Transcript of Module 1 Public Hearing on 5 July 2023

(10.00 am)

Lady Hallett: Good morning.

Mr Keith: Good morning, my Lady. The first witness this morning is Dr Catherine Calderwood.

1. Dr Catherine Calderwood

DR CATHERINE CALDERWOOD (sworn).

(Evidence via videolink)

Questions From Lead Counsel to the Inquiry

Mr Keith: Could you please provide your full name.

Dr Catherine Calderwood: Dr Catherine Jane Calderwood.

Lead Inquiry: Dr Calderwood, thank you very much for your assistance in this Inquiry so far. As I ask you questions and you give evidence could you please remember to keep your voice up so that we may clearly hear you and also so that your evidence is recorded for the stenographer.

You have kindly provided a witness statement, INQ000182605, to which you have appended your signature, and a statement of truth. Is that correct?

Dr Catherine Calderwood: Yes, that’s correct. Just before we begin, Mr Keith, I would like permission just to say a few words, if my Lady would allow that.

Lady Hallett: Certainly.

Dr Catherine Calderwood: Thank you. I just wish to express my sincere condolences, my Lady, to the bereaved families, both represented in the rooms and also in wider society. I’d also like to perhaps on this day, the 75th birthday of the NHS, to pay tribute to my NHS many friends and colleagues who worked tirelessly during the pandemic and of course for whom some suffered and have also lost their lives. Thank you.

Mr Keith: Dr Calderwood, you were the Chief Medical Officer for Scotland between April 2015 and 5 April 2020, were you not?

Dr Catherine Calderwood: Correct.

Lead Inquiry: As the Chief Medical Officer, were you the most senior medical adviser to the Scottish Government and to NHS Scotland?

Dr Catherine Calderwood: Yes, that’s correct.

Lead Inquiry: In essence, did that mean that you were the responsible officer for all of Scotland’s 15,000 doctors, as well as an important part of the health and social care structure in Scotland because you reported to the Director General for Health and Social Care within the Scottish Government?

Dr Catherine Calderwood: Yes, that’s correct.

Lead Inquiry: So were your duties owed, therefore, to the Scottish Government, to NHS Scotland, as well as, of course, to the doctors for whom you were the responsible officer?

Dr Catherine Calderwood: So my duties were quite separate towards Scottish Government as an adviser, which then does not have the same level of responsibility as my duties as the responsible officer for – to the General Medical Council for Scotland’s doctors as their responsible officer.

Lead Inquiry: All right.

Could you just tell us something of the broad nature of the duties of the Chief Medical Officer in Scotland, in terms of the advice that you give to ministers, the responsibility that you carry, or carried, for public health and medical issues?

Dr Catherine Calderwood: So I always would describe it to people as almost a translation service. What I felt that I did was took the science, took the medical advice, took the up-to-date clinical evidence, and described that in a way that politicians and ministers could understand, but that also was able to help them form policy.

I also interacted, of course, with many civil servants from not only Health and Social Care but throughout Scottish Government, as health touches, as you know, on all aspects of society.

So it was an advisory role, sometimes my advice wasn’t taken, but very often it was, and I was able also to pull in advice from the other three nations in the UK, but also from a wider pool of scientific and medical advice across the world.

Lead Inquiry: You’ve referred to your advisory role in relation to the production and promulgation of policy. Did you also provide clinical advice on medically related matters?

Dr Catherine Calderwood: Yes, of course.

Lead Inquiry: Were you in fact or did you continue to be concerned in clinical practice right up to the onset of the pandemic in November 2019, alongside your duties as Chief Medical Officer?

Dr Catherine Calderwood: Yes, that’s correct. I continued to do an antenatal clinic as a consultant obstetrician until that time.

Lead Inquiry: Does the CMO also play a role in relation to giving advice on research or for the future development of the medical structures and the clinical structures in Scotland?

Dr Catherine Calderwood: The close relationship with my Chief Scientist has – means that the CMO office holds the budget for the research and development within NHS Scotland. So yes, there is a responsibility there, and there is scientific advice that’s readily available but also funding for that research and development in NHS Scotland.

