3. Professor Philip Banfield

PROFESSOR PHILIP BANFIELD (affirmed).

Questions From Lead Counsel to the Inquiry

Mr Keith: Good morning. Could you give the Inquiry your full name, please.

Professor Philip Banfield: Yes, I’m Philip James Banfield.

Lead Inquiry: Are you in fact Professor Banfield, that’s one of your qualifications?

Professor Philip Banfield: Yes, it is.

Lead Inquiry: Thank you very much for your assistance and for the provision of your witness statement dated 12 April, INQ000205177, which you’ve signed, dated and affirmed to the truth thereof.

Professor, you are the chair of the British Medical Association UK council. What is the BMA council in the context of the British Medical Association?

Professor Philip Banfield: So the UK council is the Executive body of the BMA, the BMA is both a professional association and a trade union.

Lead Inquiry: Have you in fact sat on the UK council since 2012, and were you before then a representative in the British Medical Association of BMA Cymru, Wales, for many years?

Professor Philip Banfield: Yes, I have been.

Lead Inquiry: You are chairman of the board of directors, but you are by profession a consultant obstetrician and gynaecologist; is that correct?

Professor Philip Banfield: Yes, I am.

Lead Inquiry: You’re an honorary professor in the Cardiff University School of Medicine?

Professor Philip Banfield: Yes, I am.

Lead Inquiry: Now, you have prepared a witness statement in which you express views on the part of the BMA. Could you just make plain, please, the extent to which these views are not just your own personal views or not just your personal views alone but reflect the corporate view of the BMA as well as information and views which have been collated by the BMA through lessons learned exercises, the publication of a number of reviews which you have carried out, as well as trackers and surveys which you have conducted and call for evidence between November and December 2021. To what extent have you sought to engage your membership in the views which you express in your statement?

Professor Philip Banfield: Yes, so I’ve been chair of council since July 2022. Previous to that I was the chair of the BMA Welsh consultants committee. All of the different specialities within medicine have committees that feed into the BMA centrally, within all the four nations. So, for example, consultants, public health medicine, occupational health medicine, ethics committees. And these have done work in different areas that are relevant to this Inquiry and we have collated their work for this witness statement.

The BMA also commissioned, throughout the Covid pandemic, surveys of its members, as you have described, and then a call for evidence, because it was quite clear from our membership that they wanted early investigation of exactly what had gone on during the pandemic, not just for them but for the wider population.

Lead Inquiry: Does the BMA membership cover the whole breadth of medical practice, so, for example, it includes medical academics, medical students, as well as the particular specialities to which you made reference?

Professor Philip Banfield: Yes, and of course it, you know, quite crucially involves our colleagues in general practice as well.

Lead Inquiry: The tracker or the survey which the BMA carried out, is that a process which started in April of 2020 and then initially involved a fortnightly survey and then, latterly, monthly and then a triannual survey?

Professor Philip Banfield: Yes, it was quite clear that there was a need for information about what was actually happening on the shop floor, so the BMA undertook to do those surveys and in fact actually we were able to act on the information coming back.

Lead Inquiry: For the purposes of the statement which you’ve provided to this Inquiry, have you spoken to other organisations in the medical field, not just members of the BMA?

Professor Philip Banfield: Yes, so other organisations were involved in compiling the five Covid inquiry reports that the BMA have issued themselves.

Lead Inquiry: Did those reports address topics such as how well protected the medical profession was on the impact of the pandemic, what the impact was on the delivery of healthcare, what the government’s public health response was, and so on and so forth, those sorts of themes?

Professor Philip Banfield: Yes, they do.

Lead Inquiry: All right.

Now just turning to the broad functions of the BMA, do its functions include calling for, in a general sense, improvements in healthcare and also for improvements in the health of the population, alongside the various other more specific functions which you perform?

Professor Philip Banfield: Yes. So we advocate for high quality healthcare and we advocate, therefore, for the population that we serve.

