14. Ms Anna-Louise Marsh-Rees

MS ANNA-LOUISE MARSH-REES (affirmed).

Questions From Lead Counsel to the Inquiry

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

Ms Anna-Louise Marsh-Rees: It’s Anna-Louise Marsh-Rees.

Lead Inquiry: Thank you very much, Ms Marsh-Rees, for coming back. You gave evidence of course in Module 1, and I’m going to ask you to repeat in part some of the evidence that you gave on that occasion.

You have, for the purposes of this module, kindly produced a further statement, INQ000273792. Is that a statement that you signed, if you take it from me, on 19 September 2023?

Ms Anna-Louise Marsh-Rees: I did.

Lead Inquiry: Thank you very much.

Ms Marsh-Rees, when you gave evidence before her Ladyship in Module 1, you told us about your father, Ian, who was a retired electrical engineer, and how he was hospitalised in Nevill Hall Hospital in Abergavenny, where he became exposed to Covid and returned home without any of you knowing that he had been exposed to Covid. There was no positive test and you didn’t know.

Ms Anna-Louise Marsh-Rees: That’s correct.

Lead Inquiry: How did you find out that he had become exposed to Covid?

Ms Anna-Louise Marsh-Rees: That was some months after, when we asked for his hospital notes, and we also raised some complaints about the health board. When I say complaints, we asked questions at that point, because we couldn’t understand how that was possible.

Lady Hallett: So what was on his notes that alerted you to the fact he had been exposed to Covid?

Ms Anna-Louise Marsh-Rees: It says on his discharge summary “The patient has been potentially exposed to Covid”.

Lady Hallett: It actually says those words?

Ms Anna-Louise Marsh-Rees: Actually says those words.

Mr Keith: But there was no test, you didn’t know –

Ms Anna-Louise Marsh-Rees: They did not test him, no.

Lead Inquiry: There was no testing –

Ms Anna-Louise Marsh-Rees: They did – apologies. They not test him. They missed two opportunities to test him because there was a mass outbreak on his ward.

Lead Inquiry: Did you subsequently discover that 21 people in what was supposedly or what was meant to be a non-Covid ward, 12 of whom subsequently died from Covid?

Ms Anna-Louise Marsh-Rees: They did.

Lead Inquiry: So your father was sent home, he developed Covid or he developed the disease from the virus. Was he then re-admitted back to the same hospital –

Ms Anna-Louise Marsh-Rees: He was.

Lead Inquiry: – where tragically he subsequently died?

Ms Anna-Louise Marsh-Rees: Yes, in that week where he was discharged he became ill from that evening. My mother made 13 calls to his GP, they had four out-of-hours doctors to visit, not one person mentioned that he potentially had Covid. Even though his oxygen levels were below 95, no one suggested he have a test.

Lead Inquiry: How long was he at home for after being discharged from Nevill Hall, having been exposed to Covid, and having to go back to hospital, being re-admitted –

Ms Anna-Louise Marsh-Rees: It was just under seven days.

Lead Inquiry: Seven days.

Ms Anna-Louise Marsh-Rees: But we took him, it wasn’t on – we weren’t told –

Lead Inquiry: They didn’t direct you to do it?

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

Lead Inquiry: You just did it.

Before he died, were you aware of whether or not there was any decision or order in place for the possibility of resuscitation?

Ms Anna-Louise Marsh-Rees: Again, we found out some months after, only by accessing his hospital notes, that a DNACPR had been placed on him. It wasn’t filled out accurately or completely. We had not been consulted, which they have acknowledged. They say my father was consulted but if you would have seen him when my sister took him to the hospital, there was no way that was – in any way he would have understood what was being told to him.

Lead Inquiry: What was the position during those last few days on your ability to visit and the ability of your family to visit? Were you denied access to him? Were you allowed to visit? What were the restrictions in place?

Ms Anna-Louise Marsh-Rees: No access at all.

Lead Inquiry: No access at all?

Ms Anna-Louise Marsh-Rees: No.

Lead Inquiry: So effectively a full lockdown?

Ms Anna-Louise Marsh-Rees: (Witness nods)

Lead Inquiry: Were you able to say goodbye?

Ms Anna-Louise Marsh-Rees: We were, fortunately. Very traumatic.

And, you know, one of the things I wanted to say is to anyone that says Covid isn’t a thing, I just wanted – and apologies if this is going to be triggering. But when you die of Covid pneumonia, it’s not like you’re out of breath from running for the bus or walking up stairs, it’s like you’re trying to take six breaths a second. He was almost quivering. It’s incredibly distressing to watch him literally gasping for breath.

But can I just say, he was such a lovely positive man. Even when they were giving him the morphine drug, he was barely coherent but he asked the nurse what her name was and where she lived. I mean, it was barely coherent, but just – that just shows how, just, warm, lovely person he was.

