3. Professor Andrew Morris

PROFESSOR ANDREW MORRIS (sworn).

(Evidence via videolink)

Questions From Lead Counsel to the Inquiry for Module 2A

Lady Hallett: Professor Morris, I’m really sorry to hear that you’ve got Covid, and I imagine how you might be feeling. So we’re going to take breaks that you’ve asked for, but please just say if you find that your brain is getting fuddled, because obviously we don’t want to make your condition any worse. So you’re in control, okay, just tell me when you need a break.

The Witness: Thank you, my Lady.

Lady Hallett: We will be taking breaks, if you don’t tell us, but just tell me if you need any extra ones.

The Witness: That’s kind, thank you.

Lady Hallett: Mr Dawson.

Mr Dawson: Thank you, my Lady.

Can you hear me okay, Professor?

Professor Andrew Morris: Perfectly.

Lead 2A: Thank you very much. If you have any difficulties with hearing me or documents, please feel free to say so, and we’ll do the best we can to get through the evidence.

You’ve provided a number of witness statements to the Inquiry. The first statement is dated 14 November 2023. INQ000346264 should come up on the screen in front of you.

Professor Andrew Morris: I can see that.

Lead 2A: That is your witness statement?

Professor Andrew Morris: That is correct.

Lead 2A: And as far as you are concerned, do the contents of that witness statement remain true and accurate as of today’s date?

Professor Andrew Morris: They do.

Lead 2A: You also provided a questionnaire response dated 17 October 2022 under reference INQ000056491. Is that your questionnaire response dated that date?

Professor Andrew Morris: It is.

Lead 2A: Do the contents of that document remain true and accurate as far as you’re concerned at this date?

Professor Andrew Morris: They do.

Lead 2A: You also helpfully provided us with a Scottish Government corporate statement in your capacity as the chair of the Scottish Government Covid Advisory Group dated 23 June 2023, under INQ000215468. Is that your statement in that capacity?

Professor Andrew Morris: It is.

Lead 2A: Do the contents of that statement remain true and accurate as of today’s date?

Professor Andrew Morris: They do.

Lead 2A: I’d just like to run through some brief details of your history, Professor. You are a medical doctor?

Professor Andrew Morris: I am.

Lead 2A: You graduated from Glasgow University in 1987 and pursued a career in hospital medicine as a physician, initially in Scotland and then in Cornwall; is that correct?

Professor Andrew Morris: Correct.

Lead 2A: Later you moved to – you trained in diabetes and endocrinology as well as clinical pharmacology as a university clinical academic; is that right?

Professor Andrew Morris: That’s correct.

Lead 2A: And you were initially affiliated with the University of Glasgow between 1990 and 1994?

Professor Andrew Morris: That is correct.

Lead 2A: Then the University of Dundee between 1994 and 2014?

Professor Andrew Morris: That is correct.

Lead 2A: And while at Dundee you were appointed as a consultant physician in NHS Tayside in 1996 as professor of medicine in 2004 and, latterly, the dean of the medical school at the University of Dundee in 2012, is that –

Professor Andrew Morris: That is correct.

Lead 2A: In 2014 you moved to the University of Edinburgh as professor of medicine and vice principal data science, and as an honorary consultant physician in NHS Lothian; is that correct?

Professor Andrew Morris: That’s correct.

Lead 2A: Is it correct to say, Professor, that your main area of research has been in health data research since 1996?

Professor Andrew Morris: That’s correct.

Lead 2A: I understand that initially in the field of diabetes you built multi-professional teams who used information technology and data science, and that perhaps in subsequent years your interest in data science has widened out to – broadly across different NHS fields; is that right?

Professor Andrew Morris: That is correct.

Lead 2A: I understand that you were seconded to the Scottish Government as Chief Scientist (Health), a post about which we have already heard some evidence, three days a week between the years of 2012 and 2017?

Professor Andrew Morris: That’s correct.

Lead 2A: In that post, you tell us in your statement that you led programmes that used data in a trustworthy way for the 5.2 million citizens of Scotland. I wonder if you could tell us a little bit more about your work relating to data in that position.

Professor Andrew Morris: If one looks at the best health performing – best performing health systems internationally, they are characterised by whole-system intelligence, the ability to use data to optimise care, to improve public health, to manage the health service, to augment clinical trials, and also to perform new innovative research such as artificial intelligence.

This requires seeing data as infrastructure. In my role as Chief Scientist I worked with partners across Scotland to develop reliable and trustworthy data infrastructures to enable research at scale on up to 5.2 million people.

Lead 2A: Thank you.

When you left that role, having worked on projects relating to data in 2017, can you tell us whether you consider there to be issues, in a broad sense, with the way in which data was accessible relating to health matters in Scotland, and if so what your understanding was of how those issues were being addressed?

Professor Andrew Morris: We made good progress in Scotland in many respects, and that was through collaboration and partnership between policymakers, NHS, academia, and, most importantly, the publics. And that allowed us to create systems of what I call whole-system intelligence.

So we had made good progress in how we collect data, manage it, share it, link it, access and analyse it, and that was used not only for patient care but, importantly, for biomedical research.

However, in my view, we were still in the foothills of where we needed to be, so that those data could be used in a far more agile and real-time way to derive new research insights which could improve people’s lives. And I think this was demonstrated – this was demonstrated at the start of the pandemic: the need to have this data as infrastructure to create new insights so that information that was useful to policymakers and system leaders could readily be available.

Lead 2A: By the time the pandemic started, did these issues, with regard to the ability to be able to use data in an agile and real-time way, still exist in Scotland?

Professor Andrew Morris: There, there – I think in the pandemic we saw in Scotland examples of outstanding international practice, but there were still issues in terms of the engineering of the infrastructure.

If I may use EAVE II, of which the Inquiry has heard a lot about, EAVE II was a partnership between the University of Edinburgh and Public Health Scotland, led by my colleague Professor Sir Aziz Sheikh, and that derived whole-system intelligence that linked primary care data, vaccination data, antigen status data, hospitalisation and death data, in near real time. And it created new knowledge which had influence internationally on pandemic response.

