5. Mr Aidan Dawson

MR AIDAN DAWSON (sworn).

Questions From Counsel to the Inquiry

Lady Hallett: Sorry to keep you waiting, Mr Dawson, I gather you have been hanging around.

The Witness: Thank you, my Lady.

Lady Hallett: We do our best not to inconvenience people, but it doesn’t always work.

Ms Blackwell: Thank you, my Lady.

Mr Dawson, thank you for the assistance you have so far given to the Inquiry.

You have provided two witness statements. The first is at INQ000187474. Thank you. The second witness statement is at INQ000179733. Can you confirm that those are your witness statements and that they’re true to the best of your knowledge and belief?

Mr Aidan Dawson: They are my witness statements, and they are true to the best of my knowledge, and I should perhaps just acknowledge that I have had considerable help in developing those because I wasn’t there during the period.

Counsel Inquiry: All right. Well, we’ll deal with that in a moment.

Can I just note that you speak quite quietly, Mr Dawson, so please keep your voice up during your evidence and speak into the microphones directly so that – I think the position you’re in now is fine – the stenographer can hear you for the transcript.

You are chief executive of the Public Health Agency in Northern Ireland, but, as you have just noted, you took up that role in June of 2021, and so we appreciate that you were not in post during the time period with which this module is concerned, and during which some of the evidence that’s to be elicited by the questions will be based. But I hope that, given the assistance that you have had in preparing your witness statements and the role that you currently occupy, that you will be able to speak to most, if not all, of the issues.

You have a 30-year experience of working within the health service in Northern Ireland. You have held various roles and responsibilities in the Belfast Health and Social Care Trust, including holding responsibility for mental health services, and you’ve also worked with the British Red Cross and Disability Action.

What was your experience specifically in public health prior to joining the PHA?

Mr Aidan Dawson: I probably don’t have – I don’t have a background in public health, but I joined PHA as the chief executive. It wasn’t a requirement. However, having worked in health and social care sector in the community and voluntary sector for quite a period of time, I have an understanding of it. I also would have worked during that period of time, when I worked in the trust, with representatives of the Public Health Agency, because one of the responsibilities for the agency is to provide professional advice to commissioning arrangements across Northern Ireland in the health and social care sector and to the Health and Social Care Board, and therefore I would have met regularly with representatives of Public Health Agency.

Counsel Inquiry: So no direct experience of public health, but lots of experience of health in Northern Ireland –

Mr Aidan Dawson: Yes.

Counsel Inquiry: – and you knew how the system worked?

Mr Aidan Dawson: Yes, I’ve worked, I think as you outlined, across most of the health and social care. I had worked in the acute sector, I’d worked in the community sector, I had worked in children’s, elderly care and mental health, as you said, elective and acute services. I’d even worked in Central Services Agency, which was the precursor of BSO. I had worked in the Health and Social Care Board previously as well, so I had a broad range of health and social care positions across those 30 years, and had worked across much of the sector as well, therefore I had a good understanding of it.

Counsel Inquiry: BSO being the Business Services Organisation?

Mr Aidan Dawson: Business Services Organisation, yes.

Counsel Inquiry: My Lady has heard evidence already during the course of the Inquiry about the creation and history of the Public Health Agency, and so, Mr Dawson, I will confine myself to a very high-level summary of the agency itself in that it was established under the Health and Social Care (Reform) Act (Northern Ireland) 2009, and has functions under three broad headings: improvement in health and social well-being, including: reducing health inequalities; second, health protection; and third, service development, which is providing input into the commissioning of health and social care services.

Is that right?

Mr Aidan Dawson: That’s right. There are a few other elements as well. Do you wish me to outline them?

Counsel Inquiry: Well, I’m going to come on to roles and responsibilities in a moment, which I hope will reflect upon the other areas which you have in mind, and please say so if they don’t.

Before I do so, is the Public Health Agency to be described as an arm’s length statutory body?

Mr Aidan Dawson: We are an arm’s length statutory body, yes.

Counsel Inquiry: To what extent, then, is the agency properly described as being independent from the influence of ministers?

Mr Aidan Dawson: I’m not sure that that’s a wholly accurate statement, because we –

Counsel Inquiry: Right.

Mr Aidan Dawson: I am accountable to the board of the Public Health Agency, and the chair and the non-executive directors of that board, and there are seven non-executive directors, are appointed by the minister and are there to ensure that the agency carries out the roles and desires of the minister.

Counsel Inquiry: Right. So there is a level of influence, you would say, naturally, because it is a statutory arm’s length body?

