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

Mr Jacobs: Maybe not quite as fortunate.

Good afternoon, my Lady, these are the submissions of the Trades Union Congress. They are shortened, happily, by some of the helpful indications given this morning by Ms Carey King’s Counsel this morning.

Firstly, the submissions we have made on evidence from the frontline. The TUC’s written submission raised the importance of the Inquiry hearing directly in oral evidence from those who worked at the sharp end in healthcare. With that in mind, we welcome the assurance given by Ms Carey that the Module 3 hearings will include evidence of individuals and that the next phase of the Module 3 teamwork will include identifying witnesses who can shine a light on systemic issues including issues of unequal impact.

My Lady, that is very welcome indeed. Such evidence frames the perspective of the Inquiry. It illuminates which policies were effective and which floundered in practice, and what needs to be learnt.

We do put on record that it is not to diminish the importance of impact films or Every Story Matters, both are valuable and the TUC was pleased that the Every Story Matters team was at the TUC congress earlier this month. We hope that we can engage perhaps early next year on the breadth and focus of the evidence of individuals, and certainly in advance of the next preliminary hearing.

I’m sure my Lady will have picked up that certainly amongst a number of core participants, there is a real strength of feeling on this issue.

I turn to the provisional list of issues. In broad terms, it is a list that the TUC welcomes, it is a helpful document. We invite consideration of just a few additional matters. Firstly, the Inquiry is committed to examining the impact of the pandemic on doctors, nurses and other healthcare staff. The list of issues should reflect, we think, that one of the very many impacts was huge and demanding changes in working patterns at very short notice. The initial pandemic response saw health workers placed into physically and mentally demanding emergency rotas for weeks on end and with little choice in the hours they worked.

It was a burden that may not have been distributed equally amongst the workforce. Significantly, the NHS did not have the preparedness to make those changes in a fair or equitable way across trusts and the uncertainty compounded the challenges faced by staff.

So we say that it is important that it is explored and understood in this module, in part to provide a platform for consideration as to whether preparedness for a future pandemic or indeed other emergencies should include a national framework for emergency rotas which can be implemented swiftly, consistently and fairly.

Second, we invite the issues relating to infection prevention and control should include those in outsourced services. The point centrally is a simple one: effective infection prevention and control requires a whole hospital or whole healthcare setting approach. Measures on an intensive care ward will be less effective if there is poor infection prevention in the services cleaning the ward or in the corridors, in the cafeteria and so on.

The experience of the TUC unions was that outsourced services were beyond the effective control of system leaders, with implications for infection prevention. We note that some of the practical experiences of that are, in our view, powerfully articulated in the submissions of the Frontline Migrant Health Workers Group.

My Lady, thirdly, disparities in death rates. The list of issues includes the numbers of patients and staff who died from Covid-19. We ask that the list of issues includes reference to disparities in death rates in protected and vulnerable groups, and the reasons for those disparities, including the extent to which they were contributed to by individual and structural racism.

We presumed but we do seek confirmation that the Inquiry will be looking carefully at the unequal death rates and also the likely contributing factors to those inequalities. The Inquiry will be well aware of the widespread concerns. They included black and minority ethnic healthcare workers being far more likely to be put in hot water with Covid patients, more likely to be working in junior or temporary roles, and inherently less supported in a healthcare system with poor black and minority ethnic representation in senior roles. These are the sorts of points that have been made powerfully in the written submissions by FEHMO, and which we endorse.

We do, of course, note the general indication given in the preface to the list of issues that discrimination will be a theme running throughout the module and that is helpful. But we say it is important to be able to focus carefully and to identify on the issues that the Inquiry is really going to try to penetrate. These are complex issues and they do not simply or easily rise to the surface by themselves. They require an approach which is thoughtful and determined, and we invite that the list of issues identifies which issues precisely are going to attract that focus.

Fourth, we raised the issue of individual risk assessments for at-risk healthcare workers. We note it’s also been raised by the Royal College of Nursing and we note this morning that it’s a key theme in the early evidence from pharmacists. All I say, my Lady, is we welcome the indication that the list of issues will be amended to include that issue.

Fifthly and finally on the list of issues, in considering long Covid, which is addressed at issue 12, we invite the Inquiry to add the recognition of long Covid as a disability. It is the point made by Mr Metzer King’s Counsel this morning, and so I endorse it rather than repeat it, my Lady, simply to note that the confusion has resulted in many workers with long Covid struggling to get the adjustments needed to support them in work. It is an important issue and we invite that it is added.

My Lady, on experts, we invited the Inquiry to consider obtaining an expert statistical analysis of the available data in respect of deaths of healthcare staff. On that, I simply stand by our written submissions and welcome the indication that it’s going to receive some anxious consideration in the coming months.

My Lady, unless I can assist further.

Lady Hallett: No. Thank you very much indeed, Mr Jacobs, very helpful again. Thank you.

Ms Morris, ah, I thought I had you over on the left.