2. Ms Kate Bell

MS KATE BELL (affirmed).

Questions From Counsel to the Inquiry

Ms Blackwell: Thank you both for the assistance that you’ve so far given to the Inquiry, and for coming to give evidence this morning.

Ms Bell, if I can turn to you first, please, you have provided a witness statement which is at INQ000177807. It’s dated 21 April of this year, and can you confirm, please, that it’s true to the best of your knowledge and belief.

Ms Bell: I can.

Ms Blackwell: Thank you.

Mr Murphy, your witness statement is at INQ000177806. It’s dated April and, again, can you confirm that it’s true to the best of your knowledge and belief?

Mr Murphy: I can.

Ms Blackwell: Thank you very much.

Whilst you’re giving evidence, please keep your voices up, speak into the microphones so that the stenographer can hear you for the transcript. If either of you would like a break at any time, please just say so, but we will break throughout the course of your evidence at least once.

Ms Bell, you are the assistant general secretary to the Trades Union Congress. The TUC was founded in 1868 and, as you tell us in your witness statement, brings together 5.5 million working people which make up its 48 member unions from all parts of the United Kingdom.

Do you have members, therefore, in England, Wales, Scotland and Northern Ireland?

Ms Bell: We do, and just to start, can I say thank you for the opportunity to give evidence to the Inquiry.

Ms Blackwell: Not at all, thank you very much.

You’ve provided a very helpful document, which we can see at INQ000103540, which sets out the broad range of sectors and professions covered by the TUC’s 48 member unions. As we can see, as we scroll through this document, they come from a very wide range of professions: mobile civil aviation workers, workers in the food industries, chartered physiotherapists, teachers, lecturers, fire and rescue workers, the hospital doctors’ union, musicians and performers, building society workers, journalists, copywriters, coal mining people, footballers, radiographers and academics, and the Writers’ Guild of Great Britain being represented as well.

Can you tell us a little about what the TUC does, its purposes and its aims, please.

Ms Bell: Thank you.

So thank you again for the opportunity to give evidence. I just want to recognise the sacrifice that so many of our members made during the pandemic across all of those industries that you mentioned. Many of them were affected.

So the TUC exists to represent working people across the economy. We co-ordinate unions, we provide them with services, whether that’s education services or services around the development of union services, and we also represent those unions, whether that’s to government or to other decision-makers in society.

So we aim to provide a voice for working people right across the economy.

Just to pick up your question about those members we represent, so we represent workers right across the UK on matters which are not devolved, and that includes in Wales. There’s a separate Scottish TUC and workers in Northern Ireland are of course represented by the Northern Ireland Committee of the Irish Congress of Trade Unions, represented by my colleague here today, Gerry.

Ms Blackwell: Thank you.

You mentioned Wales there. Your statement to the Inquiry has been served on behalf of the TUC and also the Wales TUC; is that right?

Ms Bell: That is right.

Ms Blackwell: And WTUC Cymru has 48 member unions and represents 400,000 workers; is that right?

Ms Bell: That is correct.

Ms Blackwell: Is the WTUC run along the same lines? Does it have the same purposes and aims as the TUC and is there a great level of interconnection between the two organisations?

Ms Bell: Absolutely. So the Wales TUC does form part of the UK TUC, but of course has its own devolved structures and general council and decision-making and representing directly to the Wales Government as well.

Ms Blackwell: Thank you very much.

Mr Murphy, coming to you, you are the incoming assistant general secretary of the Irish Congress of Trade Unions, the ICTU; is that right?

Mr Murphy: That situation has changed slightly, in that I’m now the assistant general secretary of the Irish Congress of Trade Unions and have been so from 13 March this year.

Ms Blackwell: All right, thank you very much.

The Congress is the largest civil society organisation on the island of Ireland; is that right?

Mr Murphy: That is correct. We are 800,000 people, we represent 800,000 people across the island, 200,000 of which reside in Northern Ireland.

Ms Blackwell: Are there currently 44 unions affiliated to the ICTU, which – again, you’ve provided a very helpful document that lists them. It’s at INQ000108532. If we can scroll through this document, please, we can see, as with the previous document, there are a great range of organisations represented: teachers, nurses, prison officers, transport salaried staff, Veterinary Ireland is represented, and also USDAW.

Can you confirm what the ICTU has as its purpose and its aims, please?

Mr Murphy: The ICTU’s purpose very largely mirrors that of the Trades Union Congress in England and Wales and indeed Scotland and Wales. We represent and advance the interests of working people, we negotiate national agreements when empowered to do so by the constituent unions, we promote the principles of trade unionism, we seek to assist and develop the capacity of our affiliate trade unions and we seek to regulate relationships between those trade unions, and indeed between those trade unions and government.

Ms Blackwell: How closely related is the ICTU to the TUC?

Mr Murphy: We’re very closely related to the TUC and, indeed, to the STUC and the Welsh TUC as well. We meet formally on an annual basis in a body called the Council of the Isles. Indeed, over the course of the pandemic, we met more frequently than annually. We met virtually weekly.

In addition to that, we work very well informally together, there’s a lot of exchange on a very regular basis on an informal level between the organisations.

Ms Blackwell: Thank you.

Now, as you’ve both made reference to the Scottish Trades Union Congress, I just want to pause for a moment.

My Lady has received a statement from Rozanne Foyer, who is the general secretary of the STUC, which we can see is on screen now. It’s at INQ000180759 and it’s a statement which is dated 27 April of 2023.

Now, Ms Foyer is unable to attend today to represent the Scottish Trades Union Congress, but I would seek permission, my Lady, for her statement, together with the statements of Mr Bell and Mr Murphy, to be published. Thank you.

She says in her witness statement that:

“The STUC is an Independent Trade Union Centre to which independent trade unions affiliate their Scottish membership.”

It represents over 545,000 trade union members in Scotland from 42 affiliated trade unions and 20 trade union councils.

She goes on to say that:

“The STUC maintains a formal relationship with the TUC, Wales TUC and the Irish Congress of Trade Unions through the Council of the Isles.”