However, to mobilise EAVE II took from 20 March 2020 to 6 August 2020. That was 137 days. And that was because there were 21 requests for approval required to actually mobilise the data and enable its access for subsequent analysis. So huge potential, but blockages in how, in a trustworthy way, with public engagement, we can use data at scale, essential for the pandemic response.

Lead 2A: If, as I think you are, Professor, you are characterising that period between March and August 2020 as a delay, who was responsible for the delay in allowing access to the EAVE II scientists to that data?

Professor Andrew Morris: So we have governance processes in place, which are right and proper, which review access requests for data. In this circumstance, because the governance processes are fragmented and data is controlled by multiple bodies across any UK health ecosystem, individual approvals had to be made to, I think it was, 21 NHS bodies.

Lead 2A: And that process limited the agility, to use your word, in accessing the data which was necessary for this important work?

Professor Andrew Morris: Correct.

Lead 2A: Could I just be clear with you, Professor, that when you talk about accessibility of data in this regard, are you limiting your comments to the accessibility of data to academic researchers whose work would assist and augment government response, or are there more general data collection and accessibility issues that apply to everyone, including those decision-makers themselves?

Professor Andrew Morris: I think these are generic issues. However, there is a greater emphasis for access to data for so-called secondary purposes, of which research is a criterion.

Lead 2A: But that research could and did assist with the efficacy of government response in Scotland, and indeed the wider UK, when such access was made available through, in particular, EAVE II; is that correct?

Professor Andrew Morris: That is correct. Though –

Lead 2A: The – sorry.

Professor Andrew Morris: I would suggest what we saw in the pandemic was a unique alignment between policymakers, academics, the NHS and the public, and the very close collaboration and partnership working was essential if we were to understand this new and imperfectly understood virus. And the academic and scientific response was absolutely vital for the policy response.

Lead 2A: Is it your position, therefore, that the alignment between these various sectors of the response would have been achieved better had important data been available to that important research at an earlier stage?

Professor Andrew Morris: I concur.

Lead 2A: Thank you.

Since 2017, I understand that you have been seconded part-time to be the inaugural director of Health Data Research UK, the national institute of health data science. I wonder if you could explain for us, please, what role Health Data Research UK played in the pandemic response?

Professor Andrew Morris: Health Data Research UK is one of the medical research councils, five national institutes. It’s a slightly unusual institute in that we have nine funders from across the UK, including major charities like Cancer Research UK, British Heart Foundation, plus the health departments in the four nations. Its mission is to unite the UK’s health data to enable discoveries that improve people’s lives, in anticipation of the need for research and insight to support health system development, design and productivity.

At the start of the pandemic, HDR UK was a young organisation, only 18 months old, but it’s – as a group, because we work in collaboration with over 100 UK organisations, including 38 universities, was that there was a need to sort the data that was relevant to the pandemic.

So the three things we did were firstly to map the data, which included testing, surveillance, healthcare, mortality, non-health data and vaccination data; secondly, to convene the community to encourage collaboration, so that vital research questions relevant to the pandemic response could be answered, for example vaccine safety, efficacy, the effects of the virus on different population groups; and, lastly, we prioritised research questions to try to answer those questions as soon as possible.

We were invited by SAGE to present twice on this strategy for health data infrastructure, and the outputs were over 330 projects, with 230 scientific publications relevant to the pandemic in the UK and internationally.

So we were a convener to try to work with bodies to sort the data across the UK, working in partnership with NHS, academic and other bodies.

Lead 2A: Thank you very much, Professor.

You were a member, as I understand it, of SAGE, which you’ve just mentioned. Is that correct?

Professor Andrew Morris: That is correct, yes.

Lead 2A: And you were in attendance at early meetings of SAGE relating to the pandemic response?

Professor Andrew Morris: My first attendance at SAGE was on 26 March 2020, as I recall.

Lead 2A: Yes. That was in the capacity, I think, as the newly appointed chairman of the Scottish Government’s Covid Advisory Group; is that right?

Professor Andrew Morris: That is correct.

Lead 2A: As far as you were concerned, we’ve heard some evidence about this already, but at the time when the Scottish group was created, was it expressed to you, either by the Chief Medical Officer of the time, members of both groups, that there was a level of dissatisfaction about the extent of Scottish contribution, if one can put it that way, to the business of SAGE and its subgroups, including NERVTAG, up to that point?

Professor Andrew Morris: Those were observations that were relayed to me, yes.

Lead 2A: What was the nature of those observations? What were the difficulties that had been experienced up to that point?

Professor Andrew Morris: I think my understanding that early on, January and February, Scottish colleagues were observers on some of these groups, and a need was identified to enable Scottish policymakers and ministers to have more direct access to expert scientific advice.

Lead 2A: The ministers presumably felt that they had had inadequate access to that advice, although of course there was very considerable expertise on SAGE and its subgroups; is that a fair reflection of the position?

Professor Andrew Morris: I think that is a fair reflection. The expertise and quality of discussion on SAGE and its subgroups were, to my mind, excellent.

Lead 2A: I’d like to ask you some questions about the circumstances in which the Scottish Covid Advisory Group came to be put together, and a number of questions about the way in which it operated. But just in terms of trying to understand the way in which it was envisaged that it would work alongside the work of SAGE, we’ve seen some evidence of there being some level of reciprocity agreement and some evidence to the effect that the Scottish Covid Advisory Group would continue to consider materials which were made available to it through SAGE, and indeed SAGE’s advice. Both as regards the intention at the start and regards the practice of the Scottish group, how did its role sit alongside the SAGE infrastructure, including the SAGE subgroups?

Professor Andrew Morris: When I was appointed to chair the Scottish Government advisory group, one of the very first discussions I had was with Sir Patrick Vallance, because to my mind it was absolutely essential that the work of the Scottish group was complementary and completely integrated with SAGE. Although health is a devolved issue in the UK, and many scientific issues are reserved, science is global. So it was absolutely vital that the Scottish group interpreted SAGE outputs in the context of Scotland.

