conversation with a UK minister, and that’s one of those challenges, where you do have correspondence, it isn’t political, where not having better relationships does get in the way of doing government business that has to take place.

Counsel Inquiry: One of the issues which Wales could have grappled with, without having to wait for the Department of Health to act, is getting to grips with private care home capacity and ensuring that they had in place contingency plans, isn’t it?

Mr Vaughan Gething: So I think that’s fair. I think it’s fair to say that we could have made more progress with our own sector. The prime concern about the social care at the time was its vulnerability and sustainability full stop, and so actually that still means needing to understand who is in the sector. In general terms you had an understanding about the average size of homes, but actually the more granular detail, to understand, with local authorities in particular but also the health service, the numbers of homes, where they are, and in this area their infection prevention and control procedures in general terms as well as the specifics around the pandemic.

Counsel Inquiry: Right. Finally, Mr Gething, I want to ask you about PPE.

Lady Hallett: It’s all right.

Ms Blackwell: Not at all, I was just pausing.

Lady Hallett: It’s the pollen.

Ms Blackwell: It’s affecting us all.

At paragraph 35 in your witness statement you say:

“We have learned a great deal about the importance of PPE supplies, the adequacy of our stockpile, the importance of secure supply chains and the trade-offs between price and security of supply.”

What do you mean by the trade-off between price and security of supply?

Mr Vaughan Gething: So we had operated a just-in-time system where price drove most of our procurement decisions, including on PPE, and one of the lessons is about the length and the fragility of those chains and, again, I think it’s common evidence from a number of people that they collapsed in the face of the pandemic. So if we want to be more resilient in the future we would need to carry on investing in PPE production that is closer to home. That would almost certainly mean that it will cost more, and the challenge there is that whoever is in whichever part of the government across the four nations of the UK, there are political and financial choices that come with that.

If you want to invest in having a supply that you know is more expensive than you could buy in another part of the world but you’re doing it because you want to make sure you don’t have fragility if there is a future pandemic, you’ve got to be prepared to do that, and that has a budget consequence to it.

It’s the same with other areas of preparedness as well, and, you know, I have looked at Mr Hunt’s evidence and he talks about South Korea, so not just on PPE but on improving capacity in laboratories, for example, well, that isn’t just the capital involved in building a facility, you need the people to do that, and you’ve got to invest on a recurrent basis for that to happen.

So those are choices and that resilience, if you’re looking to build it in, if you need more capacity you can’t avoid the fact that that will cost more money, and that’s a choice that we have to be prepared collectively to make. I think that holds regardless of who is in government in whichever part of the UK.

Counsel Inquiry: Were you aware that Welsh and UK-wide planning assumptions were to plan for successive flu waves to each last approximately 15 weeks in duration?

Mr Vaughan Gething: Yes.

Counsel Inquiry: All right. I’d like to just look, please, at the document which sets out the stockpile held in South Wales of PPE.

It’s at INQ000066526.

Just reminding ourselves that the central PPE stockpile for Wales was the pandemic influenza preparedness programme stockpile. This is Audit Wales’ report entitled “Procuring and supplying PPE for the Covid-19 Pandemic”. It’s dated April of 2021.

Now, this will be the subject of evidence in later modules, but I’d just like to look, please, at page 21 and paragraph 1.26 to ask you about the planning and whether or not it was sufficient.

Can we highlight, please, the table in the middle of the page.

Mr Vaughan Gething: Yeah.

Counsel Inquiry: This is the quantity of items in the PIPP stockpile, as we’ve just established, in March 2020, and how long it lasted: aprons, six weeks; eye protectors, ten weeks; type IIR masks, which are of particular use for care homes and hospitals, 5.5 weeks; FFP3 respirators; 10.9 weeks; gloves, singles, 1.5 weeks; hand sanitiser, 4.3 weeks.

Even if we acknowledge that the assumptions that the Welsh and UK Government were planning for were not strictly adhered to by the Covid-19 pandemic, in fact in some senses they were worse, weren’t they? Do you agree that the PPE stockpile in Wales was woefully inadequate to deal with the pandemic that was being planned for?

Mr Vaughan Gething: Yes, so our collective planning assumptions did not stand up against reality. So they were not adequate for the challenge we then faced, and that is set out in the table. I think it’s very, very clear. And that –

Lady Hallett: I don’t think, with respect, sorry to interrupt, that wasn’t the question.

Mr Vaughan Gething: Sorry.

Lady Hallett: The question was the planning was for something that was going to last for 15 weeks.

Mr Vaughan Gething: Yes.

Lady Hallett: The point that Ms Blackwell is making is that it didn’t even last 15 weeks, not just Covid.

Mr Vaughan Gething: No, and that was – and I remember having a conversation about this time. I want to try to avoid going too far into the actual response.

We were going through PPE at a much faster rate than our planning assumptions assumed we would, so actually we found that our stockpile that should have lasted for a whole wave didn’t. And, you know, the rate at which we were going through it was much faster than we expected, and it’s why in the very early stages this was one of my major concerns in practice. But I don’t want to get drawn too far into what I know we’ll be going through in Module 2.