Mr Aidan Dawson: It is a statutory arm’s length body, yes, but we also work very closely with the Department of Health, who are our sponsorship body in Northern Ireland.

It is a very small nation, we’ve only a 1.8 million population, the health service system in Northern Ireland is very small, and everyone perhaps knows everyone, we have really good relationships with the Department of Health, and therefore we are very much dependent – co-dependent on each other for the delivery of our services.

Counsel Inquiry: The Public Health Agency does indeed work very closely with the Health and Social Care Board and the BSO. In terms of its responsibilities for emergency planning and response, do they include, so far as PHA is concerned, responding to public health emergencies through the provision of local arrangements, working with the HSCB to ensure that trusts and other frontline service providers maintain emergency plans, working to facilitate the training of and emergency preparedness exercises relating to staff provision, including the promotion of training initiatives, participating in multi-agency emergency preparedness and response, providing organisations with emergency preparedness guidance, and co-ordinating and providing an annual report, together with the HSCB and the BSO, on emergency planning activities to the Department of Health?

Mr Aidan Dawson: Yes, that is correct. Up until April of this year, obviously HSCB was in existence.

Counsel Inquiry: Yes.

Mr Aidan Dawson: Obviously at the beginning of April this year, the Health and Social Care Board closed and became – its responsibilities were then absorbed, migrated into the Department of Health, and they now sit as the Strategic Planning and Performance Group within the Department of Health. However, we are still working with them very closely in the delivery of commissioning as well.

Counsel Inquiry: I appreciate it’s only been a matter of a couple of months or so since that change. Have you in your position as chef executive of the agency noticed any practical change with the movement or migration, as you describe, of those services from the HSCB over to the Department of Health?

Mr Aidan Dawson: I think that transfer is still ongoing. We are still working under a draft framework document which would set out the roles and responsibilities of both organisations, and inevitably some things have to change, because previously, say, there was a temporary change in maternity services in one of the trusts, it would have been up to the Public Health Agency and the Health and Social Care Board to consider that and make a recommendation to the department. But obviously as now SPPG is part of the department, that ensures that there has to be a change in the way that we work together. So, yes, there is a change in our relationship which is still developing. And also I think that’s influenced by our commissioning arrangements are changing and we are piloting ICS Northern Ireland, which is an Integrated Care System in Northern Ireland, at this time. It is being developed. Without legislation, it can’t come into being until April of next year and can only come into being if we have legislation to allow that to happen. So our relationship is changing as well around how we commission services and discussions are ongoing between the two organisations and the department about how that relationship is transacted in the future.

Counsel Inquiry: Thank you.

So far as EPRR stretches are concerned, my Lady has heard evidence that in England the directors of public health are employed by local authorities, and in fact Professor McManus, who is the president of the Association of Directors of Public Health, has confirmed that whilst there are 152 local authorities in England, there are 130 or so directors of public health because some share an authority.

Is it right, Mr Dawson, that across Northern Ireland there is only one director of public health for the whole of the population?

Mr Aidan Dawson: That’s correct.

Counsel Inquiry: Right, and that director of public health is employed by the Public Health Agency and is accountable to the Chief Medical Officer for Northern Ireland?

Mr Aidan Dawson: Well, they’re an executive director at the Public Health Agency and are accountable to me in that role. However, they would also have a line of professional responsibility to the CMO as well.

Counsel Inquiry: Right. Does the director of Public Health have overall responsibility for all public health functions, including emergency preparedness and the development of public health emergency plans?

Mr Aidan Dawson: Yes, she does.

Counsel Inquiry: All right.

What is the Emergency preparedness/environmental hazards team, or the EPEH team?

Mr Aidan Dawson: Sorry, say that to me again.

Counsel Inquiry: The Emergency preparedness/environmental hazards team.

Mr Aidan Dawson: They’re the team which sits under Joanne, and across the bodies as well, that looks across Northern Ireland for being – emergency preparedness for reacting to emergencies.

Counsel Inquiry: So they sit with the director of Public Health?

Mr Aidan Dawson: Yes.

Counsel Inquiry: All right.

Do you know whether or not that team has been reduced in numbers over the ten-year period with which this module is concerned?

Mr Aidan Dawson: It has changed. I mean, in the bringing together of the Health and Social Care Boards into one agency, all of the director – there were previously four directors of public health or – sitting under those. They all came together in one group, so there would be a reduction, obviously, because there was duplication at that point in time.