Lead Inquiry: The mark of the man.

Subsequently, you were instrumental in the setting up of Covid Bereaved Families for Justice Cymru. When was that started?

Ms Anna-Louise Marsh-Rees: In July 2021.

Lead Inquiry: Plainly the group was started after some of the first major decisions in the pandemic had been taken by the government, and whilst the pandemic was of course still raging. What was the primary aim of the group, as you saw it, when you first commenced it?

Ms Anna-Louise Marsh-Rees: The aim was to get answers. It wasn’t to have an Inquiry for the sake of an Inquiry; it was genuinely because we didn’t know – I didn’t understand what had happened, and then I spoke to other people from Wales that didn’t understand and, you know, you start to build that picture. Predominantly it was because we didn’t understand about the nosocomial, the hospital-acquired Covid but, as I met other people, you know, that extended to concerns about care homes. One of our members ran a care home in Wrexham in the first wave where she lost 12 patients, there was no oxygen, no PPE, nothing, and yet nine miles over the border in England they had all of that.

So it was quite a differentiation from a Wales perspective.

Lead Inquiry: I’m going to come back in a moment to the issue of cross-border travel, particularly in the context of local lockdowns. But, from the beginning, did your group focus on the decision-making which had taken place insofar as it affected Wales? Was the group always and does it remain Welsh-centric?

Ms Anna-Louise Marsh-Rees: Absolutely. Once we’d formed, our objective was very much calling for a Wales-specific Inquiry because, as you know, healthcare and social care, which were our main concerns, are devolved in Wales and therefore under the control of the Welsh Government.

So, absolutely, we were born out of wanting Welsh Government decisions to be understood, and still remain of that view. But clearly, as we’re in the UK Inquiry, we want the context of how Wales performed against all of the UK nations.

Lead Inquiry: And of course the UK decision-making had direct impacts on Wales?

Ms Anna-Louise Marsh-Rees: Absolutely.

Lead Inquiry: You’ve no doubt heard the evidence which has just been given by Ms Goodman and Dr Wightman about the areas, the broad themes or areas which have been the subject of the greatest concern on the part of the next of your respective groups. So may I introduce that topic and start to identify the main themes through you, if you may.

Hospitals obviously are at the forefront of any pandemic response, and appear to be right at the heart of the greatest area of concerns expressed by members of all the groups. What is it about the hospital care that your members in general terms received, or rather their loved ones received, that’s given rise to the greatest concern?

Ms Anna-Louise Marsh-Rees: I would say segregation, or lack of, is one of the primary concerns.

Lead Inquiry: You mean the infection control in hospitals?

Ms Anna-Louise Marsh-Rees: Yeah, in the broader sense infection control in general but within that, you know, the lack of the right PPE, RPE, the lack of segregation, the lack of testing of both healthcare workers and patients, or having any regular testing. Wales were very late introducing masks, and even then not the right ones, and four months later than England in testing asymptomatic healthcare workers. We’d very much like to understand what the science was driving that.

Lead Inquiry: You are no doubt aware that the figures now show that the levels of nosocomial infection in hospital were, across the United Kingdom, extremely high. The infection was rampant across the healthcare sector.

Is it the view of your members that more could have been done by way of infection control to stop the rage of the virus through the places where their loved ones were most vulnerable?

Ms Anna-Louise Marsh-Rees: Absolutely, I think you need to go back to, you know, back to Module 1, preparedness and resilience. We’ve got reports from NHS Wales that identify, even after SARS-1, that hospitals need to be built with looking at ventilation, filtration, looking at South East Asian public healthcare as a blueprint. And then, you know, I guess from a personal perspective I was very surprised that – you know, my father was infected in the second wave – it didn’t appear that there had been any kind of progress or lessons learnt from that first phase, and yet we’d had, looking back now, almost a sort of Halcyon period of – you know, on that summer between wave 1 and wave 2 where it felt there could have been, you know, more science, as we keep hearing about, you know, that could have been put in place.

Lead Inquiry: Halcyon unless, as you yourself rightly say in your statement, you happened to be shielding or you suffered from a pre-existing chronic disease or if you suffered from a disability.

Ms Anna-Louise Marsh-Rees: Absolutely.

Lead Inquiry: But for everybody else, they were unusual days.

You mentioned a few moments ago infection control more generally. The issue of infection control in hospitals and the care sector has a clinical element to it, of course, but where do your members say the main failings, as it appears to them, if there were any, arose in relation to infection control generally?

Is there a sense held on the part of your members that there was a failure to get on top of the spread of the virus generally before it impacted on individual hospitals and care homes?

