2. Sir Christopher Wormald
SIR CHRISTOPHER WORMALD (affirmed).
Questions From Lead Counsel to the Inquiry
Mr Keith: Could you give the Inquiry your full name, please.
Sir Christopher Wormald: I’m Sir Christopher Wormald, I’m the permanent secretary of the Department of Health and Social Care.
Lead Inquiry: Sir Christopher, you are known to the Inquiry, of course, because you gave evidence in Module 1, an event you’ll no doubt recall.
Thank you for your continued assistance. You’ve provided a number of additional statements to the Inquiry. We don’t need to bring them up, but four statements in particular relate to the subject matter of Module 2, and they run to many hundreds of pages, in fact.
Sir Christopher, members of the public won’t know, but in preparation for your evidence today, the Inquiry provides you with particular documents on which it intends to focus. I know that you were sent those documents over the last few weeks, but in particular you were sent a number of documents up to and including late last night. You may not, therefore, have had a full chance to consider those documents. I apologise that you received them so late. We’re just going to go through them and we’ll just see where we go.
I also want to make plain that my questions of you are directly focused on Module 2. The Department of Health and Social Care was, of course, the lead government department in this health emergency, but Module 2 focuses on the core political and administrative decision-making at the heart of government throughout the currency of the pandemic and, therefore, we’ll be looking at those areas in which the DHSC engaged with central government or gave advice to central government or met with central government, as opposed to looking at matters which were specific to the DHSC alone. Do you follow?
Sir Christopher Wormald: Yes.
Lead Inquiry: Can I also make plain, because of some of the questions which have been put to the previous witness, that of course matters concerning the detail of test and trace, the care sector and PPE will be addressed in detail in later modules held by this Inquiry, and therefore we won’t be going into the granularity of any of those areas, we’ll only be looking at them insofar as they reflect the core administrative or political decision-making.
With that context, could I ask you, please, to start by describing the role of the permanent secretary and, in particular, your role as a permanent secretary in the DHSC in January 2020.
Sir Christopher Wormald: Yeah, thank you. And if I may, I’d like to repeat what I said in Module 1 about the department’s regret for everyone who suffered either directly or indirectly as a result of Covid and also our enormous thanks to the incredible staff in the NHS and the care sector and everyone who helped them and got them through the pandemic.
Lady Hallett: Pause there, if you would. Could you go much more slowly, please? I’m afraid our stenographer has had a tough morning already and I think she might kill me if I let you –
Sir Christopher Wormald: I’m very sorry.
Mr Keith: Sir Christopher, you know, of course, from this process before the absolute need to go slowly.
Sir Christopher Wormald: So the role of the permanent secretary I see as always in three chunks. You are the chief executive of the DHSC itself, and you lead the staff and systems of the department. You are the chief adviser to the Secretary of State who holds all the actual legal decision-making powers, which does not mean you provide all the advice yourself, indeed you provide very little of it yourself, but you’re responsible for the system of advice. And thirdly, you are the accounting officer for the resources voted by Parliament to the department to fulfil its functions, and it’s basically those three things.
Lead Inquiry: Just briefly focusing on some of the moving parts within the department, the Inquiry is, of course, extremely well aware of the vital role of the Chief Medical Officer, the principal medical adviser to the government. To what extent is the CMO part of the DHSC, or an adviser to the DHSC?
Sir Christopher Wormald: He is a completely integral part of the department, but also has a wider role across government, so he is one of the most senior staff at the department, ranked at permanent secretary level, part of the executive team that leads and runs the department. He advises the Secretary of State on particularly public health but actually any clinical matter relating to England, and then he’s adviser to both the Prime Minister and the entire Cabinet on clinical matters relating to the – both England and the United Kingdom. So if another Cabinet minister requires clinical advice, they would go direct to the Chief Medical Officer, not via the department, and likewise with the Prime Minister.
Lead Inquiry: The Inquiry understands that, as a result of the demands of the pandemic, a second permanent secretary position was created within the Department of Health and Social Care, but did you remain primarily focused on Covid whilst that other second permanent secretary dealt predominantly with other aspects of finance and group operation and the –
Sir Christopher Wormald: Yes.
Lead Inquiry: – many areas?
Sir Christopher Wormald: Yes, though it evolved over the period, so the original idea –
Lead Inquiry: Shortly, please, Sir Christopher. Did you remain responsible for the Covid – in general terms, Covid issues?
Sir Christopher Wormald: Yes.
Lead Inquiry: An important part of the permanent secretary’s role in providing advice to ministers in the department, presumably that includes the Secretary of State?
Sir Christopher Wormald: Well, it’s primarily the Secretary of State, supported by the junior ministers. I would normally be most involved in – with the Secretary of State.
Lead Inquiry: How does it work? Does the Secretary of State, whoever they may be, receive advice exclusively from the department in the discharge of their function as Secretary of State, or are there other sources of advice or information or material which they may be privy to or receive from elsewhere?
Sir Christopher Wormald: So secretaries of state are free to take their advice from wherever they like, that might be other Parliamentarians, it might be independent experts, and it might be other Cabinet ministers. There would always be official departmental advice, but secretaries of state could choose to supplement that if they wished to.
So as a department, a civil servant, you have a right to be heard, you know, you have a right to put your advice to a Secretary of State, but not either that that advice is necessarily followed or that that is the exclusive advice that a Secretary of State would receive.
Lead Inquiry: On matters specific to the Department of Health and Social Care, for example, relating to test and trace, or the care sector, or PPE, all of which the DHSC was centrally concerned in, would the majority, if not all of the information received from the Secretary of State, come from the department?
Sir Christopher Wormald: Certainly, the vast majority, but to take an example, were a Secretary of State to wish to supplement some advice on social care by talking to a local authority director of social services about what it felt like from the local authority, and they’re completely free to do that, but it would normally be a supplement to advice received by the department, and, as I say, the vast majority would have come from departmental sources.
Lead Inquiry: And the Secretary of State wouldn’t go off on his or her own and speak to somebody else without the knowledge of and possibly attendance of a member of the department or that process of meeting and the receipt of information being recorded by way of email or departmental note?
Sir Christopher Wormald: Yes, so the rules in force is if they, if a Secretary of State or any minister feels they have had a conversation which is relevant to public policy, they either have a private secretary in attendance who records that, or they feed back to their private office who record the conversation. And the test is not who was the conversation with, but is it relevant to the public record.
Lead Inquiry: Your statement makes plain, or one of your statements makes plain, Sir Christopher, that the permanent secretary is usually copied in on all advice to ministers, and of course one of your primary responsibilities is to ensure that they receive the right advice at the right time.
Sir Christopher Wormald: Yes.
Lead Inquiry: So you are, of course, aware that a number of witnesses in this Inquiry from the Cabinet Office and Number 10 have given evidence to the effect that the Secretary of State for your department regularly said things that were untrue. I want to ask you, firstly, therefore, whether you were aware during the pandemic of that view apparently held by other people in the heart of government?
Sir Christopher Wormald: So, there were two – two things that were raised. There were a very small number of cases where people said the Secretary of State had said something that was untrue. I have to say I did not either witness or come across things where I thought he said something that’s actually untrue. There were a lot of people who said that the Secretary of State was overoptimistic about what would happen, and overpromised on what could be delivered. That was said really quite a lot. I think it was a very small number of people who said that he was actually telling untruths.
Lead Inquiry: The proposition I put to you was that there were a number of witnesses who have said that the Secretary of State regularly said things that were untrue, and I asked you whether you were aware that that was their belief. Do we take it from that past last answer that you weren’t aware that witnesses, civil servants, advisers in the heart of government, were saying that the Secretary of State regularly told things that were untrue?
Sir Christopher Wormald: Regularly, yes. I had instances, individual instances raised, and, as I said, I couldn’t see any validity to the accusation on the individual things that were raised. I didn’t have it reported regularly untruth, the other category I did hear about a lot.
Lead Inquiry: So in fact your answer is: regularly, no, that’s not something – you didn’t hear that people were regularly saying he was speaking untruths?
Sir Christopher Wormald: No.
Lead Inquiry: All right.
Sir Christopher Wormald: Not untruths, you know, but as I say, my two categories –
Lead Inquiry: We understand.
When you gathered that there were instances of untruths, as you’ve described, and more, perhaps multiple, occasions of exaggeration or matters being not quite right, being said by the Secretary of State, what did you do in terms of speaking to him?
Sir Christopher Wormald: So when you come across something where you think either in public or to a Cabinet committee something that is not true has been passed on, I mean, in the vast majority of cases it’s accidental, and in those cases the – you have to put the record straight, as it were, and ministers do this quite a lot in Parliament and also in the Cabinet – you know, misremembering a number, for example.
Sorry.
Lead Inquiry: Yes.
Sir Christopher Wormald: In terms of the second category, I mean, that is a matter of perception. So I’m sure Mr Hancock will say he believed that what he’d said was deliverable. And in particular, and he did make a big thing of this, his style of leadership was to set very hard challenges as a way of motivating the system. So this came up most, probably, around the 100,000 tests pledge.
Lead Inquiry: We will come back to that in detail, but my question to you was: what did you do in terms of speaking to Mr Hancock when you became aware that there were instances of untruths and, more often, examples of exaggeration?
Sir Christopher Wormald: Well, as I say, there weren’t instances of untruths which I raised with him, there were things he corrected, but, as I say, when – on individual cases when they were raised, I couldn’t see what untruth had been told.
On the setting, you know, the – on the other category, we spoke about that, and he was always clear that he was doing it for a positive reason. So setting a very aspirational target not necessarily expecting to hit it, but to galvanise the system to do more. So that was – well, you will ask Mr Hancock, I’m sure, but my understanding that was a sort of conscious decision. And of course whether that’s a good thing to do or not, that is a matter of perception, not a matter of right and wrong.
Lead Inquiry: Sir Christopher, I’ve asked you about instances in which you agree he may have exaggerated the position. I wasn’t asking about the setting of targets. I’m asking about instances in which you became aware that the Secretary of State had said something which just wasn’t accurate, whether it was in terms of numbers of tests or things being done or things being done by the DHSC which may thereafter have required correction. What did you do when you were confronted with those instances?
Sir Christopher Wormald: So for those, which are the first category, I tried to satisfy myself whether it had happened or not. And, as I say, when I looked at the individual incidents, I couldn’t identify examples where he had said something that was untrue.
So, to take an example, he was accused of misleading the Prime Minister about whether people being discharged from hospital into care homes were going to be tested. When I looked at that, I couldn’t find any evidence that he had done that, I didn’t witness it, and it was – had been stated in public that we were not undertaking such tests. So I couldn’t see how there had been any misleading going on. And in that case there is therefore no further action to take.
So, as I say, I didn’t find any instances where he told an untruth that you could identify that you then needed to put right.
Lead Inquiry: But there were instances, weren’t there, to use the wonderful phrase of one of your professional former colleagues, I think it was Lord Armstrong, where he may have been economic with the actuality?
Sir Christopher Wormald: Erm, I’m trying to think of a specific example – well, I couldn’t point to a specific example. As I say, the things that were mainly raised with me were at the level of: your Secretary of State promised 100,000 tests by the end of April, we don’t think he’s going to get there. It was much more that sort of overpromising in the future as opposed to something that is not true.
Now, in that case it’s of course a matter of opinion, and the Secretary of State is entitled to his opinion that he will hit his target. So the things that were raised with me, they were much more in those sorts of category of overpromising as opposed to untruth.
Lead Inquiry: Did you say to him, “Mr Hancock, I’m now aware that there are a significant number of people, senior civil servants and advisers in the heart of the government, seeking to respond to this appalling crisis, who believe that you are saying things regularly that are untrue or you are exaggerating or you are simply giving a wrongful impression about the reality” –
Sir Christopher Wormald: Not in exact –
Lead Inquiry: If you just let me finish my question.
Sir Christopher Wormald: Sorry.
Lead Inquiry: – and therefore say to him, “This is damaging to the trust and the confidence which your colleagues must necessarily repose in you, and this is doing us and the department harm”?