Now, in talking this through with my team, it has changed considerably, so there would have been two consultants in public health initially which looked after emergency planning. That sort of reduced around sort of 2015 to one. Then there was an appointment of a band 8c around about 2017/18 into that role, and I think the headcount now is there is a public health consultant who has emergency planning as part of her role. There is the 8c senior emergency planning officer. There are two band 7s reporting to her, and there’s one band 4. But I think overall the headcount – but I think it’s – has perhaps stayed the same, but the multidisciplinary nature of the team has changed, so I think it’s a different approach.

Counsel Inquiry: Right, and in your view, looking at it from the position that you occupy, are there any concerns about, perhaps not the reduction in numbers but the reduction in focus that can be given to emergency preparedness by the team as it’s currently constituted?

Mr Aidan Dawson: Yes. I think that is fair to say. I would like a bigger emergency planning team. We are currently undergoing a review within the organisation which Ernst & Young are facilitating, both ourselves and our sponsorship branch under the CMO, to look at how the organisation is formed, how it is set up, the functions that it provides, et cetera, and emergency planning will come into that. But I suppose, in direct answer, yes, I would have concerns that it is not big enough perhaps to take on all the roles which we would wish it to in the future.

Counsel Inquiry: Moving on to public health laboratories. The Inquiry has heard from the Chief Medical Officer, Professor Sir Michael McBride, that prior to Covid-19, each of the five HSC trusts in Northern Ireland had its own hospital laboratory, which included microbiology and serology capacity with them, and there is also a regional virology laboratory and regional services for genetic testing.

Now, in your second witness statement to the Inquiry, you’ve told us that microbiology is not part of the PHA and is overseen through the Pathology Network.

So then, did Northern Ireland have a modest network of microbiology and public health laboratories which were part of the HSC Trust, and is that sufficient, do you think? Because we’ve also heard that certain aspects of the work which needs from time to time to be done is outsourced over to Public Health England’s laboratory at Colindale.

Mr Aidan Dawson: Yes. I mean, we don’t – I know Public Health Wales is different from us and they sort of run laboratories across Northern Ireland. There is a current project under way with NIBTS as well looking to bring all the laboratories in Northern Ireland under one structure –

Counsel Inquiry: What’s NIBTS, please?

Mr Aidan Dawson: Northern Ireland Blood Transfusion Service. Sorry for the use of acronyms. And that is progressing. But I think the point that you make is that we have a small service. We’re obviously a very small region, as outlined previously, and they’re looking to bring about efficiencies of scale by bringing it under one management structure. But there is no doubt that we have to at times send stuff to England, which is not ideal.

Counsel Inquiry: Is there any prospect of there being an expansion of the capacity within Northern Ireland so that the need to engage with Colindale is removed?

Mr Aidan Dawson: I wouldn’t be able to answer that question. As I say, we don’t manage the laboratory services. There is a – as I’ve said, I don’t wish to repeat myself, but there is an ongoing project looking at that. I’m not aware – what I can say is I’m not aware of any move to increase that capacity so as we don’t have that reliance on Colindale.

Counsel Inquiry: All right, thank you. In terms of surveillance, you tell us in your second witness statement that:

“[The Public Health Agency] had a team of health protection surveillance and information scientists who were responsible for communicable disease surveillance and epidemiology.”

But in your first witness statement, you have already told us that work to update the Public Health Act (Northern Ireland) 1967, which sets out the statutory notifiable disease requirements, was under way in 2016 but was not progressed due to the suspension of the Northern Ireland Assembly.

In terms of surveillance and what is currently set out within the 1967 Act, are you able to help us with what proposals or amendments were proposed?

Mr Aidan Dawson: I’m sorry, I wouldn’t have that detail. I know, as I said in the statement, that we are – it was being reviewed. I think the expansion – if we look at our colleagues in England, Scotland and Wales they have much broader powers under their Acts –

Counsel Inquiry: Yes.

Mr Aidan Dawson: – and they – we – the 1967 Act tends to focus on disease, whereas in England, Scotland and Wales they’ve now sort of got a much broader scope to consider all hazards, like biological, radiological, nuclear and environmental hazard. So it was more – in my understanding, it’s more an expansion in the roles.

Also it would have expanded the number of diseases which are notifiable, which would be very much helpful, because, 1967, there’s a lot more pathogens out there now than there – which are identifiable, and we don’t have powers for those to be notifiable, that’s –

Counsel Inquiry: Right, so an urgent need, I’m going to describe it as, for that 1967 legislation to be updated?

Mr Aidan Dawson: Yes.

Counsel Inquiry: Thank you.