Ms Anna-Louise Marsh-Rees: I’m not sure they would specifically say that, though obviously infection – you know, monitoring Covid out in the community was obviously vital. But it just seemed that so many people went in with, you know, with one – for some specific treatment, but either came out with – were sent home with Covid or back to a care home with Covid, or simply died of Covid, that they did not have 100% before they went into that hospital.

Lead Inquiry: Do many of your members raise the issue of the restrictions on their visiting ability to the hospitals where their loved ones were being looked after, and also the general issue of communications with medical staff? Do many of them say that they simply didn’t receive sufficient detail, or the right level of communication, and of course were being denied the ability to visit?

Ms Anna-Louise Marsh-Rees: All of the above. There was either no communication or very poor communication, which is one of the things we’ve, as a group – because, as I said, I want to reiterate, whilst we do want to know what happened and why it happened, we very much want to make a difference as a group and use our experiences positively.

You know, we’re calling for mandatory bereavement training. Nothing major, nothing onerous that takes people off their day-to-day job but, you know, some online training on how – tone of voice, the right words to use, and the smallest things make the biggest difference in terms of telling someone that their loved one is not going to make it.

Lead Inquiry: There are a number of places in your statement where you refer to an apparent absence of bereavement support, a lack of financial support, but also structures in place to help people come to terms with the loss of their loved one, as well as dealing in a far better way with funerals and the rights associated with the passing of loved ones.

Do your members feel that there is a lot more that can be done in terms of providing support, both emotionally, financially and in terms of the practicalities, returning the clothes from somebody who has died in hospital? Is that a big issue?

Ms Anna-Louise Marsh-Rees: That was one of the key issues, in that if you were fortunate enough to be with your loved one when they died, or you were just told about it, that – you know, it’s this kind of silence as you walk through a hospital, it’s always in the night for some reason, and you’ve got your bin liner or plastic bag with the belongings. There’s no – nobody tells you about the practical side of things, no-one contacts you about the psychological help.

Many of our members – I mean, this again might be quite triggering – couldn’t find their loved one, they were moved either to a different hospital before they died or after they’d died. In fact, one of our members actually had to stop her father’s body being taken to a supermorgue in Cardiff, which was because they’d obviously run out of morgue space by that time.

But, yeah, that whole … and sort of bereavement starts – when you know someone’s going to die, it starts from the moment you know they’re going to die, it doesn’t just start once they’ve died. So it’s – we’ve been trying to work with Hospices UK and palliative care professors to look at how we can – because it’s not like a long-term palliative care, it’s a very sudden pallia … how we could make that communication, how you can explain to someone the different – what happens when someone dies, actually what physically happens to them and, you know, and then there’s the practical side of it and the psychological side of the bereaved.

I know we represent the bereaved, but I also want to reiterate that we wanted to say today that we also want to give voice to those that have died as well because know they haven’t got a voice any more. So it’s not just about us, it’s very much about them, and what we don’t want is for another Peggy, Betty, Margaret, Phil, to have gone through what our loved ones went through in a room by themselves, with no wifi, no – if they were even able to use a phone. We’ve had phones with messages, missed messages.

This is a really tragic one: glasses being in the bag or a hearing aid, and whereas they’ve not been given them, you know. So we’re talking about true isolation here and it’s particularly if you’re, you know, disabled or elderly.

Elderly, yeah, you know, your world becomes much smaller naturally as you get older and now, you know, you’ve had this good, wonderful life and your last few days are truly alone.

Lead Inquiry: In your statement you refer to a cadre of people, you call them the silent generation, and you do so in the context of how many of your members feel that, because their loved ones were relatively elderly, that they either didn’t receive the treatment which they rightly expected to receive, or failed to get the levels of support of which you’ve spoken so eloquently.

What did you mean by the silent generation? Is this an issue to do with the failure of society to appreciate that there is a generation of people who are less prone to call out for help when they need it and need to be given it?

Ms Anna-Louise Marsh-Rees: Absolutely. So I think the expression “silent generation” was coined by TIME Magazine in 1950 something, and it’s a categorisation of those born between 1928 and 1945, so very much sort of grew up in the Second World War, sort of experienced – well, probably didn’t experience the swinging 60s in Brynmawr as they would have in Woodstock, let’s say, but they’re very traditionalist, very law-abiding, pragmatic, stoic.

You know, my father, when I even suggest – he had needed his cataracts done, and when I said, “Well, you can’t – there’s three years to wait”, he went – and I said, “Let’s go private”. He was horrified; that is not the thing to do, you wait your turn, you do not – you do not buck the system just because you’ve got some money.

Lead Inquiry: And is it the view of yourself and many of your members that more careful attention needs to be paid to ensuring that those who don’t want to ask for help do nevertheless receive it?