Lead Inquiry: Turning to the specific issue of pandemic preparedness, do you in your witness statement identify three broad reasons why it is the BMA’s view that the United Kingdom entered the pandemic significantly underprepared? Are they: firstly, the fact of too great a focus on influenza pandemic planning; secondly, the lack of sufficient thought given to a proper strategy to detect and contain the spread of the prospective virus; and, thirdly, what is said in your statement about the levels of resourcing and the consequential impact on a lack of resilience in the healthcare and social care sectors? Are those the three broad headings?

Professor Philip Banfield: Broadly speaking, those are the headings, but when we talk about the UK not being prepared, of course there was a local resilience community within public health medicine locally that was fully prepared for a pandemic. That’s their bread and butter expertise.

Lead Inquiry: Yes, all right. Well, starting then with the first theme, that is to say the focus on influenza, you’ll no doubt be aware of the significant amount of evidence which has been given about the policies and the guidance and particularly the 2011 strategy from the government which focused on pandemic influenza planning, as well as the evidence from politicians and administrators who have spoken of the strategic flaw or flaws contained in that strategy.

To what extent was the BMA cognisant of the government’s strategy and its approach to pandemic planning at the beginning of that decade?

Professor Philip Banfield: Well, it had replied to that preparedness and it had raised concerns especially with regards to PPE and in regards to making sure that things were going to be joined-up in the event of a pandemic. In fact we raised concerns at that time that changes proposed to public health by effectively dismantling the current situation in 2012/13, because that was being planned ahead of time, would threaten the ability to mount an effective pandemic response in the future.

Lead Inquiry: Are you referring there to the primary legislation, the Health and Social Care Act, or are you referring to something specifically concerned with that 2011 strategy?

Professor Philip Banfield: So at the point at which the 2011 strategy was issued, the contents of the Health and Social Care Act were known and, therefore, the proposed reorganisation of public health was also known, and the BMA commented specifically about the risk that was involved in effectively disengaging the regional directors of public health from the NHS.

Lead Inquiry: Coming back to the strategy itself and the focus on influenza pandemic planning, to what extent was the BMA aware of the growing academic and scientific knowledge concerning the risks of coronaviral attack? So the consequences of the SARS outbreak and then subsequently the MERS outbreak. Did that raise concern on the part of the BMA, and if so was that a concern that was raised by the BMA with the government?

Professor Philip Banfield: Well, I’m not sure we raised it directly as such. We would assume that any pandemic preparedness would effectively prepare for other types of pandemic as well. So it’s slightly misleading to say that it’s solely because it was influenza pandemic planning that was taking place that it was therefore not applicable to actually what happened subsequently.

Lead Inquiry: The strategy itself proclaims that it is applicable to non-influenza pandemic, of course, and you’ll no doubt be aware of the great deal of evidence which has addressed the topic of the extent to which that strategy could have been utilised for non-influenza pandemic planning.

But was the BMA aware of the growing debate about whether or not that was a strategy that was suitable for a coronavirus pandemic, for example MERS or SARS? Was that a debate with which you engaged?

Professor Philip Banfield: As far as I’m aware, there was no specific debate.

Lead Inquiry: You say in your statement that little consideration appears to have been given to strategies to detect and contain the virus. What do you mean by that? Is that a reference to what Mr Hancock might wish to describe as – or have described as the Hancock doctrine: the failure to try to stop catastrophic consequences, as opposed to managing catastrophic consequences which have already ensued?

Professor Philip Banfield: Well, the pandemic planning exercises that took place took a worst-case scenario, so it started with the premise that there would be a large number of deaths with a large number of the population being infected, and of course it is basic health prevention and infection protection and control to stop the pandemic from getting to that point in the first place, so to identify, to test and to contain, so that you don’t get into the situation.

Of course that was what had taken place during the SARS and MERS outbreaks, and I suppose this is why the public health community, you know, at a ground floor level, seems quite vociferous about criticism of the early management of the pandemic.

Lead Inquiry: You mentioned exercises there in your answer. Is the BMA an entity which regularly takes part in national, that’s to say cross-United Kingdom, exercises or simulations?

Professor Philip Banfield: No, it’s not.

