2. Submissions on Behalf of the Trades Union Congress by Mr Jacobs

Mr Jacobs: Good morning, my Lady. I appear on behalf of the Trades Union Congress, the TUC, with Ms Ruby Peacock, and instructed by Thompsons Solicitors.

The TUC brings together 5.5 million working people who make up its 48 member unions and who span a wide range of sectors profoundly affected by the Covid-19 pandemic.

In this module, the TUC is working in partnership with the Wales TUC, the Scottish TUC, and the Northern Ireland Committee of the Irish Congress of Trade Unions. Together we seek to represent the interests in this Inquiry of a great many unions all listed in our written opening right across the four nations of the UK.

Of particular concern to our affiliated unions is to understand the causes and learn the lessons of those of working age who died of Covid-19. They numbered over 15,000. Many suffered in a myriad of ways, including those who continue to live with long Covid.

My Lady, in this module concerning pandemic planning and preparedness, what we have learnt in respect of a plan for a pandemic such as Covid-19 has been surprisingly straightforward. Quite simply, there was no plan.

Planning was, as Dame Sally Davies put it, monomaniacally focused on pandemic flu. Even then it was focused on managing the dead, rather than protecting the living. No doubt there are many important lessons to be learned. That might include reframing our thinking around emergency planning so that we plan not only for what is foreseen as the likeliest emergency, but also for the emergency with the most severe potential consequence. It might include lessons such as – as to the structures for emergency planning, such as there being a dedicated minister and perhaps an agency specifically focused on such matters.

The Bereaved Family groups yesterday afternoon made a number of suggestions as to necessary reforms for the structures for pandemic planning, and they seem to us to carry some significant force.

We say that the Inquiry should robustly reject the narrative suggested by some that the events in the pandemic were unforeseeable and all that could really be done was to react as it unravelled.

Perhaps the one area in which we were world leading during the pandemic was in the development and distribution of vaccines. My Lady, that was not built on plucky British resolve in response to adversity as it arose, it was built on research and development, investment and the application of clinical expertise through the establishment of the Vaccine Network.

As Dame Sally Davies explained, it was the only thing we had resilience in. It was an instance of foresight and action and a welcome escape from short-term-ism.

So we have learnt, my Lady, not only that there was no plan, but also that preparedness really matters.

Our particular focus and concern through Module 1 has been on the resilience of public services and on the disproportionate impact of a pandemic upon certain vulnerable and protected groups. The unavoidable context for considering the resilience of services going into the pandemic is austerity. In our opening submission, we expressed this to be a central theme of the evidence which rested on a simple but inescapable truth: that no matter what planning is put in place, public services stretched to breaking point by over a decade of budget cuts will be severely impaired in their ability to cope with the shock of a national emergency such as a pandemic.

What we described as a striking feature of the evidence, that so many will consistently describe austerity’s disastrous consequences, has proven to be so in the oral hearings.

The only real exception has been the evidence of Mr Cameron and Mr Osborne. To us, their evidence had the feeling of having come from a distant island in which NHS staff numbers were high, NHS satisfaction was high, and the output of public services had the good fortune of bearing no relation to budgetary input.

It was not a picture we recognised, nor does it appear one recognised by any other witness in this module.

The Chancellor, for example, was at least prepared to recognise that, as Secretary of State for Health and Social Care, he had been concerned in the years prior to the pandemic as to the resilience and capacity in our health and social care services. Indeed, he described the fact that he was unable to secure a long-term funding settlement for the social care sector as one of the regrets of his time as Secretary of State for Health and Social Care.

This Inquiry has made clear that it cannot and should not express a ruling on the merit or otherwise of austerity as a fiscal policy, but it is its duty to be full and fearless about its findings about the consequences of drastic cuts to public spending.

We have heard evidence about resilience and capacity in our healthcare services. For a health service that has perennially faced the existential question of whether it can cope with the next winter flu, we didn’t really need to be told that it didn’t have the resilience and capacity for a global pandemic.

Resilience in the face of a pandemic includes not only the ability to treat the urgent cases in its peak, but also the ability to continue to provide healthcare to the population generally and to be able to return within a reasonable timeframe to something resembling an effective health service.

Given the gaps in planning, it is a real credit to the commitment, skill and determination of those in our health service that we did not run out of intensive care beds.

The real price has been longer term: in respect of the impacts more generally on the ability of the NHS to meet needs for healthcare. Quite shockingly, as of the start of this year, the number of people on an NHS waiting list for hospital treatment has risen to 7.2 million. As Kate Bell of the TUC described in her oral evidence, that number can be compared with the 4.2 million patients on waiting lists at the beginning of the pandemic.

