3. Ms Anna-Louise Marsh-Rees

MS ANNA-LOUISE MARSH-REES (affirmed).

Questions From Lead Counsel to the Inquiry

Lady Hallett: Ms Marsh-Rees, if at any stage you want to break, you’ve heard what I’ve said to other people, I do understand how difficult this must be for all of you, so just say and we’ll stop immediately. All right?

The Witness: Thank you very much.

Mr Keith: Could you commence your evidence, please, by giving the Inquiry your full name.

Ms Anna-Louise Marsh-Rees: My name is Anna-Louise Marsh-Rees.

Lead Inquiry: Ms Marsh-Rees, thank you for the assistance that you have already given. You are of course the representative for Covid Bereaved Families for Justice Cymru, and you’ve afforded assistance in that role, and you’ve also provided us with your witness statement and a number of written submissions.

I’d like to commence your evidence, please, by asking you some questions about your father Ian, who we believe returned to his beloved Wales to retire after many years of working abroad as an electrical engineer.

When Covid and the pandemic struck in February to March of 2020, did you shelter him by keeping him at home and protected in those early weeks and months?

Ms Anna-Louise Marsh-Rees: Absolutely. We kept him at home. We, you know, had – we delivered shopping to him. We made sure they were safe and well.

Lead Inquiry: He was living on his own or with your mother, Valerie? What was the position?

Ms Anna-Louise Marsh-Rees: With my mother Valerie, yes.

Lead Inquiry: Did there come a time when, terribly, as it turned out, he developed an infection later in the year?

Ms Anna-Louise Marsh-Rees: He did, he had a gallbladder infection, for which he was hospitalised, for – at the beginning of October 2020.

Lead Inquiry: Was that hospital in Abergavenny in Wales?

Ms Anna-Louise Marsh-Rees: It was, Nevill Hall Hospital.

Lead Inquiry: When he went into hospital as an in-patient, were you aware of the steps that were being taken to protect him from Covid infection and to make sure that he remained infection-free?

Ms Anna-Louise Marsh-Rees: That’s a very good question. We knew he’d been tested on admission. He had a temperature, so he’s moved into an assessment area, and then he was moved beds six times in eight days.

Lead Inquiry: Between different wards or in a single ward?

Ms Anna-Louise Marsh-Rees: Between different wards, yeah.

Lead Inquiry: Do you know whether or not the wards to which he was moved were declared to be non-Covid wards?

Ms Anna-Louise Marsh-Rees: Yes, when he tested negative after the initial test, and obviously they were treating him for the gallbladder infection, eventually he ended up on a particular ward which was a non-Covid ward.

Lead Inquiry: But did there come a day when you were told – or at least he was told that he had Covid, or was he released from hospital not knowing that he had picked up Covid in hospital?

Ms Anna-Louise Marsh-Rees: Yes, so on day 8 he was sent, he was discharged. We subsequently found out that the ward had been closed down due to an outbreak, but we weren’t informed that he had been exposed.

Lead Inquiry: So was he discharged because his ward had been exposed to Covid, was that why he was taken out of the ward and discharged home? Or was he discharged because the hospital had been able to deal with the original infection for which he had been treated?

Ms Anna-Louise Marsh-Rees: That’s debatable. I mean, he was definitely, you know, on the mend, but, you know, he was sent home without a test. We subsequently found out after many, many letters that there were actually 21 people with Covid on his non-Covid ward, 12 of whom died.

Lead Inquiry: So you weren’t told and he wasn’t told that he was positive for Covid. Did you and your –

Ms Anna-Louise Marsh-Rees: Well, he wasn’t tested, so we don’t know.

Lead Inquiry: You just don’t know?

Ms Anna-Louise Marsh-Rees: No, no.

Lead Inquiry: Did you or your mother subsequently get Covid from, it would seem, him or not?

Ms Anna-Louise Marsh-Rees: Yes, my mother wasn’t told that he had been exposed at all, so she – you know, he came home and she stayed with him, in the same room, and she subsequently got Covid, as did my sister. And she suffers from long Covid now.

Lead Inquiry: Was your father then re-admitted to hospital suffering from Covid itself?