Epidemic modelling. You tell us that the department has or had no epidemic modelling function or capability and no staff whose role was to act as a consultant epidemiologist.

Mr Aidan Dawson: We would have public health consultants and we would have epidemiologists working in the Public Health Agency. We wouldn’t – sorry, could you repeat that for me?

Counsel Inquiry: Yes. In your second witness statement, you say this:

“The department had no epidemic modelling function or capability. [It] had no staff whose role was [to act] as a consultant epidemiologist.”

Mr Aidan Dawson: Yes. That would be correct. We did not have the capacity before Covid to do modelling of disease progression within Northern Ireland. That was developed in – with the Department of Health and Queen’s and others contributing to that, under the sort of Chief Scientific Adviser, Professor Ian Young.

Counsel Inquiry: Should there have been a consultant epidemiologist employed by the agency?

Mr Aidan Dawson: I think in hindsight, yes, but also in hindsight the ability to have our own Northern Ireland modelling capabilities there, because one of the varying factors that we have which is not seen in the rest of the UK is that we have an open land border with the Republic of Ireland, which may have had a variation impact on disease progression within Northern Ireland, and therefore the ability to monitor and have realtime monitoring – or modelling, I should say, in Northern Ireland was important.

Counsel Inquiry: Well, let’s have a look, please, at the witness statement of Professor Ian Young, the Chief Scientific Adviser to the Department of Health.

Thank you very much. For the record, it’s INQ000185346. Paragraph 16, he tells the Inquiry this:

“Northern Ireland did not have established capacity in pandemic modelling which could be immediately stood up at the outset of the pandemic. In the initial stages of the pandemic, Northern Ireland relied on UK modelling which was presented to SAGE. I established [a Northern Ireland] modelling group at the end of March 2020 at the request of the [Chief Medical Officer] when I returned to work, and this group played an important role in informing [Northern Irish] policy as the pandemic progressed. UK modelling (which included modelling of the pandemic in [Northern Ireland] by UK groups) was helpful, but generally lagged behind NI local modelling which used the most up-to-date data to inform advice to the Minister of Health and the [Northern Ireland] Executive.”

If at the time the Public Health Agency didn’t have its own modelling capability, does it follow that it didn’t have the means to challenge any forecasting or modelling provided to it by the Health Protection Agency which became Public Health England?

Mr Aidan Dawson: Yes, and I think it says in the statement that we are – Public Health Agency are consumers of sort of modelling and advice from Public Health England, and currently UKHSA as well, and we wouldn’t have had the ability to challenge because we wouldn’t have had the data to do that.

Counsel Inquiry: Right, thank you.

Can we take that down, please, and look at the Hussey review, which is at INQ000102852.

This is the report from December of 2020 of a:

“Rapid, focused external review of the Public Health Agency (PHA) for Northern Ireland’s resource requirements to respond to … Covid-19 …”

Whilst appreciating immediately that, again, this is outside of the Module 1 time period, I’d like to nevertheless look at some of the results of the review.

If we can go to page 8, please, thank you.

Now, we can see here that “The effective use of evidence, health information, epidemiology and research” identifies a series of specific points raised.

If we look at the sixth bullet point down, we can see that there was concern in relation to limited modelling skills available in the Public Health Agency, despite some academic supplementation.

Is that something which you recognised when you came into your role as chief executive?

Mr Aidan Dawson: Yes. It was evident when I came into this role that we had developed a modelling approach within the agency. We had done that by bringing in consultants who are specialists in data management, plus also input from one of our public health consultants as well. And we have developed and strengthened that.

As I said, the agency is currently under review. It is our intention, learning from where we’ve come from through Covid, as part of that review we have identified that we will establish a new directorate of digital and information and innovation and appoint a director to that.

Now that is an area which we’re currently getting into, but we have maintained those modelling skills and analytic platforms that are required to do that, so that we are able, if this was to happen tomorrow, to have that ability to carry out some data analytics.

It is still very much in development, but I see it as a key way forward for the organisation in order to be able to deliver on its responsibilities.

Counsel Inquiry: Right. Well, just reflecting upon what you’ve said and what’s within the review of Dr Hussey in terms of evidence and data, could we go to page 15 of the report and highlight at page 15 the penultimate paragraph, please. Because Dr Hussey concluded that:

“Evidence and data are the ‘life blood’ of public health practice. The [Public Health Agency] should be a leader in developing and using science and intelligence to inform its work. Modern public health practice requires access to a broad base of sciences, such as epidemiology, microbiology, behavioural, economic and data sciences to name a few.”

