3. Professor Philip Banfield

PROFESSOR PHILIP BANFIELD (affirmed).

Questions From Lead Counsel to the Inquiry

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

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

Lead Inquiry: Professor Banfield, are you the chair of the BMA’s UK council?

Professor Philip Banfield: Yes, I am.

Lead Inquiry: You were asked by the Inquiry to provide, by way of Rule 9, a witness statement addressing in very broad terms, at least descriptively now, for present purposes, in very broad terms, the role of the BMA in the pandemic and the way in which, firstly, the members of the BMA, those who you represent, suffered under the pandemic, and secondly, the way in which you engaged with government on behalf of the BMA.

You were asked, I think, to focus on the impact upon those who you represent of the pandemic and the government decision-making because they might broadly be described as frontline and key workers.

But are many of the workers and the members whom you represent also members of the ethnic minorities?

Professor Philip Banfield: Yes, they are.

Lead Inquiry: So are you giving evidence now in relation to this theme, ethnicity, because the subject matter of your witness statement covers not just frontline and key worker impact evidence but also the impact on ethnic minority members of the BMA?

Professor Philip Banfield: Yes, indeed.

Lead Inquiry: All right, thank you, that’s very clear.

You prepared a statement, INQ000228384.

We’ll have it up, thank you.

Did you sign it on 21 July 2023 and declare its truthfulness?

Professor Philip Banfield: Yes, I did.

Lead Inquiry: We’ll come back to the statement in due course.

Could we start, please, Professor Banfield, with just a few questions about the structure of the BMA and your place in the general scheme of things. This is an area that we’ve covered, of course, because you gave evidence in Module 1, but it’s important to set it out again for this module.

Is the BMA a professional association and trade union?

Professor Philip Banfield: Yes, it is.

Lead Inquiry: Does its membership come from the whole breadth of medicine, from academics, students, general practice, consultants, junior doctors, public health, and no doubt many other areas?

Professor Philip Banfield: Yes, it does, and retired members.

Lead Inquiry: And retired members.

Are there of course in your organisation different committees, bodies and areas that reflect the many different specialities of medicine?

Professor Philip Banfield: Yes, there are.

Lead Inquiry: So you have committees which feed into the central structure of the BMA and committees that feed into the general structure of BMA committees in England and in Scotland and in Wales and Northern Ireland, reflective of those different specialities?

Professor Philip Banfield: So the UK council represents all four nations, the devolved nations have their own separate council to deliberate on matters that are devolved purely to those nations.

Lead Inquiry: But there is a BMA UK council, of which you are chair –

Professor Philip Banfield: Correct.

Lead Inquiry: – and information and political leadership and the degree to which there are particular issues that each committee wants to raise are fed through the UK council, are they not?

Professor Philip Banfield: For matters that affect the whole UK.

Lead Inquiry: Of course.

The BMA UK council is the principal executive committee of the BMA, is it not?

Professor Philip Banfield: It is.

Lead Inquiry: And you are its chair, as I’ve said.

Are there also within the BMA structure a number of regional councils?

Professor Philip Banfield: Yes, there are in England.

Lead Inquiry: Eight?

Professor Philip Banfield: Indeed.

Lead Inquiry: And a number of divisions?

Professor Philip Banfield: So these are our local structures at this point in time, and they cross over between primary and secondary care.

Lead Inquiry: When dealing with the UK Government, which part of the BMA provides the political leadership of the BMA and leads the engagement with the UK Government?

Professor Philip Banfield: That was mainly done at UK level by the chair of UK council, at that point Dr Chaand Nagpaul, but also the chairs of the UK branch practice committees.

Lead Inquiry: Because you took on the role of chair of the council in July 2022 in fact after, of course, the pandemic was over?

Professor Philip Banfield: Yes, prior to that I was chair of the consultants committee in Wales.

Lead Inquiry: But you had been on the UK council as well since 2012, alongside your practice as a consultant obstetrician and gynaecologist in North Wales?

Professor Philip Banfield: Yes, so I was working on the frontline during the pandemic.

Lead Inquiry: For the purposes of giving evidence today, have you gone back through the BMA’s paperwork and informed yourself as to the degree to which the BMA engaged with the government, the UK Government, during the time of the pandemic?

Professor Philip Banfield: Yes, to the best of my ability.

Lead Inquiry: All right, thank you very much.

In general terms, from late March 2020, within the BMA, did you have daily virtual meetings in order to inform the leadership, namely your predecessor, and to identify key emerging evidence and what the government’s position on various issues was for the purposes of working out what the BMA’s response would be?

Professor Philip Banfield: Yes, there were daily meetings. It was really important because things were happening so quickly, and we were getting conflicting advice, both coming down from governments, but also from clinicians on the shop floor, who had a feed in from international colleagues as to what the state of play was in Europe, and that was very worrying because that was going to come to our shores with an inevitability that we felt we weren’t prepared for.

Lead Inquiry: At what time did this battle rhythm within the BMA commence?

Professor Philip Banfield: Just towards the end of March.

Lead Inquiry: So at the time, in fact, that the government was first imposing, mid-March, social restrictions of a society-wide nature or latterly towards the lockdown period?

Professor Philip Banfield: No, we had started our deliberations. It was very quickly apparent to the profession the seriousness of what was due to happen. There was a recognition that services were likely to be overwhelmed. A number of us went about writing our wills and making sure that our life insurance was up to date, because we had no doubts that we were facing something that was completely unprecedented.

