2. Ms Jeane Freeman
MS JEANE FREEMAN (sworn).
Questions From Lead Counsel to the Inquiry for Module 2A
Lady Hallett: I hope we haven’t kept you waiting too long,
Ms Freeman.
The Witness: Not at all, my Lady.
Mr Dawson: You are Jeane Freeman?
Ms Jeane Freeman: I am.
Lead 2A: You have helpfully provided some statements to this module of the Inquiry, in particular a witness statement dated 16 November 2023 under reference INQ000273984. Is that your statement?
Ms Jeane Freeman: It is.
Lead 2A: Have you signed that statement?
Ms Jeane Freeman: I have.
Lead 2A: Do the contents of the statement remain true and accurate as far as you’re concerned?
Ms Jeane Freeman: They do.
Lead 2A: You have also provided a further witness statement to this module of the Inquiry which is dated 21 November 2023 under INQ000347982. Is that your further statement?
Ms Jeane Freeman: It is.
Lead 2A: Have you signed that statement?
Ms Jeane Freeman: Yes.
Lead 2A: And do the contents of that statement remain true and accurate as far as you’re concerned?
Ms Jeane Freeman: They do.
Lead 2A: You previously gave evidence to Module 1, as I understand?
Ms Jeane Freeman: I did.
Lead 2A: You’re currently the dean of strategic community engagement and economic development at the University of Glasgow?
Ms Jeane Freeman: I am.
Lead 2A: You’ve held that role since February 2022?
Ms Jeane Freeman: Yes.
Lead 2A: From June 2018 until May 2021 you head the post of Cabinet Secretary for Health and Sport within the Scottish Government?
Ms Jeane Freeman: I did.
Lead 2A: You left that role in May 2021, prior to the Scottish Parliamentary election in which you did not stand; is that correct?
Ms Jeane Freeman: That’s correct.
Lead 2A: Prior to holding that role, you were the minister for social security within the Scottish Government between 18 May 2016 and 26 June 2018?
Ms Jeane Freeman: I was.
Lead 2A: Your current post is a post in academia?
Ms Jeane Freeman: Yes.
Lead 2A: As Cabinet Secretary for Health and Sport, your responsibilities included the NHS and its performance, national clinical strategy, carers and adult care and support; is that correct?
Ms Jeane Freeman: That’s correct.
Lead 2A: Thank you.
I’d like to ask you some questions about your use of informal communications –
Ms Jeane Freeman: Yes.
Lead 2A: – during the course of the pandemic, and also your retention of them.
The Inquiry has seen on a number of occasions a table that was helpfully produced by the Scottish Government indicating the position with regard to usage and retention of a number of different things, including informal messaging. Now, this is dated from October of this year.
As at that time, the position communicated to us was that the Scottish Government, as it states there, understood that some WhatsApp and text messages had been retained and the Scottish Government was currently clarifying the volume but did not expect it to be large. They indicated that you had been part of a WhatsApp group of Cabinet secretaries for health of the four nations, to facilitate meeting running, and they confirmed to us that no other WhatsApp groups – that you had not been part of any other WhatsApp groups or other informal messaging with key decision-makers.
Now, obviously the position has moved on somewhat, we’ll get into that in a moment, but as at October of this year, was that the position that you held as communicated to us by the Scottish Government?
Ms Jeane Freeman: Yes, it was. I was always clear and knew that the only WhatsApp group I was a member of was with the other health secretaries, the four nations group. But then subsequently I checked the rest of the WhatsApp messages I could access and, as you know, disclosed all of those to the Inquiry.
Lead 2A: Thank you, yes. We’ll have a little look in a moment at the variety of – types of messages, with whom, and that at that sort of thing, but as at October of this year, this was the position, and then subsequent to that you managed a find a number of messages, which you’ve provided to us; is that broadly correct?
Ms Jeane Freeman: Yes.
Lead 2A: As far as your phone usage is concerned, you tell us, I think, that you used Scottish Parliament issued phone for government business, which you handed back to the Parliament when you left in May 2021; is that right?
Ms Jeane Freeman: That’s correct.
Lead 2A: Why did you not use a Scottish Government issued phone?
Ms Jeane Freeman: I didn’t feel there was a need to. I didn’t really want to have two phones running, and the number I had for the Scottish Parliament phone was actually the mobile phone number I have had, I think, since 1993, when I got a mobile phone after my father died, and so it was the number known to family and friends as well as anyone else, and so I wanted to retain the number and I didn’t want to have more than one mobile phone that I was using.
Lead 2A: I see. And our understanding from your statements is that the Scottish Parliament phone that you used was connected to the Scottish Government secure server for the retention of Scottish Government email to the Scot electronic records management system; is that right?
Ms Jeane Freeman: That would be the Scottish Government issued tablet that I used. I – and the mobile phone emails were MSP emails, so that was for the purpose of conducting my constituency business. But the tablet was a Scottish Government issued tablet that was then connected into the Scottish Government system. So if I used that for any emails, they were recorded into the Scottish Government system.
Lead 2A: So as far as email usage is concerned, is it the case that, as far as the conduct of your Scottish Government business, you used the tablet for those emails or were other devices used for emails?