As you have already made reference to, Mr Murphy.

“The STUC works in partnership with the TUC on non-devolved areas of policy. The STUC also lobbies and campaigns directly with Westminster on UK non-devolved policy issues when deemed necessary or appropriate by our affiliates.”

Thank you, we can take that down, please.

I want to begin my questioning by first of all coming to you, Ms Bell, and touching upon the fragmentation of public health institutions and the consequent effect on resilience.

The Inquiry has heard evidence about the complex restructuring of health and public services in England which occurred as a result of the implementation of the Health and Social Care Act of 2012 and the consequences of that, including the fragmentation of the public health services.

Did Unite, which is one of your member unions, report to the TUC in 2015 that many of its fears about the wholesale transfer of public health to local government in 2013 were being realised? And if so, what detail did they give you about the effect that had taken place in relation to fragmentation?

Ms Bell: So yes is the answer to that question, and in 2015 we have evidence that Unite submitted to a select committee inquiry which talked about the fears it had raised. They said that those working in public health had reported swingeing cuts to public health services, reductions in staff terms and conditions, training and pay, poor morale and deprofessionalisation and loss of status; and of course that fragmentation was accompanied by sharp cuts to the public health body, a public health body which we also believe had an impact on pandemic preparedness.

Ms Blackwell: Was there a concern about the divergence of the workforce, with non-medics moving towards local authorities and medics moving towards Public Health England and the NHS? This was something which my Lady heard about during the evidence of Dr Kirchhelle. Was that reflected in the reports that the TUC began to receive, according to what your members were experiencing in relation to public services?

Ms Bell: I think that fragmentation more broadly was certainly something that unions representing members in these services were reporting: both the fragmentation between public health authorities and of course the NHS, but also the broader sense of fragmentation following the Health and Social Care Act.

This was something, again, that the TUC had raised in submissions. So, for example, in our 2015 submission to the comprehensive spending review, we talked about increasing fragmentation. We said:

“… the government’s top-down restructuring of the NHS and a prolonged funding [squeeze] have created endemic financial stress throughout the health service which is leading to a deterioration of outcomes for patients.”

Again, we talked around the fragmentation and complexity of commissioning.

So that was, again, throughout public health but also across kind of the wider NHS services.

Ms Blackwell: What reports did you get about concerns around the status and independence of directors of public health following the implementation of the Act?

Ms Bell: I don’t think we have direct – I don’t have evidence of direct concerns around the independence of public health officials, but we do have some concerns here around plans to scrap strategic health authorities. So in 2011 Unison’s head of health, Karen Jennings, said that the union was very concerned about plans in the Health and Social Care Act to scrap strategic health authorities, and she says they played a key role in co-ordinating the response to issues such as swine flu, monitoring standards and overseeing workforce issues. So I think when it comes to the strategic level, those are the concerns we have evidence of being raised.

Ms Blackwell: Dame Jenny Harries has provided evidence to my Lady that the divergence of the workforce was occurring even before any budgetary changes, and that clinical capacity was a declining resource. She also said that fracturing of the links between public health specialists and NHS colleagues was something that she recognised as a recurrent theme every time there was a change in the system. She did acknowledge, however, that it was particularly difficult over this period of time.

Is that something that you recognise through reports that you were getting from your members?

Ms Bell: I think that is an accurate reflection of what our reports were telling us, and I think it is of course, as you say, difficult to separate the impact of those significant cuts to the public health budget – and, you know, our members have cited the analysis by The Health Foundation showing that public health was cut by 24% per capita in the latter half of the decade, and I think certainly the impact of cuts coupled with the impact of fragmentation is what our members were reporting to us at the time.

Ms Blackwell: In terms of the impact upon your members of the fragmentation and also budgetary cuts, which we will come to, what did they tell you about both the mental and physical resilience, particularly of the NHS workforce, in the years leading up to the pandemic?

Ms Bell: Do you mean to refer to the NHS workforce more broadly –

Ms Blackwell: Yes.

Ms Bell: – as opposed to just in public health?

Ms Blackwell: Yes.

Ms Bell: I think we have significant evidence of the impact of severe cuts on that NHS workforce. To give one example, the TUC surveyed 1,000 NHS staff in the run-up to 2016 and, to give you one finding from that, 88% of NHS staff said the health service was under more pressure now than at any time in their working lives, and I think if you think about the impact of that stress, that reduction in resources, the impact of the decade of pay cuts that NHS staff experienced, so we know that the average NHS worker was paid £3,000 a year less in real terms than they were in – at the end of the decade, in 2019, than they were in 2010, you can see that impact on their own well-being and morale of those pay cuts but also of operating in a service which was constrained, under significant stress, on their ability to do their job and the levels of stress they experienced on a day-to-day basis .

Ms Blackwell: Do you have any comment to make on how that effect made them or may have made them less able to respond to what happened when the pandemic hit?

Ms Bell: I think, you know, there is clear evidence of the workforce shortages on the ability to respond. I think, you know, even in 2019, Unison was saying half of NHS workers on the frontline of patient care say there are not enough staff on their shift to ensure patients are treated safely and with compassion, and I think you can see those impacts going through to the pandemic.

In our written evidence I think we raise issues around workforce shortages being identified as a critical barrier to increasing NHS capacity during the pandemic, for example, to staff the NHS – the Nightingale hospitals. And I think we also talk about work-related burn-out in that experience, additional pressures brought by Covid-19 – you know, lack of ability to rest – and those severe workforce shortages. Vacancy levels in the NHS had doubled during the period between 2010 and 2019 running up to the pandemic.

So I think we had a situation where NHS staff were already under significant pressure as we went into the pandemic. The lack of resilience for those staff, both in terms of their personal well-being but in terms of the capacity of the service, really was highlighted during the pandemic itself, and of course we continue to see those NHS staff under significant pressure today.