Lead Inquiry: In general terms, focusing on the BMA’s role and function, are there a number of areas that the BMA focuses on? So, firstly, providing individual support to members, because they are members of your body and association; secondly, providing guidance to doctors and their employers; thirdly, and this is the area upon which we’ll be focusing today, seeking to influence decision-makers on a wide range of matters related to Covid through meetings, letters and correspondence, engagement with the media, and issuing of press statements, and giving evidence in Parliament. Are those the broad areas?

Professor Philip Banfield: Yes, we advocate for excellence in healthcare and for healthy populations.

Lead Inquiry: The engagement with government presumably required the BMA to meet with and speak to and write to or correspond with a significant number of different moving governmental parts?

Professor Philip Banfield: Correct.

Lead Inquiry: In general terms, does the BMA consider that it had good access to the Secretary of State for the Department of Health and Social Care and ministers during the pandemic?

Professor Philip Banfield: Yes, it does. There was already an existing relationship between Chaand Nagpaul as chair and the Secretary of State, Matt Hancock.

Lead Inquiry: Did he have regular meetings with Mr Hancock whilst he was Secretary of State, and did he and other senior staff have regular meetings with ministers of state, for example Ed Argar MP, Helen Whately MP and others throughout the currency of the pandemic?

Professor Philip Banfield: Yes, they did.

Lead Inquiry: Were there also meetings between the BMA’s general practitioners committee for England and the Parliamentary Under Secretary of State for Public Health and Primary Care, Jo Churchill MP?

Professor Philip Banfield: Yes, there were. They started off about Covid specifically and then after a period of time went into other areas, but Covid remained on the agenda.

Lead Inquiry: May we presume that, because you’re the BMA, you were raising issues not just to do with the mechanics of Covid and the government’s response, but including many other wider public health issues, all related in one form or other to the pandemic?

Professor Philip Banfield: Yes.

Lead Inquiry: Did the BMA have regular meetings with the CMO for England, Sir Chris Whitty?

Professor Philip Banfield: Not regular, but we were able to contact the CMO as and when we felt it was appropriate to. He made himself readily available at the point at which we had any specific questions.

Lead Inquiry: So he said if you wish to raise concerns with him, in effect, you were free to do so, and he made himself available to meet you if you wished to do so?

Professor Philip Banfield: Correct. We didn’t always agree, but he was there to listen.

Lead Inquiry: Were there a number of meetings held to discuss a range of issues, the government’s approach to lockdown, PPE, the impact on your members and so on, a huge range of issues?

Professor Philip Banfield: Yes, there were.

Lead Inquiry: Public Health England, did you have regular meetings with it?

Professor Philip Banfield: No.

Lead Inquiry: Was there written communication?

Professor Philip Banfield: Yes. It was more specific. When we had concerns, or wanted to query a specific piece of advice, we would write formally about that. Our public health committee does have a number of, and a range of public health clinicians, so a lot of information for the general BMA was coming to us through that committee.

Lead Inquiry: As for the Department of Health and Social Care more generally, did you receive updates from the civil servants in the DHSC and also their representatives on a body called the SPF, is it social policy forum?

Professor Philip Banfield: The Social Partnership Forum.

Lead Inquiry: Social Partnership Forum, Covid-19 engagement forum?

Professor Philip Banfield: Yes, and, you know, there were a number of meetings set up to impart information and share it between multiple organisations and bodies, and we were part of that, either as elected members or members of staff of the BMA.

Lead Inquiry: Did the government set up what are called stakeholder meetings between the DHSC and other bodies, including Professor Sir Jonathan Van-Tam, the Deputy CMO, and the BMA, at which issues of general concern could be ventilated?

Professor Philip Banfield: Yes. It tended to be that we were listening rather than giving information.

Lead Inquiry: Finally, did the BMA have significant engagement with senior officials from NHS England?

Professor Philip Banfield: Yes, there was regular and full engagement to discuss operational matters, so the chair of consultants committee, Dr Vish Sharma, used to meet with Professor Stephen Powis, as did the GP chair at that time.

Lead Inquiry: My Lady, may I just make plain that much of Professor Banfield’s statement does deal with engagement between the BMA and the devolved administrations, but of course that is an issue which will be for later consideration in Modules A, B and C.

Just at this stage, at a very general level, what were the sorts of issues, what were the themes, what were the general areas that the BMA raised with NHS England? PPE?

Professor Philip Banfield: So PPE and a lack of testing were the two immediate issues between ourselves and NHS England. We felt that the guidance was inadequate. We had stories very early on about not being able to have PPE, so there was a lack of aprons, a lack of visors. A number of us had – our local schools were 3D printing visors for us. A number of people had to source masks themselves, especially in general practice, for example.

Lead Inquiry: Just pausing there, can I just delineate the scope of what you’ve just said. So in relation to PPE, there were in fact three areas of concern, very broadly putting it, as I say: firstly, the shortages; secondly, the guidance in relation to the use of PPE; and then thirdly, the impact of the, in cases, deficient PPE on your members?

Professor Philip Banfield: That’s true, yes.

Lead Inquiry: All right.

Professor Philip Banfield: There’s a fourth aspect, which is actually have to work in that kind of PPE. That has a – had a huge impact on people’s health and wellbeing.