Lead Inquiry: We’ve heard evidence that there is in England an Office of the Chief Medical Officer. Is there an analogous directorate or entity or body of people around the Chief Medical Officer in Scotland?

Dr Catherine Calderwood: So it would be a very small office: myself, at that time, one Deputy Chief Medical Officer, who at that time was Gregor Smith, and then we had personal assistants and perhaps three members of staff, not all of whom were full-time. So a very small team – and a clinical leadership fellow who was a doctor in training who came to have some experience working with us.

Lead Inquiry: Is that Professor Sir Gregor Smith, who became acting CMO after you, and then full-time or full CMO in December 2020?

Dr Catherine Calderwood: That’s correct.

Lead Inquiry: In terms of the working relations with other parts or other persons in the world of medicine and public health, what links did you have and how frequently did you discuss relevant matters with the other Chief Medical Officers in the United Kingdom?

Dr Catherine Calderwood: So we had a very, very good relationship. There was a – formal and informal meetings on a very regular basis throughout the year. We tended to have dinner the night before and we also then had an informal part to that more formal meeting when we discussed matters that affected all four countries. But in between those meetings I would be very easily able to lift the phone to any of the other CMOs to ask advice or because there was something that I knew they had already experienced in their own country that I wanted to talk to them about, and we did that extremely frequently.

Lead Inquiry: What about directors of public health, to what extent does the position of the Chief Medical Officer engage with them?

Dr Catherine Calderwood: In Scotland I was very keen, as CMO, to have a very good relationship with them. There are directors of public health in all of our health boards. I met with them very regularly but also would have interacted with them frequently by telephone or email should there be issues within their health boards that arose. So, again, I got to know them as individuals and they would have, I hope, felt they could have lift the phone to me for advice should that be needed.

Lead Inquiry: What about the local authority levels, so links to local resilience partnerships, the important bodies which exist at local level to plan for and then respond to emergencies?

Dr Catherine Calderwood: I didn’t have personal relationships with the local authorities but would have been able to interact with them through those directors of public health, who of course worked very closely with the local authorities.

Lead Inquiry: May I then turn to the question of the strategy which underpinned the approach from all four nations to influenza preparedness, namely the UK influenza preparedness strategy of 2011.

To what extent were you aware of that strategy document as CMO, and of the doctrinal thinking in the approach which underpinned it?

Dr Catherine Calderwood: I came into position some years after it was written. Had I needed to find it, I would have known who to ask and which parts of government were responsible, but I myself had no real detailed knowledge or understanding of that document while I was CMO.

Lead Inquiry: Whilst you were CMO, do you recall any debate about the need to revise that document, bring it up to date, redraft it?

Dr Catherine Calderwood: No, I don’t recall.

Lead Inquiry: Could we have on the screen, please, document INQ000148759. This is a draft document prepared by the Scottish Government for consultation in July of 2019, and I just wanted to ask you, Dr Calderwood, whether or not you had contributed to this draft:

“Influenza Pandemic Preparedness.

“Guidance for Health and Social Care Services in Scotland.”

There is evidence that, having been prepared, the publication of this document was delayed by the onset of the pandemic itself, of course, and therefore it never reached fruition.

Are you aware of that document? Did you contribute to it at all?

Dr Catherine Calderwood: So I am aware of that document. I didn’t contribute myself as an individual directly, but there were various members of the civil service and others who would have been delegated to be part of that. But no, myself I was not personally involved.

Lead Inquiry: Do you recall any debate from the position of the CMO about the wisdom of Scotland devising its own influenza preparedness strategy and therefore departing from the UK strategy, particularly that of 2011?

Dr Catherine Calderwood: I was not party to any debate of that nature, no, I don’t recall being part of that.

Lead Inquiry: Turning to SAGE, the scientific advisory group about which the Inquiry has received a great deal of evidence already. There was, at the onset of the pandemic, no Scottish SAGE, was there?

Dr Catherine Calderwood: No, that’s correct.