And in practice I think that’s how it worked. At every meeting of the Scottish group we would review SAGE papers, and indeed all members of the Scottish group had access to the SAGE paper repository, and vice versa.

Lead 2A: The Inquiry heard evidence in its Module 2 from witnesses including a political expert called Professor Ailsa Henderson that there were limitations as far as Scotland was concerned on the advice that SAGE could provide, given that it was – its advice was based predominantly on data which was derived from England. Did this continue to be the position as regards SAGE and its subgroups in the period after the Scottish Covid Advisory Group was set up, and if so to what extent did this reinterpretation of SAGE’s position require looking at different datasets from Scotland?

Professor Andrew Morris: My observation was that from March 26th the relationship between SAGE and Scottish participants was excellent. I was a full participant, as was Gregor Smith, Nicola Steedman, and other witnesses you’ve heard from, including Jim McMenamin and Mark Woolhouse, who you will hear from, had prominent roles in SAGE subgroups. What I also observed was there was an increasing reciprocity (inaudible) data, and I think you heard from Audrey MacDougall, who ran the Covid analytical unit within Scottish Government, and Roger Halliday, and in terms of modelling there was a sharing of methodology and the application of SAGE methods to Scottish data.

So I think we saw a gradual yet constant improvement in that scientific partnership.

Lead 2A: Thank you.

You mentioned earlier the conversation you had with Patrick Vallance at around the time of your appointment, and your desire, and I think his, to try to make sure that these groups would be aligned. Broadly speaking, do you think that that was achieved?

Professor Andrew Morris: I – my view is that that was achieved, and we saw contributions from Scottish colleagues into SAGE papers, which emphasises that alignment.

Lead 2A: Structurally speaking, it seemed to us that the Scottish group had certain components which were equivalent to elements of the SAGE system looked at broadly, but perhaps those components weren’t as prominent or as significant.

There were subcommittees of SAGE, including NERVTAG, for example, the New and Emerging Respiratory Virus Threats Advisory Group. Was there an equivalent contributor or body to NERVTAG in the Scottish advisory system?

Professor Andrew Morris: There was not an equivalent subgroup in the Scottish advisory system, but Dr McMenamin was a member of NERVTAG and was able to feed in latest advice and evidence from NERVTAG into the Scottish group. So it wasn’t a complete mirroring of the SAGE system and its subgroups, and actually I don’t think that would have been appropriate.

Lead 2A: In that regard, however, would you consider that the important advice provided by NERVTAG was able to be fed into the Scottish group through Dr McMenamin and the access to papers of that group?

Professor Andrew Morris: I would suggest that is correct, yes.

Lead 2A: There were, of course, other subgroups, including SPI-M and SPI-B, and as you’ve said already there were members of the Scottish group who sat on those groups. Is it correct also to say that the Scottish system didn’t have its own subgroups dealing with modelling and behavioural science in the same way, but achieved inputs through individual contributions, particularly from the likes of Professor Woolhouse in the first case and Professor Reicher in the second?

Professor Andrew Morris: That is correct, and Professor Robertson was also a member of SPI-M.

Lead 2A: Yes, so he was another one of the ones who sat across the two groups.

SPI-M were involved in, I think, the creation and interpretation of modelling. Modelling, I think, in the Scottish system, as we’ve heard from Audrey MacDougall, was done within a unit within the Scottish Government; is that correct?

Professor Andrew Morris: That is correct.

Lead 2A: Do I understand it correctly that if, in its deliberations and in the provision of advice, the Scottish group required access to modelling, that it could access modelling facilities, if that’s the right phrase, through this facility within the Scottish Government?

Professor Andrew Morris: That is correct.

Lead 2A: Were there any limitations or difficulties with regard to the accessibility of modelling in the Scottish system?

Professor Andrew Morris: Not – my view is that there were no limitations. The expertise and the work ethic of the analytical unit was exemplary.

Lead 2A: Thank you.

As regards the way in which modelling was used in particular, as we’re interested in this particular module, to inform advice and ultimately key decision-making, could I look at your personal statement, please, up on the screen, paragraph 176.

(Pause)

Lead 2A: It should come up on the screen in a moment.

(Pause)

Lead 2A: What you say there relates to the modelling. You say, Professor:

“A key policy challenge we observed was how to communicate uncertainty in exchanges between modellers and politicians – not only the uncertainty within the models but also the uncertainty of modelling itself. The C-19AG [the group] therefore attempted to convey this uncertainty through illustrating a range of outcomes and probabilities. This cut across normal advice to Government where a single best prediction is often preferred.”

So you’re highlighting here, I think, through experience of the group, that there were difficulties in conveying not only the uncertainty of models but within the models that you were actually looking at but also the uncertainty in more general terms of modelling itself, and you came up with this solution.

In this regard, and in light of evidence we’ve heard that, broadly speaking, modelling was an important part of advisory systems in the pandemic for government decision-making, did you have the impression, did you have any basis upon which to form an impression, as to whether your efforts to try to convey the limitations of modelling and of models had adequately penetrated the thinking of key decision-makers?

Professor Andrew Morris: You should obviously ask that question of the key decision-makers. I think a principle of the group which I reinforced regularly was the need for clear communication of the knowns and unknowns, and to recognise the limitation of science, including modelling. And most importantly that the group should expect to inform policy and not make policy.

Therefore, communicating uncertainty was a key role of the group, of which modelling was one output.

Lead 2A: I think in your answer, if I understand you correctly, Professor, you’re emphasising, I think, the second part of the – that part of the sentence where you’re talking about the uncertainty of modelling itself. What was the uncertainty, what do you mean by distinguishing the uncertainty within the models? What caused that difficulty?