Ms Blackwell: Well, let me ask you about the resilience of the NHS and hospitals in particular going into the pandemic, because the Inquiry heard last Thursday from Nigel Edwards of The Nuffield Trust, and he told my Lady that the UK has traditionally run with very low margins of spare capacity, and that in the years leading up to the pandemic, the number of beds in the NHS remained static whilst the population grew and aged, and he also said that, in terms of demand, that grew by 2% a year whilst the beds remained static, and the number of nurses went up by 0.2% over that period, which meant that hospital systems were highly constrained.

Does that accord with the information that you have received?

Ms Bell: Absolutely. I think, you know, the Inquiry has heard widespread evidence about the impact of austerity on the health service, and I think it’s important to note that the TUC was warning about this continuously throughout this period.

In 2016, we published a joint report with the NHS Support Federation, which was called NHS Safety: Warnings from All Sides, and that set out an unprecedented series of warnings raising the alarm about pressures on the NHS. That was from a wide range of organisations, and it talked about how it was common for health organisations to report that staffing was below safe levels and that low levels of funding increase from the government were leading to, I quote “short-term fixes that ultimately … increase the cost of healthcare”. That report brought together evidence from a wide range of organisations. Our own member unions reporting those significant pressures, but also professional organisations, The Nuffield Foundation – I think, from memory, The King’s Fund were also included in that.

So I think there was very clear evidence that the NHS was under pressure in terms of its capacity, in terms of, as you said, bed space, but also in terms of staffing levels, and this was having a significant impact on the ability to cope with additional shocks.

Ms Blackwell: You say at paragraph 41 of your witness statement that the TUC in their 2018 autumn budget submission referenced the latest quarterly monitoring report from The King’s Fund, which stated that:

“… ‘there is simply not enough capacity in hospitals to cope with rising demands for both emergency and planned care’, with 4.2 million patients on waiting lists today [that’s as at 2018] compared with around 2.5 million in 2010.”

But it wasn’t just the amount of staff and capacity, wasn’t it also the fact that there was an increasing amount of temporary staff? In that, I think we heard from Nigel Edwards last week that there were growing demands but there were many more people being employed on temporary contracts.

What effect does that have in terms of the workforce being able to respond to emergencies and an increasing level of demand?

Ms Bell: Well, we know kind of across the whole workforce, not just in the NHS, that the use of temporary staff can add to additional pressures. Of course those staff will need extra time to familiarise themselves with ways of working within the health service, with their colleagues, and have the understanding and trust that obviously builds up when you have been working with people over a long period of time.

I think just to give you a bit more of the evidence from that survey of NHS staff I referred to previously, they found that 69% of NHS workers said reductions in staffing and resources were putting patient care at risk, and I think that again relates to that big vacancy level, basically, that you were seeing, that doubling in vacancies, some of that being plugged by temporary staff, but that really – you know, health workers reporting time and time again that this was something that was not only making their jobs more difficult but putting patient care and safety at risk.

Ms Blackwell: Moving over to Wales, please, what were the key challenges faced by NHS Wales leading up to the pandemic? I’m thinking in particular in relation to funding and capacity.

Ms Bell: So, as with the rest of the UK, ten years of austerity did have a damaging effect on public services in Wales, and the Wales TUC set out in 2019 some of the impacts of that.

At that point the Welsh Government’s block grant was around 5% lower in real terms than in 2010/11 and, to respond specifically on the NHS, that meant you had 6,000 fewer people working in the NHS at that time.

Obviously the Welsh Government did have the opportunity to make some different choices, we know that social care had some more protection during that period, and the Welsh Government did not impose the Health and Social Care Act; and I think in the evidence from the NHS Confederation you see a little bit around the impacts of that on kind of the ability to co-ordinate, but we did have those very significant reduction in the Wales NHS, those big staffing reductions and similar kind of reports of staff shortages being reported there.

Ms Blackwell: Thank you.

Mr Murphy, I want to come to you now, please, and ask you about health spending in Northern Ireland in the ten years running up to the onset of the pandemic.

What do you say about the level of spending and how that might have affected workforce capacity and also surge capacity within the health organisations?

Mr Murphy: Before I answer that, can I just say that our experience overall very much reflects that which my colleague is after reporting for England and Wales.

Ms Blackwell: Thank you.

Mr Murphy: In terms of health spending over that period, the per capita spend compared to England and Wales in Northern Ireland over the period was 11 – almost 11% lower than the spend in England and Wales over the same period. It was 5% lower than the spend in Scotland.

The consequences in terms of capacity are very much as has been previously described.

The impacts – at a strategic level health and social care remained within the ambit of the Department of Health, so we didn’t have that particular piece of fragmentation. But what did happen was that the health and social care was outsourced to private contractors, to provide, which did cause fragmentation to occur, as unfortunately we saw, you know, later on.

The impacts fall, I think, in two areas. There was the direct impact of that decade of austerity, if you like, on public health. So by the middle of the decade, for example, in 2016, we already had 400,000 people on waiting lists. That was in 2016. That number has increased subsequently.

We had large numbers of workers, for example, employed in the health and social care sector who were earning less than the real living wage. In 2020 that figure was still 55%.

So the – I suppose, without repeating all of what my colleague has said here, the impacts, I think it’s not understatement to say, were pretty negative.

Ms Blackwell: One event, significant event, of 2016 was the publication of the Bengoa report, about which my Lady has heard, which stated at paragraph 22 that the:

“Health and social care systems in Northern Ireland and in other jurisdictions, are reporting severe difficulties in recruiting and retaining staff. There is a growing doomsday scenario of not having enough GPs, hospital consultants and junior doctors, nurses, Allied Health Professionals, and social care staff that will inevitably lead to people not receiving the care they need.”

It also went on to say:

“In recent years there have also been stark increases in costs associated with the locum and agency staff to provide a safe service where it is not possible to recruit to permanent positions.”

Again, is that something which you recognise, that there was a difficulty in Northern Ireland in recruiting permanent positions which meant that locum staff had to fit in?