Lead Inquiry: Is that the topic of risk assessment? So, because of the impact or because of the consequences of your members having to wear PPE that may not have been adequate or proper, that gave rise to very difficult debates about the extent to which they would have been placed at risk, the need for risk assessments, as well as the objective impact upon them individually of having to wear deficient PPE?

Professor Philip Banfield: Yes, because there was a shortage of PPE, the very high-risk areas, like intensive care units, were using respiratory protection throughout the pandemic, but once you got beyond an intensive care unit, with people who were Covid positive, the amount and degree of PPE very rapidly tailed off. So, for example, people were either treating patients with no masks or with fluid-resistant surgical masks, which don’t protect from an airborne virus.

Lead Inquiry: Was another area of general concern to the BMA the disproportionate impact on ethnic minority communities?

Professor Philip Banfield: Yes, there were quite early data from the intensive care community showing a disproportionate number of intensive care admissions from black, Asian and minority ethnic groups. Alarmingly, the first ten doctors who died of Covid were all in that black and Asian and minority ethnic group, and that was spotted very quickly by a number of organisations, including BAPIO, and the BMA, and the BMA then wrote immediately to raise concerns.

Lead Inquiry: So were there three areas, in fact, touching upon the issue of your ethnic minorities: one, the disproportionate impact of the virus on them; two, the disproportionate impact of the virus on members of your association who were from ethnic minorities; and, three, was there then the issue of the efficacy or suitability of particular types of PPE for those members of your organisation who were drawn from ethnic minorities?

Professor Philip Banfield: That is true, because PPE needs to be particularly well fit tested, and it doesn’t suit people with beards, for example, for religious purposes. But people from ethnic minorities are less likely to stick up and speak up when there is insufficient PPE, and they – we found that they were much less likely to have had an adequate risk assessment.

By the end of the first wave, two out of three doctors still hadn’t felt that they’d been adequately risk assessed.

Lead Inquiry: Could we now turn in a little more detail to the particular areas and issues of concern that you raised from time to time with various parts of the government, the parts of the government that you’ve now identified.

Starting – if we could have on the screen – paragraph 77 on page 20.

The BMA first became aware of the Covid-19 emergence via the media, when it was still confined to China. Did you, as a result, send in January a letter – in fact it was your predecessor who sent a letter – to the Secretary of State and to NHS England and Public Health England, offering the BMA’s support and expertise?

Professor Philip Banfield: Yes, we did.

Lead Inquiry: In that period up to the end of March, the period you’ve already identified, did you have a number of meetings or phone calls or did the BMA have a number of meetings or phone calls with senior officials in the UK Government?

Professor Philip Banfield: Yes, we did. It was to find out and to highlight the exchange of information that we were receiving both from our own experts and from our colleagues abroad.

Lead Inquiry: If you could go, please, to page 22, paragraph 86.

At the ministerial meetings, that’s to say meetings with the Secretary of State or his ministers – as you’ve said, the meetings invariably covered many aspects of the pandemic, but have you drawn out in your witness statement in that paragraph 86, reflective of the same areas that you were raising in fact with the NHS, the broad areas of PPE, testing and contact tracing, shielding, social distancing and other lockdowns?

Professor Philip Banfield: Yes, I have.

Lead Inquiry: Now, as at that time, mid to late March, to what extent did the BMA have a view on the particularity, the specifics of what the government was proposing by way of social distancing and then ultimately, from 23 March, lockdown? Were you focusing in your engagement with the government upon the impact of whatever it is the government might then have been proposing, or were you focusing on the efficacy of whatever was being proposed, would it work?

Professor Philip Banfield: Well, the biggest issue really started one step back from that, was our lack of understanding as to why the government was apparently abandoning basic public health protection measures. Our local public health teams, our local public health doctors were prepared for a pandemic, this is their bread and butter subject, and we seemed to have abandoned that first principle of control of an infectious outbreak by trying to control and contain through testing and isolating and making sure that you can support people to do that.

Lead Inquiry: Sorry, just pause there, can I just come back to something you said at the start of that sentence. You say there was an abandonment of basic public health protection measures, and you’ve referred to testing and isolating.

Was test and trace and isolation, TTI, the primary or perhaps the only way by which an infection could be controlled or can be controlled on its emergence?

Professor Philip Banfield: Well, you need to identify it, you need to contain it, and you need to then help people to isolate, but that needs local knowledge and local efforts, and there was a disconnect between the central control – and this seemed to be the message that we were trying to get across to government, was the need to involve local health protection teams as early as they could. So we couldn’t understand the decision to abandon contact tracing that was made on 11 or 12 March.

Lead Inquiry: Just a couple of features around that, please, Professor. Firstly, when you say, when you refer to local public health systems, do you mean the local authority health protection teams, the directors of public health, the local structures which were already in place for dealing with infectious disease outbreaks and environmental risks?

Professor Philip Banfield: Yes.

Lead Inquiry: Secondly, you were concerned on behalf of the BMA that the government had abandoned contact tracing; to what extent was the BMA aware of the physical or the practical limits on the testing structures that were then available?

Professor Philip Banfield: Well, that came out, I think, in discussions and communications afterwards, and there was an admission that part of the decision to do that was a lack of testing.