Professor Andrew Morris: Well, the modus operandi of SPI-M is to work with, I think it’s up to 14 groups across the UK who model, and they model independently. But the next step is key: they compare models and they compare the outputs of the models to reach a consensus statement, based upon the modelling that has been – the modelling outputs that has been accrued. And I think that’s what I’m saying in the first part of the statement.

Lead 2A: When you talk about these difficulties with the models, you’ve referred that specifically to the models provided through SAGE, but, as you’ve told us a moment ago, the analytical hub also provided models for Scotland, is that right?

Professor Andrew Morris: That is correct, yes.

Lead 2A: Your job, I think, was to try to provide an interpretation of all of that modelling that was available through SPI-M and through the Covid analytical hub in Scotland in order to try to provide advice to the Scottish ministers about your views about matters which would assist them in decision-making; is that broadly the process?

Professor Andrew Morris: The responsibility for modelling lay within the analytical hub. However, on presentation of the outputs, there was – there was often the presentation of not only the Scottish outputs but also comparator SPI-M outputs.

Lead 2A: So the analysis, if you like, of the modelling which you did was predominantly related to the Scottish-produced models, but you would refer to SAGE models to assist your analysis and interpretation; would that broadly have been the approach?

Professor Andrew Morris: That is a fair representation.

Lead 2A: Because – sorry.

Professor Andrew Morris: Bearing in mind we had the expertise of people such as Professor Robertson, Professor Woolhouse, who are very expert modellers in their own right, and sat on SPI-M.

Lead 2A: Thank you. Because if one were to have relied only on the modelling from SAGE, that would run the risk of falling into a similar problem that I think you have given evidence you understood to be in existence before the Scottish group was created, such that one would be looking at models based on English data, which might not be applicable to Scotland; is that fair?

Professor Andrew Morris: That is fair.

Lead 2A: Thank you very much.

I’d just like to ask you some questions broadly about the circumstance in which you were invited to become the chair of the group in March 2020 and the group came together.

We learned from your statement at paragraph 19 that you were telephoned by the Chief Medical Officer, Dr Calderwood, on 16 March and she asked you to act as independent chair.

Had you worked with Dr Calderwood before, in your government role, perhaps?

Professor Andrew Morris: I was Chief Scientist health in Scotland until 2017. I think I worked with Dr Calderwood in her role as Chief Medical Officer for the last 18 months of my tenure.

Lead 2A: Thank you.

Did you have the impression that the formation of the Scottish Covid Advisory Group, or were you given this impression by Dr Calderwood, that was part of a strategy on the part of the Scottish Government to try to take a more autonomous approach to the management of the pandemic?

Professor Andrew Morris: That was not an observation that I made.

Lead 2A: What information were you given at the time the group was formed about the Scottish Government’s policies with regard to its strategy as to how the pandemic was to be managed?

Professor Andrew Morris: At the time it was formed, we – please repeat the question. Are you interested –

Lead 2A: Yes, I was interested to know whether you were given information about the Scottish Government’s strategies with regard to the management of the pandemic in around the middle of March when you were first contacted by Dr Calderwood?

Professor Andrew Morris: So I was not – at the time of 26 March I was not given personally any information, but that position changed rapidly during April 2020.

Lead 2A: So I’m really just interested in understanding the extent to which the strategy at that time was made clear to you and the members, which would be a matter, I would imagine, that would be of assistance in you understanding as to how that strategy should develop.

Professor Andrew Morris: I … my sense is that strategy was emergent and became more clear in the first two weeks of April 2020.

Lead 2A: Did you understand in that period, as your understanding grew, what the Scottish Government’s policies as regards its exit strategy from the lockdown was?

Professor Andrew Morris: The group was asked to comment on the lockdown review framework on 12 April 2020, and at that time the group provided advice on to how long the lockdown should be maintained, or whether it should not be maintained beyond 12 April. So we were aware of the policy objectives at that time.

Lead 2A: What awareness did you have of the Scottish Government’s exit strategy from the lockdown? By which I mean a broad exit strategy, for example “We continue with a lockdown until we get a vaccine” or something of that nature, or what was your understanding of the plan?

Professor Andrew Morris: The … what I may do is ask for a break in two or three minutes, if that’s okay?

Mr Dawson: Absolutely.

Lady Hallett: I wondered whether you were getting a bit – would you like to break now? And Mr Dawson will repeat the question when we come back.

Mr Dawson: Of course.

Professor Andrew Morris: I would like to get a glass of water, if that’s …

Lady Hallett: Yes, I think I share that feeling at the moment. We will break for five minutes, if that’s okay? I gather the plan is that I leave but everybody else stays rather than getting lost.

(3.44 pm)

(A short break)

(3.50 pm)

Lady Hallett: Mr Dawson.

Mr Dawson: Thank you, my Lady.

Professor, just before the short break, I was asking you in that early period as the group was coming together in late March, early April, what information was made available to you about the Scottish Government’s existing strategy to exit the lockdown.

Professor Andrew Morris: Yes. Okay, thank you.

In those early days, the group understood the strategy consisted of five things: firstly to suppress the virus through compliance with the physical distance and hygiene measures; secondly, to care for those who need it; thirdly, the need to support people, businesses and organisations affected by the crisis; and, lastly, to – a phrase I don’t like – recover to a new normal by carefully easing restrictions when safe to do so; and finally, to protect against this and future pandemics.

I think the development of a vaccine to achieve herd immunity was a medium to long-term strategy, so that was my understanding of the Scottish Government strategy.

Our group was request – was invited to provide comments on that, and we made comments and formal advice to the government on 14 April, which I can – you know, I can explain the group’s advice at that point, if that was helpful.

Lead 2A: If you could, that would be very helpful, thank you, Professor.

Professor Andrew Morris: Yes.

So at that time, we thought it was – there are four or five key components. We thought it was important to communicate to the publics that we would be living with this virus as best as possible and that elimination was not – not an option.

Secondly, we emphasised the importance of four nation working that ideally policy objectives across the four nations would be desirable.