Lead Inquiry: Have you been able to look back and see to what extent the BMA was involved at all in any of the exercises of which we’ve heard evidence?

Professor Philip Banfield: Yes, we’ve had instances where elected members have been part of the exercise or have been involved with commenting – especially for Exercise Cygnus, we gave ethics advice.

Lead Inquiry: How did that come about? Was that because you were approached directly by one of the participants or observers to those exercises, or was it because the BMA itself had been engaged in the exercise?

Professor Philip Banfield: Yes, the BMA itself was not engaged, these were people who were approached for their individual expertise who had major roles within the BMA.

Lead Inquiry: Having been approached, was any consideration given to formalising the involvement of the BMA, in particular requiring it to become an observer or participant in future exercises?

Professor Philip Banfield: No, that invitation wasn’t forthcoming.

Lead Inquiry: Did you ask, though, Professor?

Professor Philip Banfield: Well, I wasn’t there at the time, so I –

Lead Inquiry: Did the BMA ask?

Professor Philip Banfield: Not as far as I know.

Lead Inquiry: All right. So if it was an invitation that was not forthcoming, it certainly wasn’t one that had been sought?

Professor Philip Banfield: I can’t comment on that.

Lead Inquiry: All right.

Has the BMA or did the BMA have any understanding of the extent to which recommendations and lessons which were the result of exercises were being implemented? Do you know or did you know then to what extent recommendations were being acted upon?

Professor Philip Banfield: Yes, we did, and we raised concerns about them not being acted upon.

Lead Inquiry: How did you find that they were not being acted upon? What was your level of knowledge corporately?

Professor Philip Banfield: Corporately, it was feedback from the exercises. I mean, obviously Cygnus we didn’t have very much feedback about at all. In fact that wasn’t released publicly.

Lead Inquiry: So how did you get to know what the recommendations had been of the various exercises, and therefore be in a position to know anything about the extent to which those recommendations had not been implemented?

Professor Philip Banfield: Well, the early ones, because there was a review, for example, of the 2009 swine flu pandemic by Deirdre Hine, so – and she made a number of recommendations, particularly about making sure that services were joined-up, that – you know, were still exposed during other exercises like Alice.

Lead Inquiry: Was that because you became aware of the later exercises and were therefore able to see the extent to which recommendations from Dame Deirdre Hine’s review had not been put into place?

Professor Philip Banfield: Yes. And in particular there was an ongoing discussion with the ethics department, because the ethics department was giving expertise to the discussion around mass casualties and population triage.

Lead Inquiry: Are you able to say in what other broad areas the BMA had expressed concern about a lack of implementation? So, for example, in relation to surge capacity or PPE stockpiling or training in the use of PPE and so on. Keeping it at that level, can you identify what other areas you’d expressed concern about?

Professor Philip Banfield: So not directly to pandemic preparedness, but the BMA for a number of years has been highlighting the issue of capacity within the health service, to all four governments. The number of beds has been falling, the number of staff has been falling, and therefore we have been raising concerns prior to the pandemic that we were not coping with the capacity that was needed to run the health service as it was, we had raised concerns that social care did not have the capacity that it needed to help the health service create capacity, and therefore that there would be no surge capacity if a pandemic happened.

But, in general, the everyday occurrence of our members was trying to get the job done that was in front of them rather than planning.

Lead Inquiry: In essence you were focused upon, for obvious and good reason, the lack of operational resources, if you like, so a lack of surge capacity or a lack of PPE or a lack of respirators, as opposed to making perhaps the rather drier point that a lack of operational resource was inevitably going to be the result of a lack of prior adequate planning?

Professor Philip Banfield: Yes. So, for example, we were raising concerns and we had had concerns by our members in all four of the nations about intensive care capacity for routine elective and emergency work prior to the pandemic, and we had been, you know, mounting campaigns – or the intensive care consultants had been mounting campaigns to get expansion of intensive care beds to deal with the increasing demand from the routine business of the NHS at that time.

Lead Inquiry: One important, very important, operational area concerns of course the availability of respirators in order to be able – and ventilators – to be able to deal with the transmission of whatever virus it is which forms the basis of the pandemic.