Ms Jeane Freeman: No, occasionally the phone would be a copy, so an email might be sent to me on Scottish Government business through the tablet and copied to the mobile phone, but it was already in the tablet. And that would be emails coming predominantly from my government private office.
Lead 2A: And as I understand the position, that would mean if it came via the tablet that email would already be recorded automatically within the Scottish Government system?
Ms Jeane Freeman: Yes, yes, yes.
Lead 2A: Thank you.
You say in your witness statement dated 21 November at paragraph 9:
“… my Scottish Parliament phone was returned to them when I demitted office and while the What’s App and text messages, I have noted at Q13 are retained on what is now my personal phone, I do not have access to those with Gregor Smith or Jason Leitch, or to the few text messages between me and Nicola Sturgeon.”
We’ll get in a minute to – there’s a big list, we won’t go through all of them, of people with whom you exchanged messages of some sort during the course of the pandemic, but it appears from that statement, as I understand it, that some messages which would have been exchanged on your Scottish Parliament phone somehow made their way onto your personal phone but some did not. Is that correct?
Ms Jeane Freeman: So the ones that did not, did not because, as you know, both Dr Smith and Professor Leitch had, I think, auto-delete or took steps to delete messages, and – so I did not have those on my phone, what was now my personal phone, it still had the same phone number, and so when I purchased that, everything was downloaded from the cloud, and that then produced the WhatsApp messages that I gave to the Inquiry.
Lead 2A: So that’s the reason why some of the messages appear there but not those you exchanged with Professor Smith or Professor Leitch?
Ms Jeane Freeman: That’s correct.
Lead 2A: What about the messages you exchanged with the former First Minister, Nicola Sturgeon?
Ms Jeane Freeman: So those would be very small number of text messages. Ms Sturgeon and I were in each other’s company every day, and so most of the business we conducted between us was conducted verbally, or by telephone call on occasion, and those text messages I couldn’t find a way to recover those but I do know that they would be very short and they were usually operational, inasmuch as me confirming to her that something she had asked to be done I had done it, or something that she was concerned about had now been fixed or resolved.
Lead 2A: I see.
So you also told us in your statement that:
“A WhatsApp group existed for the Cabinet Secretaries for Health of the Four Nations. All four health ministers agreed to the formulation of this group. The WhatsApp group was used to facilitate the running of the weekly meetings over Zoom.”
You provided us with those messages which you still held. You say:
“I am providing the messages I still hold with these individuals to the Inquiry.”
And you did provide us with those messages; yes? And you also provided us with group chats called “Health team” and “Covid-19 health”, involving junior health ministers, officials and special advisers?
Ms Jeane Freeman: Yes.
Lead 2A: Thank you.
You, as I say, provided us with a lengthy list of people with whom you corresponded by various different means, including text and WhatsApp, and the position, as I understand it, as you’ve already told us, is that you exchanged a few messages with Nicola Sturgeon by text; is that right? And that the main means of communication between you and her, because you were, I think, in the same building as her during the course of the pandemic, was, I think you said, phone calls and verbal exchanges?
Ms Jeane Freeman: Yeah – excuse me – it was primarily verbal meeting, you know, one-to-one or with others, and occasional phone calls and very occasional text messages.
Lead 2A: We’ll just get back to that in a moment, but the Inquiry has also been provided through the Scottish Government with WhatsApp conversations between herself and Humza Yousaf, yourself and Kate Forbes, and text messages between yourself and Richard Foggo.
The reason I mention those is because those aren’t mentioned in your statement. Do we take it, then, we don’t know the answer to this, they must have emanated from another source rather than yourself?
Ms Jeane Freeman: Yes. I searched all of those, I searched every single Cabinet Secretary on my phone to double check, and given the time lapse I couldn’t be certain of everyone that I might have exchanged messages with. I didn’t find any on my phone for either Ms Forbes or Mr Yousaf or Mr Foggo, but they came, as you’ve said, from other sources and I have seen those.
Lead 2A: Yes, and do you then have any explanation as to why those ones appear not to be in your possession but a number of other conversations were?
Ms Jeane Freeman: No, I don’t. I did not delete messages.
Lead 2A: Okay.
Ms Jeane Freeman: Primarily because it never occurred to me to do so.
Lead 2A: Were you aware of any Scottish Government policy which suggested that you should delete messages, whether sent by way of text or WhatsApp or any similar platform?
Ms Jeane Freeman: I wasn’t aware of that policy. That’s not to say that I hadn’t been given that policy, but in the – in the pace of the pandemic, there were some documents like that that I may not have paid as much attention to as I did rightly to others. So I wasn’t aware of that policy, and I did not delete WhatsApp messages.
Lead 2A: But in any event you didn’t delete text or WhatsApp messages?
Ms Jeane Freeman: No.
Lead 2A: And you’ve explained the reasons why, the technological reasons why you’ve not been able to produce some of the exchanges which you recognise you had?
Ms Jeane Freeman: As best I can.