Is it your experience, Mr Dawson, that, moving forwards, various elements of medicine and clinical practice, and indeed behavioural, economic and data sciences, are all necessary in order to provide the Public Health Agency with the skills and the tools needed to prepare for the next pandemic that’s coming down the line?

Mr Aidan Dawson: Yes. I mean, the reason that we are looking to develop that new directorate, currently we have three executive directors: Operations, the director of Public Health, and the director of Nursing and AHPs. The development of a further director focused on digital and information and innovation will have a remit to look across those areas. Probably we haven’t defined it as well as it is defined there, but it is one of the areas which we intend to develop closely with partners in the Department of Health and EY over the next year.

Counsel Inquiry: Right, thank you.

I’d like to look at two further features, please, of improvements to the way in which the Public Health Agency carries forwards its responsibilities in terms of EPRR and pandemic planning.

The first is to go back to another aspect of the witness statement of Professor Ian Young at INQ000185346.

This time, please, can we look at page 6, paragraph 21, and read only from the final sentence of this page, and over the page on to page 7. He says here, dealing with pandemic modelling, at the bottom:

“In terms of inequalities, one area which requires improvement is coding of ethnicity within the Electronic Health Care Record. Due to inadequacies of ethnicity coding, it was not possible for us to analyse differential impacts of the pandemic according to ethnicity in our general population, although it is also important to note that Northern Ireland has a much smaller proportion of ethnic minorities than other parts of the UK. In contrast, we were able to look at the influence of social deprivation on various impacts of the pandemic.”

Taking on board what Professor Young says about the smaller proportion of ethnic minority people in the population of Northern Ireland, is it, though, necessary, going forwards, to ensure that ethnicity coding forms part of the Electronic Health Care Record?

Mr Aidan Dawson: Yes. I think it might be helpful to understand that coding in England is much better than it would have traditionally been in Northern Ireland, partly because England operates a tariff system and the tariff is based on the coding. Northern Ireland has a block contract system of commissioning. It is less reliant on coding to ensure payment from the commissioner or purchaser through to the trust. Therefore I don’t think we’ve ever had the same focus on coding as probably counterparts in England and Wales would have had.

The second thing that I would come to is that Northern Ireland is currently in the process of a major reform of the patient records, electronic records system. That project is entitled “Encompass” and that is currently being piloted, in terms of roll-out, to one of the trusts in the South Eastern trust, with the view that it will roll out over other trusts as well. And therefore the coding would come under that group, which sits within – I’m going to use another acronym, which is DHCNI, which I think stands for Digital Health and Care Northern Ireland, which is a directorate of the Department of Health.

Counsel Inquiry: Thank you. We can take that down, please, off the screen.

I don’t know whether this has any bearing upon the organisation that you’ve just named, but is it right that, prior to the pandemic, the surveillance team within PHA didn’t have access to information technology that permitted scalable and repeatable data processing and analytical processes?

Mr Aidan Dawson: That is correct. I mean, I think I said earlier that brought in consultants during Covid to help us establish an analytics platform, and that is one of our major drivers going forward, is to enhance and drive better use of analytical platforms and innovative ways of handling data.

Counsel Inquiry: All right, thank you.

Please could we return momentarily to the Hussey review at INQ000102852 – thank you – and look at some of the points raised under “Health Protection Service and Emergency Preparedness”, in particular at point 7:

“The lessons learned so far not yet undertaken – no time to reflect.”

Then towards the bottom – thank you.

“IT inadequate – hardware and software, phones and internet crashing.”

If we could go further down, please, on to the next page, thank you, we can see at the bottom bullet point under the next section:

“Working environment poor – IT and accommodation.”

Under “Contact Tracing Service”, penultimate bullet point:

“New IT system established at pace.”

Was there a problem within public health and the Public Health Agency in terms of the IT that it was using, the systems and the capabilities of those systems?

Mr Aidan Dawson: I think it was somewhat limited, yes, which is why we’ve moved to better analytical platforms and why we’ve invested in that, and we are continuing to look at how we could do better modelling not only in health protection areas but on the wider public health issues as well going forward. And IT has been a significant issue for us, yes.

Counsel Inquiry: Just reminding ourselves that this review and report was commissioned in – well, towards the end of 2020. Were these matters not appreciated before Dr Hussey performed her review? And if so, why not?

Mr Aidan Dawson: Obviously that was before I was there, and –

Counsel Inquiry: Yes.