Sir Christopher Wormald: So we had conversations, and I couldn’t point you to, you know, a specific day, but I remember having this sort of conversation with him where I would say, you know, “People believe you are overpromising”, and, as I say, the Secretary of State was always very clear that he was doing – he was saying what he was saying, (a) he believed it was possible and (b) he believed it was very important to be both optimistic and aspirational.
So – and that is, of course, in that category, you know, it’s not untrue, but people believe you are overpromising, that is then a decision for him about whether that is the image he wishes to portray. I don’t think he was in any doubt that some people thought that of him. I don’t think there was … I think – well, you’ll find out when you question him. I suspect he will be surprised by how widespread it was. I mean, I think he was very well aware that Mr Cummings held those views of him and expressed them. I think he probably knew that the Cabinet Secretary occasionally made the same point –
Lead Inquiry: The Deputy Cabinet Secretary?
Sir Christopher Wormald: I suspect – as I say, I am now guessing about what Mr Hancock will think, but my guess would be that he will be quite surprised that Helen MacNamara had the same views. And I think some of your other witnesses have said the same thing, so I think he –
Lead Inquiry: All right.
Sir Christopher Wormald: – will be surprised, as I was, in fact I hadn’t heard that from Helen before either, that it was so widespread.
Lead Inquiry: And he would have been in no doubt, would he, about the concern that you expressed as the permanent secretary of his department at the fact that this appeared to be an issue?
Sir Christopher Wormald: So –
Lead Inquiry: Did you express concern, Sir Christopher, to him, or did you just debate objectively whether or not there was any validity to these issues?
Sir Christopher Wormald: No, in those sorts of circumstances, where it’s not about wrongdoing, I see my role as making sure that the Secretary of State is aware of the position, and it is then his choice as Secretary of State how he wishes to behave. It’s very different if you think there has been wrongdoing, therefore breach of the Ministerial Code, where you have a professional responsibility to raise a concern. So in those sorts of situations my role is to make sure the Secretary of State knows what is going on, to the best of my knowledge, and that if he is behaving that way he is doing so in the knowledge that it is raising concerns.
Lead Inquiry: Sir Christopher, we’re not concerned here with code of conduct. I’m asking you whether you said to him, “Secretary of State, these concerns, these views, these expressions of opinion about your truthfulness or your accuracy or a tendency to exaggerate or be overly optimistic, however you call it, these concerns have been raised. I, as your permanent secretary, am concerned about this because of the impact upon the working relationships between this department and the rest of government, and on the trust and confidence which your professional colleagues must necessarily repose in you”?
Sir Christopher Wormald: No, I didn’t have that conversation, but, as I say, I was not aware of the widespread view that has been expressed to this Inquiry by witnesses.
Lead Inquiry: How many times did this conversation, this matter, come up for debate between you? You said you spoke to him. Did it stop?
Sir Christopher Wormald: I can only – I can only, and, as I say, I cannot remember the date, I can only remember one conversation, but, as I say, we were mainly talking about the views of Mr Cummings, and what he was saying.
Lead Inquiry: So there was one time when you spoke to Mr Hancock about the views of other professionals in government about him?
Sir Christopher Wormald: I couldn’t … I couldn’t promise there was more than one, I can remember one conversation, but, as I say, what I was seeing at the time was a very small number of people who were not Mr Hancock’s friends saying this, as opposed to a widespread thing around government. As I say, that has been presented to the Inquiry.
Lead Inquiry: You’re not suggesting, are you, that because they weren’t his friends that they should be treated any less seriously in the concerns that they expressed?
Sir Christopher Wormald: Erm –
Lead Inquiry: Helen MacNamara?
Sir Christopher Wormald: No, well, as I say, I didn’t know that Helen held those views and she never said those views to me. It’s obviously a very different conversation if you’re saying “Mr Cummings is saying A, B, C, D and you need to be aware of that”. That was very different from there were ten people, including lots of senior civil servants, saying.
Now, that second thing I was not aware of at the time, and therefore did not have that conversation.
Lead Inquiry: All right.
Do you accept that if these witnesses are right that Mr Hancock did regularly say things that they understood were untrue, that that would have been/was very damaging to the government’s operations at this time, because of the lack of trust and confidence that his fellow ministers and his advisers and the advisers in other departments and civil servants could(?) place in him?
Sir Christopher Wormald: Categorically, yes. So at the time, I knew that there was some toxic relations both within Cabinet Office and Number 10 and between Cabinet Office and Number 10 and the Secretary of State.
What has come out very clearly from your witnesses is it was much more widespread and much more toxic in both of those categories than I knew at the time, and had I known it at the time, your statement is absolutely correct, that would be a big worry, and one of … one of my reflections so far on the evidence that the Inquiry has heard is that the amount of time and energy that appeared to be taken up very early in the pandemic on the blame game, that energy would clearly have been much better spent solving the problems that the pandemic was bringing.
Lead Inquiry: Indeed.
Sir Christopher Wormald: So I recognise exactly the point that you are making.
Lead Inquiry: That is – those questions focus on Mr Hancock and his relations with other parts of the government.
I now want to ask you some questions about the general view taken of the DHSC.
Sir Christopher Wormald: Yeah.
Lead Inquiry: Could we have, please, the witness statement from Lord Sedwill on the screen, INQ000250229, page 39.
Lady Hallett: Whilst that’s coming up, Mr Keith, could we break at about 12.45, please?
Mr Keith: Yes, of course, my Lady.
Paragraph 148, Lord Sedwill refers to the NHS, and then about six or seven lines down:
“Despite the experience of its political and professional leadership, [so that’s its ministers and the civil servants], dedicated and determined staff, and a surge of civilian and military personnel, DHSC was neither structured nor resourced for a public health crisis of this magnitude.”
It “straddled” too many different areas, responsibilities scattered across too many areas.
“Admirably, people had pulled together and front-line staff and volunteers had performed heroics, but the programmes delivered despite not because of the legacy systems.”
He says he called for major reform.
Just pause there, because there is a theme.
Mr Cummings in his statement, we won’t put it up, but he says at paragraph 120:
“The DHSC was overwhelmed by the scale of the crisis in Feb-May. It didn’t have anything like the people it needed. It couldn’t quickly build capacity … was bad at asking the Cabinet Office for help.”
It was:
“… (… hard for me to know how much of this was [Mr] Hancock and how much structural to the DHSC).”
Helen MacNamara, if we could have this up, INQ000273841, page 30, paragraph 56. Thank you:
“Further concerns were raised by Lee Cain on the communications effort, including further indications that DHSC were overwhelmed (or appeared to be). DHSC was not able (or, perhaps, not willing) to provide anyone into the Cabinet Office to support the team … look[ing] at public sector preparedness, [to] develop the policy on the NPIs or support on the … co-ordination effort.”
Then further down the page:
“We also – mistakenly – [and it’s the fourth to last line in that paragraph] did not appreciate that DHSC had focused and were focusing on DHSC and the impacts on the acute health system, rather than the wider and long-term health of the public. I do not think we fully understood this until too late to do anything to really remedy it.”
At page 88, paragraph 181, at the bottom of the page:
“It was difficult to get the right kind of engagement from DHSC or the NHS. There was an inbuilt reluctance to accept that it was possible to get to a point where the NHS was overwhelmed and/or to acknowledge that this would be something that Number 10 and the Prime Minister would need to be across and content with the handling of.”
Then you know, I won’t bring them up in light of the time, but perhaps one of them will suffice, you’ll know that Sir Patrick Vallance, the government’s own Chief Scientific Adviser, expressed on multiple occasions in his evening notes views about chaos, operational mess, inefficiency, lack of grip in the DHSC.
If we could have INQ000273901, page 594, he refers to an email from within the DHSC describing it as ungovernable and a web of competing parts. So that’s 594 of document INQ000273901.
It is obvious, Sir Christopher, that the individuals and the personnel did their very best. Much was asked of them, and a great deal was delivered. But structurally, systemically, there appears to be a view quite widely held that the DHSC, in the face of this admittedly unprecedented crisis, did fail to perform as it was expected to do?
Sir Christopher Wormald: Well, let’s – there were a lot of points, a lot of different points made in the evidence that you – that you quote, and some of them I agree with and some of them I do not.
Lead Inquiry: Well, structurally, do you accept the proposition that the DHSC was, to a significant and important extent, chaotic or dysfunctional or ungovernable?
Sir Christopher Wormald: No, I don’t think any of those things. Now, the points that were made particularly in Mark Sedwill’s first comment, about the nature of the health and care system and DHSC’s role within it, I completely agree with, and would recognise. And this was the picture that I was seeing, I mean, I’m obviously biased as I was very proud of the work of my department and how it stepped up to the mark.
I think the point about the structural questions about how health and care were organised, what levers we had, and in particular – and we covered this in Module 1, and I’m of exactly the same view now – our ability both in the health and care system and in the wider government to surge for a crisis of this size, I do think that was a big problem. So, as I say, I recognise all of those things, I don’t recognise –
Lead Inquiry: The overall problems?
Sir Christopher Wormald: Yeah, I mean – for completeness, I mean, we were obviously under a huge amount of strain. We had people working incredibly hard in very difficult circumstances, dealing with something unprecedented, and it felt – at the time it felt incredibly tough, and a huge, huge responsibility, and people were at times very down that we weren’t able to get on top of some of the problems.
So I’m not going to say this was some sort of perfect, easy situation. But I don’t recognise the sort of chaos and dysfunction. I recognise the people working incredibly hard in very difficult circumstances to get on top of huge challenges.
Lead Inquiry: So may it just be a question of degree? You would accept that, in significant ways, the DHSC did fail to get on top of problems. It was regarded as – regarded from the viewpoint of the professional colleagues working with it day in and out at Number 10 and Cabinet Office level as being chaotic or unable to deal with the things that it was asked to –
Sir Christopher Wormald: Well, let’s have – so let’s break down between the four. As I say, I thought Mark’s paragraph, which is largely about the structure of the health and care system, I largely agree with. Helen and he had – he and I had had conversations about – that’s why, you know, when I received that piece of paper I recognised the view as one that had been – that I had discussed with him. Helen’s views I hadn’t heard before. I’m slightly surprised that I hadn’t. I would be – if she had those views I would expect her to have raised them.
Likewise with Patrick, if he had issues at particular times, as his diary clearly shows that he did, I thought we had – I have huge respect for Patrick, I thought we had a good working relationship, and I would have hoped that he would have raised them directly with me.
And then for Mr Cummings, well, I mean, his views of government civil servants are long held and very public, so I would – I would put the four pieces of evidence that you’ve given me in different categories like that.
Mr Keith: My Lady, that may be a convenient moment.
Lady Hallett: We will break for lunch. I’m sorry we’ve got to ask you to come back after lunch. You were warned, I hope?
The Witness: I was warned, and there are obviously lots of important questions to be answered.
Lady Hallett: Very well, I shall come back at 1.45, please.
(12.45 pm)
(The short adjournment)
(1.45 pm)
Lady Hallett: Mr Keith.
Mr Keith: Sir Christopher, I now want to turn to some of the most important COBR meetings, and so that we can all understand the importance of this topic, COBR was of course the crisis machinery in the heart of government that responded to and responds to crises, both acute, and as we will see, longer running. It was at those COBR meetings that some of the most important decisions and the most important realisations came to be understood.
Sir Christopher Wormald: Correct.
Lead Inquiry: Yes. The DHSC was obviously aware from an early stage of the novel virus, and the evidence shows that you chaired a number of meetings in January with your officials, you chaired regular meetings from January with the CMO, the Deputy Chief Medical Officer, strategic incident director, and other bodies with which the DHSC was associated, Public Health England, for example, NHS England.
And presumably the DHSC, through yourself and others, attended all the COBR meetings?
Sir Christopher Wormald: Yes. So I chaired meetings, I think, from January 20th, and I went on doing so until there were regular ministerial meetings.
The initial COBR meetings were chaired by, as I think is well known, the Secretary of State for Health, and I attended, I think, all the COBR meetings that he chaired, and then subsequent COBR meetings where it was alternate between the Prime Minister and the Secretary of State.