Lead Inquiry: The SAGE which convened in London was a body which could be convened by the governmental Chief Scientific Adviser and it is generally chaired by the governmental Chief Scientific Adviser or, if it has been convened to deal with a health emergency, jointly by the governmental Chief Scientific Adviser and the Chief Medical Officer.

Is that a body from which the Scottish Government and its own advisers may draw intelligence and learning and whatever it is that they need to be informed about?

Dr Catherine Calderwood: Yes, absolutely. I think that was a committee that I would have been aware of. There would – there were Scottish representation – or Scottish invitations to that. I think in quieter times the flow of information from that committee was very good, but as we got into the pandemic with very regular meetings, very regular remote calls with Scotland dialling in to those, that communication became much more difficult because that was based and London and Scotland was not fully part of that.

Lead Inquiry: You attended, therefore, some of the SAGE meetings as the pandemic struck?

Dr Catherine Calderwood: Correct.

Lead Inquiry: Did you find that an easy form of communication? Were there difficulties in, literally in hearing what was being said and in understanding the flow of the information which was being fed into that committee and then being relayed out of it?

Dr Catherine Calderwood: Yes, very much so. Unfortunately there were a large number of people dialed in to meetings. Of course our infrastructure for remote working was nothing like it is now, and so we would – I would have attended or my deputy attended or – with several other people from Scotland. But very often the quality of the line was poor, it dropped out very frequently, and there was often not really a fully fluent read-out from some of those very important meetings in the early days of the pandemic.

Lead Inquiry: What other scientific posts or medical posts are there within the Scottish Government which may provide advice to the government in the event of a public health emergency?

Dr Catherine Calderwood: We have our Health Protection Scotland colleagues, now within Public Health Scotland, and I had my – the Chief Scientific Officer, with whom I’ve described a very good relationship. He, Professor David Crossman, latterly followed on from Professor Andrew Morris, had very – both of them had very good networks which extended across the UK and beyond and were, therefore, very, very solid and robust advisers to me, and to the rest of government.

Lead Inquiry: Are there also healthcare and scientific advisers within the Health and Social Care Directorate within the Scottish Government?

Dr Catherine Calderwood: So there is an overall Chief Scientist in Scotland and then there is Chief Scientist, Health, and the second Chief Scientist for the environment.

Lead Inquiry: Is there a science advice team within the Health and Social Care Directorate also?

Dr Catherine Calderwood: So within the Chief Scientist office there was a small team which sat on various committees. A lot of those, though, would have been outside Scottish Government and actually placed within the NHS.

Lead Inquiry: We have before us an organogram which sets out some of the public health and civil contingencies bodies in the Scottish set-up. Two such bodies are the Scottish Science Advisory Council and, although I’m not sure the second one is actually on the screen, the Scottish Health Protection Network: Infectious Diseases sub-group. Were they bodies with which you were familiar and with which you worked as CMO?

Dr Catherine Calderwood: It’s very small on the screen, but listening to what you said, I would have worked with them either directly or indirectly, yes.

Lead Inquiry: All right. Did there come a point in March of 2020 when you appreciated that the source of scientific and medical advice from SAGE – or particularly, I should say, scientific advice from SAGE was inadequate for the purposes of the Scottish Government, in part for the practical reasons which you’ve identified, and therefore you set up, together with a colleague, Professor Andrew Morris, the Chief Scientific Adviser, a new group, the Covid-19 Advisory Group?

Dr Catherine Calderwood: Yes. So just to be clear, Professor Andrew Morris had been my Chief Scientist prior to the current Chief Scientist at the time, so I went back to my colleague, Andrew Morris, and asked him to set up a Covid-19 Advisory Group for Scotland, that’s correct, in March 2020.

Lead Inquiry: What was the membership of that group?

Dr Catherine Calderwood: He pulled together a very wide-ranging group of people, actually, which in fact, and at my insistence, some of those people were people who had been quite openly, particularly in social media, critical of some of the responses to the pandemic up until that point, and I was very keen to have a very broad range of people, not just to have people who agreed with the government and the current thinking. I think that to be challenged and to have the opportunity for lively and – particularly lively scientific debate is very important.