Thirdly, the importance of practical guideline to support the public, so the behavioural science dimension, including the importance of explaining to the publics the collective nature of the pandemic response and that we should not squander the gains we’ve made in combatting the virus.

Lastly, we highlighted disadvantaged groups. Any new strategy needed to really think through the impact on disadvantaged groups or people from ethnic minority backgrounds or homeless people, or people with mental health problems, et cetera.

Lead 2A: Thank you very much, Professor.

As far as the disadvantaged groups that you’ve mentioned were concerned, what material were you given to suggest that an assessment of the likely harms to those disadvantaged groups had been undertaken by that point by the Scottish Government?

Professor Andrew Morris: I don’t think we were given any specific evidence at that time.

Lead 2A: What, at that time, and going forward in accordance with your group’s broad recommendation that disadvantaged groups needed to be considered, what information or data was made available to you in order to support your assessment of what the harms being caused to them were and how best those harms might be addressed in the strategy?

Professor Andrew Morris: The evidence was emergent over the course of the pandemic, and a key group which was discussed not only in the Scottish advisory group but also at SAGE was the impact, the disproportionate impact of the pandemic on ethnic minority groups.

And you may be aware – well, in Module 2 Professor Kamlesh Khunti was chair of the ethnic minority group at SAGE, and we advised in Scotland in June that a similar focus on the acquisition of data to really define the differential impact of Covid on ethnic minority groups was essential.

Lead 2A: So before that advice was tendered in June, that data wasn’t sufficiently available; is that correct?

Professor Andrew Morris: I – I think it was in the process of being accrued, but even today we do not have sufficient efficient capability and ability to differentiate the impact of Covid on specific – specific groups.

Lead 2A: And did that data subsequently become available to the group after the recommendation in June, given your observation that it is still not available to the level you would have expected?

Professor Andrew Morris: Increasingly so. The Scottish Government established a – it was not related to the Covid-19 group, but an expert reference group on Covid-19 and ethnicity, and that group had the responsibility to look at systematic issues and data issues in relation to Covid in Scotland. It was our recommendation that this was a priority. We didn’t execute the work ourselves.

Lead 2A: The reason I ask it in that particular field, Professor, is that we are in possession of some evidence from a group, a black and ethnic minority support group in Scotland, BEMIS, who tell us that one of the very problems with that ethnicity subgroup was that the data was not available to be able to demonstrate the particular effects of the pandemic and its response on those groups, such that they required to plead their case anecdotally. Is this a phenomenon that you would recognise?

Professor Andrew Morris: So I – I’m aware of that comment, and it is – it is something that I recognise, yes. And it was actually highlighted by Professor Khunti in his SAGE subgroup.

Lead 2A: Indeed.

Professor Andrew Morris: Simple things around coding of ethnicity in many ways are at too high a level to be able to make meaningful conclusions.

Lead 2A: I think the broad suggestion was that there were a number of ethnic groups that were grouped together in Professor Khunti’s work, such that the right response for different ethnic groups was not able to be reached because the data was too broad. Was that roughly the thrust of it?

Professor Andrew Morris: Correct, insufficiently granular.

Lead 2A: Thank you. And of course it would be important, as regards ethnicity, that Scotland’s particular circumstances be reflected in local data, because the make-up of ethnic groups in Scotland is different from England and the rest of the UK; isn’t that correct?

Professor Andrew Morris: That is correct.

Lead 2A: To broaden out the discussion here into areas beyond simply ethnic minorities to other – the phrase you’ve used is disadvantaged groups, would you say that this phenomenon, that we’ve identified as there being a lack of sufficient data to allow a proper analysis of the impact of the virus and the response measures, applied to other groups that might be included in that broad umbrella? I’m thinking, for example, of disabled groups or other minorities.

Professor Andrew Morris: I think this is a broader problem, I agree.

Lead 2A: And so in the pandemic response, there was insufficient data to be able to provide proper assessments of the way in which these disadvantaged groups, as you put it, should be dealt with?

Professor Andrew Morris: That is correct, and that was a component of our advice on 14 April 2020, on the lockdown review.

Lead 2A: But did that continue to be an issue throughout the group’s continued involvement in the pandemic response?

Professor Andrew Morris: I think that is a fair reflection, yes.

Lead 2A: Thank you very much.

You’ve mentioned 14 April, there was another thing I think happened on that day, you’ll no doubt correct me if I’m wrong. We are aware that over the period before your group was put together one of the major issues which had affected Scotland was the number of people infected and who died in care homes, but also people who are cared for within their own home.

What was your understanding at the time the group was formed of the Scottish Government’s strategy to try to protect individual at risk in those groups, in particular in light of documents which were issued, guidance documents which had been issued by PHS in the preceding month?

Professor Andrew Morris: So your question is: what was our understanding of the Scottish Government’s strategy –

Lead 2A: Position at the beginning. And I’ll move on in a moment, I know that there was a deep dive meeting that took place in this area and I’d like to just discuss with you what your advice was as to how it should be developed. But your understanding of the position at the time when the group was coming together in early April?

Professor Andrew Morris: Our understanding was that there was an epidemic within an epidemic, and that there were major concerns about the impact of the pandemic on some of the highest risk individuals who are residing in care homes. Our understanding was that a Scottish Government nosocomial advisory group had been convened, under the leadership of Professor Jacqui Reilly, and that they were defining policy in relation to care homes.

Lead 2A: Right. I understand that a deep dive meeting led by the First Minister and the members of your group took place in relation to care homes on 14 April; is that correct?

Professor Andrew Morris: I think that’s correct, yes.

Lead 2A: If I could just take you to a document, we’ve struggled slightly to find minutes of that particular meeting or more detailed material, but if I could take you to a document which is INQ000214740, this is a document of the nature of which – of a nature that we’ve seen before. It’s called, in Scottish Government terms, a SGoRR sitrep which stands for the Scottish Government Resilience Room situation report.

Were documents – did you get access to documents like this on the group, or is this something that you don’t recognise?