Lead Inquiry: Yes. The first one that I want to take you to, although it’s not the first in order, is 29 January 2020, page 1 of INQ000056226. With all these documents, and with all these minutes, Sir Christopher, I’m going to ask you to focus, please, on what your understanding on the part of the DHSC was when you received the information and the relevant facts –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – and so on and so forth, in the course of these meetings. We can see the attendance on the first page, the ministers. Second page, officials, including yourself in the middle of the page on the left.
If we go to page 5, we can see in paragraph 3 the CMO telling the attendees that:
“… the UK planning assumptions were based on the reasonable worst-case scenario. There were two scenarios to be considered. The first was that the spread was confined within China, the second was that the spread was not limited to China and there would be a pandemic like scenario, with the UK impacted.”
It appears from this, Sir Christopher, that the DHSC, amongst all the other attendees, was being told that if the spread – if the virus spreads from China and is not limited to China, but is anywhere else, other than China, there would be a pandemic-like scenario with the UK impacted. That is to say, if it leaks from China, it’s coming.
Sir Christopher Wormald: Yes, that’s what – that’s certainly what it – that’s certainly what it says. The CMO’s views at the time, as he expressed them, and he of course is the DHSC in this case, there wasn’t a sort of – there isn’t a difference – I think were a little more nuanced than is set out here. But those were the two broad scenarios.
Lead Inquiry: In that second scenario, therefore, on the basis that the virus leaks from China, to what extent did the attendees ask themselves: well, if we’re being told that, if it leaks from China, there would be a pandemic-like scenario and the UK is impacted; what measures do we need to start thinking about now to stop the United Kingdom being impacted once the virus has spread from China?
Sir Christopher Wormald: Well, so that was the whole reason there was – there were COBR meetings at this time at all, and – because, as I’m sure you know, it’s quite a high bar –
Lead Inquiry: Sir Christopher, I’m so sorry. What measures were in any or all of your minds as to – what thoughts were in your minds as to what measures could be taken to stop this second eventuality arising?
Sir Christopher Wormald: Oh, sorry. I’m terribly sorry, I slightly misunderstood your question. So the measures people were thinking at the time would have been all the measures up to the full implementation of the pandemic flu plan that we’ve discussed before. That’s what would have been in people’s heads.
Lead Inquiry: There is no debate, if you take it from me, on the face of this document, as to what those measures might be, what can be done to start putting them into place or thinking about them or arranging them. Why is that?
Sir Christopher Wormald: Well, I mean, there was definitely thinking and discussion of that going on. COBR – and this is one of the things we need to reflect on about the process. COBR tends to deal and is set up to deal with incidents, and you see that from the agenda of this thing, it was dealing with like very specific things. So from my recollection, there was definitely discussion within DHSC and within SAGE about the kinds of measures that you would need to take, and discussion of the flu plan. It’s not in this particular meeting, that is true.
Lead Inquiry: So the answer is: it wasn’t debated in COBR, which is the primary body for crisis machinery in the United Kingdom?
Sir Christopher Wormald: I haven’t checked when it began to be discussed in COBR, certainly not in this meeting.
Lead Inquiry: Could we look at page 6, please, paragraph 12. The reasonable worst-case scenario planning: the government “continuously plans for a pandemic”, it’s an “international issue”, local resilience forums had planning assumptions for pandemic influenza.
There are then a number of bullet points about repatriation, dealing with British nationals in Wuhan, pandemic plans in place for prisons, border staff, PPE, transmission possibly of the virus through food or animals.
Then over the page, transport – communications. Summing-up, 16, there must be a clear communications plan. The CMO should lead communications, more detail on Wuhan returnees.
Are you surprised, looking at this now, that there was no debate at all about whether or not anything could be done to stop the virus coming once it had left China, or secondly what measures in practice might have to be contemplated?
Sir Christopher Wormald: I didn’t think – I have to say I didn’t think so from memory about this specific meeting, because I did know all those discussions about the flu plan were – well, they were certainly going on in DHSC. Now, I mean, the closest this meeting gets to it is the thing we went past on the reasonable worst-case scenario assumptions, and that was clearly the focus of the work at the moment, was working out – was working out those.
Now, and the only further thing I’ll say is at this stage what the communications were to the general public about what they should do, that is the first stage of preparing for a novel disease. I know it’s not directly relevant to your question, but it’s more than just … sorry, something very odd happened on the screen. It’s more than just comms in the traditional sense.
So if I’m honest, I can’t say at that meeting I was surprised, because the meeting was discussing, as it were, the business of the day.
Lead Inquiry: Communications appears to be at the forefront of matters considered by this committee. It appears to be the focus of the summing-up. Why was so much focus relatively placed on communications as opposed to considering the practical measures which might be taken to stop the virus reaching the United Kingdom, assuming it had left China?
Sir Christopher Wormald: For the reason that I just said, that the question – and I’m sure you’ll want to ask our public health specialists who you’re talking to later, the question of what are you advising the public to do is the first thing that you want to do – you know, whether you advise people to go to particular places, wash hands, all those sorts of things, those are public health interventions done via communications, and from my mind – and it’s particularly why there’s a reference to the CMO leading communications here, it’s about, from memory, that sort of public health communication, you know, not is the government going to issue a press notice.
Lead Inquiry: You’ve referred twice to the flu plan.
Sir Christopher Wormald: Yeah.
Lead Inquiry: In summary, and is this a correct summation of the position, Sir Christopher, the flu plan upon which the government at this stage was still proceeding –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – dating back to 2011, the flu pandemic strategy, envisaged measures such as providing for proper legislative powers to be exercised –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – the Coronavirus – or flu Bill, the possibility of school closures, washing hands and managing excess deaths. Were those the broad heads of –
Sir Christopher Wormald: Erm, plus the communications bit. So what the flu plan envisages –
Lead Inquiry: Just yes or no, are those the correct –
Sir Christopher Wormald: No.
Lead Inquiry: – heads? You say plus?
Sir Christopher Wormald: Yes, so – and in some ways the heart of the flu plan is voluntary – I must remember not to use the acronyms – non-pharmaceutical interventions, voluntary non-pharmaceutical interventions, which are dialled up and down to control, so that is the other thing in the flu plan that we were expecting to do. So the work going on in the department at this point is: can we update the flu plan for this different disease but, as you say, the presumption was that we would be following, basically, the flu plan.
Lead Inquiry: Forgive me. What non-pharmaceutical interventions was the DHSC actively considering other than those measures which I have already mentioned which were part of the existing flu plan, the possibility of school closures, dealing with the physical problems associated with excess deaths, arranging for legislative proposals to be advanced, and washing hands?
Sir Christopher Wormald: It’s what advice you give to the public on how they should be behaving –
Lead Inquiry: Those are not non-pharmaceutical interventions. What other non-pharmaceutical interventions?
Sir Christopher Wormald: Sorry, those are non-pharmaceutical interventions.
Lead Inquiry: The ones I have mentioned are non-pharmaceutical interventions, I am asking you what else was under consideration by way of other non-pharmaceutical interventions, not communications to the public, I’m talking about practical measures to stop the spread of the virus?
Sir Christopher Wormald: Sorry, this is where we’re slightly misunderstanding ourselves. Advice to the public on how to behave are non-pharmaceutical interventions designed to stop the spread of the virus, is my point.
Lead Inquiry: INQ000146557, pages 1 and 2.
This is an email enclosing minutes from a SAGE meeting. It is an email which goes to the permanent secretary at the dhsc.gov.uk. We can see that in the top right-hand corner. Would that have been you?
Sir Christopher Wormald: Yes.
Lead Inquiry: If we look down at the bottom of the page, we can see that Professor Sir Chris Whitty says, of the four scenarios, only two in practice are worth considering.
“The other is the opposite end of the risk scale and is our reasonable worst case scenario for which plans are also being developed. With R [the reproduction rate] of 2-3 …”
That’s one person infecting two to three other people in an unimmunised population.
“… mortality of maybe 2% (wide confidence intervals around both of these and all other numbers), a doubling time currently of maybe 3-5 days and an incubation period of mean 5 [days] this could within the next few weeks …”
Emphasise that, please, Sir Christopher.
“… become widespread and turn into a significant pandemic relatively quickly.”
The Chief Medical Officer was saying, in essence, was he not, “We have a basic understanding of the reproduction rate, we’ve got a basic understanding of the mortality rate and, therefore, we can work out how many people might die, a doubling time, and therefore that this could spread within the next few weeks and become widespread”.
With that information available, and with the knowledge from the COBR meeting that once the virus has left China, if it leaves China, it’s coming, why were those two pieces of information not put together to reach the realisation, with those characteristics and with no practical means of stopping it once it’s left China, we are in real trouble?
Sir Christopher Wormald: No, and that was the view of the department. I mean, a few days after this, the Chief Medical Officer is saying that we might be looking at 100,000 to 300,000 deaths in that scenario, and that was the basis – that that might happen at this pace, not that it will, but it might, was the basis on which DHSC was working.
Lead Inquiry: Once it leaves China, it will happen?
Sir Christopher Wormald: Yeah, and the “once” is very important here, so Chris – and I’ve talked to him on a number of occasions about this – was clear that the conditional bit of that is very important. So he is not saying there will be a pandemic, he is saying, if it’s not controlled in China, then it’s very likely to become a pandemic and then, as becomes clear a few days later, he is saying “And in the UK that might lead to 100 to 300,000 deaths”, so I don’t think there’s any sort of dispute about what we thought at the time.
Lead Inquiry: And by the beginning of February you discovered that it had indeed left China?
Sir Christopher Wormald: Well, in – at that point, in extremely small numbers. Now, this is why I say that the CMO’s view is rather, slightly more nuanced, or certainly how he described it to me, than is set out here.
So, I mean, as I say, I’m sure you will ask him yourself, but his view was if you have, as it were, very small outbreaks elsewhere that can be contained, in exactly the same way as our strategy started with contain, then of course it doesn’t become a pandemic, it’s when you get sustainable human-to-human transmission across a wide range of countries. At that point his view was it was very, very difficult to stop and would become a pandemic.
Lead Inquiry: So you’re saying that the assertion in the COBR minute that the virus would become widespread – the second contingency, it would become widespread once it leaked from China, is wrong?
Sir Christopher Wormald: No, it’s not wrong, it’s a – certainly, as I understood the CMO’s views, but of course you’ll ask him yourself, that it’s a – it’s about what you mean by leaked from. So a case, one case appearing in another country that is identified, contained and doesn’t lead to human transmission, he would not say that is – has leaked from China. Once you’ve got sustained human-to-human transmission outside China, I think that’s what he would describe as – I mean, I’m slightly – why I’m um-ing and ah-ing –
Lead Inquiry: I’m not asking for the Chief –
Sir Christopher Wormald: That was my understanding.
Lead Inquiry: That’s right. I’m asking for your understanding.
Sir Christopher Wormald: Yeah.
Lead Inquiry: INQ000146558 is a letter from the private secretary in Downing Street to the DHSC, because it says:
“The Prime Minister met your Secretary of State, the CST and colleagues from the centre today for his first DHSC Departmental Performance meeting.”
Much of this statement or this letter deals with matters concerning the NHS objectives for manifesto commitments, performance, and so on.
There was, however, in the meeting a short update on coronavirus, which appears to relate to the need to explain the plan, whatever that plan was, and dealing with travel restrictions.
Why was so little time, relatively speaking, devoted in that meeting to coronavirus, in light of the information from the COBR and that email from the Chief Medical Officer saying the plausible scenario is once the virus leaks from China it is coming?
Sir Christopher Wormald: So I’ve covered this meeting in quite some detail in my statements, but – so the meeting was set up at the request of the Prime Minister to cover –
Lead Inquiry: Sir Christopher, I don’t wish to be impolite. Please would you answer the question: why was so little time, relatively speaking, spent on the issue of coronavirus during this meeting?
Sir Christopher Wormald: Well, what time was devoted to what was the choice of the chair of the meeting, which was the Prime Minister.
Lead Inquiry: All right. So your answer is the Prime Minister –
Sir Christopher Wormald: We had – we had asked for coronavirus to be added to the agenda, and the CMO came specially, was not an original invite to the meeting, because we believed that we should update on the status of Covid, which was done. How the meeting was then run in practice was, as I say, a matter for the chair.