Lead Inquiry: Now, you know that there is in place or there was in place, of course, a system by which, whenever a disease emerges or there is an infectious viral outbreak, a data set can be prepared, a structure can be put in place whereby the first few hundred cases are tracked, contacted, tested, traced, isolated, but there was a distinct limit on how many cases that First Few 100 system could accommodate.

To what extent did the BMA become aware that that basic system for test and trace and contact for high-consequence infectious disease was lamentably inadequate for dealing with the demands of a massive viral outbreak?

Professor Philip Banfield: I mean, that was known quite early on, because public health had already – or our public health colleagues had already highlighted the risks of the disconnect between local health protection teams and the NHS, and it meant that possession of data was essential to control the outbreak, and because they were then sitting within different systems, the data didn’t reach the frontline. We saw that – a good example of that later on when there was a local lockdown in Leicester, where there was detailed information about the test results but not about the results and prevalence in the local population. And that made it really difficult to control it.

Lead Inquiry: Is that because at the beginning one of the other features of the First Few 100 system is that that’s a nationally-run system, it’s not run by local authorities or public health directors?

Professor Philip Banfield: Well, normally it would be, you would expect it to be run locally for a local outbreak and have it co-ordinated by the regional directors, who would then be feeding up to the centre. What happened here was the centre gave public health policy from the top downwards.

Lead Inquiry: What about the absence of or the very limited number of PCR tests that were then available? You can’t run a testing system, even at a basic level, unless you’ve got the testing kits, then, all that there was after the initial diagnostic tests were prepared, a PCR test. To what extent did the BMA become aware that there was a very distinct limit on the physical number of tests, testing kits available?

Professor Philip Banfield: Well, that happened very quickly, because we were relying on the availability of the PCR tests to keep people in work. In the absence of the PCR tests, we were having to isolate for 14 days, isolate if we were contacts. We were already short of staff and we ended up in that first wave with huge numbers of staff not being in work when they potentially could have been if there were tests to test both them and the patients around. And of course the consequence of not having sufficient tests in those early days were that we were admitting patients to unsuitable areas with patients who hadn’t got Covid. So the chance of passing Covid around a hospital was very high.

Lead Inquiry: Was there a general difference of view between the BMA and the government in relation to the level of government intervention in terms of the robustness, if you like, of the way in which the government was taking action? Was that a subject of concern and of debate?

Professor Philip Banfield: It was a subject of concern. There wasn’t very much that we could do about it, because a lot of public health policy that was announced was announced in the daily briefings, and that caused a problem for public health teams on the ground, because the first that they might have known of a change of tack or a change of policy would be at that meeting, and yet they would then be on call that evening trying to find out as to what the implications were for the local population.

Lead Inquiry: As the clock turned through those dark days of the end of March, to what extent did the BMA seek to engage with the government on the primary decisions to, firstly, throughout mid-March, impose social restrictions, and then, on 23 March, announce the lockdown?

Professor Philip Banfield: Well, we had been advocating for strengthened measures, these non-pharmaceutical interventions, as soon as contact tracing was abandoned. That 11-day delay until the lockdown, and given that there was already a plan in place, just seemed to be increasing the number of infections unnecessarily. And that had a huge consequence not only to the public but to the health service as well, because the number of admissions soared during that time, the number of people who caught Covid and had been affected by it soared during that time, and we did feed back both to government and then publicly in the media that we thought that this was an unnecessary delay.

Lead Inquiry: Can we just unpick some aspects of that answer. So on 12 March the government announced that there would no longer be testing in the community and such PCR test as there was would be kept for healthcare workers.

By that time, the First Few 100 dataset, the analysis of index cases and the pursuit of their contacts and the isolation of their contacts, had given up the ghost, it stopped at 415?

Professor Philip Banfield: They’d lost control.

Lead Inquiry: They lost control. So are you saying that thereafter, from 12 March to the lockdown day of 23 March, there was in practice no way of assessing the degree of spread of the infections through the community at large?

Professor Philip Banfield: That’s what it seemed like to our members.

Lead Inquiry: And if you don’t know how the virus is spreading, other than by way of estimate or modelling, what means of control have you got to suppress it?

Professor Philip Banfield: Very little. We were seeing the results of that actually on the frontline.

Lead Inquiry: There were a number of areas where the BMA’s entreaties to the government had greater degrees of success, were there not?

Professor Philip Banfield: Yes, indeed.

Lead Inquiry: So could you turn, please, to page 34, paragraph 139. You were obviously trying to influence the government on multiple issues at any one time, but going over the page, to page 35, in relation to the wearing of face coverings. later systems for testing and contact tracing, and the exiting of lockdowns safely, did your lobbying meet with some, if not always completely unalloyed, success?

Professor Philip Banfield: Indeed, yes. It’s difficult to actually put a cause and effect onto that, but eventually the measures that we were calling for came into play.

Lead Inquiry: In relation to exiting lockdowns safely, at paragraph 142, did you publish documents in July and November 2020 setting out what you believed the government should do to ease restrictions that would keep control upon the virulence, the level of virus in the community?

Professor Philip Banfield: Yeah, it was really important to us, because we had a sense across that summer that we were failing to prepare for the inevitable second wave, and therefore we took it into our own hands to try to give guidance into the public domain, that we shared with various parts of government, as to how to keep the levels of virus low enough to be able to get through the following winter.