Mr Aidan Dawson: But my assessment would be, looking at it, was they weren’t appreciated. I think the review was necessary, and – so I would accept that there was probably an impact over a period of time that we had a number of interim chief executives, over a period of years, which may have contributed to that.

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

I want to move on to funding, please. To what extent within the Public Health Agency are funds spent on pandemic preparedness ringfenced?

Mr Aidan Dawson: They do have a budget. There is that team which is established. So to that extent they are ringfenced, and haven’t changed to any great extent year on year.

Counsel Inquiry: Did the Public Health Agency feel that the provision of budget in relation to pandemic preparedness and EPRR functions was adequate, or did the agency, over the period of time with which this module is concerned, feel that it was underfunded?

Mr Aidan Dawson: In preparing, I did consider that, and discussed it with my team. They have advised me that the team was small, it did – but it could do within the resource that it had. I suppose my observation back to them was: well, it was not on the risk register as a concern, and therefore the only thing that I could lead to or conclude from that is that it hadn’t been considered a significant enough risk, therefore must have been considered adequate at that time.

Counsel Inquiry: Do you mean that funding wasn’t identified on the risk register?

Mr Aidan Dawson: That’s correct.

Counsel Inquiry: All right.

What about the training budget? Is there a separate budget for training within the department?

Mr Aidan Dawson: There is a budget of £30,000 per year, and there is an option to seek an enhancement of that for additional training and exercise –

Counsel Inquiry: Sorry to interrupt you, but was there a plea put forwards for that to be increased to £50,000 in the year 2018 to 2019?

Mr Aidan Dawson: Now, there might have been but I’m not aware of that, and it’s not something that was brought to my attention.

Counsel Inquiry: All right. Is that something which you would support? Is there a need for the training budget to be increased?

Mr Aidan Dawson: I think going forward, and as we take the lessons out of Covid as we go through the review, I would imagine that is one of the things that we would look to increase, as I imagine the training may take a different approach going forward as well. So I think it will have to increase.

Counsel Inquiry: One of the matters which was raised by Michelle O’Neill in her witness statement to the Inquiry, and indeed one of the findings in the Hussey review, was that there were overstretched staffing problems, insufficient training budget, and that was across the emergency prevention, preparedness and response capability. Is that something that you recognise?

Mr Aidan Dawson: Yes, and I think if we – one of the other issues I think you’ll probably raise with me is planning for EU – Brexit.

Counsel Inquiry: Yes.

Mr Aidan Dawson: And one of the significant factors there would be that we have a small team, as I outlined earlier –

Counsel Inquiry: Yes.

Mr Aidan Dawson: – and when they were doing Brexit, that was the team that was focused in preparing for Brexit, and therefore you have the opportunity cost of: if they were doing that, then they couldn’t be focused on emergency planning in the sense that they generally were.

Counsel Inquiry: Before we turn to look at the effects on the agency of being caused to focus on the possibility of a no-deal EU exit, I just want to cover emergency response plans. Because, at a very high level, would you agree with other witnesses from whom the Inquiry has heard that there was a plethora of plans within all aspects of health in Northern Ireland, that the situation could and should be simplified, and that that is because too many plans, too many strategies cause significant confusion?

Mr Aidan Dawson: Yes. I would agree. I agree on that, and I think the outcome of one of the exercises, maybe it was Stannis, was that there was a recognition of the number of plans that could lead to confusion and a need to simplify the system of emergency planning.

I think it also recognised that those that worked in the system seemed to know what they were doing and how they should interact, et cetera, and how they should respond. But there was a recognition that simplicity, especially in the face of an emergency and a need to respond at scale, would benefit from a more simplified approach.

Counsel Inquiry: Thank you.

Coming then to the impact of the United Kingdom’s exit from the European Union.

From your perspective – and I appreciate coming into the role when you did in 2021 – what have your colleagues told you about the practical effect on them being asked to focus upon ensuring that plans were in place for the possibility of a no-deal Brexit and how that affected their level of preparation for emergencies?

Mr Aidan Dawson: I think in – 2017 saw the appointment of the emergency planning officer, band 8c. In speaking to her, she would advise me that the biggest issue was that she wasn’t doing the emergency preparedness to the extent that she should have been, that they were – also had a number of vacancies at that time and therefore all her focus was into Brexit and preparing for that, and therefore there was an opportunity cost, because it’s one team, they could only do that one thing at a time, and therefore there were perhaps missed opportunities to focus on planning for the pandemic.