Professor Andrew Morris: I do not recognise this specific document.

Lead 2A: Okay, but did documents of this nature, these situation reports, were they made available to the group or not generally?

Professor Andrew Morris: I think you will know we had 11 so-called deep dives with ministers. When papers were being prepared and generated by the group, we were given access to those papers, but I’m not familiar with this paper.

Lead 2A: No. Just to be clear, this is a paper which is generated not for your purposes or by you, it is dated the day after – you can see from the top right-hand corner – the meeting to which I referred. It is a document which contains a vast array of information that was presented to SGoRR, which you’ll be aware is part of the Scottish Government decision-making resilience structure. I simply wanted to take you to page 19, please.

Professor Andrew Morris: It’s coming up.

Lead 2A: Thank you very much. Excuse me just one second.

(Pause)

Lead 2A: You can see, I hope, Professor, there’s a big box in the middle which is called – entitled “What is being done” and a passage has come up which says:

“An FM-led deep dive on care homes was held [on] 14 April. An action plan is being drawn up urgently including the interim CMO letter to care homes, improved information flows, an enhanced focus on prevention and more support for care homes for example on staffing, PPE and testing.

“In discussions between FM, Cab sec and interim CMO, it has been agreed that while it may not be clinically required – for public confidence – we will move to a system where any symptomatic patient in a care home will be tested.”

We know that an announcement was made subsequently on 21 April that a number of different measures would be put in place with regard to care homes, including the requirement, for someone to be moved from a hospital to a care home, for them to have two negative tests and various other supervision requirements including an enhanced role for the Care Inspectorate.

Can you assist us, as we are somewhat short on precise information about the deep dive meeting; is this a deep dive meeting that took place with your group?

Professor Andrew Morris: I would – that’s the first time I have seen that document, so I cannot comment on that document.

Lead 2A: Of course. I’m simply asking – I’m trying to use this document to help you orientate in your memory as to whether – I don’t have any better documents to give you, I’m afraid, Professor. But I’m trying to work out whether a deep dive took place with your group on

Professor Andrew Morris: The first deep dive I was involved in was on 8 May, which was a contact tracing deep dive.

Lead 2A: Okay.

Professor Andrew Morris: So I did not participate. So that’s why I was looking slightly –

Lead 2A: Not at all. It’s a mystery we’re trying to solve ourselves, Professor, so thank you for your assistance. We’ll move on, then, if that’s not a matter with which you can help us.

Again asking you a question about the period when the group was being put together, what was your understanding of the Scottish Government’s strategy at that time with regard to the management of a possible second wave of the virus?

Professor Andrew Morris: (Pause). My … my understanding was the Scottish Government’s strategy was: to break chains of transmission through test, trace, isolate and support policy; secondly, to protect healthcare workers and continue to manage the epidemic within care homes; thirdly, to enhance constant surveillance and population and sharing of data in real time; continue with the NPI measures and maintain clear and honest communications with the public, including transparency of risk level; and to use lockdowns sparingly. And the anticipation April to discuss care homes? was that the above strategies would buy time to enable the vaccine developments to achieve population immunity through vaccination.

Lead 2A: Thank you. Could I just ask you, there are a number of references in Scottish Government materials to the Covid Advisory Group, they tend to call it the “CMO advisory group”, and obviously as we know it was set up and you were appointed as chair by Dr Calderwood. What role did the CMO play in the meetings? In particular, what was the CMO’s role in understanding and discussing the advice of the group and then subsequently conveying it to ministers to assist in their decision-making?

Professor Andrew Morris: The group was established to report through the Chief Medical Officer to Scottish Government ministers and officials. The CMO himself, I think – I think Dr Calderwood attended three meetings of the group, and I think Professor Smith attended 32 meetings of the group, out of 60 in total.

There was always a member of the CMO’s office at every group meeting, for example a DCMO. Advice was always submitted through his office for further dissemination across Scottish Government.

Lead 2A: Thank you.

Professor Smith gave evidence to the Inquiry yesterday and he explained that the CMO’s role was as principal medical adviser and that in that role, while he held it, and in the role, as is the case with his predecessor, he provided direct advice to key decision-making ministers.

Does the fact that he failed to attend the third, fourth, fifth, sixth, seventh and eighth meeting of your group, should that be taken to indicate to us that he was insufficiently engaging with the expert advice of the group which had been formed by his predecessor?

Professor Andrew Morris: There are multiple demands on the CMO’s time. I endeavoured to ensure that any – following each meeting I would have verbal communication with the CMO to update him on the group’s current thinking and advice.

Lead 2A: The group contained a wide variety of experts in various different fields; isn’t that right?

Professor Andrew Morris: That is correct.

Lead 2A: And in order to engage with that expertise properly or appropriately, it would have been necessary for the CMO to have attended the meetings and listened to the views and expert opinions of that wide variety of experts, would it not?

Professor Andrew Morris: You could conclude that, yes.

Lead 2A: Thank you.

As far as the membership is concerned, we have a list of the members, and I’ve been helpfully provided with statements from the perspective of a number of the members. As regards the selection of the membership, was the membership selected by Dr Calderwood, by yourself, in consultation? What was the process that went into selecting the members of the group?

Professor Andrew Morris: A draft membership was compiled by a deputy director, Ms Naimh O’Connor, in discussion with the Chief Medical Officer and the Chief Scientific Adviser, who at that time was Professor Sheila Rowan. A draft list was then submitted to myself and the CMO and the Deputy CMO, Professor Smith, for comment.

I only made one addition, who was Professor – suggested addition, Professor Sir Aziz Sheikh, and I understand the CMO recommended Professor Devi Sridhar join the group, and the Deputy CMO recommended Dr McMenamin join the group.

Key was an interface with the Scottish science advisory committee, which was a standing – an established advisory structure in Scotland.

Lead 2A: Although there is a wide range of academic specialities represented – public health, epidemiology, microbiology, behavioural science, your own role in data, Professor Sheikh’s role in research, et cetera, including a number of representatives of key public health bodies and the medical advisers to the government – were there any other areas that you felt would be beneficial to have represented in your important work?