Lead Inquiry: In the summer of 2020, was there a general concern being expressed that, because the virus – the levels of virus in the community had not been brought down low enough, too great a degree of relaxation in restrictions, or complete freedom, would allow it to unspring, uncoil itself like a spring, back out into the community violently?

Professor Philip Banfield: Yeah, I’m advised by my public health colleagues that you need a rate of around 10 per 100,000, which is around 100,000 cases per day, and the UK was above that.

So, you know, the data were suggesting that it was unsafe to ease lockdowns at that point. We were advocating mandatory use of face protection, face masks for the public. We were advocating later for a higher degree of protection from vulnerable people, as the shielding came out of play.

Lead Inquiry: Just finally before lunch, then, and just identifying certain aspects of the face mask debate, the government did impose a mandatory face covering order, firstly in relation to public transport and then latterly shops and supermarkets, but relatively speaking you were calling for mandatory face masks across the population at an earlier time?

Professor Philip Banfield: Yes, we were. It didn’t make sense to us that there would be – and if you’re going to ask the public to wear face masks, then why not do it all in one go rather than this phased approach, which seemed to us to be sustaining the transmission unnecessarily.

Lead Inquiry: Did you at the same time call for ways in which the government could ameliorate, make better, the position of people who were subject to restrictions? There were some people, of course, a lot of people, who were subject to continuing shielding restrictions, and during the lockdowns themselves, of course, people who required better financial support, help with combatting the effects of isolation, and so on.

At the top of page 36, for all these particular issues, did you go into bat against the government?

Professor Philip Banfield: Yes, we did. The best phrase that I’ve heard about that situation was that we were all in the same storm, but not in the same boat. There were clear discrepancies about how the pandemic was affecting different parts of our society, the poorest, the homeless, those who were already vulnerable. And that stayed with us. So when the country came out of lockdown, in inverted commas, right at the end in 2022, we’ve still got a situation in which very vulnerable people feel very exposed and are still hiding away from society.

Mr Keith: My Lady, that a convenient moment?

Lady Hallett: Certainly.

Are you okay to come back this afternoon, Professor? Thank you.

2 o’clock, please.

(1.02 pm)

(The short adjournment)

(2.00 pm)

Mr Keith: Professor Banfield, at paragraph 145 you say this:

“While not a specific [non-pharmaceutical intervention], the BMA contends that a key failure of the Government was, and continues to be, the failure to properly acknowledge (and at an early enough stage), that Covid-19 was spread by aerosol transmission and to adapt their public messaging, guidance to health services or the focus of their NPIs appropriately.”

Was that because there was an issue in the very early days as to whether or not Covid was transmitted by droplet or aerosol or both, and when it became apparent that it could be spread by both vectors, or both forms of transmission, the government didn’t sufficiently tailor its messaging?

Professor Philip Banfield: That’s true in some ways. We have always advocated a precautionary approach to public health measures, and it was known that similar coronaviruses are transmitted by aerosols, you know, airborne spread rather than droplets, so it seemed sensible from a professional point of view to consider that possibility. There became more emerging evidence across that summer, and it became unequivocal, and at the point at which it became unequivocal, there were temporary changes to the advice from Public Health England that then got reversed after the vaccination programme came into play.

Lead Inquiry: So relatively late?

Professor Philip Banfield: Yes.

Lead Inquiry: Now, earlier in the course of your evidence you described a number of areas in relation to which the BMA had not met with much success of persuading the government of the merits of its own views, but in relation to some other areas, starting on page 39, did you have a greater degree of success as a result of your interventions in influencing government decision-making?

So firstly, do you believe that the interventions you made in relation to the exact manner in which the first lockdown was eased in the summer of 2021 had an impact?

Professor Philip Banfield: So I do beg your pardon, there is a typographical error in paragraph 154 in that that refers to us having influence in the lockdown of 2021.

Lead Inquiry: You mean 2020?

Professor Philip Banfield: No, it’s listed as 2020, which is the first year, and it actually is 2021.

Lady Hallett: Oh, the headline is 2020.

Mr Keith: Right.

Professor Philip Banfield: And the delay was, we feel, four weeks at that point.

Lady Hallett: Sorry, the delay in what?

Mr Keith: Oh, is that because in the summer of 2021, pre-Omicron, the government, having announced a final exit date, the complete lifting of restrictions in that summer –

Professor Philip Banfield: Yes.

Lead Inquiry: – put the date of the lifting of the restrictions back by two weeks?

Professor Philip Banfield: By four weeks, it was, actually. So –

Lead Inquiry: But you asked for a delay of two or four weeks or just a delay?

Professor Philip Banfield: A delay.

Lead Inquiry: All right, okay. So there’s a typo in relation to the two weeks and also the year?

Professor Philip Banfield: Yes, I beg your pardon.

Lead Inquiry: All right.

At paragraph 155, you met with some success in relation to calling for further work to be done on the impact of the pandemic on people from ethnic minority backgrounds, because in April of 2020 the government announced that they would be conducting a review led by Public Health England?

Professor Philip Banfield: Yes.

Lead Inquiry: Was that the disparity review that PHE carried out?

Professor Philip Banfield: It was indeed, yes.

Lead Inquiry: You say there that you did have some concerns about the findings, though. What were those concerns?