I came out of the meeting thinking that the messages about how serious this was and what the likely death toll would be had been delivered, so I wasn’t thinking that our objectives for that bit of the meeting had not been achieved, even though it covers lots of other things. In my mind, we were there to tell the Prime Minister this is very serious and the likely death toll and to hear from the CMO, and that had all been achieved.
Lead Inquiry: Do you agree that the letter from Downing Street reflecting upon the meeting on behalf of the Prime Minister makes absolutely no reference to the death rates?
Sir Christopher Wormald: No, it doesn’t, which – now, my –
Lead Inquiry: Just yes or no, please.
Sir Christopher Wormald: No, it doesn’t. Just as a matter of fact it does not.
Lead Inquiry: The COBR meeting on 5 February, INQ000056215.
Page 1, attendees. Page 2, officials, you’re there again. Page 5, paragraph 2:
“… the CMO said …
“- On average individuals who had died as a result of the novel coronavirus had spent between seven to ten days in hospital …
“- The two most high-risk groups appeared to be the elderly and those with pre-existing illnesses.
“…
“- The fatality rate estimate remained at 2-3%.”
Scrolling back out, please, paragraph 4 deals with the issue of returnees.
Paragraph 6 notes that screening controls would be unlikely to delay the arrival of the virus by very much.
Paragraph 7 deals with communications – I’m sorry, it deals with repatriation of those persons coming back from China. I think maybe item 3 deals with – item 4 deals with communication strategy, and item 3 reasonable worst-case scenario:
“The DIRECTOR OF THE CIVIL CONTINGENCIES SECRETARIAT set out the planning priorities …
“… the following points were made:
“- The committee agreed the need for a clear communications strategy …
“… an emergency bill for support the UK’s response.”
And the link between the devolved administrations and local resilience forums.
Where was the debate about whether or not borders or a test and trace system or other practical form of NPI could prevent the spread of the virus if it came to the United Kingdom?
Sir Christopher Wormald: Well, I think, and this is from memory, if we look at the slides mentioned in paragraph 9, that is the report of the planning that is being done for the – for the reasonable worst-case scenario, which is that the virus has escaped from China and become a pandemic. So I think it is that bit of the discussion.
Lead Inquiry: The planning priorities there referred to were drawn, were they not, from the 2011 pandemic flu strategy document, which, as we’ve discussed, talked in terms of washing hands, talked in terms of the possibility of closing schools, talked in terms of how to manage large numbers of dead people, and communication.
Sir Christopher Wormald: And the things I mentioned earlier.
Now, on the two things you raise specifically, so the closing of borders, and I can’t remember the exact date, but our scientific and clinical advice at the time, and certainly the WHO’s advice, was that closing borders would have not more than a marginal timing effect. So I’m not surprised –
Lead Inquiry: We’ve read that –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – bit out.
Sir Christopher Wormald: So I’m not surprised that was not discussed. At this point I don’t think anyone in the UK was talking about an extensive test and trace system as being a possibility. Again, given that at this point I don’t think we … I may get my timeline wrong, but this is just – this is the point when the first tests are being invented, as it were. Certainly no one was talking about an extensive test and trace system at this time. So I’m not surprised it wasn’t discussed.
Lead Inquiry: So is this the position: border measures by way of screening for symptoms and the like was – and in fact your department advised on 21 February and the measures and the advice were accepted on – sorry, of January. The advice was accepted by the Secretary of State on 22 January, to the effect that symptom screening at borders was unlikely to be particularly effective –
Sir Christopher Wormald: Yes.
Lead Inquiry: – and would only secure a few days’ delay, if that?
Sir Christopher Wormald: Yeah.
Lead Inquiry: There was a recognition that there was no testing system scaled up or in place. Other than the first few hundred index cases, there was no real test and trace system, was there?
Sir Christopher Wormald: No.
Lead Inquiry: That was because under the 2011 pan flu strategy it was understood you don’t need and you don’t have to have a test, trace system for dealing with flu; correct?
Sir Christopher Wormald: Well, basically, yes.
Lead Inquiry: Right.
Sir Christopher Wormald: As I say, at that point, there’s no testing infrastructure at all, so –
Lead Inquiry: Yes. Doctrinally, because of the latent period, the incubation period, the characteristics of flu, there’s no point having a test, trace system. You take Tamiflu, an antiviral, and you wait it out.
For this virus, which you knew was not a flu virus, where was the understanding that you did need a test, a massively scaled-up test, trace system if there was to be any practical means of preventing the virus from reaching the United Kingdom and spreading?
Sir Christopher Wormald: That came much later.
Lead Inquiry: Why didn’t it come then?
Sir Christopher Wormald: Well, of course, at this point – as I say, I can’t quite remember the timeline of the actual creation of – creation of tests, but it’s –
Lead Inquiry: The diagnostic – forgive me – the United Kingdom on the same day as South Korea invented a diagnostic test for coronavirus –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – it was, in fact, in the middle of January, but there was no scaling up of the test and trace system beyond the first few hundred index cases until well after –
Sir Christopher Wormald: Yes, that’s correct. And at this point, the scientific advice we were receiving was – I’m not quite sure what the right words are, not definitive about how good even the tests were at this point, so for quite a long period, for example, it was believed that the test did not reliably pick up either presymptomatic or asymptomatic cases and it wasn’t clear how reliable it was for symptomatic cases till a bit later.
So at this point with the development of the testing technology and the understanding of the testing, nobody, as far as I know, was – from either the policy side or the clinical or scientific side, was saying that what you’re laying out was a practical proposition for stopping the virus getting into the country in the first place.
So the focus was, as is then set out in the plan on March 3rd, on the contain – the “contain” bit and then the other stages of the plan.
Lead Inquiry: Do you accept that other countries turned it very much into a practical proposition?
Sir Christopher Wormald: Oh, well, and – and I’ve said, I’ve said before, that some countries in South East Asia clearly did very, very well.
Lead Inquiry: Yes.
Sir Christopher Wormald: Now the only think I’d add on this, and again I think I put it in my statement, that even the countries in Europe which had a much bigger testing capacity, particularly Germany, which had a very extensive diagnostics industry, they didn’t succeed in using testing to stop the virus getting in either. So it wasn’t simply a question of how many tests you have – and as the Chief Medical Officer gave in his witness statement – in his evidence to Module 1, when you look at what South Korea had done, what they’d done was a very big investment in public health in general, of which testing was one part, as it were. So what I wouldn’t like to leave you the impression with was that even – even looking at South East Asia, but the testing bit is a complete silver bullet. It was – clearly they did it very well, they did it much better than us, I think there’s absolutely no doubt about that, but at this point no one in the UK was thinking of a test and trace system as being the answer.
Lead Inquiry: Regardless of Germany, with which we’re not overly concerned in this Inquiry, regardless of whether it was a silver bullet, there was no practical or policy consideration given at all, until very much later, to the practical proposition of a test and trace system to prevent the spread of the virus?
Sir Christopher Wormald: No, and the advice we were receiving from our clinicians and the scientists didn’t include that measure, that is true.
Lead Inquiry: INQ00056227 is a COBR on 18 February.
At this stage, we can see there the attendees. Page 2, the officials, including yourself again. Page 5, a CMO update. A debate about the reasonable worst-case scenario. And I’m not going to deal with you with the point about whether or not focusing on the reasonable worst-case scenario and whether it would eventuate misdirected attention away from the reality of what was happening.
But this COBR minute makes plain that – you will see from the CMO’s description in paragraph 2 – there was a risk of onward transmission, escalation to a global pandemic remained realistic possibilities.
Scrolling back out, please, repatriation, paragraph 4. Paragraph 5, the repatriation of nationals and the possibility of infection from persons entering the United Kingdom.
Scrolling back out, and then going to the next page, legislation, so again a debate about the legislative basis for anything that might need to be done.
Scrolling back out again, the following page:
“Planning for a Reasonable Worst Case Scenario”:
“The DIRECTOR OF THE CIVIL CONTINGENCIES SECRETARIAT said that there was work to be done to create a clear plan of activity (across the UK Government) from the moment of sustained transmission to its estimated peak …”
If you’re right, Sir Christopher, that there was already thinking about NPIs and what measures reflective of the existing flu strategy or additional to the existing flu strategy could be contemplated and imposed, why was the COBR still at the stage of just talking about the need to create a clear plan of activity?
Sir Christopher Wormald: Well, I mean, what it says is there was still work to be done, which there was, the work had begun, but it had not finished. I think the situation is exactly as described on the page.
Lead Inquiry: You were obviously closely engaged with Number 10 and Downing Street and the Cabinet Office through these late days in February, were you not?
Sir Christopher Wormald: Yes.
Lead Inquiry: How effective was the working relationship at ministerial and at official level?
Sir Christopher Wormald: So, and again, I’ve done this in some detail in my witness statement, I believed that in terms of relations at official level, actually throughout the pandemic, they were good, with the Cabinet Office, and – at political level, and we’ve discussed some of this already, they were rather more up and down. But we felt we had good communications, that we got a hearing, that we’d engaged with the Civil Contingencies Secretariat, that COBRs were happening, all those things we had asked for, we felt those relationships were good.
Lead Inquiry: You say in your statement that conflicts and tensions were time consuming and consequently affected the efficiency of the government’s response, so it appears you accept that to some degree, but we mustn’t overexaggerate it, the ability of the government to respond was adversely affected –
Sir Christopher Wormald: Yeah, I mean, so –
Lead Inquiry: – clashes?
Sir Christopher Wormald: It wasn’t surprise you I thought about my words here extremely carefully, so – and it’s exactly as I say in my witness statement. So I don’t believe, and I’ve never believed, that the core decision-making of which NPI to implement when in this period, this March period, was affected by any of those issues. When I was – my recollection at the time and when I’ve reviewed the evidence, you can see the golden thread from the scientific advice we were receiving to the decisions that the government made on NPIs. So I thought that core bit was following a proper process of advice et cetera.
What was affected by the issues that you mention was, exactly as you said, it was the efficiency of the government machine to do a number of other things.
Lead Inquiry: Right.
Sir Christopher Wormald: We had two, and I think I raised – and it’s in the evidence, two very specific practical things that went wrong that made us less efficient. One was meetings being called by several different bits of Downing Street and Cabinet Office at the same time with the same people on the same subject. And the other, which I have some text exchanges with Tom Shinner and with Mark Sedwill on, is multiple commissions on the same issue, and in one case I think there were two or three commissions on a procurement issue which turned out none of them were what the Prime Minister wanted and we wasted an entire day.
So there were definite – I’m not disputing at all, there were definitely those sorts of issues. I didn’t think, and I didn’t raise, therefore, that those core decisions on NPIs, I didn’t see any of that being affected by those issues.
Lead Inquiry: But the efficiency of the government’s response was affected, yes or no?
Sir Christopher Wormald: And in the examples I have given, and I put it on record at the time, and we dealt with them, yes.
Lead Inquiry: Right.
INQ000279915 is a record of a WhatsApp communication between yourself and then Sir Mark Sedwill –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – where on 18 March you were worried about the fact that Number 10 SPADs were attending SAGE?
Sir Christopher Wormald: Yes.
Lead Inquiry: By 18 March, deaths had started to occur in the United Kingdom, had they not?
Sir Christopher Wormald: Yeah, and by –
Lead Inquiry: No, just please wait for the question.
Sir Christopher Wormald: Oh, sorry. Yes.
Lead Inquiry: Why were you concerned with a matter of process of this type as to who was attending SAGE when presumably the focus of every single minister and official should have been on the delivery, the outcome of these committee meetings and what was being done?
Sir Christopher Wormald: Because of the part at the top of the page. So 18 March is between the decision on 16 March to go for much more extensive voluntary restrictions and then the decision on 23 March to go for full lockdown.
My concern about SAGE here, and, as I say, I was normally a big fan of SAGE, my specific concern is in the second text here, which was, as far as I could see, SAGE had changed its analysis particularly around, I think it was, the effects on the NHS, without there being an explanation of new data.
So that was what I was concerned about. And then I was concerned about the purity of the SAGE advice which was going to the Prime Minister and others because SPADs were available. Those were my concerns, so I raised them.
Lead Inquiry: Sir Christopher, a concern about the substance of the advice coming from SAGE is one thing. Why were you wasting time concerned with the process of the system?