Professor Andrew Morris: My reflection is the group was well constituted, and was manageable in size. So I thought that in terms of the disciplines represented, it was good, but I always encouraged group members to look outwith their own speciality, and also outwith Scotland, so that we derive the best scientific evidence and information possible.

Lead 2A: The Inquiry has heard significant evidence that health pandemics can be expected to have a greater impact on those who suffer from pre-existing structural and health inequalities or the most vulnerable in society. Did you consider having members of the group whose expertise was predominantly in those areas and who may have been able to have provided a perspective, which the data perhaps could not, on the way in which the pandemic and its response would affect these groups?

Professor Andrew Morris: I think that is a very valid comment. Not specifically, but I would be confident that Professor Carol Tannahill, who at the time was Chief Social Policy Adviser, has a significant track record in inequalities.

Lead 2A: There was no independent representative outwith Scottish Government, however, who provided that expertise?

Professor Andrew Morris: That’s correct.

Lead 2A: You very helpfully tell us in your statement at paragraph 195 – I’ll just read the short passage out – that ideally the rapid assembly of the group would have been part of a mature and pre-existing advisory structures with deep integration across the four nations.

Are you reflecting in that, Professor, your view that it would have been better had a group of that nature existed before, as it takes time for a group performing such an important role to embed itself and therefore perform its function to an optimum level?

Professor Andrew Morris: I think that is a fair reflection, yes.

Lead 2A: Did you, at any time during the course of your important deliberations, have access to any information with regard to the position of patients or families of those who had been infected or who had died from Covid?

Professor Andrew Morris: We did not, we were constituted as a scientific advisory group.

Lead 2A: Would insight and access to such material have been of assistance to the group’s deliberations?

Professor Andrew Morris: I – I think it would, yes.

Lead 2A: Thank you.

Professor Andrew Morris: (inaudible) that we had frontline clinicians on the group who actually provided relevant commentary, expertise and relationships that were valuable in the group’s discussion.

Lead 2A: Those frontline clinicians, however, were not intensive care doctors or respiratory medicine specialists working at the coalface, if you like, of the response, were they?

Professor Andrew Morris: Tom was, yes, the …

Lead 2A: Tom Evans, perhaps, of the University of Glasgow?

Professor Andrew Morris: Yes.

Mr Dawson: Thank you. I think we’re due to take a short break now, Professor.

Lady Hallett: I just want to check, (a) would you like to have a break, Professor, and (b) if we have a break do you think you could survive another 25 minutes or so? Please be honest.

The Witness: I’m here to serve, so I’ll do my very best.

Lady Hallett: Thank you very much. Right, five minutes.

(4.18 pm)

(A short break)

(4.23 pm)

Lady Hallett: Mr Dawson, we’ll finish at 4.45, come what may; it’s not fair on the professor.

Mr Dawson: Absolutely.

I can assure you, Professor, not much further to go, just a few more questions. I’d just like to ask you some questions about some of the operational aspects of the group of which you were chair.

The first relates to the fact that we are aware that, in addition to the advice provided by your group, the Scottish Government received advice from numerous other groups on other policy areas relevant to the Covid response. This manifested itself perhaps most obviously in the period when – in the summer of 2020, when a number of groups were formed, including the group to which you have already made reference, the group dealing with matters pertaining to ethnicity, but also other groups which provided advice on other aspects of the pandemic and its effects, including economic and other groups.

Your group had a number of subgroups which looked at particular aspects of the area in which you had an interest. As far as the other – the groups from other spheres were concerned, would it be correct to understand that you, your group, did not have access to those groups either in the sense of their recommendations and input or, indeed, actual opportunity to discuss the broad response with those groups?

Professor Andrew Morris: That is correct.

Lead 2A: There has been some commentary, including from certain members of your group, that it might have been beneficial to be able to understand that, given the fact that the ultimate task of balancing the various harms – to put it in Scottish Government language – then fell to ministers which occurred outwith the presence, if I can put it that way, of these expert advisory groups which had been put together for the purpose.

Would it have been beneficial, do you think, to have had some level of access to what other groups were saying so as to be able to provide, from your group’s perspective, any input you felt you could to assist with the balancing of various and at times copious evidence received by Scottish Government decision-makers?

Professor Andrew Morris: I personally subscribe to co-ordination and connectivity of scientific advice. Our group was focused very much on trying to quantify and provide advice on the first two so-called harms. During a pandemic, it was also essential to try and quantify the impact on harms 3 and 4. So I think that convergence of advice givers would have been advantageous, yes.

Lead 2A: It’s quite clear to anyone wishing to look, Professor, that the group was an expertly constituted group for the purpose of contributing advice in respect of harm 1, namely the harm of the virus and its control. However, you mentioned also that it provided some element of role relating to harm 2, which you will recall related to non-Covid harms, health harms.

Was your group really in a position to be able to provide advice on that aspect of the pandemic, or would that more appropriately have come from other spheres?

Professor Andrew Morris: Partially. Partially. For example, in some of our advice to government in relation to relaxation of restrictions, we provided advice on opening up cancer and other services. So partially, but not predominantly.

Lead 2A: Thank you.

We discussed with Professor Sridhar earlier the period over which she provided advice, either through the group or more directly to decision-makers, and in her evidence she suggested that, given that her focus had been predominantly on harm 1 and an attempt, as you were, to try to minimise and lessen – lessen infection and minimise the harm of harm 1, that her predominant role in that regard she felt came to an end towards the end of 2020 and that the arrival of a vaccine started a different level of approach on the part of the Scottish Government.

It seemed to us that your group met frequently in the period up to May 2020, but started to meet much more infrequently as the pandemic progressed. By, I think, 2021 there were relatively infrequent meetings, other than in December 2021 where a few meetings were convened to discuss the Omicron threat.