I don’t want to go into the operational side of this issue, but was the BMA aware of whether or not there had been any planning for or preparation for the debate about the extent to which a future pandemic may be caused by a virus which was more transmissible than other viruses, in particular because it may be transmitted by aerosol transmission as opposed to droplet transmission? Was that a debate or an issue in which the BMA engaged pre-pandemic?

Professor Philip Banfield: So the BMA discussed that within the public health community and within its own public health committees, because the local public health teams will have been practised and exercised in infection control measures.

Lead Inquiry: Are you aware of the extent to which persons on the inside of government were debating the consequences of there being a pandemic which had a high degree of aerosol transmission? Do you know whether that is something that was being addressed?

Professor Philip Banfield: No. There was no discussion and the general feeling is that there was a disconnect between anything that was going on in central government and the local public health teams.

Lead Inquiry: Now turning to the third broad area which you’ve identified, which is the capacity and health of the public health systems and the identification of a lack of resource being relevant to a lack of preparedness by virtue of the impact upon resilience – and avoiding contentious or overly political epithets such as “Tory-led austerity cuts”, of which we’ve heard I think quite enough in evidence – why is level of resourcing relevant to resilience in a public health or healthcare system?

Professor Philip Banfield: Well, at the moment public health is funded for business as usual. Clearly in any sort of infection outbreak you need to be able to escalate things like testing for the disease, contact tracing, being able to isolate or quarantine, and having expertise, as the local public health teams do, in this is incredibly important, and what has been eroded is their ability to plan and scale up rapidly, and that’s what we saw.

So, for example, they would have expected testing to have become more widely available more quickly, they would have expected the NHS – 44 NHS labs to be available and brought into use, and the point at which that didn’t happen and testing was taken into the private sector and into the Lighthouse labs, we started to get a disconnect of information because the IT systems were just not compatible.

Lead Inquiry: To what extent is it possible to say that that lack of resource in the public health testing system, for example, is the result of lack of resourcing and the lack of – or reduction in levels of funding in prior years, as opposed to a combination of lack of funding and a lack of administrative focus, that is to say a deliberate step to ensure that those resources and that testing structure are put in place by way of preparedness? How can we ever assess whether it is just the result of funding decisions as opposed to a failure to focus on the particular need?

Professor Philip Banfield: The split of public health from NHS into Public Health England, which took health protection and some of health improvement into government, effectively, split, then, the health improvement and the public health assessment of the care needs and the health needs of the local population. By doing that, it split the resource, because you now had the local health protection function diluted. The terms and conditions were different in local authorities than in government. So you started to have more medically-focused personnel centrally, more non-medical locally, and you started to lose some of the resilience and expertise in managing local outbreaks.

So, for example, where that expertise was retained, an example would be Ceredigion in Wales, they managed to contain and had very low rates of Covid for a lot of the pandemic.

Lead Inquiry: So just taking a step back, then, what you’re saying is that the – one of the direct impacts of the Health and Social Care Act and the transfer of the public health functions, if you like, away from the NHS to local government was not just changes in the funding and the resourcing, which was then a matter for local government, but there was a direct impact in terms of the level of speciality or the medical experience or the skill sets of public health officials in local government thereafter?

Professor Philip Banfield: That is correct.

Lead Inquiry: Turning your attention to the adult social care sector, putting aside resourcing, what changes were brought about, as the BMA sees it, in the social care sector by virtue of the fact that that is a matter run primarily by local government?

Professor Philip Banfield: I’m not quite sure that I understand the question.

Lead Inquiry: Yes. In terms of the resilience of the sector, what impacts, if any, are there of the fact that the social care sector is run essentially by local government, on what we’ve heard is quite a fragmented approach, with only an indirect central government control?

Professor Philip Banfield: Well, part of the problem with social care, and in fact actually we saw it as well with public health, was that there is no consistency of record. So there are no data that can be shared, no one knew what the state of social care was within the locality.