Sir Christopher Wormald: Because whether the advice is pure, and this was the reference to Chilcot you will see here, that one of the key findings of the various reports around the Iraq War, including the Chilcot one, was the mixing up of the technical factual advice and the political advice. That is the reference to Chilcot.
Now, as I say, this had been a key issue in that Inquiry –
Lead Inquiry: I’m going to –
Sir Christopher Wormald: We therefore wanted to take it very seriously.
Lead Inquiry: Forgive me. You’ve made the point, you were concerned about the recommendations of the Chilcot Inquiry. We don’t need to go into what they were.
Let’s go back a few days to another COBR, 26 February, INQ000056216.
Pages 1 to 3 give us the attendees.
If we just scroll, please, through page 2, we can see that again you’re there.
Then if we look at page 5, paragraph 1, an update on the current global situation.
There was particular concern at the 26 February – COBR – wasn’t there, Sir Christopher, about the fact that in Italy there had been an explosion of the virus? There had of course been a quarantining or a lockdown of a number of northern municipalities in Italy, and concern was expressed there about sustained human-to-human transmission in Italy, which receives a high number of travellers to and from the United Kingdom.
If we scroll back out again, and just cast our eyes down the page, we have health advice for travellers and schools; over the page, international response, that’s to say helping other countries and helping the WHO; and then (d) on page 6, paragraph 11:
“… the reasonable worst case planning assumptions looked close to becoming the reasonable planning assumptions as cases in Italy demonstrated the need for heightened alertness …”
Progress legislation, ensure good public communications, and there are references then to massive numbers of deaths under the reasonable worst-case scenario, which was of course appearing increasingly to be the reality, guidance on excess death management, a reference to economic impact.
And then if we just go over and scroll, pages 8, 9 and 10, we will see references to travellers – thank you – excess death management, and actions for the processing of the Bill, the Covid-19 Bill.
Where is the practical debate about measures to stop or control the spread of the virus, which is now in Italy and is envisaged to undoubtedly, if it had not already come to the United Kingdom, to come here?
Sir Christopher Wormald: So I would say that would be in the HMG preparedness section that you described. Now, of course the other thing that was going on at the moment, which I think every attendee at the meeting would have known is this is when we were preparing the – for publication the Covid action plan that went out on 3 March, and that was the big thing that was being done at that point, which was to set out that strategy, and the – and just for completeness, we were of course still in the contain phase in the UK at this time.
Lead Inquiry: Yes. On 28 February, before that action plan was published, a paper was prepared by the Civil Contingencies Secretariat with the assistance of the Department of Health, correct?
Sir Christopher Wormald: Yes, I don’t remember the paper at the time, but having read it, that is clearly the case.
Lead Inquiry: INQ000146569. The UK’s preparedness, written by the Civil Contingencies Secretariat, paragraph 1:
“Covid-19 looks increasingly likely to become a global pandemic although this is not yet certain.”
Sir Christopher Wormald: Yeah.
Lead Inquiry: Did you agree with that sentence?
Sir Christopher Wormald: Erm, at that point, I thought – I mean, as I say, I don’t remember the paper at the time, but, as I say, WHO at this point had not declared a global pandemic, we were still in the contain phase –
Lead Inquiry: I’m so sorry to interrupt, Sir Christopher, regardless of whether the United Kingdom was in a contain or delay or mitigate stage, a matter of process in a plan yet to be published, did you think on 28 February that that sentence was correct?
Sir Christopher Wormald: Well, as I say, I didn’t see that sentence on 28 February –
Lead Inquiry: Were you –
Sir Christopher Wormald: I think – and the danger of hindsight is very large, I think that our and the CMO’s view was that it was very, very likely indeed at this point.
Lead Inquiry: So that crucial document, setting out for the first time in this form the Civil Contingencies Secretariat’s view, the crisis machinery’s view in government of the UK’s preparedness, starts with a sentence of vital importance that is materially mistaken, in your view?
Sir Christopher Wormald: Not materially mistaken, the sentence is not inconsistent with what I have said.
Lead Inquiry: All right.
Sir Christopher Wormald: I think, and, as I say, the danger of hindsight here is very high, I think, at that point, I and the CMO would have – and particularly the CMO, would have made it stronger than that. But, as I say, my danger of hindsight, just to be completely honest, my danger of hindsight is very –
Lead Inquiry: Where is the hindsight, Sir Christopher? You said “I think that the CMO’s view was that it was very, very likely indeed at this point”.
Sir Christopher Wormald: No, yeah –
Lead Inquiry: Where is the hindsight in that?
Sir Christopher Wormald: Well, it’s very easy to say on a particular date a view was X, which I can’t evidence, but so I’m giving you what I think is my honest view.
Lead Inquiry: The UK’s approach, underpinned by science – we’ll come back to the issue of following the science in a moment – is currently to contain the small number of cases here and reassure the public.
When you, your department, your officers, your officials, read this document, what answer did they come up for the question: how is the United Kingdom to currently contain the small number of cases here?
Sir Christopher Wormald: Well, so, at this point, when you’ve got a small number of cases, you can contain via contact tracing, and that was what was being – happening at this time. You go into the delay phase, as it became, as you say, in the strategy, later, at the point when you can no longer do that. So that sentence, I assume, is a reference to that.
Lead Inquiry: The action plan, could we have, please, INQ000106107. This was, the Inquiry has heard, an action plan which was described by a number of – or one particular official in Downing Street as being a comms plan. Mr Warner said in his statement: where was the real plan?
This plan had its genesis, although it was dated 3 March, some time before in a request from the Secretary of State in early February; correct?
Sir Christopher Wormald: I can’t remember the exact date of that –
Lead Inquiry: INQ000106107.
Sir Christopher Wormald: – that he commissioned, but …
Lead Inquiry: 10 February, from somebody in the exchange administrative group:
“… we have discussed updating the 2011 pandemic flu strategy.”
So just noting there, Sir Christopher, the prevailing impact of that 2011 strategy on documents being brought together, drawn up in the face of the coronavirus pandemic:
“I wanted to flag that SoS has commissioned for THIS WEEK a coronavirus version of the strategy document … there are many pan flu supporting strategies … which are more recent … [but] this is an additional ask”, and so on.
Sir Christopher Wormald: Yeah.
Lead Inquiry: So on 10 February, an action plan designed to deal with the fast-moving new, novel viral pandemic was sought to be introduced, to be drawn up?
Sir Christopher Wormald: Yeah.
Lead Inquiry: If you look, please, at the minutes of the meeting in which that direction was made, INQ000279883, you will see:
“… We are building a campaign site which will be the public window for the plan. We’d like to get the site launched next week …”
Then over the page, please, page 2:
“[The Secretary of State] wants an acronym … for the plan.”
There was a debate about how you describe the “mitigate” phase.
“On timings … he’d would be happy to publish on the 24th February, however later that week or up to the 2nd March would also be fine.”
You were aware that the position was changing rapidly –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – hour by hour, day by day. What was the point on 10 February of commissioning a report wouldn’t be published until up to 2 March by which time no doubt events had moved on radically?
Sir Christopher Wormald: Well, and from memory this is why it was extremely difficult to finalise the plan, because you were updating it for events as you went. So I was confident, and indeed we had the Chief Medical Officer sign off the factual accuracy of the plan, that the plan as published was up-to-date at that point, obviously something that, if it had been written on 10 March and then published on – sorry, 10 February, and published on 2 March, it wouldn’t have been.
Lead Inquiry: When the report – the action plan was published on 3 March, it proposed that the United Kingdom thereinafter adopt a strategy comprising firstly control and secondly delay?
Sir Christopher Wormald: Contain.
Lead Inquiry: Contain, I apologise: contain and then delay.
SPI-M-O had by that date formally acknowledged sustained community transmission in the United Kingdom, had it not?
Sir Christopher Wormald: Yeah, there was a scientific debate going on at this point. I mean, the actual decision on when you move from contain to delay was taken by, I think, the Chief Medical Officer, and I don’t have it here, but there were a series of scientific debates about whether we were still in the contain phase moving into the delay phase, and that decision was finally taken on, I believe, 12 March.
Lead Inquiry: So at the date of publication, a formal part of the government scientific advisory process, SPI-M-O, had already formally acknowledged that there was sustained community transmission within the United Kingdom –
Sir Christopher Wormald: Yes.
Lead Inquiry: – ie –
Sir Christopher Wormald: Yes, but that was not the whole of the scientific advice that we received. As I say, there was a scientific debate going on at this point which was resolved, as I say, by the scientists.
Lead Inquiry: This was your department’s action plan, or at least an action plant to which you contributed?
Sir Christopher Wormald: Yeah.
Lead Inquiry: Did you not ask yourself on 3 March: why are we publishing a plan that provides for containment and delay in the future when I am aware that SPI-M-O has as a committee formally acknowledged the existence of sustained community transmission, that is to say absence of control in the United Kingdom?
Sir Christopher Wormald: Because the formal scientific advice, which is consensus advice, drawing on a range of scientific sources, was given to us by, in this case, the CMO but normally the CMO and the Government Chief Scientific Adviser on advice of SAGE, and they were at that point not advising that we were out of the contain phase, that happened, as I say, I think on 12 March, the day after WHO had declared a pandemic.
Lead Inquiry: But the United Kingdom’s position did not of course depend on whether or not the WHO had declared a pandemic or not?
Sir Christopher Wormald: No, but it depended upon what the, in this case, CMO’s assessment was of the consensus of scientific opinion which – and I’m sure you will ask me this question, you know, that is a judgement call and scientists had different – had different views, and that is how our scientific advice worked.
Lead Inquiry: Strategy.
We are not going to re-debate, Sir Christopher, the proper meaning to be given to a one-peak strategy or mitigation versus suppression. You know very well what the debate is.
You say in your statement that you believe, with hindsight, that you did place too much store in shielding as being the key measure in reducing deaths from Covid –
Sir Christopher Wormald: Personally, yes. Now, and I hope I made –
Lead Inquiry: Just will you please just wait for the question.
Sir Christopher Wormald: Sorry.
Lead Inquiry: You say in your statement you believed you placed too much store on shielding. Shielding is of course a crucial part of the mitigation, the squashing the sombrero with added herd immunity strategy, because you allow the virus to spread through parts of the population while shielding the vulnerable, and you hope, you expect a majority or some or a proportion will become infected and that will then prevent reinfection or rather prevent novel infection later and a second wave.
Sir Christopher Wormald: Not quite, no. So as I’ve described in my statement, I didn’t think of herd immunity as an objective –
Lead Inquiry: I’m not saying it’s objective, I said it was a byproduct of the one wave mitigation strategy?
Sir Christopher Wormald: Yeah –
Lead Inquiry: No, no, I’m so sorry, Sir Christopher, you just have to wait for the question.
To what extent did you and the DHSC resist the change of strategy that took place from mitigation to suppression between 9 March and that weekend of 14/15 March?
Sir Christopher Wormald: That’s not when the change occurred. So I’ll say a couple of things. So I’ve been very surprised by the number of references to a one-peak strategy. I don’t remember that being said at the time at all. And I know it’s come up in a number of witness statements, and as I’ve read and listened that has surprised me. Almost all pandemics in the whole of human history have had more than one wave. It’s very –
Lead Inquiry: Please let us not worry about why doctrinally –
Sir Christopher Wormald: As you –
Lead Inquiry: Forgive me, Sir Christopher – why doctrinally it came to be called by some people as the one wave strategy. It is what it is.
Why, if you did, and maybe you did not, but did you resist the change in strategy that other parts of the government came to understand was required and then began to pursue?
Sir Christopher Wormald: I don’t think I did resist. The change happens – and I’ve set this out in my witness statement, my recollection – between 16 March and 23 March, and as I understood it, you know, basically up until 16 March we are still following basically the flu plan of voluntary, at that point quite heavy restrictions, and then between the 16th and the 23rd the government switches to legal restrictions, which become known as lockdown. I’ve set out in my statement why I think that change occurred. I don’t think I particularly – in fact, I don’t think I did resist that strategy, and I don’t think DHSC did. I think there was a general move in government that the position we established on the 16th, in line with the scientific advice at the time, of heavy voluntary restrictions wasn’t going to be enough and we switched to legal restrictions on the 23rd.