Mr Murphy: Absolutely. Of course, yes, I do recognise it very much indeed. That issue, and the issue of provision of services and, you know, appropriate levels of staffing and safe staffing levels continue to be issued to this very day.

We began in 2010 as a Congress – the Irish Congress of Trade Unions, in 2010 – a campaign around jobs and services, we moved on with the second campaign in 2018 around the same issues, and we’re currently on the third iteration of a campaign around jobs, services and funding.

In between times we consulted and, you know, made submissions on a number of programmes for government on the same subject. We currently have two – a brand new acute hospital in Enniskillen with an ability to fill posts.

This – you know, this is reflective also of the experience in England and Wales. Unite, for example, brought this to the attention of the British Government in 2011 in a submission they made. Unison, indeed, brought it to the attention of the Northern Ireland Executive in 2016 in a submission which they made, and, as I’ve already pointed out, we have been doing it as a Congress continuously really for a decade. So huge impacts again.

Ms Blackwell: One of the issues as my Lady has heard about from several witnesses that pertained and continues to persist is the lack of ministerial oversight from time to time.

Robin Swann told my Lady that the lack of an Executive between 2017 and 2020 had an adverse effect on the preparation of the health and social care system because it contributed greatly to inadequate staffing levels at the time, and key decisions couldn’t be taken around those issues in the lack of any ministerial presence and oversight.

When he gave evidence, Mr Swann said that he was of the view that Stormont had let the NHS in Northern Ireland down because it hadn’t looked after health and social care services as well as it could, and that vital services were underfunded, that short-term decisions were preferred over long-term planning, and that difficult choices were ducked.

Do you agree with the description that he gave to the Inquiry about how things were left to drift, if I can put it in that way, in the absence of any ministerial oversight?

Mr Murphy: I entirely agree with him, and I think we should all be very grateful to Robin Swann, not only for the work that he undertook over the course of the pandemic but for his frankness to this Inquiry.

It’s particularly disappointing given that Rafael Bengoa had produced what was at that point the third iteration – or the third reporting on the inadequacies of the existing health and social care system in Northern Ireland. And compounding that, the minister at the time, Michelle O’Neill, had produced a report which had achieved something pretty unique in Northern Ireland circumstances insofar as everybody was bought in, so five political parties and the trade union movement generally all bought into the plan which had been brought forward. Then on – in January of 2017 the Executive collapses and it’s not possible to enact any of that.

So I would agree with the thrust of your question, yes.

Ms Blackwell: All right, thank you.

Professor Sir Michael McBride also gave evidence to the Inquiry. He told my Lady that the health service in 2020 was not as resilient as it had been back in 2009, for a number of reasons, there were several contributing factors to the increased lack of resilience.

How resilient do you consider the NHS in Northern Ireland was going into the pandemic?

Mr Murphy: Going into the pandemic, it had already been on the receiving end, as indeed had the entire public service, of ten years of austerity. You know, that had saw, for example, over that period the recurrent budget fall by £177 million or 1.6%.

Given that health inflation is generally accepted to run at approximately 6% per annum, you don’t have to be a genius to work out that, you know, there have got to be negative consequences.

So it wasn’t in a particularly good place, I believe, and the evidence would suggest that, indeed the evidence this Inquiry has heard would suggest that further.

So it wasn’t in a good place. That’s pretty evident and Rafael Bengoa references it in his report in terms of political – or, sorry, medical health and social care inequalities. So it was pretty clear that, you know, those who were less well off were … the actual reference point I think Bengoa uses is hospital admissions, so those from less well off areas, their hospital admissions were considerably more than those from more prosperous areas, shall we say. But that was manifested not only in that it was premature death, suicide rates, all sorts of negative indicators.

Ms Blackwell: Thank you.

I’m just going to pause for a moment and move over to Scotland to see what Ms Foyer’s witness statement says on these subjects. It’s at INQ000180759. We can see, if we read from paragraph 13, that:

“At the start of the pandemic Scotland’s health, social care, local authorities and other key public services were already struggling. Staffing levels had been cut across devolved public services including the civil service, other public bodies, colleges, local government and schools. The UK Government’s austerity programme slashed government spending across departments and reduced the Scottish Government budget year on year.

“14. Scottish Government spending decisions had also consulted in cuts to local authority budgets at a higher rate than the reduction to the Scottish Government budget. COSLA [that’s the Convention of Scottish Local Authorities] represents local authorities across Scotland and reported in Fair Funding for Essential Services:

“‘In the last 5 years, the Scottish budget has reduced in real terms by 0.4%. Local government budgets have reduced 10 times that much by 4%.’

“15. In the same publication, COSLA reported that:

“‘The workforce had fallen by 15,000 in the last 5 years’ and warned ‘there is no room left for manoeuvre.’

“16. This evidence aligns with reports by Unison Scotland who conducted a series of surveys of members working in local government which showed the impact of the budget levels on services and workers. Unison Scotland represents over 150,000 members and is the largest union in local government in Scotland. Unison reported that:

“‘cuts to staffing and increased workloads are placing enormous strain on staff. The majority of members report that their workload is growing and that they are working long unpaid hours and skipping breaks to try and maintain a quality service … [Morale] is very low, staff feel undervalued and exhausted by the efforts they put in to maintain services. The loss of business support staff means that many spend time on admin tasks when they should be focusing on other parts of their jobs which would provide a better service to the public. Salami slicing of services avoids headlines but the long years of austerity are having a severe impact on our services and the staff trying to deliver them with limited resources’.”

Thank you.

Were the concerns in relation to what we have seen in NHS services also reflected in the social care sector?

I’ll come to you first, Ms Bell.

Thank you, we can take that down, please.

Ms Bell: Absolutely, and I think, you know, we’ve been long referring to a crisis in social care, and that happened significantly before the pandemic. To give you one example, in 2016, GMB, a union which represents a large number of social care workers, presented a special report to their congress that talked about campaigning to prevent the collapse of social care, and that stated:

“The adult social care sector is under unprecedented strain and it is care workers and service users that are bearing the brunt of disastrous and wholly unacceptable trends in the way that care is funded, commissioned and provided.”