Counsel Inquiry: The Inquiry has received a witness statement from Peter May, who tells my Lady that in July of 2019 the task and finish group submitted the draft Northern Ireland health and social care influenza pandemic surge guidance to the department, but the department considered that the draft didn’t fully meet the brief, and that subsequent consideration and reflection upon it really just fell by the wayside because of the need to refocus on the possibility of a no-deal EU exit.

Did the Public Health Agency have any involvement in the preparation and drafting of that guidance?

Mr Aidan Dawson: Yes.

Counsel Inquiry: All right.

Mr Aidan Dawson: The Public Health Agency were one of the lead agencies in developing that guidance, and I think it was submitted by Dr Carolyn Harper, who was then the DPH in the Public Health Agency.

Counsel Inquiry: Right.

So are you able to assist us, Mr Dawson, with when that guidance was once again picked up and reconsidered and whether or not it’s been finalised?

Mr Aidan Dawson: I spoke to my team about this last week, and what they advised me was that the first that they’d heard that it didn’t quite meet the brief was when they’d seen that in Peter May’s statement.

Counsel Inquiry: Right. So –

Mr Aidan Dawson: And therefore we haven’t officially heard back any commentary from the department on that guidance since it was submitted.

Counsel Inquiry: And if that was in the process currently of being reflected upon, and perhaps parts of it being redrafted, that would be done with the assistance and involvement of the Public Health Agency, would it not?

Mr Aidan Dawson: Yes, it would.

Counsel Inquiry: So can we therefore take it that that piece of work has not yet been finalised?

Mr Aidan Dawson: It has not been finalised, that’s correct.

Counsel Inquiry: And you don’t have any update to provide to the Inquiry as to when that might be done, because you’ve not heard anything back from the Department of Health?

Mr Aidan Dawson: That is correct.

Counsel Inquiry: Thank you.

Finally, the Inquiry has heard that, as Ireland is a single epidemiological unit, formal systems, processes and structures should be put in place to prepare for future planning on an all-island basis at an official level as well as at a political level. Do you agree with that?

Mr Aidan Dawson: At the minute there are no formal structures between Northern Ireland and the Republic of Ireland. There are very good operational and professional relationships where we exercise together, we share information, et cetera. I do think it would be helpful, because we are an island with an open border, if we did have some degree of formal structures to enable us to have those regularised points of contact and not be reliant on individual relationships.

To what extent that should be developed would obviously be a government matter, and I wouldn’t wish to comment further on that, and that would be sitting between the two jurisdictions and governments. But as a Public Health Agency who have responsibility, I feel – as does my organisation – it would be helpful to have regularised and formal relationships to take away the risk that if individuals, left the relationships may deteriorate or no longer exist.

I would hope that that wouldn’t happen, but clarity and process and structure, which is embedded, would – is always more helpful than dependent on individuals having relationships.

Counsel Inquiry: Thank you very much.

Mr Aidan Dawson: Does that answer the question?

Ms Blackwell: Yes, it does, thank you very much.

My Lady, that completes my questioning for Mr Dawson. I know that provisional permission has been given to Covid Bereaved Families for Justice Northern Ireland to ask a short collection of questions. I don’t know whether it’s Mr Lavery or Ms Campbell King’s Counsel.

Lady Hallett: I’ve got Ms Campbell on my list.

Ms Blackwell: Great. Well, I’ll hand over to her, then.

Lady Hallett: Ms Campbell.

Questions From Ms Campbell KC

Ms Campbell: Mr Dawson, thank you. As you’ve just heard, my name is Brenda Campbell and I, together with others, represent the Northern Ireland Covid Bereaved Families for Justice.

The primary question that we have for you – and I’ll break it down in a moment, but if I can let you know what it is – is whether you agree, from your reflection as well as your current post, that in significant respects the Northern Ireland Executive and the Public Health Agency appears to have been unprepared or ill prepared for the pandemic that hit us. Now, that’s a very broad question. Are you able to give us a yes/no answer?

Mr Aidan Dawson: I can give you a yes/no answer, I think, on the Public Health Agency. And on reflection, in discussion with people that worked in post in the agency at the time, it is fair to say that they were not prepared for the pandemic in the scale that it arrived. So you asked for a broad answer; I can comment on the agency on that. However, I don’t think any part of the system of healthcare in Northern Ireland was prepared for that, and perhaps government.

In terms of commenting on the Executive, I don’t have enough information, I feel, and I don’t know that it’s my place to comment on the Executive because it’s part of government. I would feel comfortable in commenting on my own organisation that I have responsibility for now, but I – whilst I wish to be helpful to the Inquiry, as I sit here, I don’t feel that I am in a position to give an appropriate answer on the preparation and preparedness of the Executive.