Lead Inquiry: Do you agree that from 1 March onwards there were scientists in Imperial College London, the London School of Hygiene and Tropical Medicine, beginning to realise and beginning to say openly: with this infection fatality rate, with this infection hospitalisation rate, with this number of people in the population, there is going to be a massive wave of deaths?
Sir Christopher Wormald: Yes, there were definitely scientists saying that, and the debate, and this is very important, was about the timings of restrictions, not that there would need to be so.
So – and the clearest description of this is at the COBR on 12 March, where SAGE sets out, Patrick Vallance describes this very clearly, the NPIs that were being considered and SAGE’s recommendation of which ones should be done now and which ones should wait a few weeks.
So on 12 March, the government accepts exactly what SAGE, via the government Chief Scientist has advised on which NPIs are needed at that precise moment in time.
Lead Inquiry: When, Sir Christopher, did you realise, as was an inevitable part of any reasonable worst-case scenario involving 800,000 deaths, that it was that reasonable worst-case scenario that was coming to pass, and it would inevitably involve the swamping of the NHS?
Sir Christopher Wormald: I can’t – I can’t put a specific date on it. I agreed, and I think I’ve said this in my witness statement, I agreed with the SAGE advice that we received on that day. It made sense to me, given the data, and, as I say, and you’ll see this very, very clearly in the minutes, that the debates were not about: would we have to take further restrictions; the debate was about: what is the best time to implement those restrictions, and that was a debate, as I say, I agreed with.
Lead Inquiry: The debate about what measures could work and when they should best be employed was a different debate from the stark realisation that unless something radical was done, the NHS would be overwhelmed?
Sir Christopher Wormald: And, as I say, the question that was being debated was: when is the right point in the upturn to implement which NPI, and that is what we received SAGE advice on, which was, in part, based on their assessment of what the effect on the NHS would be. And that changes radically between 12th and the 16th, when we get updated advice that basically says we’re much further up the curve than we thought we were.
Lead Inquiry: On 12 March – forgive me, on 12 March you had a WhatsApp exchange with Lord Sedwill – could we have INQ000279901 – where, notwithstanding the emerging scientific view that there would be a wall of death that would swamp the NHS, notwithstanding the figures from the NHS beginning to emerge as to bed capacity, and therefore the need for a radical change in strategy to suppression, Lord Sedwill said to you:
“I don’t think [the Prime Minister] & Co have internalised yet the distinction between minimising mortality and not trying to stop most people getting it.”
So a reference to the herd immunity debate. Do you agree?
Sir Christopher Wormald: Well –
Lead Inquiry: Is that a reference to the herd immunity debate?
Sir Christopher Wormald: No, I don’t think it is. So what Mark says here is pretty much identical to what Patrick Vallance says at the COBR meeting later that day that we’ve just been discussing. So as far as I’m concerned, Mark was reflecting the state of the scientific advice at that point –
Lead Inquiry: “Indeed presumably like chicken pox we want people to get it and develop herd immunity before the next wave …”
So obviously it was a reference to the herd immunity debate, Sir Christopher?
Sir Christopher Wormald: Oh, yeah, he was – he was talking about the herd immunity.
Lead Inquiry: And your position was:
“Exactly right. We make the point every meeting, they don’t quite get it.”
Why were you, Sir Christopher, still wedded to the mitigation herd immunity approach in the face of the emerging scientific evidence, the advisory evidence commissioned by your own department?
Sir Christopher Wormald: I would refer you to the very clear scientific advice from the body that was charged with drawing up the consensus, which was SAGE, via the government’s Chief Scientist, given to COBR on this very day endorsing that strategy.
Now, I was very, very loose in my reply, I was answering the exact question at the end of Mark’s text that we should be focusing on protecting the most vulnerable. But, as I say, what Mark sets out there is pretty much exactly, as I say, what we were hearing from SAGE and what the Government Chief Scientist presented at the COBR meeting on that day, so it wasn’t an unusual position here, and I accepted, as I’ve said, I agreed with the SAGE advice.
Lead Inquiry: On 15 March at 5.00 pm that weekend –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – when there were multiple meetings with the Prime Minister, Mr Cummings and Mr Warner and Ms MacNamara and others had raised their concerns about the calamity, the catastrophe that was about to overwhelm the United Kingdom. The Prime Minister had, as I said, a number of meetings in which he asked his advisers as to what should be done, and there was repeated debate about the need to change strategy and whether herd immunity approach or a mitigation approach was leading the United Kingdom astray.
At that 5.00 pm meeting, there was debate, was there not, about the need to accelerate and suppress – accelerate measures and suppress the virus, and you were there?
Sir Christopher Wormald: Yeah.
Lead Inquiry: Mr Cummings was there, Sir Patrick Vallance was there, Mr Warner was there, correct?
Sir Christopher Wormald: Yes.
Lead Inquiry: In Sir Patrick Vallance’s notes, and in Mr Cummings’ witness statement, there is a reference to you, when Sir Patrick Vallance said, “We must change course, we must accelerate practical measures, we must suppress this virus, it’s going to overwhelm us”, that you were incandescent, “I got a ticking off indirectly from the permanent secretary of the DHSC”.
Sir Christopher Wormald: Yeah, and I have to say, well – and as I’ve said before, I have huge respect for Patrick and he was clearly referring to something. I do not have any recollection of ticking off the Government Chief Scientist. I clearly said something that caused him to think that, and, as I say, Sir Patrick is one of the most honest and straightforward people I know, so I’m not denying his … but I don’t recall doing anything as described there, it may have been a miscommunication, and I think it says, I haven’t got the thing on screen, but I think it does say indirectly, so it may have been a miscommunication, and in terms of that –
Lead Inquiry: Who says that?
Sir Christopher Wormald: Sorry, I don’t have it on the screen, I thought you said indirectly, I may –
Lead Inquiry: Saturday mid-March:
“I dropped a bombshell of needing to move fast, I got a ticking off indirectly from the permanent secretary of the DHSC.”
Sir Christopher Wormald: Yeah.
Lead Inquiry: “He was incandescent.”
Sir Christopher Wormald: “Got a ticking off indirectly”, yeah, so it may be – as I say, I don’t remember this at all, it may be when he says “I got a ticking off indirectly” somebody said to him that. I don’t know who that person was and I don’t know what they’re referring to. Now, in terms of the meeting itself –
Lead Inquiry: No, no, just pause there, please, I haven’t asked you about the meeting generally.
It became apparent and more and more people signed up to the change of strategy, that there had to be more stringent measures –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – imposed, and there were measures imposed on 16 March –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – and then, of course, firstly consideration had to be given, time had to be allowed to seeing whether those measures work, correct?
Sir Christopher Wormald: Yes.
Lead Inquiry: Secondly, the government had to be able to have time to put into place the practical arrangements associated with any further stringent measures, correct?
Sir Christopher Wormald: Yeah.
Lead Inquiry: And so no decision was taken to lock down over that weekend of 14/15 March, was it?
Sir Christopher Wormald: No, and my recollection of the meeting was that, by the end of the meeting, where there had been a, as you say, a robust debate about what the right thing to do was, my recollection was everyone had coalesced around the actually rather extensive package that then went to COBR the next day –
Lead Inquiry: The package put into place on the 16th?
Sir Christopher Wormald: Yes.
Lead Inquiry: Right.
Sir Christopher Wormald: And as far as I was concerned, the meeting and all the participants in it had, by the end of the meeting, agreed that that package was the right set of things to do.
Lead Inquiry: And the DHSC was tasked with the obligation of providing a battle plan –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – an overarching plan for how these measures would work, what needed to be done, and of course envisaging any further possibility of further, more stringent –
Sir Christopher Wormald: Yeah, now –
Lead Inquiry: If you would just agree that –
Sir Christopher Wormald: No.
Lead Inquiry: – your department took on the obligation of developing and producing a battle plan?
Sir Christopher Wormald: Yeah, so we were formally commissioned on, I believe, 20 March.
Lead Inquiry: 20 March.
Sir Christopher Wormald: The actual work that went into the battle plan had begun considerably before that, I think basically from the point of the strategy, so we were able to deliver the battle plan back on, I think, the 22nd. Now, we didn’t develop it from scratch over those two days, as you would imagine, so it was the culmination of a large set of work within the department.
Lead Inquiry: All right.
Now, the lockdown decision and the time –
Lady Hallett: Are you moving to a –
Mr Keith: Yes, my Lady, I am.
Lady Hallett: I think probably we will take a ten-minute break now because I suspect we are going to have to take another break because it could be a long day.
Mr Keith: I’m sorry, yes, I’m afraid so.
Lady Hallett: So I will return at 3.05. Sorry for another interruption.
(2.55 pm)
(A short break)
(3.05 pm)
Lady Hallett: Mr Keith.
Mr Keith: Sir Christopher, the lockdown, the mandatory stay-at-home order of 23 March. Ultimately, the national lockdown, if I may call it that, was ordered when it became apparent that the NHS would be overwhelmed and the existing measures of 16 March proved not to be enough to ensure compliance.
In your statement, you recognised that the voluntary NPIs, if I may call them that, of 16 March proved not to be enough, which is why a lockdown had to be in the end imposed.
Sir Christopher Wormald: Not quite.
Lead Inquiry: Will you just wait for my question, please.
You do accept that, had voluntary NPIs, as you describe them, been introduced earlier, it is possible – and I emphasise, only possible – that they might have worked and there may have been no need for a lockdown in order to preserve the NHS?
Sir Christopher Wormald: I’m sorry, right. So, we don’t know, and we will never know, what the effect of the 16 March package would have been, because there was not long enough between it and the national lockdown to be able to tell. Which is why I’ve phrased my statement in the way that I did, I think. And there is – from what I have seen, there is some evidence that the wave was already beginning to turn because of the 16 March package, but, as I say, we will never know, because we introduced the 23 March.
And I set out in my witness statement the reasons why I think the government changed course, which was certainly a belief amongst a number of people that those measures were not enough. It was seeing lockdowns all over Europe and us being out of step, and it was a sense, driven by a lot of the media reporting, that people were not complying with the 16 March things –
Lead Inquiry: Stop –
Sir Christopher Wormald: – so in my mind it was those three reasons, but just to be clear, I’m not – I don’t know and we can’t know what the effect of that 16 March package would actually have been.
Lead Inquiry: But you accept it is at least possible that had those 16 March measures been thought of, conceived and imposed earlier, and I emphasise, possibility –
Sir Christopher Wormald: Yeah.
Lead Inquiry: – then there may have been no need for a lockdown; we just don’t know?
Sir Christopher Wormald: That is certainly a possibility. And as I’ve said in my statement, with hindsight we were at least a week late at all points of the NPI decisions. I agreed with the decisions at the time and the timing but, looking back, we should have done each of the things on the 12th, the 16th, the 23rd, if we had got to the 23rd, at least a week earlier.
Lead Inquiry: Should the government have changed course earlier? If it had, then of course whatever measures were imposed on 16 March might have been imposed earlier –
Sir Christopher Wormald: Yeah.
Lead Inquiry: And there may have been an earlier realisation that there were no other practical measures open to it. Should the government have understood the position and changed course earlier?
Sir Christopher Wormald: So, and I hope I have been clear about this, I think the decisions based on the scientific advice were completely rational at the time and I agreed with them. With hindsight, I would agree with you that we should have imposed them earlier.
Lead Inquiry: We should have what, sorry?
Sir Christopher Wormald: Sorry, so with hindsight, I agree with the proposition you put to me that we should have imposed them earlier.
Lead Inquiry: It is obvious that it took a number of weeks for the government to understand the predicament it was in, it took a number of weeks for the whole of government to understand that, regardless of the modelling, the infection fatality rate and the lack of practical means of controlling the virus gave it very little room for manoeuvre. Should not that awareness have taken place, come to the government earlier?