I’m a member of the government’s Low Pay Commission that hears evidence from social care employers and workers every year, and every year since 2017, at the point at which I became a member of that commission, we have heard both from employers within the social care sector and from workers themselves that the sector is in crisis, that terms and conditions are particularly poor.

To give you some specifics on the terms and conditions for the social care workforce, so that GMB report, using data from April 2015, found that a quarter of all care home staff were earning less than £7 an hour, and that’s at a time when the national minimum wage was £6.50, so a very, very low paid workforce. Turnover rates across the whole sector were 25%, 30% for care workers, and a quarter of those workers, as is still the case today unfortunately, were on zero hours contracts. So an underpaid, insecure workforce and one coping with significant funding pressures.

Ms Blackwell: Thank you.

The Inquiry will hear this afternoon from Dr Jennifer Dixon of The Health Foundation. She has provided a witness statement which sets out the fact that, as the pandemic emerged, England’s system of adult social care was underfunded and understaffed and that, when adjusted for an ageing population, funding per person fell by around 12% in real terms between 2010/11 and 2018/19.

She goes on to say that despite rising needs, fewer people were receiving support from local authorities over that period, and that workforce shortages were estimated at approximately 120,000, and that many care homes relied on agency staff working across multiple sites.

She describes that the organisation and delivery of social care in England was complex and fragmented.

Does that description sit alongside what you have received from your members?

Ms Bell: Absolutely. I think you have that combination of factors: the sharp cuts in funding to local authorities, which have been described in our witness statement and of course throughout the Inquiry, affecting the funding of social care; the fragmentation, so I think the National Audit Office found in 2020 there were 14,800 registered organisations providing care across 25,800 locations, so a hugely fragmented and diverse sector; and one which was not able to and was not paying its staff adequately or giving them the decent terms and conditions they needed.

I think one other impact of that I’d like to bring out in this evidence, if that’s okay, is not just the impact of that insecure work, which, as the evidence you’ve heard from Professors Marmot and Bambra, is a key determinant of health, so impact of that insecure work on the care workforce, but also their lack of decent sick pay. So our evidence shows that those on zero hours contracts, again a quarter of the social care workforce on zero hours contracts, are much less likely to have access to decent sick pay. So around a third of those on zero hours contracts don’t earn enough to qualify for sick pay when they fall sick.

We also had evidence throughout the pandemic, again highlighted by GMB, that many workers in the social care sector were not receiving contractual sick pay, so they were simply receiving the statutory minimum, and we have some evidence from Unison that when care workers asked for access to full sick pay funded by the government’s infection control fund, they were told, for example – this is a quote from an employer writing to a social care worker:

“The law states it’s not compulsory to pay it [that’s full pay for self-isolation]. These are not my decisions. It’s head office that decides it all.”

Lady Hallett: I’m sorry, we’re moving on now, we’re going way beyond the scope of Module 1.

Ms Blackwell: My Lady, I was just about to invite Ms Bell to bring herself back to the period of time that Module 1 is concerned with.

I would, though, like to ask you about planning within the care home sector for infection prevention and control.

Before the pandemic hit, but accepting that some of the evidence that you will rely on has come to you since the pandemic hit, what level of planning and preparation have you come to understand was taking place within care homes in terms of infection control?

Ms Bell: So we do not have evidence from unions that that planning was taking place, and I think, you know, it’s been heard throughout the Inquiry that, following Exercise Cygnus, recommendations around pandemic preparedness within the social care system were not acted on, and I think we see this as a sign of the Cinderella status of the social care sector, that it had been underfunded and ignored throughout.

I thought it was very striking the evidence that was heard from Emma Reed showing that the Department for Health and Social Care had not prioritised plans prior the pandemic to augment adult social care and community care during the pandemic; and of course when the pandemic hit, recognising that this is outside the scope of this Inquiry, efforts to source PPE for staff working in social care homes were very difficult, and we saw some of the devastating consequences of that for staff and patients.

Ms Blackwell: Is there anything that you would like to add in terms of the information that has come to you about the social care system in Wales, and in particular on any pandemic planning that was present or that should perhaps have been increased in terms of social care in Wales?

Ms Bell: I don’t have the evidence in front of me on Wales right now.

Ms Blackwell: All right.

Coming to you, Mr Murphy, is there anything that you would like to add in terms of what was happening in Northern Ireland and were they facing similar issues?

Mr Murphy: The issues were virtually exactly the same. The low pay, the high turnover in staff, insecure work, and that sick pay issue was an issue as well, equally. So, as became clear as the pandemic unfolded, there was no planning or provision in respect, it would appear, to inspection of care home – in the health and social care sector in particular in respect to care homes.

If I can just say, in another reflection of, you know, the impact of austerity, the Health and Safety Executive Northern Ireland would appear to have been badly under-resourced when it came to looking at and assessing risks going forward, although care homes particularly are – specifically weren’t their concern. But across the broader industrial employment landscape, the fact indeed that the Health and Safety Executive, even though it’s allowed under statute to have three trade union representatives on its board, had none, meant that it was devoid of any vital evidence and intelligence which may have been possible for a workplace representative to provide to it.

Ms Blackwell: Is there anything that you would like to add in terms of infection control and prevention and how that was being manifested within the care sector in Northern Ireland, in the run-up to the pandemic?

Mr Murphy: I have no evidence to offer in respect to that. I simply don’t have – we have nothing from our trade – from our affiliated trade unions and nothing from our interactions with the Northern Ireland Executive at that time either.

Ms Blackwell: All right.

Well, I’m going to return to Scotland momentarily, and ask that we look again at Ms Foyer’s witness statement, in relation to which she says:

“In 2019 the Fair Work Convention published their report on social care in Scotland, ‘Fair work in Scotland’s Social Care Sector’. The report outlined the main challenges in social care including the undervaluing of social care work, low pay and problems with recruitment and retention. The report reflected on the impact of austerity on the sector:

“‘It is widely accepted that the social care sector is facing severe challenges due to austerity. It is also working to meet the needs of an ageing population that is living longer, but with more complex needs. Evidence taken by the social care working group was that 200,000 people receive adult social care services annually, with 100,000 people receiving half of the total health and social care budget: most are accessing many different aspects of the health and social care system’.