I have to be completely frank with you, my Lady, Mr Dawson, I am not the most technologically gifted member of the Scottish Government at that time, and so I searched as best I could and as best as I understood it and then provided to yourself and to the Inquiry everything that I found.
Lead 2A: You say in your witness statement at paragraph 17, page 6:
“All of the noted informal communications [which are the ones listed there] covered variously, progress of the pandemic, progress on pandemic response delivery, information exchange, factual and clinical or scientific information, clarification on clinical and/or scientific advice received or problem/issue resolution – all dependent on with whom I had the exchange. No decisions were made in any of these informal communications which were not then entered into the Scottish Government system, the process necessary to record and instruct action.”
Do you accept that these exchanges are likely, therefore, to hold and to have held important information about the way in which decisions were reached, in particular the scientific basis upon which decisions were arrived at?
Ms Jeane Freeman: Do you mean the messages?
Lead 2A: Yes.
Ms Jeane Freeman: No, I don’t think that’s entirely fair. They were primarily operational. The Inquiry has seen, for example, a very long set of text messages exchanged between myself and John Connaghan, who was the principal operating officer for the NHS at that point, which are all about operational matters, about whether or not ventilators have arrived or hospital beds or whatever it might be. We weren’t reaching decisions in those exchanges, because there would be no point in reaching decisions in those exchanges unless you then entered them into the system, because only by entering them into the system could you ensure that they were acted on.
Now, I had an agreement with my private office that if, for example, I had a phone call with Mr Macaskill or one of the health union leaders that I would then tell the private office what the outcome of that call was so that they could keep that record.
Lead 2A: When you say the “outcome” of the call, do you mean any decision that had been reached?
Ms Jeane Freeman: Anything that I wanted to then happen. Usually those calls were either confirmatory of decisions that already had been reached or the individuals in those examples I’ve given you were raising with me concerns that they might have around, for example, the distribution of PPE, “The systems were in place but care home X or hospital section Y hadn’t received their supply”. And so then I would tell my private office, and ask for officials to investigate that and sort it out.
Lead 2A: But were you under the impression that the obligation to record information on the corporate record was limited to information which showed that a decision had been taken?
Ms Jeane Freeman: No, I don’t think the obligation to record on the corporate record was only decisions. In the corporate record for meetings, for example, or from Cabinet meetings, in that I know the Inquiry has the minutes of all the relevant Scottish Cabinet meetings, would always have a bit of text or often have a bit of text that said “in discussion the following points were made” and then the decision or the action. So that was often the case.
Lead 2A: Because in the passage that I’ve just taken you to, information exchanged about the progress of the pandemic, the “progress on pandemic response delivery, information exchange and factual and clinical or scientific information, clarification on clinical and/or scientific advice received or problem/issue resolution”, all of these things, including as you mentioned earlier things about PPE procurement and the like, all of those things are important context, are they not, to the environment and background against which decisions would ultimately be taken?
Ms Jeane Freeman: They were all important, because they were about the matters that I’ve set out, but you will also, I’m sure, find the context for decisions recorded in the official record, whether that is in Cabinet papers or in email exchanges or whatever it might be, because that was the only way to make things happen. You had to put it into the system in order to ensure that action would then be taken.
Lead 2A: But your position, as I understand your evidence, is that the obligation as you understood it was not limited to recording exchanges which showed decisions being taken, it was wider than that, isn’t that right?
Ms Jeane Freeman: Yes, yes.
Lead 2A: And that the width of the obligation included the obligation to record the context, as you’ve put it?
Ms Jeane Freeman: Yes, well, for example, if I had – and I did have frequent phone calls, usually on my way home at night, perhaps with a health trade union leader or with Mr Macaskill, the context for that, the subsequent email that would go from my private office to the relevant officials would be to set out the context. I’m not quoting exactly here, you understand, but, for example, “Ms Freeman spoke to whoever last night on her way home, they’re raising concerns about … can you do the following”.
Lead 2A: So the corporate –
Ms Jeane Freeman: The context would be recorded as well as –
Lead 2A: I see –
Ms Jeane Freeman: – “Just please do”.
Lead 2A: Just to be clear – thank you for the explanation – that the context, as you say, which would ultimately be recorded on the formal record by an email or some other means, would include the sort of information that you’re identifying there as having been communicated informally –
Ms Jeane Freeman: Yes.
Lead 2A: – but it would then be recorded formally?
Ms Jeane Freeman: Yes, yes.
Lead 2A: Thank you.
You mentioned already and you say it in your statement at paragraph 21 that:
“Where pertinent issues arose as a result of any of these informal communications that required action by me, these will be retained in the Scottish government corporate record by my private office.”
Could you just, I think you’ve touched on this, but explain the process by which you or your private office transcribed or transferred pertinent issues which arose in your WhatsApps or texts into the corporate record?
Ms Jeane Freeman: So one of the examples I’ve already given, and it did come up in some of those calls or conversations, informal conversations, would be around the distribution of PPE. As you know, and we may come to this, we set up a number of additional distribution routes from pre-Covid times. They did not always work as effectively or slickly as we might want. There was a helpline to record issues, but also specific problems might be raised directly with me and I encouraged that. So I would then say to my private office “I have just spoken to, for example, Donald Macaskill, and he is telling me that care home X hasn’t received what they asked for, can you get onto NSS or whichever official it might be and ask them to double check this, find out what’s going on and fix it”. And they would then put that into an email and give that context, “Ms Freeman has just spoken to …”
Lead 2A: I see.