The advantage of having local public health teams is that they know their local population, so they know what works. The cutbacks in general with social care remove resilience. And part of the planning that goes into a pandemic is what happens when you start to lose staff, either because they are ill or they’re removed because, you know, in the case of Covid, they were shielding, or they have caring responsibilities.

So going into a pandemic with a lack of resilience because of pressures on staffing does invite there to be a problem from the start.

Lead Inquiry: There has been clear evidence to the fact that there was a lack of understanding at DHSC level of the number of care homes, the number of providers, the number of staff, the numbers of the workforce, as well as the number of persons receiving care, as well as the numbers of those persons who required care but who were not receiving it.

Does the BMA have a view on the general state of data gathering of the adult social care sector? Is it a system which historically has been – I can’t think of the correct word – it’s simply not been amenable to any proper Understanding of what its moving parts consist of?

Professor Philip Banfield: We don’t have a particular and specific view about that. But, for example, we went into the pandemic without the Department of Health and Social Care having an up-to-date list of the regional directors of public health.

Lead Inquiry: What is your view on that?

Professor Philip Banfield: Well, I’d – it shows that we were not prepared for the pandemic that was coming, and it showed the disconnect between the front line and the people who were responsible for planning.

Lead Inquiry: Turning to the question of inequalities, again, an issue which you address in your witness statement, what is the BMA’s view as to the extent to which pre-existing non-clinical inequalities were taken into account and planned for pre-pandemic?

Professor Philip Banfield: Well, a number of instances had arisen, for example when talking about respiratory protection, about the need to have close-fitting filtering face piece masks, for example, and this wasn’t taken into account. It did occur at some stage during the pandemic as people started to do this fit testing more appropriately and to take it more positively and more proactively.

Lead Inquiry: What is the link between fit testing and ethnic or societal –

Professor Philip Banfield: Because one mask does not fit all. You know, different people have different size faces, so it was predominantly a male face that masks were built for, for example.

Lead Inquiry: So this isn’t a question so much of inequalities as of ethnic differences failing to be taken account of in the context of mask fit testing?

Professor Philip Banfield: Yeah.

Lead Inquiry: What about generally in relation to the government’s approach to identifying those persons who may suffer from non-clinical inequality and who therefore may need to have especial attention paid to their needs in the context of pandemic planning? Is that something on which the BMA has expressed a view?

Professor Philip Banfield: Well, it has expressed a view. I mean, if you are referring to, for example, the way that the letters were sent out for the extremely clinically vulnerable, for example, there was a presumption that people could read and write; the way that information was given didn’t include sign language, for example, so – you know, there were also inequalities in the social gradient. People went into this pandemic very vulnerable because of their health inequalities that had been getting worse over the previous ten years.

Lead Inquiry: Drawing the threads together from the various topics which you’ve just addressed, do you set out in your witness statement a number of lessons which the BMA believes are required to be learnt for future pandemics and other whole-system emergencies?

If you agree, say “yes”, Professor, rather than nodding, so the stenographer can pick it up.

Professor Philip Banfield: Yes.

Lead Inquiry: Do these include ensuring in future that recommendations are, from pandemic planning exercises, properly implemented?

Professor Philip Banfield: Yes, it does.

Lead Inquiry: Highlighting existing responsibilities under health and safety law. Why are health and safety legal requirements relevant to proper pandemic preparedness? What do such legal structures provide which, if implemented correctly, can assist with pandemic preparedness?

Professor Philip Banfield: Well, there is a legal duty on behalf of the employer to the employee to make reasonable attempts to protect that employee, and we feel very strongly that the information that was available prior to the pandemic wasn’t heeded. So the Health and Safety Executive, for example, in 2008 had its own investigation of fluid-resistant surgical masks, and showed that virus was behind each of the masks tested. So these were not protective of the respiratory tract. And we had seen a lot of comment – everyone that comments about the influenza pandemic and future influenza pandemics talks about how unpredictable the pandemic might be in both its virulence and how severe it might be.

So, you know, there should be a health and safety duty to take a precautionary approach, and that wasn’t taken. We think that that’s because occupational health medicine has collapsed in this country, effectively.