Ms Anna-Louise Marsh-Rees: I think culturally we need to change. There’s a choice to be made here. One thing that’s for certain is we will all get old, and I think we have to start to think about giving people a voice. I think it probably was there already, but I think the pandemic has highlighted this, that – you know, and so many times I’ve heard “Well, he was old anyway, wasn’t he?” Like, well, yes, but that doesn’t mean to say their lives are any less valid than anyone else’s.

Obviously the Inquiry will look at certain aspects of that but, you know, there has to be ways that we don’t put old people – you know, now it’s like, “Oh, they’re over 70”. Well, 70’s not old. It’s –

Lady Hallett: Thank you for that.

Ms Anna-Louise Marsh-Rees: Oh, sorry.

Lady Hallett: It’s all right.

Mr Keith: So, Ms Marsh-Rees –

Ms Anna-Louise Marsh-Rees: To my point.

Lady Hallett: Yes.

Mr Keith: If you’ll allow me to move over from a slightly awkward moment –

Ms Anna-Louise Marsh-Rees: Yes.

Lead Inquiry: – would you accept that essentially what you’re railing against is the inequality of age, the fact that because of age some people are treated less equally and therefore need the extra assistance? Is that what –

Ms Anna-Louise Marsh-Rees: Absolutely, yeah, there’s no doubt about it, you know, people that are older are ignored, they – maybe they’re deemed less important, their lives less valuable, and because of this whole reticence to maybe, you know, call out or stand their ground or complain, that exacerbates the situation. And I think that’s maybe why I’m here, and our members are here, is to give them the voice. They were the silent generation, they are most certainly silent now, but we thank the Inquiry for giving them that voice now and the platform to discuss some of these things that could impact us culturally, socially for the future.

Lead Inquiry: Well, if I may say so, you have given the most eloquent of voices.

I’d said that I’d come back to the issue of cross-border. In the context of the social restrictions and the NPIs that the government put into place, obviously an issue arose as to whether or not there were differences in application and impact between Wales and England.

One other very interesting area in your statement is the level of complaint which appears to have been felt by those people who, in Wales, were aware of people crossing the border into England and thereby circumventing restrictions or moving from areas which had different epidemiological tiers associated with them.

Has that been a significant issue in the views of your members?

Ms Anna-Louise Marsh-Rees: It really has, because it was very unclear, it was very confusing which country had which rules. There was also people being treated, that lived on the borders, being treated in England; there was a lot of healthcare workers that lived in Bristol that were going to Wales, so there’s a whole big question around: was it right that different nations had different rules in place, and why, and should that happen again? You know, I’m not here to judge, but it doesn’t seem logical, when you’ve got porous borders to allow that, or …

Lead Inquiry: And did it make it extremely hard to adhere to, if there was an unnecessary degree of complexity or confusion?

Ms Anna-Louise Marsh-Rees: Absolutely. I mean, I was travelling between England and Wales so I was personally affected and I couldn’t – you know, it was difficult, was I wearing a mask here, wasn’t I wearing a mask there? You know, going across the Severn Bridge was like going across the Mexican border, you didn’t know whether you were going to get stopped. You know, and was I flouting the rules? When my father was ill, possibly I was. But …

Mr Keith: Well, that’s all right.

Ms Marsh-Rees, thank you very much.

The Witness: Thank you very much.

Lady Hallett: Ms Marsh-Rees, when you spoke about trying to persuade your father to have private treatment, you reminded me of trying to persuade my mother to get a taxi, “You can’t spend money on taxis”. Just, you’re absolutely right. As Mr Keith said, you’ve been an excellent and eloquent voice, both for the bereaved and for those who died, and always constructive.

So thank you very much indeed.

The Witness: And that’s what we aim to do. We do want to know what happened but we also want to make a positive – we want to use our negative experiences to a positive future. So … and apologies for the comment, but I think my point stands that 70 is not old.

Lady Hallett: No, no, I consider it to be a compliment.

Mr Keith: I can’t quite believe you’ve returned to that subject, Ms Marsh-Rees.

The Witness: It was a compliment, I promise.

Lady Hallett: Thank you very much indeed.

The Witness: Thank you very much.

(The witness withdrew)

Lady Hallett: Right, so that’s all we have time for this afternoon.

Obviously we have one more bereaved witness, Ms Myles, who is going to give evidence tomorrow morning, and obviously we’re looking forward to hearing from her, and I’m sorry that she has had to wait until tomorrow morning, but it’s just one of those things, we’ve done our best to get as much in as we can.

I think that’s it for today, isn’t it?

Mr Keith: Will you order 10 o’clock tomorrow, my Lady?

Lady Hallett: 10 o’clock tomorrow. Well, I think what I’ll say is it’s 10 o’clock unless I say to the contrary.

Thank you all very much.

(3.41 pm)

(The hearing adjourned until 10 am on Thursday, 5 October 2023)