Lead Inquiry: Turning to the risk assessment process in Scotland, the evidence shows that whilst at UK level there is, now, an NSRA – a National Security Risk Assessment – process, that document and that process is recalibrated for Scottish purposes and from that process is drawn a Scottish Risk Assessment. Do you recall, as the CMO, having a hand in the drawing up, the drafting of that Scottish Risk Assessment?

Dr Catherine Calderwood: I would have been aware of that Scottish Risk Assessment but I did not have any hand in drawing that up, no. That would have been for civil servants.

Lead Inquiry: Are you surprised that, as the CMO, you weren’t approached for your views in relation to how risks relating to health emergencies should be identified, managed and dealt with?

Dr Catherine Calderwood: I’m tempted to say a number of things in government surprised me, Mr Keith, but the – on reading that risk assessment more clearly now, and with the benefit of hindsight, yes, I think that the CMO should not just have been copied in to documents of that sort of nature.

Lead Inquiry: You would expect now that the CMO is directly invited to comment on the substance of that process?

Dr Catherine Calderwood: Very much so.

Lead Inquiry: All right.

Exercise Iris in 2018 was an exercise with which you were familiar. It was a one-day tabletop exercise conducted in Scotland, and you refer to it in your witness statement at paragraph 7.

To what extent were the recommendations which came out of Exercise Iris implemented; do you recall?

Dr Catherine Calderwood: So I have had a chance to look at those, and my understanding is that several – whilst several recommendations were implemented, there were several that were not, and then, perhaps ironically, some of those were in fact not continued with because staff were taken away from that implementation process in order to move into Covid-19 pandemic work.

Lead Inquiry: There were 13 actions which came out of Exercise Iris. Do you recall which of them, in broad terms, were the ones that were not ultimately implemented?

Dr Catherine Calderwood: The most important ones I believe, if I’m remembering correctly, were the information to boards about PPE and the distribution and also the fitting of FFP3 masks, and the encouragement that health boards would ensure that staff – that they had not only had supplies of PPE but they also had done FFP mask fitting.

Lead Inquiry: Exercise Iris was designed to test Scotland’s readiness for a MERS coronavirus outbreak. Do you recall whether or not those actions which came out of the exercise which were concerned with the drawing up of guidance for the HCID that is MERS coronavirus were dealt with? Do you recall whether that was an area that was also not fully implemented?

Dr Catherine Calderwood: In my subsequent – I wouldn’t recall at the time, but in my reading subsequently, that’s correct, that those – that guidance was not fully implemented.

Lead Inquiry: I want to ask you some questions now, please, about your understanding generally of the United Kingdom science advisory system and the scientific and research base from which we benefitted on the onset of the pandemic.

Is it your view that, in order to be as well prepared as we may be for the future, it’s vital that our research base, our scientific advisory structure, is not unravelled in any way, but is maintained in order to prepare for the next pandemic?

Dr Catherine Calderwood: I think that there are many things that we have learned already in what was done: our extraordinary vaccine production in this country, our incredibly rapid assimilation of data, of studies that have continued, and our much, much better co-operation and collaboration across the UK but also, very importantly, with other countries across the world. There is, and there is already in my view, a tendency to move back to type, and that is happening to some extent within the NHS already, so that some of the improvements that were made and practical changes are gradually already slipping back to the old ways. I think it would be of paramount importance that we do not slip backwards in those scientific advances that you have discussed, in particular those – the data collection, the digital infrastructure, the innovation and the co-ordination and, in particular, collaboration with other countries, because certainly my feeling is that we didn’t learn from countries where SARS and MERS had been an issue, we were late and slow and there wasn’t a co-ordinated or formal way in which to communicate with other countries where we could have learned more rapidly.

So to untangle that – or, sorry, unravel that at this stage, I think would make a big difference in our – to our detriment if there was to be another pandemic.

Lead Inquiry: Just identifying and looking for a moment at each of those broad areas, Dr Calderwood, in relation to data, it’s apparent that during the course of the pandemic a significant number of very sophisticated data gathering exercises or processes were put into place, from the SIREN study of healthcare workers, the ONS COVID-19 Infection Survey, the Vivaldi survey in relation to care homes, there was then also the COVID Symptom Study, there was the whole process by which the RECOVERY Trial process was put in place which led to the discovery of the benefits of dexamethasone.