Ms Blackwell: So do you agree, Mr Gething, that the plan that was in place was not just a plan for the wrong pandemic, but it was an inadequate plan in any event, even for the pandemic that it was being created for?

Mr Vaughan Gething: I think it’s fair to say that the plan for an influenza pandemic would still have had challenges. If we’d had an influenza pandemic – I hesitate to say it was inadequate because it’s such a loaded term, but it certainly – with all the evidence that I’ve seen, and I know the Inquiry have seen, the planning for an influenza-type pandemic was not complete, and we would have had vulnerabilities if it had been an influenza pandemic.

Counsel Inquiry: Thank you.

My Lady, those are all the questions I have for Mr Gething. You have provisionally provided permission for a series of questions all to be asked by Covid-19 Bereaved Families for Justice Cymru. Please may that be done now?

Lady Hallett: Certainly.

Questions by Ms Shepherd

Ms Shepherd: My Lady.

Lady Hallett: Ms Shepherd.

Ms Shepherd: Mr Gething, my name is Laura Shepherd and I appear on behalf of Covid-19 Bereaved Families for Justice Cymru.

I’m going to start off by asking you about stakeholders. I don’t know if you heard the evidence of Rosemary Gallagher that she gave last week. She spoke about the engagement or perhaps lack thereof that she had with the United Kingdom Government. Did you as Health Minister invite the Royal College of Nursing or the British Medical Association or any other clinical stakeholder groups to have input into the Welsh Government’s pandemic planning?

Mr Vaughan Gething: No, I didn’t ask for royal colleges to take part specifically. In the way that pandemic planning was undertaken, you have had this evidence from a range of people, officials within the Welsh Government worked with a range of partners, but I’m not sure whether they did engage with the royal colleges or not. But I did not see Rosemary Gallagher’s evidence on this point.

Ms Shepherd: Were you aware that in her report in 2011, Dame Deirdre Hine, this was following the swine flu pandemic, she advised as to increased stakeholder engagement in pandemic planning?

Mr Vaughan Gething: Yes, I’m aware of that in preparation for this Inquiry. I’m not sure if she defined the list of stakeholders, but I’m aware that it was one of the recommendations.

Ms Shepherd: I’m going to move on now to ask you about surge capacity. So you have been asked questions about the sufficiency of the PPE stockpile, and I know that you heard the evidence that was given earlier by Andrew Goodall, and he spoke about the workstream that was in place as to surge capacity and how that wasn’t finalised before January 2020.

When it got to the pandemic, do you agree that there was a difficulty with surge capacity in Wales?

Mr Vaughan Gething: Yes, there was a difficulty in surge capacity in Wales, as in the rest of the UK, and the challenges, during a surge capacity it’s not just a facility, it’s people you need, and that is the big challenge. So if you could invest in more people you have more capacity to surge to, but those people will be working before you need to change things. So the ability to surge is about people, it’s partly about facilities, it’s also – and I think I went through this briefly in questions earlier – you have to choose what you’re not going to do to create that space, whether that’s the number of people who you would then expect to provide care to give you more capacity, or whether that is stopping some services from happening, or reorganising the way that they do.

Ms Shepherd: Were those choices made in preparation or were they made at the time when Covid hit?

Mr Vaughan Gething: So some of that work had been done in preparation, I know you heard this from Dr Goodall, the work hadn’t been concluded but the thinking about it was not starting from a zero base. The challenge then is when it happens you have to think very quickly. That’s why the workstream on regulation is relevant as well, because part of that surge capacity was a change in regulation that was swiftly introduced, and was envisaged, actually, in terms of pandemic preparedness, to allow you to have people put back on the professional registers to undertake work they wouldn’t otherwise have done, and that of course relies on those people wanting and being prepared to come forward.

So I guess fair to say that the work wasn’t complete, but it doesn’t mean that nothing had happened, because when the time came there was thinking to rely on as well as the need to make choices.

Ms Shepherd: I just want to have a look at some of the planning presumption when it comes to surge capacity.

If we could have up on the screen, please, INQ000089573.

This is a document you’ve already been referred to today, this is the Wales Health and Social Care Influenza Pandemic Preparedness and Response Guidance dated February 2014.

If we could have a look at page 7, please. So in the box there in the middle of the page, the very top row in that box says:

“Up to 50% of the population could experience symptoms of pandemic influenza over one or more pandemic waves each lasting 15 weeks.”

Then if we look a couple of boxes down it says:

“1-4% of symptomatic people may require hospital treatment.”

So that’s up to 2% of the entire population of Wales in hospital, potentially in a 15-week period. Was Wales prepared for that?

Mr Vaughan Gething: Not in the sense we had the hospital capacity at the start of the pandemic. That’s a simple matter of the maths of the matter. To be prepared to know that you might have to do that in general terms we didn’t have a granular plan on: here is how we will create that capacity.

I think it’s also fair to point out, Ms Shepherd, that the planning assumptions are on the reasonable worst-case scenario, so that is if you’re not taking action, and actually of course we did act, and the assumptions are these things can happen if you don’t take action.