Sir Christopher Wormald: As I say, I thought the decisions were rational at the time, and they are – and having looked back at the record, they are fully in line with the scientific advice that was received. Now, the debate at the time, as I say, there was – I think everyone agreed we were going to have to have more and more restrictions, the debate was about what the right timing was. And the clear view of the Chief Medical Officer and others that there were big downsides, as was proved to be absolutely correct, to our NPI regimes, and therefore going into them at the right time and coming out of them as quickly as possible to minimise, as I say, what is been correctly identified as the sort of collateral damage of NPIs and lockdowns was very, very important.
As I say, this all seemed at the time to me completely rational of the timings of what we did when. As I say, looking back, I would take different decisions. Obviously I wasn’t the decision-maker, but I would have supported earlier implementation, as you say.
Lead Inquiry: By contrast, Sir Christopher, in relation to the second lockdown, your view at the time was that that second lockdown, the lockdown of November 2020, was implemented too late?
Sir Christopher Wormald: Yes. Now, and I hope I’ve made this clear in my witness statement, so the issues in March are lack of knowledge and understanding about the virus and taking decisions in, you know, considerable uncertainty. That is not the case for the second lockdown. By this point we have a lot of testing, we know a lot about the virus, we know – we’re not modelling, we basically know how it goes up and down. And the debates, which I was nothing like so close to, so I’ll give the caveat that I was, as it were, watching from DHSC rather than in the room at this point, but the debates in November are not about what is the situation, they’re about what is the right strategy. And that – that’s certainly how it looked to us. It was much more: are lockdowns a good idea or not? Not, what is the timing of a lockdown and what do we know.
Now, my point – and I do understand the argument, I don’t agree with them, but I understand the arguments from people that lockdowns are more damage than they do, and that case is made, I understand it, I don’t agree with it, but if you’re going to have a lockdown, which we did, it would have been much better to do it earlier, in my view, I wasn’t the decision-taker, but in my view, than when we did in November.
So I see the decision-making very, very differently in that March first lockdown, which I say was based on uncertainty, and the second and third ones which were based on certainty but disagreements about the right strategy.
Sorry, that was a long answer, but does that make sense?
Mr Keith: Well, that’s not for me to answer. I have no more questions.
My Lady, there are a number of Rule 10 questions.
Lady Hallett: There are.
Ms Campbell.
Questions From Ms Campbell KC
Ms Campbell: Thank you, my Lady.
Sir Christopher, I ask questions on behalf of the Northern Ireland Covid Bereaved Families. I want to take you back, please, to that period in January and February 2020, and in your witness statement, I think it’s perhaps your ninth one, you exhibit a document that is ultimately dated 25 February 2020, and we’re going to have a look at it, if we may. It’s INQ000051209.
Whilst it’s coming up, Sir Christopher, and because we’re limited for time, this is a Public Health England document that is endorsed by your department, and it is entitled, as you can see, “Guidance for Social/Community Care and Residential Settings”.
If you just look at the very bottom of the first page, you can see it’s endorsed and accredited by the Department of Health and Social Care, and indeed the Chief Medical Officer. Do you see that?
Sir Christopher Wormald: Yes.
Ms Campbell KC: And, as I say, although this version is 24 February, it’s ultimately published the next day.
Could we go over the page, please, to page 2. We can see on page 2 the list of community organisations to which this is to apply, and the bottom three bullet points: care homes, which are nursing care homes; care home services without nursing; support to people in their own homes. And of course there are other children’s homes, homes for people with learning disability and so on.
At the very bottom of page 2, the advice on 25 February, that very bottom paragraph, please:
“This guidance is intended for the current position in the UK where there is currently no transmission of COVID-19 in the community. It is therefore very unlikely that anyone receiving care in a care home or in the community will become infected.”
Okay? So it’s very clearly stating right at the end of February that it is very unlikely that those who reside in care homes are going to be infected, much less, of course, seriously ill or die.
Before I ask you a question, let’s look at a few other pieces of advice that are in this document.
Can we go to page 6, please.
It is reiterated in the top paragraph of page 6, last sentence:
“It remains very unlikely that people receiving care in a care home or the community will become infected.”
Page 12, just give me one second to make sure I have the right reference.
(Pause)
Ms Campbell KC: I’m so sorry, I’ll read it out to you, I just can’t see it as it appears on the screen here, but on page 12 it’s repeated:
“Currently there is no evidence of transmission of COVID-19 in the United Kingdom. There is no need to do anything differently in any care setting at present.”
Okay?
Now, I’m not going to put it on screen, but your department at the same time on 25 February 2020 had published a situation report, a daily situation report, and you’ll be familiar with those. Isn’t that right?
Sir Christopher Wormald: I suspect so, yes.
Ms Campbell KC: That report indicated that, as at 25 February, fewer than 6,800 people in the UK had in fact been tested, but of those tested there were 13 confirmed cases domestically. Okay? It also indicated that the situation internationally was that China was experiencing widespread infection, causing by that stage some 2,700 deaths. The situation in Italy was rapidly deteriorating and deaths had started and doubled overnight. And of course the situation in the Diamond Princess was that short of 700 people had become infected. Okay?
You’ve told us in your evidence today that as at the end of January of 2020, your department was working on the basis that once the virus leaves China we’re in real trouble, isn’t that right?
Sir Christopher Wormald: As we covered earlier, yes.
Ms Campbell KC: Yes. Why is it, then, that as at 25 February 2020, when the situation internationally was grim, and that the virus had arrived domestically, you were telling the care home sector or at least endorsing the advice that risks of infection were very unlikely and that there was no need to do anything at the moment?
Sir Christopher Wormald: Because that was the clinical advice at the time, so at this moment actual infection numbers in England, as this was, were believed to be very low indeed. So, as I understand it, this is a description of what the situation was at that time, it was not a prediction of the future. So I think everything you’ve read out – I mean, obviously this was signed off by a number of clinicians, not by me, but I think everything that you have read out is entirely consistent with the actual number, believed number of cases in the UK on that date.
Ms Campbell KC: But of course, Sir Christopher, once the virus arrived in the UK, once the virus arrived, you knew and your department knew that we needed to be acting on the reasonable worst-case scenario basis; isn’t that right?
Sir Christopher Wormald: Well, at this point, the –
Ms Campbell KC: Sir Christopher, I’m quoting your evidence from this morning to you.
Sir Christopher Wormald: In terms – so the distinction that I think is important here is between what were our predictions of the future and what was our advice to people to do at that moment in time. So it is completely consistent that there may be, as there were at this point, very small numbers in the UK that could be contained, and that our prediction of the future, the reasonable worst-case scenario of what might happen, might be very high. Those – I don’t see those two things as in contradiction at all.
Ms Campbell KC: Let’s look at it in this way: the Diamond Princess had many features that are consistent with care home or residential home features: high occupation, high occupancy, a lot of people sharing facilities, staff going from room to room and, perhaps even demographically, an older age group. We know that by that stage the Diamond Princess had suffered such an infection that 700 people on that ship had been infected. Okay?
Now, if we put it in context, was any consideration given at that point as to whether or not you should be advising care homes that your department was acting on a reasonable worst-case scenario and that they may well have to at least prepare to take plans to protect their residents?
Sir Christopher Wormald: Well, you’ve displayed how this document was put together, and who signed it off, and what you’ve just described was not the clinical advice that we were receiving at the time.
Ms Campbell KC: Well, can we put up, please, document INQ00047541.
And to put it in context, this is a document that comes from Professor Jonathan Van-Tam. It is advice that he provide, as he says, to his DHSC colleagues on 24 January 2020.
Can we please in that document scroll down to page 3. The heading is “Significant spread and transmission in the UK”, and the second paragraph, please. These are his corrections to a DHSC document:
“If community transmission occurs in the UK, it [is] most likely that widespread community transmission would follow on rapidly; this would be a tipping point at which we would cease contact tracing, as it would be no longer be possible or a plausible route to stop the virus.”
So as of 24 January your department was receiving advice that if community transmission occurs in the UK, it is most likely that widespread community transmission would follow. Were you aware of that advice at the time?
Sir Christopher Wormald: Yes, and it’s completely consistent with what I’ve said in the rest of this hearing, and with what I’ve just said. So the key words in that paragraph are “if community transmission occurs”.
Ms Campbell KC: Yes.
Sir Christopher Wormald: Now, at the point that that guidance was put out, there was not evidence of community transmission occurring. As you say, there were, I think, from your numbers –
Ms Campbell KC: 13 cases in the UK.
Sir Christopher Wormald: – 13 cases, and from memory they were at that point largely imported cases and we didn’t have evidence of community transmission. So I think the guidance is completely in line with what Professor Van-Tam has written, which is not surprising given that, as you showed at the beginning, the guidance was signed off by the Office of the Chief Medical Officer of which Jonathan Van-Tam was a part. So I don’t see any inconsistency here.
Ms Campbell KC: You say you didn’t have evidence of community transmission at that point in time. There had been fewer than 7,000 tests. We had 13 confirmed cases. You knew what had happened internationally. You knew what had happened on the Diamond Princess. Would it not have been safer to operate on the basis that there was, at the very least, a risk of widespread community transmission starting from around the end of February and continuing well beyond?
Sir Christopher Wormald: Well, I can only repeat, we were acting on the clinical advice that we received at the moment, and – at that time, and I’m sure we will cover this in great detail in future modules, but in essence there were no non-damaging options here. So it’s been widely reported the damage to individuals that isolation, non-pharmaceutical interventions, lockdowns have –
Ms Campbell KC: Sir Christopher, I’m going to –
Sir Christopher Wormald: – so we were exactly with the clinical advice that you were quoting.
Ms Campbell KC: I want to move on and ask you whether you were aware of an article, again authored by Professor Van-Tam, at this stage in 2017, in relation to the possibility of an influenza pandemic, in which he said that long-term care facility environments and the vulnerability of their residents provides a setting conducive to the rapid spread of the influenza virus and other respiratory pathogens. And later in the article he talks about the risk in care homes potentially being explosive.
Sir Christopher Wormald: I’m not aware of that article –
Ms Campbell KC: Does it follow that insofar as the department endorsed this advice, it did not put together the risk to residents in long-term care facilities, the global picture and the likelihood of transmission at least moving towards being widespread in the UK?
Sir Christopher Wormald: Well, I can only say the same thing that I have said in response to previous questions. This was advice clearly signed off by the clinicians and scientific advisers at the time about what the best thing to do was in the very specific circumstances that you’ve described where we did not have evidence of community transmission and therefore the kinds of things that you’re describing were not triggered. I mean, I get the point you’re making, but my answer is, as it were, the same, that that was the scientific and clinical advice we were receiving at that time.
Ms Campbell KC: So the advice to those who manage care homes is: do nothing, don’t worry, any risk is very small?
Sir Christopher Wormald: And I think at that particular moment in time that has proved to be correct. Now, obviously later in the pandemic, and as I’m sure I will be giving evidence on this in a future module, that position changes completely, but at this particular moment in time I haven’t seen anything to suggest that that advice was incorrect or out of line with our scientific advice at that time.
Ms Campbell KC: Sir Christopher, one more topic, if I may, because I’m sure I’ve overrun my time.
Can we please put up INQ000106319.
This is a paper produced again by your department. We understand on 31 March 2020. You can see it’s PPE guideline comparison. Can we go quickly, please, to page 2. There will be a great deal of other evidence in this module and indeed in future modules about procurement of PPE, but on 31 March your department was proposing, under the intensive care column on the right-hand side, that to deal with the problem of a lack of PPE or a risk of lack of PPE, FFP3 respirators which had been recommended to be one per patient interaction was to be changed, and those who work in intensive care were to wear one over the course of two hours. Do you see that?
Sir Christopher Wormald: Yes.
Ms Campbell KC: And you would accept no doubt that that would mean many patient interactions and indeed colleague interactions potentially within that two hours?
Sir Christopher Wormald: I should say I am not an expert in infection control at all, so –
Ms Campbell KC: I’m not asking you for your expertise in infection control, but you do know that those who work within intensive care facilities may well encounter several patients and several colleagues over a two-hour period?
Sir Christopher Wormald: Yes.
Ms Campbell KC: If we go down, please, to gloves, one per patient interaction is to be proposed to be changed to one per two hours.
So, again, those who work in those intensive care circumstances are to be wearing a single pair of gloves per two hours.
In relation to surgical theatre gowns, one per patient interaction is to be changed to one per four hours. Do you see that?