Are those surveys or at least the structures which underpin those surveys and that trial work being started to be unravelled or are they all still in place, do you know?

Dr Catherine Calderwood: I would sincerely hope they are all still in place. I don’t know the detail. I wouldn’t be close enough to say if there’s a concern there about those being unravelled.

Lead Inquiry: All right. You mentioned research and the research base in the United Kingdom. What about the clinical advances which have been made? Presumably the clinical developments which took place during the course of Covid are still in place, because that learning and that knowledge continues to exist. Is there anything you want to say about that aspect of it?

Dr Catherine Calderwood: I think that even us here speaking remotely, that has been a huge advantage to people being able to be consulted. If you look at a country like Scotland, with a lot of long distances for people to travel, that’s made a huge difference. The risk – risks that we believed in not seeing people face to face have probably to some extent been mitigated against, and I would like to see that our advances that we’ve done, both in this sort of remote working but also in some of the less invasive testing that can be done and interpreted remotely, that we continue in our NHS to use where we were forced, I suppose, into situations by the pandemic, that actually some of these have ended up being huge improvements in patient care, and that those continue.

Lead Inquiry: It is obvious that, along with all your colleagues, one of the greatest problems faced by scientists and healthcare specialists and administrators during the onset of the pandemic was the need to scale up the diagnostic testing and the contact tracing systems in light of the pandemic. Practically, what capabilities, in your view, need to be maintained to ensure that in future there can be a much better process by which our facilities and our procedures can be scaled up to deal with the likely numbers from the next severe pandemic?

Dr Catherine Calderwood: I suppose if – and if I can give you then the example I’ve alluded to, are other countries. So eventually, in March of 2020, I had a very, very helpful meeting with the Chief Medical Officer of Singapore, who I happen to know, so that was through an informal contact. He and many of his staff and our staff in the Scottish Government met together remotely, and what really struck me was that they had had a taskforce which had sat dormant following their outbreaks – outbreak of SARS, and that taskforce had within it the capabilities similar to what you are discussing here. They were able to immediately mobilise that and did so way back in November 2019. It is that sort of example and that sort of, I suppose, capability that we could easily keep dormant, that we could easily have exercises that enabled those to be immediately re-instigated and that the capabilities could then be spread, mitigating, to some extent, against another pathogen which spreads as rapidly as Covid-19.

Lead Inquiry: In your field of clinical medicine, how does one ensure that healthcare specialists and the health system remains well prepared for a future unknown contingent hazard whilst at the same time having to deal with the more immediate, the more practical day-to-day demands and health emergencies which all clinicians are faced with? How can you keep the system at a high state of readiness when it has to deal with the day-to-day reality of running a healthcare system? How do we deal with that?

Dr Catherine Calderwood: I think that’s extremely, extremely difficult. Our NHS is at the moment working at or if not beyond full capacity at all times. If you take my own area, the labour ward, the babies keep coming, day and night, and we don’t have the luxury of saying, “There’s going to be an exercise, we’re going to send six of you for mask fitting”, for example. We haven’t got the luxury of being able to have six spare midwives who could then go off to do that exercise. What we do do is exercises that are relevant and pertinent to the emergencies that might happen on a labour ward. Very engaged staff, those drills happen extremely frequently because we need to be slick, but it’s very difficult, without increased capacity within the NHS, to think how we could ever have exercises that would be – well, able to free up staff for a start, but also that we would be able to run exercises where staff could become engaged, because they are unable, certainly at the moment, to leave work that is prescient and the emergencies that are sitting facing them that minute, that day, especially when it’s something that’s, one, an unknown, and, secondarily, the timing is unknown. To engage people in something that may or may not happen in several years’ time is always going to be very, very difficult in a hard-pressed system.

Lead Inquiry: As the CMO, Dr Calderwood, you must have given that conundrum a great deal of anxious consideration.

Dr Catherine Calderwood: Absolutely.