Lead Inquiry: So are you saying that if health and safety workplace law and guidance were properly to be implemented and enforced, there would be a greater attention to detail and therefore, by implication, it would be less likely that that sort of risk assessment process would be overlooked and less likely that flaws in, for example, the use of respirators and the systems for their use would be allowed to go unchallenged? Is that the nub of it?

Professor Philip Banfield: It is the nub of it, yes.

Lead Inquiry: All right.

A third area that you alight upon is the need to maintain an adequate rotating stockpile of PPE. I don’t wish to go into the detail of the operational side of PPE – and procurement, which is a matter for subsequent modules, but to what extent did the planning for the future use and availability of PPE oblige those persons, who held on to stockpiles and who made them available, to rotate them, to make sure that they were up to date, to make sure that they were fit for purpose?

Professor Philip Banfield: Well, I mean, there is an obligation to review stockpiles. The reality was that there was a conscious decision to reduce stockpiles since 2009 up to the pandemic, so the stockpiles were, my understanding, about 3% of what they were or should have been planned for, especially with respect to respiratory protection and respirators.

Lead Inquiry: All right, well, that’s an issue that – the degree of availability of PPE is something that will be looked at in a later module.

But is the BMA aware of the degree of planning and the guidance and the policy material which underpinned the position with PPE? Is that something that you’ve looked at?

Professor Philip Banfield: No.

Lead Inquiry: All right.

Improving health and care data, you’ve referred to this already. The government has, it’s plain, sought to review its provision of health and care data and has started to look at ways in which the accumulation of data in the health and social care sectors can be improved.

Has the BMA contributed to any post-pandemic review of data or assisted in any way in which the processes can be improved?

Professor Philip Banfield: Not that I’m aware of.

Lead Inquiry: Do you know, have you been approached at all to assist the government in this way or not? Do you know –

Professor Philip Banfield: Not that I’m aware of.

Lead Inquiry: You then say that in future consideration of inequalities must be central to pandemic preparations and must be closer to the heart of what is required to be done in preparation for pandemic.

What do you mean by that in practice? Do you mean that planning documents, planning approaches, plans have to have the needs of sectors of the population and consideration of inequalities far more clearly identified? They need to be at the forefront of all planning; is that what you’re suggesting?

Professor Philip Banfield: Yes, it does, but it’s not just about the population and patients we have, but it’s about our staff as well.

Lead Inquiry: In what practical ways do you suggest that the needs of your staff and of the population who suffer from inequalities and of inequalities generally need to be better highlighted? Does that mean there needs to be a focus on those issues and it needs to be at the forefront of future planning?

Professor Philip Banfield: Well, I mean, reducing health inequalities and – and health in all policies is one of our highlights that we wish to see government introduce. You know, the reality is that if you are in an environment where a portion of your population is sicker than another one and it’s due to, you know, social determinants of ill health, then unless you tackle those a specific area and subset of your population will be more vulnerable to a pandemic or another flu pandemic, which will come, you know, it is almost inevitable, and we are duty bound to be prepared for that.

Lead Inquiry: So, in essence, it’s not really a question of planning, it’s a question of ensuring that inequalities are reduced and the health of the population, in particular those who suffer from ill health, is improved, so that we are all better off for the next pandemic?

Professor Philip Banfield: I mean, that’s partially true, but when it comes to, for example, inequalities within our healthcare and social care workforce, we are still in a situation where the recommendation is for fluid-resistant surgical masks, which of course are not protective against aerosols at all. So that advice is affecting disproportionately those with inequalities.

And ventilation within our NHS estate and social care isn’t – hasn’t been addressed either.

So the risk assessments and the assessment of hazards is still being poorly done, and it affects certain members of both our patients and our staff disproportionately.

Lead Inquiry: So that’s not so much an issue concerning health improvement of the population as a whole or for those who suffer from inequalities as much as a need to focus on societal and ethnic differences in the particular context of ensuring that, in future, respiratory facilities, respirators and so on and so forth, are fit for purpose?

Professor Philip Banfield: Correct.