Was it your impression that the influence or importance of your group waned in the period from the summer of 2020 onwards, despite the fact that the pandemic continued to rage in Scotland?

Professor Andrew Morris: That was not my observation. The group was constituted to serve the need of policymakers and ministers, and what I would propose is that the knowledge base and the learning and understanding of key components of the pandemic response was learnt within government and civil service departments. So it was a knowledge transfer, which in many ways is a good thing.

Lead 2A: Such that by the latter half, if one might put it, of the pandemic in Scotland, your group was no longer required; is that what you’re suggesting?

Professor Andrew Morris: No, I’m not suggesting that, but I – our advice was to provide expert advice independently to government, and the frequency of that advice did change over the course of the pandemic.

Lead 2A: Thank you.

As regards the way in which advice was commissioned, I think you tell us in your statement, helpfully, that sometimes advice was specifically requested on aspects of the pandemic, for example, as you’ve said, you gave advice in connection with the extension of the lockdown in early May of 2020, but at other times you suggest that advice was provided by SGCAG on its own initiative.

I wonder if you could help us with the relative balance between advice provided on request and advice provided on the initiative of the group, and in particular areas, if you can recall, where advice was provided in that latter category?

Professor Andrew Morris: So, the group provided 40 formal pieces of advice to government. I would suggest that at least 70% or 80% of those pieces of advice were commissioned. Examples where there was a spontaneous piece of advice would include, for example, the advice on black and minority ethnic groups which we touched upon earlier; secondly, a paper in August 2020 on risk and risk communication, because we thought that was a key facet for – of the pandemic which would be very helpful to policymakers; and, finally, a submission on testing very early in the pandemic.

So I think it was about 80% commissioned, but there were at least eight examples of advice where it was spontaneously generated by the group.

Lead 2A: Thank you very much.

I think in passing we mentioned earlier the period of the summer of 2020. There are a number of documents which deal with the issue of a subject we have an interest in, which is broadly defined under the banner of zero Covid for the possibility of eliminating the virus.

The group provided a number of papers and considered this issue in a number of places, including in an advice paper under the subtitle “Long term strategy” – which, for the purpose of the transcript, is INQ000217685 – where it said that:

“There is a need for greater overall clarity as to whether the approach that the government is pursuing is still one of containment or elimination. Clarity as to what extent our approach will continue to be broadly aligned with that being pursued by the UK Government is important as elimination would require UK-wide strict border controls (currently centred on self-quarantine). These would be needed for arrivals from every country with COVID-19 – likely to be a large number in the foreseeable future. The Group considers this cannot be a Scotland only aspiration, and that the aim is to suppress the virus to as low a level as possible.”

There are also some minutes from a meeting which took place on 13 April – which, again for the benefit of the record, is INQ000217503 – in which there is reference to there having been a minority view of the group that a zero Covid approach, the objective to eliminate the virus, not merely to suppress it, should be considered. It states that:

“However, a zero Covid strategy in Scotland was unlikely to have been sustainable because of essential travel to and from Scotland, consistently with the other paper.”

Can I take it, then, Professor, that the view of the group that a zero Covid strategy, defined in that way, was unattainable in Scotland given its circumstances?

Professor Andrew Morris: That is correct. I had the privilege of challenging – I had the privilege of convening a group with a great diversity of scientific viewpoints, and that is a good thing, when a new challenge arises. However, I think we’ve explicitly stated there that a minority view on the group was that zero Covid might be attainable. The majority view of the group was that maximal suppression was the only viable strategy.

Lead 2A: Do I take it that the minority view was represented by Professor Sridhar?

Professor Andrew Morris: I – you may. You may conclude that, yes.

Lead 2A: Yes, we’ve heard evidence from her just today about her views on that. I’m interested in knowing whether that minority was a minority of one or whether there were others who were of a similar view to her?

Professor Andrew Morris: From recollection, it was a minority – minority of one.

Lead 2A: Thank you.

Did you have direct access via messaging or emails or phone calls to ministers who made decisions about the pandemic, including the First Minister?

Professor Andrew Morris: Did you use the word “informal” there?

Lead 2A: I’m talking about any means by which – I’m using “informal” to try and include a number of different possible ways of communicating, but I wish to include phone calls, emails, text messages and the like.

Professor Andrew Morris: When we established this group, I was very keen to remind members that our job was to inform policy, not make it, and I was also very clear about how we should interact with colleagues.

So the five ways which the First Minister may have seen outputs of our group were: firstly, the response to commissioned advice; secondly, the advice on our own initiative; thirdly, the comments we made on policy documents before publication; fourthly, the deep dives, so I would have – I would chair the deep dive meetings with the First Minister and the Cabinet, I chaired 11 of those, of which the First Minister was present at nine; and lastly, I provided an informal SAGE update after each SAGE meeting. I had no other direct contact with any minister.

Lead 2A: Do I take it from what you said that you were keen to counsel members of the group that, in order to maintain independence, that those methods that you have mentioned should be the only means by which their advice be communicated to ministers?

Professor Andrew Morris: That was my recommendation. I remember at the first meeting of the group I suggested we should be useful rather than famous, because the blurring of science and policy can be unhelpful.

Lead 2A: Thank you.

Were you aware, while you chaired the group, of any of its members having any such direct communication routes to ministers?

Professor Andrew Morris: No, I was not.

Mr Dawson: Thank you.

My Lady, those are the questions which I have for the professor.

Lady Hallett: Thank you very much indeed.

Thank you so much, Professor. Thank you for all the work that you did, and your colleagues did, during the pandemic, and thank you for enabling us to stick to our timetable. I do hope you recover soon and you don’t suffer any long-term consequences.

Thank you very much indeed.

The Witness: Thank you, my Lady. Thank you.

(The witness withdrew)

Lady Hallett: Right. So it is 10 o’clock tomorrow?

Mr Dawson: Thank you, my Lady.

Lady Hallett: Thank you.

(4.40 pm)

(The hearing adjourned until 10 am on Wednesday, 24 January 2024)