Lead Inquiry: You are, of course, aware of the need to ensure that Scotland was prepared for whatever health emergency might eventuate for pandemic outbreak and so on and so forth. Where does the answer lie? Is it in having an obvious, clear, transparent process by which the right people are made to exercise and to train for the relevant and correct future risks?

Dr Catherine Calderwood: Again, if I take you back to Singapore, they have some flex in the system. There’s some slack, some flex, so that the taskforce – which is run by different people with different skills, but that there would then be exercises, who would be able to take, for example, midwives from the labour ward, because not every midwife is needed at every second for their own emergencies.

So I think the planning there and the potential needs to be built into our capacity in the NHS in Scotland.

Mr Keith: Thank you very much.

My Lady, you have you’ve granted permission –

Lady Hallett: Just before you do, I just have one question.

Mr Keith: Yes, I’m so sorry.

Questions From the Chair

Lady Hallett: Dr Calderwood, you mentioned that there’s a tendency to slip back into old ways, and I think you suggested there were examples of it happening in the NHS. Do you have any examples of where, instead of learning from the pandemic, we’ve slipped back into old ways?

Dr Catherine Calderwood: So, for example, in the pandemic 60% of orthopaedic outpatients were either not done at all in fact or done remotely. That suited everybody. It suited the patients, who didn’t want to come to hospital just to be told they were all right, because they already knew they were all right, and it also suited the hospital capacity. We’re already seeing signs of the, “Well, we’ll just see them this once”, or … so there’s a drift where actually we had – risks were mitigated against, people could telephone if they were concerned, it wasn’t that people weren’t being seen who needed to be, and I see that that gradual drift will move into other areas. But it’s already happening.

Lady Hallett: Thank you.

Mr Keith: My Lady, you’ve granted permission to Covid-19 Bereaved Families for Justice United Kingdom to ask five minutes’ worth of questions, and five minutes also to Scottish Covid-19 Bereaved Families for Justice.

Lady Hallett: Thank you.

Mr Keith: Two topics.

Lady Hallett: Ms Munroe.

Questions From Ms Munroe KC

Ms Munroe: Thank you, my Lady.

Dr Calderwood, can you hear and see me?

Dr Catherine Calderwood: I can hear you, I can’t see you at the moment, no. I can see you now.

Ms Munroe KC: Thank you very much. My name is Allison Munroe and I ask questions on behalf of Covid-19 Bereaved Families for Justice UK. Just a few questions, please, Dr Calderwood, in relation to data collection and analysis in Scotland.

Now, to put those into context for you, the Inquiry has heard some evidence already about the importance of data collection, in particular from professors Sir Chris Whitty and Sir Patrick Vallance. I don’t know, Dr Calderwood, have you had an opportunity to see or read their evidence?

Dr Catherine Calderwood: No, I’m afraid I haven’t.

Ms Munroe KC: Well, literally in a few sentences, the important takeaways for Professor Sir Patrick Vallance were that data is important for decision-making, ie the planning phases, and that the paucity of data at the start of the pandemic led to problems, “you were flying more blind than [one] would [like] to”, and for both of them an important takeaway was that the gathering of basic data, such as how many people are in hospital and how many are in intensive care, assist in order to evaluate the spread and who is likely to be most at risk, and that is of fundamental importance during the course of a pandemic.

Would you agree with all of that?

Dr Catherine Calderwood: It’s absolutely true to say that our data was – there was a paucity of data, absolutely, and that very, very clear – at the beginning, when we were struggling with our decision-making, that lack of data really, really affected how rapidly and also how effectively we could make those decisions.

Ms Munroe KC: Thank you.

Professor Woolhouse, who will be giving evidence in fact later today, makes reference to the Early Pandemic Evaluation and Enhanced Surveillance of Covid-19, better known as the EAVE study, which was led by Professor Aziz Sheikh, at Edinburgh University. He references that, Professor Woolhouse, in his statement, saying that it was one of the notable success stories that came out of the pandemic, and that effectively Professor Aziz and his team linked demographic and near realtime clinical data from almost the entire population of Scotland and monitored it on a daily, weekly basis, looking at the progress of Covid, and evaluated the effectiveness of therapeutic interventions in approximately 5.4 million individuals registered in general practices across Scotland.