Ms Jeane Freeman: And then the reply would come back.
Lead 2A: You’ve given a helpful example of a hypothetical or unhypothetical situation where you’re discussing important matters relating to pandemic management. You’ve mentioned that you were often, in the period when you were Cabinet Secretary, physically present in the same place as other important decision-makers, including the First Minister; is that correct?
Ms Jeane Freeman: Yes.
Lead 2A: Just to expand on that a little bit, just to explain the physical situation, a number of people including ministers over that time will have been working remotely, isn’t that right?
Ms Jeane Freeman: Yes.
Lead 2A: But a number of people tended to be based in a centralised office building of the Scottish Government; is that right?
Ms Jeane Freeman: Yes, that’s correct.
Lead 2A: And that would include yourself?
Ms Jeane Freeman: Yes.
Lead 2A: And the First Minister?
Ms Jeane Freeman: Yes.
Lead 2A: And what other key advisers or decision-makers, without naming them, just broadly the types of people that would have been involved?
Ms Jeane Freeman: So the First Minister and I would be in St Andrew’s House seven days a week, in fact. We would also have our private offices with us. But in addition you would have the CMO, National Clinical Director, Chief Nursing Officer, some senior officials. Now, that cast list, if you like, would vary, and they wouldn’t necessarily be there every one of those seven days, but they would be there certainly most days, because the practice was that the First Minister and I would have a meeting at 11 – round about 11 o’clock every morning where we were looking at the data that had come in overnight from Public Health Scotland on case numbers, occupancy rates in hospitals, whatever the issues were. We would then – as you know, regular media briefings were instituted. We would then have a very brief discussion just before those and then a follow-on discussion afterwards, and may then subsequently meet again later in the day, depending on what issues we were dealing with.
Lead 2A: So you would have meetings and conversations with, amongst others, no doubt, the key people that you’ve just mentioned in that list, who may have not been there all the time, but will have been there part of the time; is that fair?
Ms Jeane Freeman: Yes.
Lead 2A: What mechanisms existed for transcribing into the corporate record verbal conversations or, I think you mentioned also, telephone conversations, the type of information that I think we’ve – we both think required to be incorporated into the record, discussions around decision-making?
Ms Jeane Freeman: So from that, for example, from that usually 11 o’clock in the morning meeting, there would be further – often further requests for more information that the First Minister or I or both of us thought we needed, specific things checked, for example, so that we were absolutely sure of what we were doing and the data that we were basing our actions on. That would then be communicated into the system from primarily the First Minister’s private office, not necessarily mine, but the First Minister’s private office. And if we had a senior official – or it might be the Chief Medical Officer’s directorate, and their office, if we had a senior policy official then they – and they were tasked with finding something out, taking some kind of action, then they would then put that into the system to their team to do whatever was necessary.
Lead 2A: You see. I think what you are talking about there is information that would be obtained externally from whatever the appropriate body was to try to augment your knowledge, data or other such information. What I’m interested in is the extent to which there was a system which aimed to record on the corporate record the nature of discussions taken between or amongst the key individuals whom you have described as being involved in the pandemic response at that stage, about your views on things, the way in which the pandemic seemed to be going, decisions you might take or might not take, why it is that you think one course would be better than the other. If these happened predominantly verbally or on telephones, there was a risk, I think, that they may not have been properly transcribed into the corporate record.
Ms Jeane Freeman: So they rarely, if at all, happened between me and the First Minister by telephone. In fact, I can’t recall any discussion quite as you’ve described it, they would be in-person discussions, and they would be transcribed into the system as part of the context for the ask that was now being made.
So, for instance, “The First Minister and the Cabinet Secretary are unclear as to whatever this data is actually telling us, can you please provide more information in order to help them, help their consideration”, or whatever it might be.
Lead 2A: So the instruction to the external body for more data, information, would be recorded but the –
Ms Jeane Freeman: The context for it would also be recorded.
Lead 2A: Right, in what form?
Ms Jeane Freeman: In the form I’ve just described, in the form of – so – and this is important for everyone we were asking things of. They were working extremely hard, whether they were civil servants, public health officials in PHS, whatever they might be doing, they were very, very busy, so you can’t just issue an instruction for “X” without explaining to them why you want it. And that also gives them a feel for, “Well, they want this, that must mean that we’ve not been clear enough so far, so let’s give them a bit more information to explain what it is we’re telling them”.
Lead 2A: So we should be able to find that context on the corporate record?
Ms Jeane Freeman: I would expect so, yes.
Lead 2A: Thank you.
I’d like to ask you some questions about the very early period when the threat of the virus started to emerge. You were the Cabinet Secretary for Health and Sport at that time?
Ms Jeane Freeman: Yes.
Lead 2A: You were holding a very important position in a moment of crisis that was coming over the horizon; is that correct?