What we did meant that fortunately 2% of the population did not require hospital treatment, and to create the capacity for that – again, I’m trying not to get drawn into Module 2, my Lady, but of course we did have to rapidly go through some of the challenges around field hospital expansion.

Ms Shepherd: I’m going to move on now then to excess deaths, and what I mean by this is the measures in place to deal with that, body bags, mortuary capacity and the ability to maintain the dignity of those who died.

According to a Welsh Government document from the Technical Advisory Group, there were 2,257 deaths involving Covid-19 between 1 March 2020 and 31 May 2020, so that’s a period of 12 weeks. Wales was not prepared for that number of deaths, was it?

Mr Vaughan Gething: I think in terms of the briefing that I had, excess deaths were mentioned. I was aware there was work on excess deaths that needed to be completed. I don’t think that work was finalised. The most difficult part, I think, is not the physical capacity, it’s the dignity in death that I found most difficult.

Ms Shepherd: If we could have a look again, please, at the INQ000089573 document, page 7. Again we’ve got excess deaths below the table on page 7, and again it says here:

“Planners should aim to be able to cope with between 12,000, and 15,000 deaths in Wales …”

That’s over a 15-week period, and we had just over 2,000 deaths in Wales over a 12-week period. Do you accept that that lack of preparation led to real pain and suffering of the bereaved in Wales?

Mr Vaughan Gething: I think, in honesty, addressing the issue of excess deaths does lead to pain and suffering and it did lead to it, because, as I say, one of the things I found most difficult was the dignity in death, and knowing what a bad death is and understanding that that has a real impact on people who are left behind, and when we started and had to consider the measures we might have to take immediately for mortuary capacity and for crematoria – and I knew that crematoria capacity and there were plans that had gone through and been discussed with partners about how to increase crematoria capacity, but actually all of this work was not fully completed, and that meant that when Covid came, we were not as prepared as we could and should have been, and that does, yes, Ms Shepherd, lead to additional pain for bereaved families.

Ms Shepherd: Do you accept that you had responsibility to plan for that?

Mr Vaughan Gething: Yes, I’m the minister in the government, of course it’s my responsibility.

Ms Shepherd: There is one final area I wanted to ask you about, and that’s infection control and in particular isolation rooms in hospitals. The evidence that we heard earlier today from Dr Sandifer, and we also heard it yesterday, was there was no provision in Wales whatsoever to deal with HCIDs, which means that if people in Wales – if someone in Wales has an HCID, they’re taken to London or I think it’s Newcastle. Do you accept that lack of preparedness for even one case of SARS in Wales reflects a big oversight from those who were responsible for pandemic preparedness?

Mr Vaughan Gething: No, and I think the reason is important. So if you have two centres in England, you’re dealing with very small numbers of a high-consequence infection. The challenge we are looking at is how do we make sure we have the ability to deal with a small number of high-consequence infections. For the scale of the pandemic, the centres in London and Newcastle could not cope and would not reasonably cope. Actually the challenges around how you surge capacity, as we had to with intensive care and more, is much more relevant to pandemic preparedness and coping with a genuine pandemic, as we did in the early stages of containment, and I think Chris Whitty has given evidence on this as well, I don’t think it would have made any difference if we’d had a centre in Wales. If that had been in the Heath in Cardiff, if you live in Betws-y-Coed, that wouldn’t have been the place you would have gone anyway. So there is a challenge about understanding the difference between a very small number of high-consequence infections – if you recall, when there was a nurse who returned from the work she was doing and the challenge around Ebola, actually that is where you have those very limited number of high consequence facilities. The pandemic is a different order.

Ms Shepherd: SARS was an HCID until March 2020 and there was not – sorry, Covid – coronavirus and SARS was HCID until March 2020, and there was not one single isolation unit in Wales that could deal with it, was there?

Mr Vaughan Gething: Not at that time, no. And, as I say, in terms of – I think we are maybe talking about different points here. Having an individual unit with a small number of beds would not have prevented the challenges of the pandemic. The scale and the depth of what we needed to prepare for and to deal with would not have been changed if we’d had four high-consequence infection beds at University Hospital Wales in Cardiff. That’s the point I’m trying to make. I think there’s a danger that you say, “This is the issue”, when actually it’s the much broader challenges of preparedness I think that are the real challenge.

Ms Shepherd: Thank you, my Lady.

Lady Hallett: Thank you very much, Ms Shepherd.

Ms Blackwell: My Lady, that completes Mr Gething’s evidence.

Lady Hallett: Thank you very much for your help, Mr Gething.

The Witness: Thank you.

(The witness withdrew)

Ms Blackwell: Would that be a convenient moment to take our afternoon break before the final witness of the day.

Lady Hallett: Yes, of course. I’m just trying to think – it’s very important that we finish Mr Drakeford’s evidence today.

Ms Blackwell: Perhaps ten minutes? Sorry, you’re getting mixed messages.

Lady Hallett: I am getting mixed messages. Ten minutes. 3 o’clock.

(2.50 pm)

(A short break)

(3.00 pm)

Lady Hallett: Mr Keith.

Mr Keith: The First Minister of Wales, please.