Professor Woolhouse also says this, though, at paragraph 21 of his statement, and there is no need to bring it up:

“Issues with data access had been raised repeatedly by me and others prior to 2020. For example, as part of a correspondence with the office of the then CMO Scotland, I wrote in May 2018: ‘My personal view is that the system for accessing health data in Scotland is terminally dysfunctional … This is a hugely disappointing state of affairs and one that urgently needs attention. I dread to think of the consequences if we ever find ourselves facing a health emergency such as pandemic influenza’.”

Dr Calderwood, do you accept that Professor Woolhouse repeatedly raised that particular issue before 2020?

Dr Catherine Calderwood: I’m interested to hear of that email. I’m afraid at the moment I don’t recall receiving and reading that, but I would be absolutely very, very happy to have that email looked at and see what my response to that was at the time and what actions I took when Professor Woolhouse wrote to me.

Ms Munroe KC: That sort of answers my next question, then, whether it had been raised personally with you. You don’t recall the email; do you recall any occasions when Professor Woolhouse raised this issue personally with you?

Dr Catherine Calderwood: Professor Woolhouse emailed in, I think, February of 2020 and did visit me personally in my office, I think in February or March 2020, I do recall those meetings.

Ms Munroe KC: Was this issue of data, the paucity of data collection and analysis, raised with you, and if so what was your response?

Dr Catherine Calderwood: I don’t recall the specifics of the paucity of data being raised. I do recall that he talked to me about modelling of the coronavirus and what that – effects that might have in the community and how we might need to react to it.

Ms Munroe KC: Thank you.

Finally, then, another reference, Professor Crossman, you’ve mentioned him already today. My Lady, for reference purposes, we don’t need to bring it up, but his statement is INQ000185342, paragraph 14 of that statement, Professor Crossman says that data collection and analysis was distributed between Public Health Scotland, Scottish Government analysts and the Chief Statistician in Scotland, and he suggests that “a single unified data source for information, analysis and research might be a desirable aim”.

My question, Dr Calderwood, is this: to what extent was this issue of data collection and analysis considered prior to the formation of Public Health Scotland?

Dr Catherine Calderwood: So, again, I wouldn’t have been personally involved in those conversations but I have to say that I agree with Professor Crossman, and one of the frustrations I think, as CMO, and in talking to him, was that complexity of data access and data collaboration in a small country. We should be able to use, as you’ve quite rightly illustrated with the EAVE study – and which then of course was very rapidly mobilised into the EAVE II study – and I know that was a frustration not only from myself and my Chief Scientist at the time but from many people in research and development in the NHS in Scotland.

Ms Munroe: Thank you very much, Dr Calderwood.

My Lady, thank you, those are my questions.

Lady Hallett: Thank you very much, Ms Munroe.

Ms Mitchell.

Questions From Ms Mitchell KC

Ms Mitchell: My Lady, I hesitate to contradict my learned friend, but I think we have been given ten minutes. I don’t think we’ll take that long, but lest anyone thinks that I’m overstaying my welcome asking questions.

Dr Calderwood, can you hear me and see me?

Dr Catherine Calderwood: Yes, I can, thank you, Ms Mitchell.

Ms Mitchell KC: Dr Calderwood, in your statement, we don’t need to bring it up, but for purposes of the record it’s INQ000182605, page 3, paragraph 8, you say:

“These regular pandemic preparedness exercises are key policies in this context and formed the roadmap for dealing with a pandemic. These policies were part of a four-nation approach to the threat of a pandemic to ensure that expert knowledge and experience was shared across the four nations …”

Now, what I want to ask you about really is two particular areas of the four nations approach. One, the experience and the sharing of that experience; and, two, the sharing of expert knowledge.

First, I understand from reading the disclosure that you delegated Professor Sir Gregor Smith, the Deputy CMO, to attend Exercise Cygnus; is that correct?

Dr Catherine Calderwood: Yes, that’s correct.