Ms Jeane Freeman: That’s correct.
Lead 2A: And at that time, we understand from other evidence that you were involved in a number of early meetings of COBR?
Ms Jeane Freeman: Yes.
Lead 2A: And also, as we’ll come to, a number of meetings of the Scottish Cabinet and similar emergency meetings including SGoRR, the Resilience Room within the Scottish Government?
Ms Jeane Freeman: Yes.
Lead 2A: And over that period, you received a considerable amount of emerging information from –
Ms Jeane Freeman: Yes.
Lead 2A: – other sources, and our understanding is that, broadly speaking, insofar as one required medical advice, that medical advice was coming to you through Dr Calderwood, the Chief Medical Officer?
Ms Jeane Freeman: Yes.
Lead 2A: Could I ask you, please, to have a look at INQ000352450.
This is an exchange we’ve looked at before, but I would be interested in your perspective on this. If we go down to the final page, please, page 5 – I think this may be it, in fact.
This is an exchange of emails that the Inquiry has seen already between Dr Calderwood and a consultant epidemiologist at Edinburgh University called Professor Mark Woolhouse, who no doubt you will know from his involvement in many different spheres, but in particular the Scottish Covid Advisory Group subsequently.
Ms Jeane Freeman: Yes.
Lead 2A: In this correspondence, as we’ve already gone through in some detail with Professor Woolhouse, what he is trying to do, it would appear, is bring to Dr Calderwood’s attention concerns, an obvious concern, as you see expressed there, about the developments that are coming to his attention about the threat, and he says:
“The obvious concern (increased by yesterday’s not unexpected announcement of human-human transmission) is that this will become a pandemic, and therefore will affect Scotland. This is not yet certain, but in my judgement it is likely, certainly sufficiently likely that we should be prepared for the eventuality. Other colleagues share this view.
“There are some instructive parallels with the H1N1 pandemic in 2009-10. Indeed, one possibility is that this could turn out to be quite similar in some key respects: a widespread epidemic fuelled by mild cases but with mortality among vulnerable patients.”
As you will, I hope, be aware, there is a series of correspondence in this vein that then comes over the next few days, some of which we might look at. Were you aware of this correspondence having taken place?
Ms Jeane Freeman: I don’t believe I was aware of the specific correspondence, in terms of having sight of that email or the correspondence, but I did know from Dr Calderwood that Professor Woolhouse had been in touch with her, as had others, or she had also reached out to others, experts in this field, that she was aware of, and clearly her colleague CMOs in the four nations.
Lead 2A: When did you become aware of these exchanges? This is 21 January 2020.
Ms Jeane Freeman: I can’t recall the specific dates, but I would think around about the same time as these exchanges. I mean, we were conscious that this – I can’t think of another way of putting it – this thing that appeared to be emerging from China and appearing elsewhere was potentially very, very serious indeed, and of course his reference to the H1N1 pandemic resonated with the former First Minister, Ms Sturgeon, because she had been Health Secretary during that time.
Lead 2A: What was the significance of the H1N1 pandemic in the assessment of the level of the threat?
Ms Jeane Freeman: So people were – I clearly was not in government – or wasn’t an MSP at that time. People were referring back to that, and referring to the concern that they had around the seriousness of it at the point, which did not then play out in practice, but were also very clear that that may have been the case then but we don’t know that this one’s going to be the same. And of course as you know and I’m sure we will come to, subsequent modelling of the Covid-19 virus produced some very stark numbers about its likely level of impact on the population.
Lead 2A: We’ll get to that in a moment, yes. Is it fair to say, therefore, that the H1N1 experience provided a degree of reassurance in the approach, given that it had not turned out in Scotland to be as serious as it might have been?
Ms Jeane Freeman: I did not find it reassuring. I found it interesting to understand what had happened then, but my primary position was: that was then, this is now, and we don’t know it’s going to be the same.
Lead 2A: What was your understanding of, at this time, the significance of the possibility raised by Professor Woolhouse that the epidemic may be fuelled by mild cases?
Ms Jeane Freeman: At that point, I don’t think, as a non-clinician and not a scientist, I don’t think I had a particular view. I think it’s one of those situations where you hear that, you say “Well, it might be”, but the other voice in your head is saying “But it might not, let’s find out, let’s keep finding out till we know”.
Lead 2A: Obviously it is correct to point out, Ms Freeman, that you’re not a clinician, but of course you were in a position to receive medical, clinical and scientific advice –
Ms Jeane Freeman: Yes, of course.
Lead 2A: – from, amongst others, the Chief Medical Officer. Was she explaining to you at this time the potential significance of an epidemic fuelled by mild cases?
Ms Jeane Freeman: No, not in as categoric terms as those. She was explaining what she knew had happened when it was H1N1, but also keeping very much open the door in our mind and in her own that this may not be the same kind of epidemic, and in fact became a pandemic.
Lead 2A: Professor Woolhouse also mentioned the possibility of mortality among vulnerable patients. What did you consider – what did you understand from Dr Calderwood or otherwise this class of vulnerable patients to constitute? Who were these people that he was talking about?