“19. Further the report detailed the complexities in the mixed market economy of social care, the changed role of local authorities in delivering care and the challenges in commissioning and procurement where both voluntary and private providers reported budget pressures due to procurement processes. These factors led to a variety of challenges including a ‘disconnect between strategic planning, service commissioning and procurement approaches’ and a system that ‘creates and relies upon competition has, according to some stakeholders, accelerated a “race to the bottom” as providers compete to win contracts’.”

All right, thank you, we can take that down.

I want to move on to touch upon information that has come to your attention about gaps in PPE planning.

Ms Bell, the Inquiry has heard evidence about the pandemic stockpile and PPE will be the subject of more detailed analysis in a later module, but you deal in your witness statement with the lack of planning for PPE across sectors other than health and social care, and I would like to deal with that, please.

In particular, you touch upon the need for PPE amongst Royal Mail staff and the fact that several workers made contact to say that the planning for PPE in relation to that sector was substandard.

What do you have to tell the Inquiry about your information in relation to that regard?

Ms Bell: So our kind of evidence on the lack of planning for PPE beyond the healthcare sector is really evidenced by the experience during the pandemic. So we can’t say – it’s difficult to talk about the absence of something.

Ms Blackwell: Yes.

Ms Bell: But the evidence we have from during the pandemic suggests that there was a lack of planning across other sectors. So, as you mentioned, our witness statement sets out the Communication Workers Union.

Ms Blackwell: Yes.

Ms Bell: They were receiving numerous accounts from Royal Mail staff that sourcing PPE was next to impossible, and of course they’d been designated as key workers who needed to continue working during the pandemic.

We also had evidence from the Prison Officers’ Association. In March 2020, they warned their members that the Prison Service was planning to ration supplies –

Ms Blackwell: Well, we –

Ms Bell: Is that straying in –

Ms Blackwell: We’re straying in.

All that really you can assist my Lady with in this module is information that has come to your attention about the lack of planning. If we’re straying into Module 2, then I think we need to leave that until that module begins.

Is there anything that you would like to add, Mr Murphy?

Mr Murphy: Apart from the fact that we weren’t consulted at any time about planning or PPE, the provision of PPE in the run-up to the pandemic.

Ms Blackwell: All right. I think it’s right to say that in her witness statement Ms Foyer confirms that the Scottish TUC received reports from trade unions at a very early stage in the pandemic about lack of planning of PPE. So that appears to be a general theme across all the nations. All right.

I want to now turn to the extent of the engagement between the government and various trade unions with respect to civil contingency planning. So I’m going to come to you first, Ms Bell, to see, from information which you have received from your members, to what extent did the government seek the views or draw on the expertise of your organisations, the TUC and the Welsh TUC, or indeed individually some of your members.

What information can you give my Lady about that?

Ms Bell: So to the best of our knowledge there was no consultation or attempt to engage with trade unions or the TUC regarding civil contingency planning.

Ms Blackwell: At all?

Ms Bell: Not as far as we’re aware of.

Ms Blackwell: Mr Murphy, what’s your experience in that regard?

Mr Murphy: My experience unfortunately is exactly the same as that of my colleague. There was no attempt to engage as far as we are aware, no attempt to engage at Irish Congress of Trade Unions level or with individual trade unions.

Ms Blackwell: All right.

Returning to you, Ms Bell, what, first of all, could the TUC have provided to the government by way of advice and assistance in relation to civil contingency planning?

Ms Bell: I think we could have brought the voice of our workforce, who of course hold considerable expertise across the areas which are covered by that civil contingency planning. So of course we represent workers in the key sectors which are involved, and I think – you know, hindsight is a wonderful thing but I hope we would have been able to bring their expertise to bear on some of the issues we’ve been talking about today: so, the pressures that those staff were already under, and perhaps their lack of capacity to respond to another emergency; I hope that we would have been able to raise the fact that those workers – workers beyond the health sector were likely to face an impact, recognising that healthcare workers travel to work, need to use community services; and to recognise the interrelationships between those workers, which is of course a core issue of the TUC.

And I think, you know, our experience is that the process of dialogue with the workforce, as is common in many other areas of public life, is one that normally reveals issues and the expertise of the workers on the frontline, and we hope that we would have been able to provide some of that insight and information.

Ms Blackwell: All right.

And Mr Murphy?

Mr Murphy: Very much the same, and I think what I probably could add would be intelligence to that as well. I think it might have been extremely helpful to the Northern Ireland Executive to have had the insight from people on the ground, you know, who were providing the services directly. And I don’t mean those managing, I mean, you know, at a level – at levels below that. It would have been extremely helpful – for example, you – PPE was mentioned earlier, I think it would have – the absence of PPE would have become apparent much quicker had the actual workforce been involved in the preparing for the pandemic.

Ms Blackwell: In terms of future preparedness, to what extent, Ms Bell, have things improved up until today’s date in terms of consultation with the government and the TUC? Or what do you suggest might take place from today going forwards, and does the TUC recommend any particular areas in relation to which the government might reach out to you?

Ms Bell: Certainly. So I think to start with that point about consultation and dialogue, we think that the process of social dialogue and regular consultation with trade unions should be a key part of how government does business normally, and that should include the process of planning for future emergencies, and we hope that the experience of our members throughout this pandemic, terrible experience for many of them, might be used to learn future lessons.

In terms of some of the lessons that we might bring to bear during that period, if I can go on to that, I guess the impact of cuts to funding on resilience, the impact on staff morale, resilience, their health, their mental health and their ability to respond to an emergency; the impact of a decade of cuts on those services we think is something they would bring to bear.

Ms Blackwell: All right, but in terms of a joined-up, perhaps more formal level of contact between the TUC and the government, is that something that you can see working?