Professor Philip Banfield: Well, we knew that a large number of stakeholders had been interviewed, and there seemed to be a large amount of evidence missing from the original report. Furthermore, the report didn’t have any recommendations in it, so we were suspicious, and later had it confirmed to us, that pieces had been removed. At that point we wrote and asked for the report to be reissued.

Lead Inquiry: And was it?

Professor Philip Banfield: It was modified in that the stakeholder engagement was then published later, and there were then recommendations.

Lead Inquiry: So it wasn’t, though, that their conclusions were for some unknown reason omitted, it was that the report had the ability to be able to cite passages of material submitted by stakeholders and a lot of the material or some of the material submitted by stakeholders wasn’t reflected on the face of the final report?

Professor Philip Banfield: As put to me, people felt hugely let down and as if it had been watered down.

Lead Inquiry: So it went beyond the mere lack of replication of their submissions on the face of the report; it went to the issue of whether or not the report properly reflected the – that – the conclusions that had to be drawn from their material?

Professor Philip Banfield: Correct.

Lady Hallett: It’s a very non-specific criticism, Mr Keith.

Mr Keith: Yes.

Lady Hallett: Are we dealing with anybody else, or …

Mr Keith: No, that’s all that I was going to ask about that, because it doesn’t seem to me to be particularly specific.

Paragraph 158, there’s another important point. You raise the issue of what you say is the lack of independent public health expertise informing and supporting the public health response to the pandemic.

Now, obviously a large number of members of the BMA work in the public health field. Was a general concern raised that the government was not receiving sufficient advice from public health experts, experts perhaps in pandemic management or the delivery of appropriate healthcare facilities at local level, as opposed to the epidemiological aspect of this affair?

Professor Philip Banfield: Our public health members who have expertise in this field felt deeply disrespected and that their views and expertise was being ignored. It was felt that decisions were being made at governmental level and were not seeking the expert views and opinions of people on the frontline with local and contemporary public health expertise.

It’s difficult if you are in a government environment to stand up and openly criticise a government, and our public health colleagues are quite good at saying when something isn’t right, and they felt that that ability to criticise or push back or challenge was missing.

Lead Inquiry: And you should make plain, of course, that that is in no way an attack on the expertise of the Chief and the Deputy Chief Medical Officers, who were undoubtedly expert in that field?

Professor Philip Banfield: Correct.

Lead Inquiry: All right.

At the same time, was concern raised about the over-reliance on behavioural expertise?

Professor Philip Banfield: It was. There was a lot of concern about how the necessary measures for public health protection would be received by the public, whether the public would agree to lockdown and, if so, for how long. And, you know, as it turned out, the public responded very well, but that seemed to drive the narrative in, for example, mask wearing. So instead of bringing it in in one go, they staggered it. It seemed to be based on what was a political imperative to engage with the public rather than a public health narrative. The public health narrative seemed lacking, actually all the way across the pandemic.

Lady Hallett: Is that fair, Professor? Because if you do have concerns about how the public will respond, it’s not necessarily a political imperative so much as an imperative trying to ensure people will comply with the guidance or advice. Is that really fair to accuse it of being a political imperative?

Professor Philip Banfield: I think some of the messaging became confused –

Lady Hallett: I’m not denying that. What I’m saying is you called it a political imperative when I’m just saying maybe it was a “We need to keep the public onside so they will comply” imperative.

Professor Philip Banfield: I think I’m suggesting that there were economic and other factors that lay outside public health necessities in deciding what the messaging to the public was.

Mr Keith: So not political, but just not public health –

Professor Philip Banfield: Political with a small p.

Lead Inquiry: Right. I’m going to go in for the double punch, Professor, because in your witness statement you actually say that the concerns were expressed about behavioural expertise having too great a prominence rather than that the decision-making was infected by overtly political considerations.

Professor Philip Banfield: That’s true. But what that means by that is that it wasn’t necessarily driven by the public health measures themselves that would be expected to contain and stop the spread of the virus.

Lead Inquiry: But that’s just simply a reflection of the fact that the BMA’s view was that behavioural expertise was valuable, shouldn’t be given too great a prominence against other public health-related considerations?

Professor Philip Banfield: Correct.

Lead Inquiry: All right.

Now, the final part of your statement deals with the BMA Covid review. Between January 2020 and May 2022, did the BMA carry out a number of reviews, five published reports, in fact, the first one concerned with how well protected the medical profession from Covid was, and the fourth one, the public health response by the UK Government?

Professor Philip Banfield: Yes, it did.

Lead Inquiry: And I think the BMA drew those reviews from a number of Covid tracker surveys, five Viewpoint surveys, some 190,000 responses in fact in total from members of the BMA, and, we’ll come to this later, also another specific survey carried out.

In general terms, did those reviews conclude that there had been failings by the government in the same way as – or, rather, the same failings had taken place on the part of the government as those areas of concern or failings which you had identified in your engagement with the government as the pandemic moved on?

Professor Philip Banfield: Yes. They reflected and they formalised and codified much of the information that we had been receiving across the pandemic. We felt it important that doctors were able to tell what had happened. We felt that there was a need for them to undergo a kind of grieving debrief.

It was very clear that the profession was traumatised, not only from within itself, but what it had seen happen to its patients. And we felt that because there was likely to be a delay with the Covid Inquiry, that this should be collated, you know, as quickly as possible with a view to providing evidence to this Inquiry.