Ms Mitchell KC: Presumably, given the importance of that, after he went to that he would come back and debrief you, talk about the issues, that sort of thing?

Dr Catherine Calderwood: So that’s not my recollection, Ms Mitchell. What – with the CMO, I suppose, the delegation to somebody as competent as Professor Sir Gregor Smith, had there been any particular issues or concerns I would have expected to have a briefing on that, but when I was delegating him to attend such a meeting, I would not necessarily have had a detailed read-out, no.

Ms Mitchell KC: Do you recall any issues being raised with you in that manner?

Dr Catherine Calderwood: I don’t, no.

Ms Mitchell KC: I wonder if we can have a look at, on the screen, Inquiry statement INQ000006210 and that’s a one-page document.

I’m just waiting until it comes up on the screen.

Dr Catherine Calderwood: Could I have that zoomed a little larger? I can’t see that. Thank you.

Ms Mitchell KC: Yes, certainly.

Dr Catherine Calderwood: Thank you.

Ms Mitchell KC: What I’m going to ask you to look at is the paragraph which starts:

“Whilst DAs found the discussions on the escalation …”

Thank you very much, it’s been highlighted for you.

“Whilst DAs found the discussions on the escalation of contingency plans useful, there was a feeling that the issues raised, particularly in population-based triage, were rushed and not widely shared prior to the exercise. As a result, DAs felt they were not able to contribute as much as they would have liked.”

Now, this is a document which is a Civil Contingencies Secretariat round table with devolved administrations post Exercise Cygnus. Do you recognise any of the views shared there in respect of Exercise Cygnus?

Dr Catherine Calderwood: Not in respect of Exercise Cygnus, no, I don’t, Ms Mitchell.

Ms Mitchell KC: Would you have expected that to be shared with you, had it been the view of those representing Scotland, ie Professor Sir Gregor Smith?

Dr Catherine Calderwood: So if I may answer with a slightly longer … so sometimes these large four nation meetings, with a lot of people attending them, and depending on how many people are in the room or how much is done remotely, I think that that sentence about the DAs feeling that they couldn’t contribute or that there was rushed … what’s the word? That there was rushed – a shorter time left for the DAs often at the end of the meeting or that they didn’t feel always that they would have their voices heard. So that is my experience of some, not all, very much not all, of some meetings of this nature.

I don’t, as I’ve said already, recall this specifically, reading this or this being alerted to me about Operation Cygnus, no.

Ms Mitchell KC: Thank you.

Moving on, we’ve heard about your close working relationship with the CMOs for the nations. I want to ask you about sharing expert knowledge with the devolved administrations in relation to Exercise Cygnus.

I wonder if I could have on the screen INQ000006129, Inquiry document. This is a COBR meeting notice, and in that at bullet point 4 it was noted that:

“Public Health England and GO-Science to share modelling on the projected use of antivirals with the Devolved Administrations.”

Were you aware of that sharing process going to happen?

Dr Catherine Calderwood: No, I’m not aware of the detail.

Ms Mitchell KC: Okay.

We’ve heard that you’ve given indication of practical difficulties in communication with SAGE, literally our wifi, which even in this Inquiry doesn’t seem to have necessarily held up so well from Scotland.

What I would like to know, Dr Calderwood: was there a formal system for sharing the knowledge and information, to share that expertise and knowledge, as between the UK and devolved administration?

I understand you had a good relationship with other CMOs, but what I’m wondering was: was there a structure underlying that where we could be sure we were getting the relevant information?

Dr Catherine Calderwood: I do believe so. So I believe that after these sort of UK exercises that civil servants would have taken that, the outputs, and those would be shared with civil servants in the other nations, yes.

Ms Mitchell KC: Were you the recipient of that sharing?

Dr Catherine Calderwood: I may have been copied in, I may not have been, I’m afraid I don’t recall.

Ms Mitchell: No further questions.

Lady Hallett: Thank you very much, Ms Mitchell.

Thank you very much, Dr Calderwood, thank you for joining us.

The Witness: Thank you.

(The witness withdrew)

Mr Keith: My Lady, the next witness is Professor Jim McManus, please.