That is a huge long-term cost to patients of the lack of resilience and capacity in the NHS. It is also, of course, an unfair demand on the workforce, who, burnt out from the demands of battling a pandemic in an under-resourced system, now face the pressures of managing and responding to enormous and growing waiting lists.

As Ms Bell highlighted in her oral evidence, in a survey by the TUC of 1,000 NHS staff, 69% said that reductions in staffing and resources were putting patient care at risk. The issue is not, therefore, only one of waiting times, but of patient safety.

We have also heard evidence about resilience in social care. In our opening, we suggested that in social care the problem has been not so much one of repeated restructuring and reorganisation, but one of neglect. There has been no attempt to structure at all.

We observed that adult social care in England is now provided by around 18,000 organisations. We observed that the overall workforce is larger than in the NHS, yet there is no equivalent to NHS England seeking to provide some strategy and direction to the sector. We pointed out that the TUC has repeatedly called for a national social care forum to bring together government, unions, employers, commissioners and providers to co-ordinate the delivery and development of services, including the negotiation of a workforce strategy.

We also suggested that co-ordinating a national effort across a hotch potch of private organisations is impossible.

My Lady, all of those observations have been underlined by the evidence you have heard. On being asked about funding and the difficult picture facing the social care sector, Mr Osborne pointed out that the cuts in local authority funding were not secret but were publicly announced as part of a programme of trying to reduce government expenditure. No doubt they were, but an openness as to cuts in funding does not make the challenges faced by the social care sector any less difficult.

There are huge challenges facing the workforce. The Inquiry has received evidence that in the year going into the pandemic there were care worker turnover rates of around 40%, in the region of 115,000 staff vacancies, and around one quarter of its staff were working on zero hour contracts.

Bruce Mann described the UK Influenza Pandemic Preparedness Strategy from 2011 as very slim on the social care aspect. From the Department of Health and Social Care’s own operational response centre lessons learned reviews, it is clear that there was confusion within the department regarding whether it even had responsibility for social care pandemic planning. It states:

“Some commented that emergency planning had assumed care providers would be responsible for their own response, and a centralised government role had not been anticipated.”

The Inquiry has of course received significant evidence from witnesses, including Sir Christopher Wormald, that key recommendations in respect of social care following Exercise Cygnus were not implemented before the pandemic.

Perhaps a scarcity of detailed planning is unsurprising when viewed in light of the complete lack of visibility and centralised oversight in social care as an undoubtedly fragmented sector. The Inquiry has heard that going into the pandemic there was no central government understanding as to how many people were receiving or needed adult social care, nor how many registered homes were providing such care. This is a glaring omission, given the complexity of the sector.

The Department of Health and Social Care described in its opening statement the fact that social care is managed across 152 local authorities and is made up of around 25,800 registered social care establishments.

The reality, as described to the Inquiry, is that a complex and fragile sector, upon which so much of pandemic response relies, went into the pandemic without even the most basic of preparations.

The Inquiry should move forward from Module 1 with some pretty stark findings as to preparedness and capacity in social care. The Inquiry cannot seek to recommend the solutions to those problems in this module, but it should be moving forward towards a future module in social care with a sense of conviction that fundamental change is needed.

My Lady, you’ve committed to understanding and making findings as to the unequal impact of the pandemic. It is widely recognised that the pandemic disproportionately impacted certain protected and vulnerable groups. It is important for this Inquiry to understand the drivers of that disproportionate impact and to understand, crucially, how planning for future pandemics can mitigate those impacts.

As a starting point, it was foreseeable that a pandemic would have a disproportionately adverse impact upon lines of socio-economic disadvantage and along the intersection of such disadvantage with precarious work, with ethnicity, disability, age, gender, caring responsibilities and poor health.

As explained by Professors Marmot and Bambra, the historic and global experience of a range of whole-system shocks, whether it be a financial crisis, extreme weather events or indeed pandemic flu, is that such shocks expose and amplify pre-existing health inequalities.

The examples are numerous, but perhaps among the most striking, given its timing, is that in the 2009 swine flu pandemic the mortality rate in the most deprived 20% of England’s neighbourhoods was over three times higher than in the least deprived 20%.

It is evident that the uneven impact is not unique to Covid-19.

It is also evident that these matters were not considered in the UK’s pandemic planning. The evidence is that such consideration relating to unequal impacts of a pandemic as there was, was limited to clinical vulnerabilities. That was acknowledged by both Sir Christopher Wormald, in evidence given on behalf of the Department of Health and Social Care, and by Katharine Hammond, in evidence given on behalf of the Cabinet Office.

The Module 1 evidence establishes, then, that the disparate impacts were foreseeable and were not considered. Those have been important points to understand, but they also give rise to, in a sense, a rather more important and certainly more difficult question: how should planning for a pandemic address these matters?