Lead Inquiry: So may we summarise it on this basis: if you look at page 45, I’ve referred to the fourth report, the public health response by the UK governments – in fact, I apologise, could you go back, please, one page, to the bottom of page 44. The general points made in that fourth report are reflective of the points you’ve already raised: (a), the government was slow to react to the emergence of Covid-19 globally; (b), there was an absence of a sufficiently strong independent public health presence on SAGE; a slowness in introducing face masks to the public; the decision to shift capacity away from contact tracing on 12 March whilst not controlling the population for a further 11 days; the public messaging consequences of Eat Out to Help Out; the cost of outsourcing contact tracing and testing away from local public health capacity; the chopping and changing particularly in relation to the tier 3 structure concerning the imposition of enhanced restrictions; the clarity and simplicity of early pandemic messaging giving way to the more ambiguous instructions later; and the increasing public rhetoric concerning easing restrictions.

Those were the themes in that fourth report?

Professor Philip Banfield: Yes, they were.

Lead Inquiry: Likewise, in a further report published in March 2021, entitled “Mitigating the impact of Covid-19 on health inequalities” – could we have page 64 – the BMA went in to bat on the subject of a number of aspects of the way in which the pandemic had affected members of the ethnic minorities, and it asked for or it identified several key priorities for the government: reducing the overall transmission of the virus; ensuring vaccine access; improving financial security; protecting the long-term health outcomes of children; and investing in a strong public mental health response.

You set out at paragraph 232 onwards, page 68, how the pandemic had highlighted disparities within society, widened health inequalities, and impacted groups differently, and you sought to make a number of recommendations about how to ameliorate that position?

Professor Philip Banfield: Yes, we did.

Mr Keith: Thank you very much.

My Lady, there have been a number of applications for Rule 10(4) questions to be put by core participants. You’ve declined some of them. In light of Professor Banfield’s evidence, would you please grant –

Lady Hallett: It’s Mr Thomas, I think.

Mr Keith: – permission – yes – to Mr Thomas King’s Counsel.

Lady Hallett: Mr Thomas.

I’m afraid, Professor, Mr Thomas is behind you, don’t get a crick in your neck.

Questions From Professor Thomas KC

Professor Thomas: Professor, I’ve only got a few questions for you, some of which you have touched upon already this morning, but if I can just put the question to you, and you can amplify if necessary. Yes?

Professor Philip Banfield: Yes.

Professor Thomas KC: So the first question that I’ve got for you is: we’ve looked at the experience of black, Asian and minority ethnic healthcare workers in the profession; I would be interested to know what insights that you have and whether you can elaborate on what you think the key concerns posed were relating to those healthcare workers in terms of the virus and their vulnerabilities?

Professor Philip Banfield: There were a number of issues that arose going into the pandemic. Firstly, the NHS is acknowledged to be institutionally racist; there are discrepancies both in the way that staff are treated and the experiences that staff have at the NHS as well as patients. So, taking the disproportionate physical effect on them, the ability to protect staff during the pandemic was affected by the biases and discrimination. People from an ethnic background are less likely to seek out and be upheld with their risk assessments, they are less likely to be forthright about saying, “I need to have appropriate respiratory protective equipment”, they are more likely to have been posted to the frontline and exposed to high-risk cases. And the recognition that that was the case emerged across the pandemic and has been recognised by the NHS, and there are very active steps being put to correct that, both driven by us and by NHS England.

Professor Thomas KC: And so, if I can just follow up on that, so to be absolutely crystal clear, these aren’t imagined concerns, these are very real concerns, are they?

Professor Philip Banfield: Yes, they are, and they have been found in multiple reports.

Professor Thomas KC: Thank you.

Can I move on, then. I think you’ve dealt with that fully.

What considerations were made regarding PPE that could cater for the needs of black, Asian and minority ethnic healthcare workers and communities? So you told us what the difficulties were, but what considerations were made in fact?

Professor Philip Banfield: Well, I mean, firstly you can help people to work in safer environments. There is PPE and respiratory protective equipment that is available for different shaped faces or for the presence of beards. But getting hold of that at the beginning of the pandemic was very difficult. So what has been done is that that has been now, largely, rectified.

Professor Thomas KC: Next, what tangible steps could government institutions take to tackle some of those healthcare disparities that you’ve told us about amongst ethnic minority communities, particularly in the context of the pandemic?

Professor Philip Banfield: Well, I mean, there’s a greater recognition of the need for cultural competency. You know, we went into this pandemic with one set of health messages and made no attempt or little attempt to adapt those for different recipients. So it took a long time, for example, for videos to be – and messaging to be worked up with the BBC World Service, for example, into different languages and to become culturally competent to the communities that were actually subjected to huge discrepancy and bias.

Professor Thomas KC: Sorry, just to be clear, so you’re saying, if I can paraphrase, it was only being looked at through one lens, a white lens?

Professor Philip Banfield: I’m going to say that it was looking, to start off with, as that as the default.

Professor Thomas KC: Yes.

Professor Philip Banfield: I would say that it became very apparent very quickly that that was the wrong lens, and I think that enormous efforts have gone – been made since then to recognise and correct that. And that’s part of our longer term wish, to make sure that inequalities, both inside the health service and in our communities, are narrowed and resolved. Because, you know, this country cannot go on like this.

Professor Thomas KC: Can I ask my final question: what suggestions would you propose, you know, being in the BMA, for moving beyond our established understanding, you know, to effectively address these health disparities?