Mr Keith: All right, well, we can leave it there then.

Professor, thank you very much, I’ve no further questions for you.

My Lady, I believe you have granted permission prospectively to Bereaved Families for Justice, ten minutes.

Lady Hallett: I have been. I’ve got Mr Weatherby. Ms Munroe, it’s you, is it?

Questions From Ms Munroe KC

Ms Munroe: It is, my Lady, good morning.

Good morning, Professor Banfield. My name is Allison Munroe and I ask questions on behalf of Covid Bereaved Families for Justice UK.

There are a few matters, some discrete topics, I’d like to ask you about, some of which you have already touched upon in your evidence, so I will try and tailor the questions to the answers you’ve already given.

The Inquiry, Professor Banfield, has heard evidence obviously that the UK was preparing for an influenza pandemic at the exclusion of other pathogens, and in your statement at paragraph 17 you say this:

“This narrow focus was an oversight …”

You go on at paragraph 18, you have been taken to the start of that paragraph, where you said:

“Little consideration was given within pandemic planning policies of strategies to detect and contain the spread of disease, but rather the emphasis was on how to respond in a situation where there was already significant mortality and morbidity.”

But the rest of that paragraph you say this:

“For pandemic planning policies to be comprehensive and effective, both strategies need full consideration. This relatively limited focus on disease containment within the UK’s pandemic preparations may explain why the UK Government was slow to implement public health and occupational hygiene measures when Covid-19 arrived.”

So in that context, Professor Banfield, a relevant issue is whether the UK could have even contained an outbreak of an emerging infectious disease of the proportions envisaged by the National Risk Register at the time.

Now, firstly, were you aware – in your position and as the BMA as an organisation, would you have been aware and conversant with the National Risk Register during this relevant period?

Professor Philip Banfield: Yes, we would. So we would have been aware that pandemic flu was the risk register’s number one risk.

Ms Munroe KC: Thank you. In that case, I won’t bring up the document, but, my Lady, for reference, it’s the 2019 National Risk Register, annex B, INQ000185135, pages 4 and 8.

Were the BMA, Professor Banfield, aware that that 2019 National Risk Register contained a planning assumption for an emerging infectious disease outbreak of 2,000 cases and 200 fatalities in addition to the pandemic influenza scenario?

Professor Philip Banfield: Not specifically.

Ms Munroe KC: Well, I’ll come on to the next question, then. It sort of follows from that.

Dr Michael Prentice from NHS England – again, no need to bring up his statement. He has provided a statement, hasn’t given evidence to the Inquiry, but for reference, my Lady, it’s INQ000177805, paragraph 181.

He talks about the number of airborne high-consequence infectious disease units located in the country, and he says in that paragraph airborne HCID units are located at Guy’s and Saint Thomas’ NHS Trust, adult and paediatric services; secondly, Royal Free London NHS Foundation Trust with a paediatric service provided by Imperial College Healthcare and St Mary’s. Then Liverpool University Hospitals NHS Foundation Trust, with a paediatric service provided at Alder Hey Children’s Hospital, and, finally, Newcastle upon Tyne Hospitals NHS Foundation Trust, both adult and paediatric services. Each centre routinely provides two beds, eight in total, for airborne HCID. Specific service specifications outline the care pathway and unit requirements.

Was the BMA aware that there were only four units in England for airborne HCIDs, with two beds each?

Professor Philip Banfield: Yes.

Ms Munroe KC: Well, firstly, those figures, those are the bald facts and figures from both the National Risk Register and the number of HCID units; would you agree that eight beds for an airborne HCID is woefully inadequate to contain 2,000 cases?

Professor Philip Banfield: Yes, I would.

Ms Munroe KC: These are figures that the BMA would have been aware of at the time. You’ve said it’s woefully inadequate.

I mean, in terms of your concerns as an organisation, did you raise these at the time to those who were planning? Because you’ve spoken about the need or the possibility to plan up and scale up rapidly. They would have to scale up very rapidly, wouldn’t they? Was this something that was part of the dialogue or the discussions that the BMA were having with – amongst yourselves, but more importantly outside of the organisation?