Ms Jeane Freeman: Those would be, I understood it to be, and in my own mind would think it to be, people who had other serious clinical conditions, comorbidities, and that would also include those who were elderly, but not exclusively those who were elderly.
Lead 2A: Thank you.
If we could scroll up, please, to the 25 January email, page 4, I think. Maybe 3.
(Pause)
Lead 2A: So this is a further piece of correspondence, again from Professor Woolhouse to the Chief Medical Officer, Dr Calderwood. In this, he reports some further information relevant to the epidemiology, including the basic reproduction number, of which there was a central estimate of 2, the R 0, and a case fatality rate of 4%.
Again, were these things that were brought to your attention at that time, and was the significance of these figures explained to you?
Ms Jeane Freeman: Yes, they were, and in those numbers, around the R number, as I think we all came to clearly understand it and talk about it, the ranges were there. Of course Dr Calderwood was receiving information not only from Professor Woolhouse but from others, and all our science, epidemiologist, virologist colleagues and chief medical officers were working hard to try to get a grasp of what we were dealing with, so we were often dealing with a range of information. It could be “Between this and this”, for example. In any event, as I heard it, I heard it as “this is very serious”.
Lead 2A: You say that advice was being received from others at this time. Could you recall who were the other advisers that were providing input similar – on the same subjects at least as Professor Woolhouse?
Ms Jeane Freeman: So Dr Calderwood would be attending discussions with the other CMOs and of course the Chief Scientist, including discussion with the Chief Scientist for health, and there would be others that she was in touch with as a consequence of her career. I don’t have the names of those, but she would mention them, who she had been speaking to and the calls that she had been involved in, and what she was understanding from all of that information that she was gathering in.
Lead 2A: The message which we’ve seen on a couple of occasions in the sort middle paragraph, here in the bottom half of the page, relates to putting the numbers I’ve just mentioned into an epidemiological model for Scotland, and that the prediction would mean:
“… over about a year, at least half the population will become infected, the gross mortality rate will triple (more at the epidemic peak) and the health system will become completely overwhelmed. We can formalise those predictions (and there are many caveats to them) but those are the ballpark numbers based on information from WHO. Please not that this is NOT a worst case scenario, this is based on WHO’s central estimates and currently available evidence. The worst case scenario is considerably worse.”
I’m not sure, Ms Freeman, one requires to be a clinician to read that passage with a considerable amount of trepidation about the position.
Ms Jeane Freeman: No, you do not, and I think as I’ve already said, I had a growing feeling of trepidation about what we were about to have to deal with all through that month of January. And that feeling on my part was not in any respect undermined by Dr Calderwood, who herself was increasingly clear with me and with her colleagues in the health directorate about just how serious this could end up being, and to quickly disabuse ourselves of any notion that this might be a repeat of H1N1.
Lead 2A: What steps were you, practical steps, advised that Scotland should start to take in order to deal with this threat?
Ms Jeane Freeman: So the numbers that are indicated here and the numbers that then fed into the four nation action plan that was published, I think, at the very beginning of March.
Lead 2A: 3 March, perhaps.
Ms Jeane Freeman: Those numbers were emerging, they weren’t finalised but they were emerging, and what that told me was that a significant proportion of the population, a very high proportion of the population, would be infected, that a significant proportion of that number would require hospital treatment, including intensive care treatment, and that a proportion of that number would also die. And so that told me that I had to begin work, undertake work with our health service colleagues, our NHS colleagues, to look at: what is our current bed capacity; what do we need to do to increase that bed capacity so that we can take people who are ill? What is our current position in terms of ventilators and ICU and what do we need to do to increase that?
In both those figures, the obvious answer, the clear answer was we need to increase bed capacity and we need to increase ICU capacity. And so work began to look at: how do we do that.
Lead 2A: Just to be clear as best you can, with a bit more precision, to be fair to you, about the timeline, when was it that – you mentioned ventilators, ICU capacity was being a primary consideration in light of this information; when did it start to be that that was your focus and you started to take steps to try to investigate what the capacity was and what you might do about it? Was it at this time in January or was it later?
Ms Jeane Freeman: January into February.
Lead 2A: Right.
Ms Jeane Freeman: I think we had – I’m not sure if I have it with me, but we had an early number in February, an estimate of the size of the population in Scotland that would be affected, infected by this virus. And of course then there was, as I said, the modelling in the three nation plan – four nation plan.
Lead 2A: Was the modelling that was done around that time simply taking the UK figures and scaling them down for the relative size of the Scottish population or was it based on specific Scottish information?
Ms Jeane Freeman: So at that point, in the early days, it would be looking at how the UK-wide figures would be apportioned in Scotland, but then work was undertaken to factor in other factors, for example the levels of comorbidity amongst our population, the level of health inequality amongst our population and so on, to refine the figures. But the bottom line is the figures are high.
Lead 2A: Yes.
Ms Jeane Freeman: And you can model them to make appropriate changes, that doesn’t alter the fact the figures are high. And as you know, the 3 March modelling, reasonable worst-case scenario was 80% infected, 4% requiring ICU (4% of that 80%), 1% deaths.