Ms Anna-Louise Marsh-Rees: Yes. So during that week he deteriorated almost from the minute he was discharged, he got sicker and sicker. He was falling asleep in his – while eating. He had severe diarrhoea. One of – I think Jane from the Scotland team also mentioned that the three symptoms aren’t always prevalent in older people, and these were obviously overlooked.

He had – my mum made 13 calls to the GP and they had four out-of-hours doctor’s visits, none of whom ever suggested he might have Covid, despite, we now know, that it was on his discharge notes that he’d been exposed to Covid.

Lead Inquiry: So let’s be clear about this. So when he was discharged from hospital the first time he was discharged with discharge notes, and your examination of those notes, perhaps much later, showed that actually he had been tested and was tested positive for Covid prior to his initial –

Ms Anna-Louise Marsh-Rees: He wasn’t tested but they just said he’d been exposed to it.

Lead Inquiry: He’d been exposed to it?

Ms Anna-Louise Marsh-Rees: Yeah. So I think that’s –

Lead Inquiry: By virtue of the ward on which he had been placed?

Ms Anna-Louise Marsh-Rees: Absolutely, with – yeah. And three of the people on his bay had already tested positive for Covid.

Lady Hallett: So on his notes it said “exposed”, but to you, the family –

Ms Anna-Louise Marsh-Rees: Nothing.

Lady Hallett: Not informed?

Ms Anna-Louise Marsh-Rees: Not informed.

Mr Keith: So when he was re-admitted, suffering from the symptoms he was, you couldn’t have known or wouldn’t have known whether or not that was Covid or anything else?

Ms Anna-Louise Marsh-Rees: Not at all. It was – when he was re-tested that evening we were incredibly surprised to find out he had Covid, even more surprised to find out that his oxygen levels were – were decreasing quite rapidly. Yes, it was a real shock.

Lead Inquiry: Then did his condition deteriorate rapidly, having been re-admitted to hospital?

Ms Anna-Louise Marsh-Rees: It did. You know, we would be calling almost, you know, hourly, it seemed. I mean, it wasn’t, but, you know, it would be 5 litres – “He needs 5 litres of oxygen”, “He needs 10 litres of oxygen”. By the Wednesday it was 15 litres, “You need to be prepared” conversation. You know, we – we just – completely in shock.

Lead Inquiry: Was he placed on a CPAP?

Ms Anna-Louise Marsh-Rees: He wasn’t, no, no.

Lead Inquiry: Then did you find out at some point, terribly, that a DNACPR had been placed on him?

Ms Anna-Louise Marsh-Rees: Yeah, it wasn’t until we saw his notes some months later that we saw the DNACPR that had been placed on him. And this was without consultation with us. Apparently they tried to call us but we were eating dinner. How they knew that I’ve no idea, but we were not aware of that.

Lead Inquiry: So you never knew at the time and no one told you that a DNACPR had been placed on him or given you any opportunity at all to challenge that or to ask brutally and simply what was going on?

Ms Anna-Louise Marsh-Rees: Not at all.

Lead Inquiry: Tragically then he died.

Ms Anna-Louise Marsh-Rees: He died.

Lead Inquiry: I don’t want to go into the detail of it all, but, as a result of the things which you’ve raised, have you been engaged in a long course of dealing with the hospital and with the health services in Wales in order to try to find out some of the answers to the questions which you’ve posed?

Ms Anna-Louise Marsh-Rees: Absolutely. It’s in fact two years nine months today since we first complained – or not complained, asked questions of his health board. There have been a series of letters and responses and subsequently a nosocomial investigation by the Welsh Government into all hospital-acquired Covid deaths, and I’ve been told, even now, responses are inaccurate, incomplete and inconsistent.

It’s almost like – I say it’s almost like an Agatha Christie mystery, that we – you have to find out bits, you know, new information all the time. I’ve been told that my final response, it’s been sitting on the CEO of the Aneurin Bevan Health Board now for two months, but I’ve still not received anything.

Lead Inquiry: All right.

Was it as a result of your father’s death and the way in which it came to light that he had been exposed to Covid that you formed or joined, perhaps, if it was already formed, Covid Bereaved Families for Justice Cymru?

Ms Anna-Louise Marsh-Rees: Absolutely. So I think first of all you’re – you’re in shock that it happened to you, but I think it’s only happened to you, and then you find out, you know, through various social media groups, that there are other people maybe in the area that sort of have a similar story, and then you find out there’s other people from other health boards, and the picture builds to: this wasn’t an isolated incident, this was, you know, quite a regular occurrence of people going into hospital with one thing and not coming out, or – or subsequently dying from Covid.