Professor Philip Banfield: Well, I mean, the first thing to do is to acknowledge that they exist, and then to work to eliminate them, and I think that there is work that’s going on. I’ve talked about NHS England, for example. We’ve talked about the institutional discrimination within the NHS. So we are working together and want to work with whoever to make sure that this is improved and changes, because we have to have change out of this.

Professor Thomas KC: So acknowledgement. What else, if anything?

Professor Philip Banfield: Listening. Listening to what the needs are of the communities and how best to address them, and then tailoring our health service and the way that we work with people to that.

Professor Thomas: Thank you, that’s all I ask.

Lady Hallett: Thank you very much, Mr Thomas.

Mr Keith: My Lady, there are two further points, if I may.

Firstly, we gave an assurance to the long Covid groups that I would ask a question about long Covid of Professor Banfield, which, I apologise, I omitted to do. May I put that question?

Lady Hallett: Of course.

Further Questions From Lead Counsel to the Inquiry

Mr Keith: Professor, is it the position that the BMA has long advocated the issue of long Covid and the impact of long Covid on its members, so doctors and other healthcare workers, and has published a number of reports concerning and addressing the healthcare challenges of long Covid in the medical profession?

Professor Philip Banfield: Yes, it is.

Lead Inquiry: You’ve made representations to government and during the pandemic, because of the impact of long Covid and the prevalence of that syndrome, you in fact made arguments to the government as to why there should be delay in the lifting of restrictions because the greater incidence of the virus would lead to an increased number in long Covid cases?

Professor Philip Banfield: Yes. I mean, we’ve had feedback from over 600 doctors with long Covid, and their stories are horrible. It’s disrupted their lives, it’s stopped their careers. And there’s still a lack of acknowledgement that this could and is most likely to have been gained at work.

Mr Keith: That’s all, in fact, that I have for Professor Banfield, my Lady, unless there are any questions that you –

Questions From the Chair

Lady Hallett: Just following up on that, Professor Banfield, one of the problems I’ve noticed with other conditions which I’ve dealt with in the course of my career is when there’s no objective test it can sometimes be difficult to persuade, dare I say it, your colleagues of the existence of a condition.

So how do you – this is obviously a very real condition and we’ve heard from several people who have suffered.

Professor Philip Banfield: That is true, but one of the advantages of having the academic committee and the broader science is that I do know that there are tests on the horizon that would help us with that as a positive diagnosis.

What’s really difficult about all of this is that a large number of doctors with long Covid caught this in the first wave before testing and acknowledgement and any kind of PPE was in place, but at a time that they were self-isolating from their families. At the start of this, we all used to go in in scrubs, we used to get to our front doors, switch our clothes off, go and shower, keep ourselves away from the rest of our families. So it’s difficult to see how they could have caught Covid any other way.

Lady Hallett: Thank you very much.

Mr Keith: My Lady, thank you. That concludes the evidence of Professor Banfield.

Lady Hallett: Thank you, Professor, very grateful for your help.

(The witness withdrew)

Mr Keith: Lastly, my Lady, in relation to the theme of ethnicity, you will recall that you ordered that a large number of questionnaires be sent out to groups and organisations, bereaved, impact and voluntary organisations, asking them for their views on this area, this theme. We’ve drawn together just a very high-level summary of what those responses amount to.

I don’t propose to read out the questionnaires or indeed to put them up on the screen. I just wanted to summarise them in this way, that they make absolutely plain that there are a number of themes dealing with ethnicity, which are actually largely reflective of the evidence of Professor Nazroo and Banfield. Respondents highlighted in particular: the lack of consultation and involvement in decision-making, resulting in a lack of influence over the decisions that affected them; the fact, secondly, that the Covid pandemic and some of the measures implemented exacerbated pre-existing inequalities; thirdly, that the government communications were unclear and failed to consider the impact on disadvantaged groups.

Many of the questionnaires – much of the material and many of the questionnaires make plain that members of ethnic minorities are disproportionately affected by long-term chronic diseases and therefore that there were comorbidities in place and therefore they were disproportionately impact by the pandemic, they were at greater risk because of exposure to the virus in key worker roles, and children and older people from minority groups faced specific challenges.

The Runnymede Trust in particular says the BAME communities and their disparities were not fully considered by the government when making decisions about the response to Covid, and the Traveller Movement noted the contrast between the response in the Republic of Ireland and Northern Ireland and the United Kingdom. In the Republic of Ireland travellers were supported whilst in isolation or quarantine through the provision of food, phone helplines and mental health support.

Lastly, some respondents noted that the disproportionate rates of Covid deaths from the minority communities was both inequality and a safety work issue. Because so many key workers from minority communities faced greater risks and were placed at greater levels of exposure.

Lady Hallett: Just to add – thank you, Mr Keith, for that – we do have one more witness, I think, from the organisation Mr Thomas represents, who is tomorrow afternoon.

Mr Keith: Indeed.

Lady Hallett: And I assume will be dealing with this too.

Mr Keith: Absolutely.

Lady Hallett: Thank you.

Mr O’Connor.

Mr O’Connor: My Lady, as Mr Keith indicated, the witnesses you have heard so far today have been addressing the issue of ethnicity. We now move to another area, that of later life, and for that reason may I invite you to re-call Professor Nazroo.