Professor Philip Banfield: No, no, they were not, but they had been the subject of the review after Ebola, and one of the exercises that took place is quite striking because it ended up with three cases being admitted to Newcastle, and them using something like 70 members of staff to treat those three cases and removing 18 care beds from the system.

So the reason I say that is for those particular high virulent high mortality situations that capacity was not enough. When it comes to the Covid pandemic, the issue of capacity and the need to create effective isolation either within single rooms or then cohorting was very quickly appreciated by the medical profession, because we were getting feedback from China and from colleagues in Italy, and there was a sudden realisation within the medical community of what was coming our way, and it was all hands to the pump trying to plan where our intensive care beds would be, because we had half the number of beds of the European average, a quarter of the intensive care beds that Germany had for example, and I’ve never seen doctors so worried about how they were going to cope with the influx of seriously sick patients to the extent that, you know, we had intensive care consultants doing physics calculations of oxygen flow through pipes to see whether we could get more oxygen round the hospitals.

We knew that this was unprepared for, we had no idea what was coming our way, we were suddenly in a position where not only patients were going to die but our colleagues and ourselves were in a position where we might die because we felt so unprepared. And, as was referred to earlier, the surveys that we did with the medical profession continued in that vein for some time into the pandemic.

Ms Munroe KC: That sudden realisation by the medical profession of what you were faced with, could that and should that have been planned for and prepared though?

Professor Philip Banfield: Sorry?

Ms Munroe KC: Could that and should that have been planned for and prepared for?

Professor Philip Banfield: Yes, and we feel that the disconnect between central government and the realities of the shop floor was one of the recommendations that was consistently not addressed during any of the exercises.

Ms Munroe KC: Then finally, on the question of exercises, you’ve told us already in your evidence, Professor Banfield, of the limited involvement that your organisation, the BMA, would have had in those exercises, both in terms of before, planning them, being part of them and finding out what happened as a result of those exercises.

Surge capacity. There was a report on the Ebola preparedness surge capacity exercise from 2015.

Again, I won’t bring it up but for reference it’s INQ000090428.

Was that a report from 2015 that you were aware of at the time?

Professor Philip Banfield: Not me personally, but the BMA –

Ms Munroe KC: The BMA would have been aware of.

Now, it took place in March of 2015 and that exercise indicated that even a small outbreak of a contact – high-consequence infectious disease such as Ebola could overwhelm existing plans and provisions and effectively overwhelm the NHS.

Was that something that was very much at the forefront of the BMA’s mind at the time when you saw that review, or that report?

Professor Philip Banfield: We’ve been quite consistent in trying to highlight the lack of capacity, and the disjointedness of the expertise that lies within local public health provision and the central planning, because the best defence is to test and isolate quickly so that you don’t get the kind of spread that you’re discussing.

Ms Munroe KC: So as an organisation, being concerned – and you’ve said you highlighted – in practical terms what did you do as an organisation or what were you able to do as an organisation to highlight this?

Professor Philip Banfield: Well, we have consistently pushed back at government and escalated to central government about the lack of preparedness, but most of that has come really with the onset of the pandemic, because, like so many other people, I think we were concentrating on getting on with the everyday day job rather than the planning of what may or may not happen because, you know, we’re under such pressure – or our members are under such pressure every day, we’re working constantly on the premise that, you know, our system may tip over at any moment.

Ms Munroe: Thank you very much, Professor Banfield.

My Lady, thank you, those are my questions.

Lady Hallett: Thank you, Ms Munroe.

Mr Keith: My Lady, that concludes the evidence of Professor Banfield, and in fact this morning’s evidence. We are actually one witness ahead.

Lady Hallett: Thank you very much indeed, Professor Banfield, thank you for your help, really grateful.

The Witness: Thank you.

(The witness withdrew)

Lady Hallett: Very well, I will return at 1.55, please.

Mr Keith: Thank you.

(12.55 pm)

(The short adjournment)

(1.55 pm)

Mr Keith: Dr Dixon, the chief executive of The Health Foundation, please.