Sir Christopher Wormald: Yes.
Ms Campbell KC: Were, so far as you know, ministers told that PPE, in order to prevent a crisis in availability, was going to have to be worn for longer and worn for multiple patient and colleague interactions in order to extend its usage?
Sir Christopher Wormald: Sorry, were ministers –
Ms Campbell KC: Yes. Yes. They were aware of that, is that right?
Sir Christopher Wormald: Yeah, I mean, this was – this was being widely debated, it was very high up our issues list, we were very worried about it, and I think … I’ll have to go away and check and give you the answer afterwards, but I think at this point ministers are holding several meetings a week on PPE, possibly daily. So I think they were very well sighted on these issues.
Ms Campbell KC: Were you aware whether the proposals made in this document were the result of any UK trials having been undertaken to test whether they were safe, both for patients and staff?
Sir Christopher Wormald: I couldn’t tell you. Now –
Ms Campbell: Well, those are all my questions. Thank you.
Lady Hallett: It’s not your fault, Ms Campbell, but we have another witness to get through this afternoon, so I’m sorry to interrupt you.
Mr Metzer.
Questions From Mr Metzer KC
Mr Metzer: My Lady, I have been asked and I have agreed to limit my questions further in light of the position today.
Sir Christopher, I ask some questions on behalf of the Long Covid groups.
On 7 July 2020, it was confirmed by email that the DHSC had planned to raise public awareness about the long-term effects of the Covid-19 but it was only on 21 October 2020 that the DHSC finally launched its one and only video on indiscriminate risk of Long Covid, which was directed at young people. Why was there a delay of over three months in publishing the single awareness-raising video on Long Covid?
Sir Christopher Wormald: I don’t know about the video, I can go and check, but there had been a lot of activity on Long Covid before that, going back to 5 June, when the NHS issued its first guidance on the aftercare needs of inpatients recovering from Covid-19 and then the Secretary of State holds a roundtable on Long Covid on 1 July. So we were well aware of the issue and I should say, as it hasn’t come up before, it’s a very serious issue that we take very seriously but, as I say, I don’t know about the video. I can find out but there was a lot of activity on Long Covid before the dates you’re describing.
Mr Metzer KC: Okay. Leave this video aside, there was no reason, was there, to delay the accompanying press release?
Sir Christopher Wormald: Again, I couldn’t tell you. I can find out.
Mr Metzer KC: Yes, please.
Do you agree that this one public health video over three years was insufficient to warn people, including parents, of both the symptoms of Long Covid and that Long Covid is caused from infection of Covid-19?
Sir Christopher Wormald: I think if the video had been the one thing that had happened, I would agree with you. But, as I’ve said, there was an awful lot of other activity on Long Covid from when it became apparent after the first wave that this was going to be an important thing for the country and for its sufferers. So, I mean, I’m terribly sorry, I can’t really focus on the video because I don’t actually –
Mr Metzer KC: I’ll ask you a more general question: do you agree overall that the information provided was insufficient to warn people, including parents, of two things: the symptoms of Long Covid and the cause, the fact that Long Covid is caused from infection by Covid-19?
Sir Christopher Wormald: No, I don’t. I mean, there are other witnesses from my department and related who your questions will be better answered than particularly the clinicians. My impression is that, actually, we and our colleagues in the NHS were very front footed about Long Covid, both in terms of its research and what we put in place around its treatment. I’m sure more is needed, as I say, this is a very significant thing, but I don’t, certainly from what I have seen, I haven’t seen either a lack of focus or a lack of action on this important issue.
Mr Metzer KC: Please can we put up INQ000061266, bottom of page 2, and the top of page 3, under item 5.
Eight months later, after the video, the DHSC convened the Long Covid oversight board with other government departments to co-ordinate the whole of government activity and policy development. We can see from these minutes of the first meeting in June 2021 that ES, who I am assuming is Ed Scully, raised concern that there was a gap on the broader government view of Long Covid and how that was being communicated.
Why at this point had the DHSC still not implemented a communications strategy for Long Covid?
Sir Christopher Wormald: I think, well, there was a lot of communication about Long Covid, I think the point – and I think you’re correct that it’s Ed Scully – I think the point he’s making here is about the cross-government nature of the communications, as opposed to that done directly by the NHS, I think that’s the point. I mean, again, I’m sorry, I don’t know the story of this in the detail that your questions require, so again, on some of these I’ll take your questions away and come back, if that’s okay, with a more detailed and more expert answer.
Mr Metzer KC: You certainly agree that the DHSC hadn’t implemented a communications strategy by that point?
Sir Christopher Wormald: Well, as I say, I think what Ed is talking about, but I need to go away and check, is about the cross-government wider implications, I mean, my understanding is there was a lot of communication being done by the NHS, as it were, on the straight clinical issues, in the way that we do for all conditions. I think he’s making a point about the wider government but, as I say, I’ll check and give you a better informed answer than I can give today.
Mr Metzer KC: Thank you.
Do you know whether the discussions of the Long Covid oversight board fed into Cabinet Office messaging on Long Covid?
Sir Christopher Wormald: I don’t know, off the top of my head, I know that my ministers, and particularly, at this point, I think it was Lord Bethell, took a very keen interest in Long Covid so I know it was a very important thing within the department, with a lot of escalation, and obviously the NHS, as I’m sure you know, have done an awful lot in this area. I couldn’t tell you what was put to Cabinet Office.
Mr Metzer KC: All right. Do you know whether there was a Cabinet Office strategy on public messaging of the risk of developing Long Covid from Covid-19 infections, either in June 2021 or at any time since?
Sir Christopher Wormald: Again, I don’t know, but I’ll find out.
Mr Metzer KC: Okay, thank you.
You’ve said in your evidence today that advice to the public on how to behave are non-pharmaceutical interventions designed to stop the spread of the virus. Do you agree that the public had the right to know about the risk of Long Covid so they could protect themselves from it?
Sir Christopher Wormald: Yes, and I think whatever we knew and the NHS knew about Long Covid was put into the public domain. I don’t think there’s a point when we have information that we don’t share. Again, I’ll have to go and check with my experts on this, and confirm, but I’m not aware there was ever a delay in, as it were, our scientists knowing something about Long Covid and that being made public, but, once again, I’ll have to check.
Mr Metzer KC: Thank you. On 5 June 2020 –
Lady Hallett: Sorry, Mr Metzer, but I’m afraid – I think if you’ve got questions, it sounds as if this witness can’t really answer them and that he could put them into writing.
Sir Christopher Wormald: Yes, if you would like to write I’d be absolutely delighted to get somebody much more expert than me to …
Mr Metzer: My Lady, I –
Lady Hallett: Make this the last one, Mr Metzer.
And anything else we’ll put into writing, all right?
Mr Metzer: Thank you very much, my Lady.
On 5 June 2020 – I’ll say it as speedily as I can – the DHSC identified longer term sequelae of Covid-19 as one of four major implications for the health and care system in a presentation. I’m not going to cite it, you probably know it. Despite the DHSC’s concern about this, you say in your witness statements that you can’t recall that the risk of Long Covid was taken into account for decisions taken in relation to the second and third lockdowns. Thank you.
Sir Christopher Wormald: Yes, that’s factually true. I don’t think those lockdown decisions – I think they were taken on the basis of the hospitalisation rate, the spread of the disease and the likely death rate, I think those were the three big conversations. Now, I should emphasise that that doesn’t mean that Long Covid was not being taken seriously. It’s just in the context of, as it were, the very extreme measure that a national lockdown is. I don’t think that Long Covid was one of the considerations. It was certainly important to the government but I don’t, as far as I know, the decision-makers were not doing it on that basis.
Mr Metzer KC: I’m going to reduce the question still further, and we will probably do a fuller request in writing, thank you.
Do you agree that there was a difference in approach to Long Covid between the DHSC and Cabinet Office?
Sir Christopher Wormald: I’ll check, I’m not aware that there was. You would expect the Department of Health and the NHS to have a focus on a medical condition that was much greater than that of Cabinet Office with all its responsibilities. I don’t think you would expect much more from us than them. I don’t think – I’m not aware that there was ever a disagreement between us and them on this subject.
Mr Metzer: All right. So final question –
Lady Hallett: We’ll leave it there, Mr Metzer, I’m sorry.
Mr Metzer: Thank you, my Lady.
Lady Hallett: Anything else will have to be in writing.
Mr Dayle, I’m afraid I’m going to have to be very strict with you as well, and then Mr Menon, because we have another entire witness to go.
Mr Dayle.
Questions From Mr Dayle
Mr Dayle: Thank you, my Lady.
Sir Christopher, I ask questions on behalf of FEHMO, that’s the Federation of Ethnic Minority Healthcare Organisations, and I have three hopefully very brief topics that I wish to deal with with you.
Firstly, were there specific considerations or actions targeted interventions, if you will, that were pursued to identify and address the additional support needs of black, Asian and minority ethnic healthcare workers during the pandemic?
Sir Christopher Wormald: Yes. Yes, there were. I do think this is an area where we learned a lot and ramped up our activity accordingly. The two biggest things I would point you to is the CMO and SAGE commissioned PHE study done by Professor Fenton and others in April 2020, specifically on these issues, and then the development of the QCovid tool, commissioned in May 2020, that was trying to take a much more individualised approach to assessing people’s risks, including not just their clinical risks but their socioeconomic risks as well.
I think those were probably – certainly in the early stages, those are probably the two biggest things I would point you to.
Mr Dayle: Second topic, how did the DHSC respond to the concerns and experiences of black, Asian and minority ethnic healthcare workers regarding PPE and the recommendations issued by the Public Accounts Committee on February – in February 2021, which included “improving understanding of the experience of frontline staff, particularly focusing on those from different ethnic backgrounds”?
Sir Christopher Wormald: I’ll have to check what exactly we did – yes, I’m talking the wrong way, sorry. I’ll have to check exactly what we did with that specific recommendation. We report to the PAC on their recommendations quite regularly so there will be a published report of what we did with that specific recommendation. On the general, and I think we’ve set this out in our witness statements, so I won’t repeat, there was a basically escalating action to deal with the very important issues that you raise, and certainly my understanding is we moved from a position where we had not very much understanding of these important issues to having a much greater understanding and that significant action was taken.
Mr Dayle: Thank you.
My third and final topic, this question arises from WhatsApp messages between yourself and Lord Mark Sedwill on 25 March 2020 regarding PPE, and the reference – and it’s not necessary to bring it up – is INQ000279918. In that exchange, Lord Sedwill writes at 5.31:
“Stories like this in The Telegraph likely to come up. Nurses in near revolt as some used bin liners to protect themselves.”
My question is: from your vantage point, what would you say was done to ensure that PPE provided was suitable to fit and properly protect all staff, including black, Asian and minority ethnic healthcare workers?
Sir Christopher Wormald: Well, that is a huge question that would require a very, very detailed answer. And I think, as we’d said earlier, there’s an entire module on procurement, including PPE, and I think it would probably – I think the substantialness of that question demands more than a sort of few seconds answer, so I think it would probably be better, if that’s okay, to answer that question in the module that’s devoted to it.
Lady Hallett: We’ll have to come back to it, Mr Dayle, sorry.
Mr Dayle: Very well.
Lady Hallett: Thank you.
Mr Menon?
Mr Menon: Having listened to the evidence of Sir Christopher today and reflected further, we have no questions.
Lady Hallett: Thank you, Mr Menon.
Mr Menon: We aim to please, my Lady, we aim to please.
Lady Hallett: I think you’ve just made yourself one of the most popular people in the room, Mr Menon!
I’m really sorry that we’ve had to cut people short and I know that Mr Metzer wanted to ask more questions but I’m sure we can get the answers that you seek, even if – maybe if at another stage we could read them out, if we get them, if that helps, Mr Metzer.
So thank you very much, Sir Christopher, I feel, as you’ve envisaged, that this isn’t the last time that we shall meet.
The Witness: I suspect not.
Lady Hallett: So thank you.
I’m now going to keep quiet, everybody else is going to keep quiet while we do the handover for the next witness, so the stenographer can rest her fingers.
(The witness withdrew)
Lady Hallett: Yes.