Lead 2A: Yes.
Ms Jeane Freeman: Those are big numbers. And the February modelling number that I received was 75,950 hospital admissions in Scotland.
Lead 2A: Right.
Ms Jeane Freeman: Now, they’re not all admissions at the one time, of course, but over the piece that’s – what was expected, and we had a bed capacity of 3,000.
Lead 2A: Right.
You mentioned that there was a point at which what one might describe as local data was taken into consideration and one wasn’t deriving it simply from the UK data scaled down. I think you recognised that it was important to do that based on the demographics of Scotland’s population, in particular its elderly population and the existence of a number of comorbidities and health inequalities. Did I pick you up correctly?
Ms Jeane Freeman: Yes.
Lead 2A: When was it that that local data started to be factored into the planning?
Ms Jeane Freeman: So the analysts would begin doing that through February, I mean, hence we had a number given to us in February as a possible, a modelling number, and the – you know, analysts were quite clear, quite rightly, modelling was not a prediction, it was a model, but it gives you an idea of what you might be dealing with, and they would then begin to factor in some of those other factors to see what changes that might make.
But from my point of view, I didn’t see that modelled number of just under 76,000 coming down because Scotland has a higher comorbidity, a more elderly population, greater health inequalities. I could only see it rising.
Lead 2A: Yes.
Ms Jeane Freeman: So let’s just deal with this. It doesn’t matter if you add 10,000 on to this, or whatever you do, this is a big number and we need to do serious work to try to deal with this.
Lead 2A: You were focusing, quite rightly, on the question of ICU capacity, ventilators, hospital capacity, but of course there were other more specific measures that might be taken into consideration in order to try to deal with the particularly vulnerable individuals whom we’ve identified. What steps were taken to try to understand the extent of Scotland’s vulnerable population in order to try to inform the best measures that might be taken to try to protect them?
Ms Jeane Freeman: So that understanding, if you like, or that work comes into play when you start to look at the specific measures that you might take. So, whether you’re looking at the impact of the virus on a particular part of, for example, Glasgow, where we know the health inequalities are higher than another part of Glasgow, it doesn’t really matter too much in terms of hospital admissions and ICU demand. You know what you’re going to get. Where it does matter is when you are looking at vaccine take-up, access to testing and so on further down the line. And also your communication, so that what you were trying to ask the public to do is communicated as widely as possible in order to reach all areas of the population.
Lead 2A: Just to be clear, again, and to try, if we can, to put this in the timeline.
Ms Jeane Freeman: Mm.
Lead 2A: You mention there, for example, obviously access to vaccines came much later, although very much under your watch, if you like. As far as access to testing is concerned, you’ve mentioned, I think, that that was something that was being considered for more vulnerable people further down the line. When did access to testing for more vulnerable people become part of the narrative?
Ms Jeane Freeman: So, to be clear, so we don’t misunderstand each other, access to testing was significant in my mind from the outset, not least because we did not have sufficient testing capacity and capability. So my initial concern was not who is going to be able to be tested, but initially how can we increase our testing capacity. That – that was the first and most important thing to focus on, we started out with a per day testing capacity of around 350 tests. The very initial – the very, very early tests for Covid were sent I believe to Colindale, and I think you have heard from other witnesses as well that tests were being developed for this particular virus, as they have to be for all particular viruses. But particularly, in answer to your question, my primary concern initially around testing was our capacity and capability to process tests speedily and in a higher volume than the 350 that we started out with in February.
Lead 2A: So was that – the capacity for testing throughout February was 350 a day; is that right? And how long did that last for, do you recall?
Ms Jeane Freeman: So that was our starting point. By 18 March we had a 780 capacity per day of PCR tests across three of our NHS labs. We increased that by the end of April to 4,350. And of course by that point the Glasgow Lighthouse lab, part of the UK Lighthouse Network, was being established and, as the NHS laboratory testing increased, the Lighthouse Laboratory testing also came in, not exclusively for Scotland for tests – to process tests taken in Scotland, but a significant proportion, but it was part of the UK network.
So the capacity increased exponentially from that point, but in those early days and months, the capacity was low.
Lady Hallett: Did you ask anyone why you had such limited capacity at the beginning?
Ms Jeane Freeman: I did, and, my Lady, I probably asked them in fairly robust terms. And I think, in fairness – I can’t recall the specific answer, but I think, in fairness, the answer would be that, in the prioritisation of NHS resource over the years previously, it had not necessarily featured highly, and the resource, limited resource, for our health service had been prioritised elsewhere.
Lady Hallett: So one of your predecessors?
Ms Jeane Freeman: It could have been many of my predecessors, from the point when the Scottish Parliament reconvened in 2000. I think it is one of the significant lessons, if I may, and my apologies if I’m jumping ahead, but one of the significant lessons is the importance of retaining a core testing capacity that you can scale up. Now, that’s not straightforward, it’s about the skills, it’s about the kit, as well as – so it’s about the capability as well as the actual capacity, and so it is disappointing to me that the Glasgow Lighthouse lab wasn’t retained, because I believe – it was a UK Government decision, but I believe it could have been re-purposed for other important tests in Scotland.