Lead Inquiry: Were these all persons to whom you spoke because you had already joined the group Covid Bereaved Families for Justice, or were they people that you met having formed Covid Bereaved Families for Justice Cymru?

Ms Anna-Louise Marsh-Rees: So both, really. So our group, the Cymru group, emanated from the UK group. Obviously we’ve got different objectives, different governments. Health and social care are devolved in Wales. But, you know, also people – once I started to do some media interviews we’d get a huge amount of, you know, interest from others that had, you know, suffered a similar experience.

Lead Inquiry: Is the same of Bereaved Families for Justice Cymru, as you see it, to try to find answers to the questions and the concerns which had been raised by members of your group, and also to campaign in a wider sense for things to be done, for procedures and decision-making processes to be changed?

Ms Anna-Louise Marsh-Rees: Absolutely. Of course we want to find out what happened and why it happened, you know, who was responsible, who was accountable. I mean, that’s been one of our major areas of – challenging areas, is that we have different health boards and different care homes, all with different processes and ways of doing things, almost devolved amongst themselves. But not – but we do want change and we have – I think we’ve been very successful at not just being a campaign group to get answers, but also trying to change things already.

So we’ve been introduced to the National Bereavement Steering Group of Wales, and through that we have – because we got zero bereavement support from any hospitals in Wales, we’ve now set up working groups with each of the health boards, so we are trying to – trying to channel that grief, frustration, heartbreak into – into areas where we can really make change and using our lived experience to do that.

Lead Inquiry: From what you’ve said then, the main, the overarching aims and concerns of the group appeared to be to continue to provide bereavement support, because of the absence of bereavement support, as your members saw it, at the time, and, in terms of the hospital care which your members or rather their loved ones received, infection control and nosocomial infection appears to be at the heart of many of the concerns expressed by your members?

Ms Anna-Louise Marsh-Rees: Absolutely. Most of our members were impacted by hospital or care home acquired –

Lead Inquiry: Infection?

Ms Anna-Louise Marsh-Rees: – infection – yeah. And infection control is obviously key to that: where was it? What guidelines were being followed? Was anyone – how were they being communicated? How were they being embedded, monitored, iterated upon?

We have yet to find out what happened, and, you know, it kind of haunts us all that, you know, people go to a hospital – you know, people used to say, “Well, they’re in the right place”, when they go to hospital. I’m not sure they would say that anymore.

Lead Inquiry: One of the areas in which your campaign has been successful insofar as the Welsh Government is concerned is that you’ve campaigned successfully for there to be at least the start of an official inquiry into nosocomial infection in Welsh hospitals; is that correct?

Ms Anna-Louise Marsh-Rees: That’s correct, that’s been running for a year and they are investigating each of those cases.

I guess the key thing is what comes out from that, and we’ve had the first – it’s running for two years, so after that first year there’s an interim report. Our – what we want to ensure now is that it’s not just a report on a dusty shelf that – but they are being implemented so this does not happen again.

Lead Inquiry: Is your group also campaigning, and do its primary aims also include other aspects of hospital and care home and nursing home treatment? So the availability of PPE and respirators, ventilators and so on and so forth for the purposes of the health and social care staff, the broad issue of communications between hospitals and care homes and the loved ones of patients and those being cared for, and also importantly, as we’ve heard from other evidence, the whole issue of the arrangements which were then put into place for dealing with loved ones at the end, the way in which there were communications from hospital staff and care homes, the way in which they were buried, the way in which they had their funerals conducted, and so on.

So not just the hospital and the care home setting –

Ms Anna-Louise Marsh-Rees: No.

Lead Inquiry: – but, as you describe it in your statement, the aftermath as well?

Ms Anna-Louise Marsh-Rees: Yeah, and I think that’s very important for us. You know, the preparedness is – in terms of response and controlling an infection, obviously we’ve covered – it’s been covered quite extensively over the last few weeks. What I think we’re very interested in to ensure is that it’s the at death and after death impacts of a pandemic are considered as well. So, you know, end of life care, dignity in death, the sort of palliative care. You know, being kind of crude, what happens to bodies.