Ms Bell: Absolutely. So there are some, still, social dialogue institutions within the UK where we have that formal process. I mentioned the Low Pay Commission. There are – there is a health workforce forum which could provide one opportunity to do that. There may be other workforce forums, but we would imagine at the national level there should be a structured process of dialogue with unions and employers.

Ms Blackwell: Can you explain to us how the workforce forums are set up and how the government might be involved in that?

Ms Bell: So normally that would be a situation where the government meets on a regular basis with representatives of the trade unions. The TUC would normally suggest which unions might, you know, represent workers within the sector that’s of particular relevance, and I guess the key points are regular meetings, a spirit of openness and collaboration, and a clear process for how government and unions themselves will act on those findings.

So that’s the key – the key system of a kind of process of social dialogue that we would want to see in the context of emergency planning as well.

Ms Blackwell: I think you’ve described how those forums are beneficial in other areas that the TUC looks at on behalf of its members. Is this something which is difficult to organise? Is it something which the TUC could assist to facilitate?

Ms Bell: I don’t think it’s difficult to organise but the TUC exists, you know, to provide that kind of representative and that mediating function between government and unions, and, you know, it’s absolutely our job and something we’re very willing to do, to provide that forum to ensure there is access to representatives of the workforce.

Ms Blackwell: Is there anything to suggest that your members would not be prepared to engage in workforce forums of that nature?

Ms Bell: No.

Ms Blackwell: No, all right.

Coming to you, Mr Murphy, do you agree with Ms Bell’s suggestions, and is there anything in addition to that that you foresee as being beneficial in connecting the government to your organisation in terms of future civil contingencies planning?

Mr Murphy: I absolutely agree with Ms Bell that a formal social dialogue mechanism to facilitate co-operation and joint working, if you like, between government and the trade unions is essential. Indeed, in Northern Ireland such a body was established in 2005 by the then Secretary of State, Paul Murphy. Unfortunately it didn’t meet after 2016.

We campaigned and have continued to campaign pretty relentlessly on this subject. We think it would be extremely useful. It worked very well for our Welsh counterparts, it works very well for our Scottish counterparts, it works very well across mainland Europe in various countries, and we think it would work perfectly well for us.

There was a glimpse of how it might work at the very beginning – and I’m hopefully not straying into Module 2 – at the beginning of the pandemic, with the establishment of the Northern Ireland Engagement Forum, which was able in two weeks – two weeks – to produce two very important documents which then became the bedrock of the Northern Ireland Executive response in terms of workers and workforce.

Ms Blackwell: Yes.

Mr Murphy: So there is examples of how it could work.

Ms Blackwell: All right, thank you very much.

My Lady, I’m being invited to take a short break at this stage. I appreciate it’s slightly earlier than we would normally do so, but may we have our mid-morning break now, please.

Lady Hallett: So when you said short break, you’re talking about the usual break?

Ms Blackwell: Yes, please.

Lady Hallett: All right. 11.45, please.

Ms Blackwell: Thank you.

(11.30 am)

(A short break)

(11.45 am)

Lady Hallett: Ms Blackwell.

Ms Blackwell: Thank you, my Lady.

Just before the break, we spoke about ways in which the government can connect with your organisations, both in terms of the TUC and in terms of the individual organisations that make up your membership, and we discussed the possibility of workforce forums.

The Inquiry heard on Thursday of last week from Melanie Field of the Equality and Human Rights Commission, who confirmed that, in her experience, during a crisis was not the best time to try and get everything right and have systems in place, and mechanisms, and indeed relationships, which can be used to connect and engage one with the other.

What other areas or procedures exist for there to be the provision of information from the TUC and your organisations to the government on issues of civil contingency planning, and is there anything in place at the moment that can be adapted in order to assist in matters of civil emergency, or are there any additional procedures that you think should be considered to make sure that there is a close connection between the government and the TUC and your member organisations?

Ms Bell: To the best of my awareness, there are no procedures around civil contingency planning in particular. There may be some around the fire service and the ambulance service, but I don’t have details of those now.

I think the normal ways in which government engages with us are through a formal process of consultation –

Ms Blackwell: Yes.

Ms Bell: – where they will ask us to provide written evidence, perhaps to come to some meetings. But, in our experience, the best way to have continued and effective engagement is through the establishment of dedicated forums where the ability to not just provide information but to build relationships of trust and confidence can also be put in place.

Ms Blackwell: I think before the break you also suggested that another way in which the TUC could assist is telegraphing to the government the particular organisations that might be important in certain respects of civil contingency planning. Is that something that exists in other areas of the TUC’s work, and do you find that to be an effective use of the TUC’s time and energy?

Ms Bell: Absolutely. So the TUC will often play a convening role, and I think, you know, the purpose and one of the benefits of having a peak level organisation of unions is that we do have that cross-economy view: we understand how transport workers may relate to health workers, or the particular needs of aviation workers with respect to emergency planning. And I think we’re very willing – you know, we exist to play that convening role and that’s something we’ve done before and are very happy to do again.

Ms Blackwell: Thank you.

Mr Murphy, is there anything that you would like to add?

Mr Murphy: Just to say I agree again with what Kate’s after describing there. We, in Northern Ireland, had an opportunity, I believe, with the 2016 programme for government, which, as I referenced earlier, you know, was built around co-design, co-production, but an explicit statement of outcomes. I think if and when we see a return to government in Northern Ireland, if that pathway was maintained with those principles in place, that would be extremely helpful. But we still need the formal mechanism to facilitate social dialogue between not only the trade union movement and the Northern Ireland Executive, but also broader civic society and indeed the employers.

So those two things – and of course it would be essential that adequate funding would be put in place to facilitate that. We’re not going to be able to achieve any of that if we continue to pursue this failed doctrine of – sorry, that’s straying into politics here, but –

Ms Blackwell: Well, please don’t stray into politics –

Mr Murphy: – if we’re going to continue with austerity.

Ms Blackwell: – Mr Murphy.