An important aspect is no doubt having appropriate structures for planning. Of course we urge a departure from the arrangements we described in opening as something resembling a bowl of spaghetti. But this Inquiry must also, we suggest, always have in mind what it considers should be in a pandemic plan – or, perhaps more helpfully described by the Department of Health and Social Care in its opening, what should be in the toolkit of capabilities to respond to the many different possible characteristics of a future pandemic.

Whilst it may be hugely important, for example, to recommend that there be a minister with sole responsibility for emergency planning, this Inquiry will not have done its job effectively if that minister is not left with a concrete understanding as to the practical requirements of an effective pandemic plan.

To an extent, those concrete measures will be revealed in future modules, but we do not believe we are getting ahead of ourselves in considering them now. These issues should be at the forefront of the Inquiry’s consideration throughout, and it is in part necessary to have them in mind to ensure that the Inquiry is continuing to look at the right issues.

It appears to us that the lessons to be learned, certainly in relation to Covid-19 in the workplace, really fall into two baskets. The first relates to the health generally of our nation and the extent of the growing structural health inequalities. The evidence is that the UK entered the pandemic with increasing health inequalities and with health among the poorest people in our society in a state of decline, as it has been since 2010. One of the starkest features of that health inequality is the vast difference in life expectancy between the most and least deprived areas.

As the Marmot and Bambra report describes, the health picture coming in to the pandemic was stalling life expectancy, increased regional and deprivation-based health inequalities and worsening health for the poorest in society.

One of the key determinants of health is work. Being in good employment is protective of health and, as Professors Marmot and Bambra describe, good work is free of the core features of precariousness, such as lack of stability and high risk of job loss, lack of safety measures and the absence of minimal standards of employment protection.

Insecure and poor quality employment is also associated with increased risks of poor physical and mental health.

My Lady, unemployment is relatively low, but, as described by Professor Marmot in the 10 Years On report, there have been some profound shifts in many aspects of the labour market and employment practices. One challenge is rates of pay, with more people in poverty now being in work than out of work. Insecure work has increased. One aspect of that is zero hour contracts. In 2010 there were 168,000 people working on zero hour contracts –

Lady Hallett: I think, with respect, Mr Jacobs, you’re straying beyond the powers that I’ll have in this Inquiry to tackle such issues.

Mr Jacobs: My Lady, I quite agree, and in fact that is a point which I am going to come on to, which is that part of what we have learnt in this module, my Lady, is that unless we become a healthier, fairer and more equal society, then a future pandemic will again see a disproportionate impact on disadvantaged groups.

What we say, it is important that the Inquiry makes appropriate findings as to pre-existing structural inequalities and their relevance to uneven impacts, but it may also be, my Lady, that the answers to a point lay beyond this Inquiry. It comes, ultimately, to questions such as the value we as a nation put on matters such as fair work, access to core services, and public health.

The Inquiry itself cannot answer those questions, but we do say it must make crystal clear findings as to the consequences of not addressing those sorts of matters.

But it is also, my Lady, crucially a question of planning. Adequate planning can at least mitigate the uneven impacts of a pandemic. This, my Lady, is the second basket of lessons that we say are to be learned relating to uneven impact of the pandemic in the workplace, and in contrast, my Lady, they absolutely can and should be answered by this Inquiry.

A number of witnesses and organisations have put forward suggestions as to the lessons to be learned in respect of pandemic planning and mitigating the uneven impacts of the pandemic.

Of course in a sense we welcome all ideas, but we do say that many, particularly when focused on how to plan to address inequalities, have tended to be rather nebulous in nature, and it is not at all clear how they would lead to concrete and meaningful action. Some have been, to take an observation of yours during the public hearings, my Lady, and in fact just a minute or so ago, noble but beyond the scope of your Inquiry.

So what does the Inquiry do about that, my Lady?

We say that ultimately, in considering uneven impacts at least in the workplace, the Inquiry must not ignore some simple truths. During the Covid-19 pandemic, there was a continued need for us to travel and to eat, there was a need for food retail staff to attend work, for transport workers to attend work, for food processing workers to attend work, and many others. There was a need, more broadly, to keep the economy going. And the burden and risk of continuing to attend work falls not on the professional occupations but on those professions who need to attend work in person and, in doing so, expose themselves to risk, and, my Lady, that pattern will inevitably repeat itself in a future pandemic.

Moreover, the burden falls, therefore, not on a cohort – sorry, the burden falls on a cohort of working people, a great many of whom are in low paid and insecure work and who suffer from structural health disadvantages. Unless there are some fundamental changes in our society as to the labour market and factors driving health inequalities, the unequal impact will repeat itself too. But the Inquiry will hear in future modules, if it seeks the evidence, that the mitigations in those sectors where there were frontline and key workers were pretty hopeless.