I think Jane mentioned as well, something that was not communicated to us was that once somebody with Covid dies, they are almost treated like toxic waste. They are zipped away and you – nobody told us that you can’t wash them, you can’t dress them, you can’t do any of those things, the funerals, the ceremonies, you just can’t do any of those. You couldn’t sing at a funeral. You know, we’re Welsh, that’s something you have to do.

And it’s to ensure that all of those factors are considered in preparedness as well as the sort of more practical things.

And also the psychological effects. So, again, I said we’re working with various people on, like, Hospice UK, et cetera, to, you know, understand what a good death is. You know, my dad did not have a good death. Most of our members’ loved ones did not have a good death.

Lead Inquiry: I understand. And presumably, and not least of course on account of your father Ian’s death, this issue of the way in which DNA cardiopulmonary resuscitation notices are given, end of life care is an absolutely vital topic?

Ms Anna-Louise Marsh-Rees: Absolutely. You know, there’s very valid reasons for putting a DNACPR on someone, and it’s a medical decision, but it’s the way it’s communicated, and we’re really campaigning for the whole process to be much more formal – you know, if it needs a signature from a loved one or from the patient themselves if they are – you know, if they have the capacity to do that. It’s simple things like that.

You know, some of the other things – I know this sounds really silly, but when we left the hospital, my dad – we were given my dad’s stuff in a Tesco carrier bag. Some people were given somebody else’s clothes that were in a pretty awful state. It’s those things like that that don’t often get considered, and yet one wonderful lady, who is in the bereavement team, I can’t remember which health board, but she has designed paper bags, carrier bags, for – you know, for all deaths in hospitals, so that there is dignity all round for someone that has died, whatever the circumstances.

And I do think as – if there’s one good thing that kind of came out of this, is that we are maybe able to talk about death more openly, more realistically, and talk about it more. Because there’s one thing that is definitely going to happen to all of us. So, you know, we want the whole piece around death and a good death – because there is such a thing as a good death, and I think that was very overlooked during the pandemic.

Lead Inquiry: And to better prepare for it and to make it happen –

Ms Anna-Louise Marsh-Rees: Absolutely, 100%, yeah.

Lead Inquiry: – in the event of a future health emergency?

Ms Anna-Louise Marsh-Rees: Absolutely.

Mr Keith: Thank you very much.

The Witness: Can I say one thing?

Lady Hallett: Of course you may.

The Witness: First of all, I want to say thank you very much for the Inquiry to date, and all of the people involved. We have been treated, you know, hugely respectfully and sensitively and we thank you for that.

Just one more thing: there is a whole generation, my mum’s generation, who haven’t got the mechanisms like maybe I have to complain and question, and they are heartbroken and really in shock. You know, my mum cries daily and – even though it’s nearly three years. But we’d like some change to happen in their lifetime, and, you know – and I know – I know, you know – we’re all doing our best, but that’s something we would really appreciate, because if it doesn’t then, you know, they … it’s just – they’re just left with that feeling of nobody cared, and if that can be expedited in any way, we will really appreciate that.

Lady Hallett: We’ll do our very best, I promise.

The Witness: Thank you so much.

Lady Hallett: I know how much you’ve contributed to the Inquiry, and since the very first day of the consultation exercise when we met in Cardiff, so I’m extremely grateful for everything that you’ve done. As I said to Mrs Morrison, it takes great courage to channel your obvious grief into trying to help others and to reduce the suffering of others in the future.

I’m really sorry to hear about your mother and about the long Covid, and she’s obviously still grieving, and that’s something I did learn during the consultation exercise, and you may have heard me say it before, that grief is bad enough in normal circumstances but grief during times of lockdown and isolation and the circumstances you’ve described is just dreadful. So thank you very much for everything you’re done.

The Witness: Thank you.

Mr Keith: Thank you.

(The witness withdrew)

Lady Hallett: So I’m asked to take another break?

Mr Keith: Yes, please.

Lady Hallett: Ten minutes, and I shall be back at 11.50.

(11.41 am)

(A short break)

(11.50 am)

Mr Keith: My Lady, the fourth witness from this group of witnesses is Brenda Doherty, from the Northern Ireland Covid Bereaved Families for Justice branch of Covid Bereaved Families for Justice Group.