Mr Murphy: Yes.

Ms Blackwell: All right.

My Lady, that concludes my questioning of both of these witnesses.

My Lady has provisionally provided permission for five minutes of questioning each from Scottish Covid Bereaved and also Covid Bereaved Families for Justice Northern Ireland.

So if that still persists, may I invite Claire Mitchell King’s Counsel to put her questions on behalf of Scottish Covid Bereaved first. Thank you.

Lady Hallett: Ms Mitchell.

Questions From Ms Mitchell KC

Ms Mitchell: I’m obliged.

We’ve heard evidence about the well-being of health workers this morning. You’ve talked about the additional stress that was caused by the ten years of austerity.

I want to ask you more broadly about workers perhaps with vulnerabilities, and we’ve heard in your evidence this morning about zero hour contracts, insecure work and the effects that they have on sick pay.

I would like to ask each of you: did the ten years of austerity pre-pandemic disproportionately affect the health of workers who had vulnerabilities, making the vulnerable more vulnerable when the pandemic arrived?

Perhaps if I can ask Mr Murphy first.

Mr Murphy: I think that’s absolutely correct. What ten years of austerity did was it exacerbated existing inequalities right across society. So the working people, the families of working people and communities as a whole who were already suffering from economic inequality, health inequality, educational inequality, and – you know, all of those things were exacerbated as services receded in the face of government cutbacks.

Ms Mitchell: Can I ask the same question to yourself, Ms Bell?

Ms Bell: Yes, absolutely. I think the extent of insecure work is something that had been highlighted frequently in the years in the run-up to the pandemic. You will remember the UK Government commissioned a report into the quality of work called the Taylor report, and widespread evidence was provided during the period of that work of the impact of poor quality work on people’s health.

So the report states the quality of people’s work is a major factor in helping people to stay healthy. That’s also been highlighted in the evidence from Professor Marmot.

And I think our evidence on the extent of insecure work, well over 3 million people in some form of insecure work, shows that that has a particular impact on those already vulnerable in the labour market. So, to give you one example, our research then finding black workers twice as likely to be on zero hours contracts as white workers. So that quality of work issue exacerbating inequalities, which we know then lead to health inequalities in the wider population, which leads to reduced resilience.

Ms Mitchell: Thank you.

Lady Hallett: Thank you, Ms Mitchell.

Who is asking questions for – Mr Fegan?

Questions From Mr Fegan

Mr Fegan: Yes, my Lady, Conan Fegan on behalf of the Northern Ireland team.

My questions are for more Mr Murphy and they relate to co-operation generally between the Northern Ireland Executive and the government of Ireland.

At paragraph 46 of your witness statement, Mr Murphy, you said that:

“The level of co-operation between the Executive and the government [of Ireland] was inconsistent and sporadic …”

The first question relates to – we’ve heard a bit about it this morning, about civic – our civil dialogue, and what I would like to ask you is: do you think that the all-island civic – or an all-island civic dialogue forum would support co-operation between the Northern Ireland Executive and the government of Ireland in addressing pandemic preparedness, and if so how?

Mr Murphy: Well, first of all, I do believe that an all-island civic forum would be extremely helpful or would have been extremely helpful in preparing for a pandemic. There were existing and there are indeed existing areas of co-operation in the area of health on an all-island basis, children, pancreatic cancer services – or children’s – sorry, paediatric cancer services being one example.

There’s co-operation in the area of the provision of emergency services along the border in particular, and indeed along the border again there were example – there was a short-term experiment around the provision of services by GPs.

So that was all helpful.

The Strand 2 elements of the Good Friday Agreement provide an architecture which would allow for the building of provision on an all-island basis, all of which would have been extremely helpful.

As the pandemic unfolded, there were what we describe as sporadic attempts to align, if you like, the response in the two jurisdictions. That wasn’t entirely possible: there were different stages of lockdown, there were different stages of restriction, there were different processes at play at different times, and indeed different responses to data being produced as well.

So I think the short answer to your question is yes, and the provision of such a forum would be extremely helpful and possibly one of the learnings that we may take from this.

Mr Fegan: Thank you, Mr Murphy.

The second question that I have relates to how trade unions across the border could co-operate, and it is: how have the trade unions in Northern Ireland and Ireland been involved in promoting co-operation on pandemic issues?

Mr Murphy: Pre-pandemic there wasn’t any work to any significant degree in that area. Over the course of the pandemic and post-pandemic, that has improved. We are now about to see, for example, the unfolding of a very significant health project involving Unison and Fórsa, which is the second largest public service trade union in the Republic of Ireland.

So there definitely is scope for the trade unions to move into that space. It isn’t possible or it wasn’t possible pre-pandemic, but I think we’ve all learnt now that closer co-operation has to be, you know, something that we factor into how we prepare for civil emergencies, or pandemic, in the future.

Mr Fegan: Just to take up that theme, the final question is: how could co-operation between the Northern Ireland Executive and the government of Ireland be improved in the future, in particular regarding pandemic preparedness and response?

Mr Murphy: Co-operation between the government in the Republic and the Executive in Belfast is a political question. I’m not going to go there, if you’d like –

Mr Fegan: You’re declining, then, Mr Murphy?

Mr Murphy: But from a trade union point of view, I think the social dialogue mechanism that I referred to earlier is well established in the Republic of Ireland through the LEEF process. So I think we could borrow from them in that respect, and apply in the north, and that would, I think, greatly assist not only with the work of the trade union movement but would allow for increased levels of working across the economy as a whole.

Mr Fegan: Thank you, Mr Murphy, and thank you, my Lady.

Lady Hallett: Thank you, Mr Fegan.

Ms Blackwell: My Lady, that completes the evidence of Ms Bell and Mr Murphy.

Lady Hallett: Thank you both very much indeed for your help.

Mr Murphy: Thank you, my Lady.

Ms Bell: Thank you.

(The witnesses withdrew)

Mr Keith: My Lady, the next witness is Professor Philip Banfield of the British Medical Association council, please.