What all of that means is that one crucial aspect of planning to mitigate uneven impact is, quite simply, planning to keep frontline occupations safe.

My Lady, that requires pandemic planning across a range of workplaces. In our opening, we said that pandemic preparedness across the whole range of workplaces was not so much a theme that is emerging but a theme that we are concerned is not emerging, and, my Lady, we still wait in hope for the Inquiry to address these issues.

Planning across the necessary range of workplaces and sectors must clearly include an adequate plan for PPE. It must include planning for PPE across a range of sectors. What will the provision and guidance be in advance of the next pandemic for PPE in a processing plant, in a supermarket, or on a bus? Will that be government stockpiles or will it be for employers to be able to cater for that in meeting their health and safety obligations? If the latter, are those health and safety obligations adequately clear and well understood? These questions remain unanswered, but they are important.

The relevance of PPE across a range of settings was a point stressed at least in the written report of Professors Marmot and Bambra.

Planning across a range of sectors must also include ensuring that those in the relevant occupations have the financial support to be able to self-isolate when poor pay, insecure work and a lack of sick pay means that workers are faced with a choice between not self-isolating or self-isolating but not having the money to live and eat.

The TUC has raised repeated concerns about the limitations of statutory sick pay and repeatedly raised it during the pandemic in connection with the effectiveness of self-isolation as an NPI.

As Ms Bell described in oral evidence, our evidence shows that those on zero hour contracts are much less likely to have access to decent sick pay. Around a third of those on zero hour contracts don’t earn enough to qualify for sick pay when they fall sick.

Fundamentally the TUC believes it would be better for fair rather than insecure work to be embedded in the labour market, but at the very least, and when it comes to pandemic planning, there must be proper provision for pay and support during self-isolation and it needs to be planned for.

My Lady, these, ultimately, are the sorts of concrete measures that need to be seen in pandemic planning, and which will help ameliorate its uneven impact in key and frontline sectors.

Of course those sorts of measures will mean little in practice without an effective health and safety regulator with sufficient resources and powers of inspection. We fear becoming a broken record on this point, but it is important, and we still cannot see that it is being addressed.

To place an emphasis on health and safety and health and safety regulation may not be a glamorous answer to these problems, but ultimately it is important. The severe cuts to the UK Health and Safety Executive and its Northern Ireland counterpart, particularly following 2010, were accompanied by a dangerous narrative that dismissed workplace health and safety as unhelpful red tape that did nothing but frustrate businesses and the economy. But that is a reckless approach and the inevitable consequences have come to pass. To a worker sitting on a processing plant who may already be suffering the disadvantages of low pay, insecure work and suffering the associated poorer health outcomes, an effective health and safety regulator may be the difference between working in an environment with or without adequate measures such as social distancing and PPE. We have reiterated on a number of occasions the inability of the HSE to respond to the pandemic.

Delivering a plan which achieves measures across a range of workplaces also requires an approach of partnership in consultation with the relevant industries, including both employers and unions. Ultimately, if preparedness is needed across a range of workplaces, then there needs to be engagement of frontline workers across the necessary range of sectors. The answer must lie in the responsible action of employers, supported by government.

As Gerry Murphy, assistant general [secretary] of the Irish Congress of Trade Unions, stated during oral evidence, a formal social dialogue mechanism to facilitate co-operation and joint working between government and the trade unions is essential.

As Mr Murphy explained, formal engagement fora have worked in the devolved nations and in counterparts across unions, and the TUC, the Welsh TUC, the Scottish TUC and the Irish Congress are, of course, in a position to provide a representative and mediating function between government and unions.

As Ms Bell explained, 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.

My Lady, our key points on pandemic planning for the workplace may be summarised relatively shortly. Pandemic planning needs to consider health and safety measures across a range of workplaces. It needs to be supported by an effective and funded health and safety regulator. It should be achieved in partnership with employers and workers via representative unions, and doing those things will preserve lives of those at work and will help ameliorate some of the uneven impacts of the pandemic.

Although this is the closing submission for Module 1, aspects of what we say is needed in pandemic planning and preparedness really look forward to what we say is necessary in future modules.

We say respectfully that we have not in this module seen the necessary consideration of preparedness in sectors beyond health and social care, but we also say that with the hope and expectation that the issue is going to be the subject of detailed evidence in future modules.

My Lady, we have been grateful for the opportunity to contribute to this Inquiry thus far. We again commend the Inquiry for its endeavour for getting to this point in this timeframe, and we look forward to some timely findings and recommendations. As ever, my Lady, we stand ready to assist.

Lady Hallett: Thank you, Mr Jacobs.

Mr Allen, I think I can see you back there.