Ms Campbell KC: Well, I think that’s fair, and therefore for the remainder of my questions, if we can focus on your role and the role of the Public Health Agency before you, if you like, came on board.

The evidence may point to the fact that there were both macro issues and also micro issues. The macro issues facing Northern Ireland that we have heard about are the collapse of the Assembly, the impact of austerity and financial restraints in particular on the health and social care services, and the diversion of resources away from pandemic planning to preparation for a no-deal EU exit.

Do you recognise those three significant strands as having an impact on the Public Health Agency’s preparedness?

Mr Aidan Dawson: As part of the Northern Ireland health and social care system, we all faced those pressures, and therefore I would suggest obviously it would have had an impact upon the Public Health Agency, as it would have the wider health and social care system, and the sort of Delivering Together and work of Professor Bengoa indicated that we needed to move towards a more resilient population, one with better health and one with better health and social – one with better mental wellbeing as well, and I don’t think that we progressed that in the way that we could have, as a society, across Northern Ireland.

Ms Campbell KC: And is that prior to the pandemic, or in preparation for?

Mr Aidan Dawson: I think prior to the pandemic.

Ms Campbell KC: Well, as it happens, to a significant or perhaps greater or lesser extent, those three issues prevail: we still don’t have or we currently don’t have an Assembly; you may have heard the evidence of Professor Sir Michael McBride that the situation for health and social care is perhaps worse than it was in 2020; and of course there are still pressures in relation to Brexit.

So the question from the Public Health Agency’s perspective is: well, what can be done to ensure that as an agency, given that those issues still prevail, there is sufficient focus on pandemic preparedness in future?

Mr Aidan Dawson: I think we are, as I said earlier in my evidence, undergoing a review as an organisation, that has been ongoing now for about a year and we’ve still probably got a year left to run, about how we organise ourselves, how we create better resilience within our workforce, how we provide better training, how we provide better IT and analytic platforms, and also how we better model impacts of things that we might do in terms of the space of public health to improve health and social wellbeing going forward, to ensure that we’re adopting best practice in those fields.

Ms Campbell KC: Well, we know, including the answers that you’ve just given, that you’ve told us about the need for a bigger emergency planning team within your department, the need for a significant and urgent review of the 1967 public health legislation, the employment of a consultant epidemiologist, the need to ensure consistent modelling capacity, the improved IT, the need to code for ethnicity minorities to ensure we understand the community that any response has got to reflect.

It’s a very significant amount of work that needs to be undertaken in the Public Health Agency?

Mr Aidan Dawson: It is.

Ms Campbell KC: And if it is going to be achieved within the next year, bearing in mind we don’t know what the future holds, I mean, on behalf of the bereaved families, what assurance can you give us that it’s achievable and will be achieved?

Mr Aidan Dawson: I don’t think we – what we’re trying to achieve in the next year is to build the platform and foundation for that. I imagine it will take a number of years after that to get all the pieces in place. And I would say in terms of public health, healthcare is just one part of it. The other bits of what defines your health are the environments in which you live in, your income, the job, your education, the places that you work. So it really takes a cross-departmental approach, and one of the things which we know is – there, is making life better – which was the sort of approach to the strategy document for improving public health and providing that better resilience – has come to an end in 2023. There is a new all-party – sorry, it’s not all-party – all-departmental officials working group to be established under Professor Sir Michael McBride as CMO, which we will contribute to, to ensure that we try and build that better society which is more resilient with all of the parts of government playing into that.

Ms Campbell KC: But are we not in some sense circular, because although we can have building blocks and cross-departmental discussions and recognitions, if we don’t have finances and a functioning Executive and elected representatives, there is a limit to which you can fulfil those ambitions?

Mr Aidan Dawson: Yeah. There will always be a limit to what a Public Health Agency working in isolation can achieve. It does require all of government and all of society to improve and step forward, and I suppose, as others have said, the absence of a working Assembly perhaps takes away the drive or impetus to achieve that.

Ms Campbell: Thank you very much.

Thank you, my Lady.

Lady Hallett: Thank you, Ms Campbell.

Ms Blackwell: My Lady, that concludes the evidence of Mr Dawson, and indeed the evidence for today.

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

The Witness: Thank you, my Lady.

(The witness withdrew)

Lady Hallett: 10 o’clock tomorrow?

Ms Blackwell: Yes, please.

Lady Hallett: Thank you.

(4.00 pm)

(The hearing adjourned until 10 am on Thursday, 13 July 2023)