Now, regional laboratories were built up, NHS regional laboratories were built up, and part of the thinking behind that was to retain a core capacity post-pandemic.
But, Mr Dawson, you’re rightly pointing me to where we were at the outset, and that is where we were.
Mr Dawson: Thank you.
Is it the case, therefore – because you’ve highlighted that there are a number of component parts one has to have to an effective testing system – is it the case that at this stage Scotland did not have the skills, the kit or the capability to carry out adequate testing?
Ms Jeane Freeman: Well, I would say Scotland certainly did have the skills and the Glasgow Lighthouse is testimony to that in how it could bring skilled personnel in so quickly. What we did not have was the physical space or the kit in order to do that. And so we began the increase in our existing NHS laboratories with that increase to 780, that was in the NHS labs in Glasgow, Edinburgh and Dundee, and then by the end of April every one of our territorial boards had local access to that testing. Processing of tests is actually, strictly speaking, what it is.
Lead 2A: If could we go back – sorry, it’s my fault for not asking to cue it up – to INQ000352450 again, this is the Professor Woolhouse emails.
I’m looking now at page 2, please. There are various scenarios – this again is another one in the chain of correspondence with Professor Woolhouse where he sets out various scenarios. He talks about a third, a SARS scenario, and talks about various things that might be done. This is – he says there:
“This is the scenario that I outlined for you yesterday (though I didn’t give you the worst case version of it). This is what we have to expect if the current case fatality rates are roughly correct. The measures we could consider are:
“A vaccine.”
And then, going over the page, various other antivirals.
And then effectively he rolls that out as being something that’s open at the moment. And so he says back to public health measures. And he points out there that public health measures which ought to be used are case isolation, infection control and contact tracing, public messaging and social distancing.
So these are – you talked about the testing capacity being built up subsequent to this, but at this stage what is being suggested is that there needs to be case isolation, which means test – which means there requires to be testing before one could find out what the cases are, isn’t that right?
Ms Jeane Freeman: That is right.
Lead 2A: And there also needs to be a system put in place of infection control involving contact tracing so finding people that might have been infected by the index case; is that correct?
Ms Jeane Freeman: Yes.
Lead 2A: As far as – we’ve talked about the testing capacity but as far as contact tracing systems were concerned, our understanding is that that wasn’t put in place until much later, when the Test & Protect system started; is that correct?
Ms Jeane Freeman: Not quite. It was certainly scaled up at that point, but Scotland has always had, through our public health system, a capacity for contact tracing. It’s used through our local incident management teams who may be – at this very moment may be undergoing contact tracing perhaps for sexually transmitted disease in a particular area or for other viruses that arise. So we had that system in place that undertook contact tracing, and it was that system that we used to build.
So contact tracing, as I know you know, was used for the cases that came from the Nike conference. That was the use of a system already in place.
Lead 2A: What efforts were made at this time to try to expand that existing contact tracing system or build a new contact tracing system to the level and scale of the sorts of prognosis or prediction that Professor Woolhouse was making?
Ms Jeane Freeman: So in the first phase of the four nation plan is about containment and that rests a lot on contact tracing.
Of course contact tracing begins with a positive test, and so where you have limited test capacity your contact tracing is, from the outset, limited. So the scaleup, limited though we might see it as being at this point, with hindsight, was part also of being able to have more contact tracing if that was what was needed.
Lead 2A: Why is it necessary to look at the deficiencies in the scaleup of the contact tracing system in hindsight? Because what you had here was a recommendation from a recognised epidemiological expert as to the kind of scale that you might be looking at and the need for contact tracing to try to prevent that. At the time it was known that that would be necessary, isn’t that right?
Ms Jeane Freeman: Yes, so with respect what you said I said is not what I said, if I may.
What I said was that in order to scale up contact tracing, you have to scale up testing. And, you know, as we look at it now, going from 350 in February to 780 by 18 March may not look like a significant increase, and it wasn’t a significant increase, but it was the best that we could do in that – at that point, with the resources that we had. We then increased that, as I say, significantly by the time we got to April, but that is about acquiring premises, kit, and people. But that’s fundamental to a number of things in responding to the pandemic, but it is fundamental to contact tracing.
Lead 2A: To be clear, when you talk about a lack of resources you’re talking about a lack of premises, kit and people; is that right?
Ms Jeane Freeman: Yes.
Lead 2A: So that’s what you had to build, because it wasn’t there before?
Ms Jeane Freeman: Yes.
Lead 2A: As far as public messaging is concerned, Professor Woolhouse was also of the view that this was tremendously important.
Ms Jeane Freeman: Yeah.
Lead 2A: You’ve mentioned the Nike conference and the public messaging around that. What public messaging about the threat took place in February?
Ms Jeane Freeman: To be honest, Mr Dawson, I can’t recall. Certainly I know that I had alerted Cabinet colleagues to the virus through our Scan system, which I think you’re familiar with. It’s basically a notification system for every Cabinet meeting to every Cabinet Secretary on issues of importance that you think your colleagues need to know about but no decisions need to be taken at this point. So the first Scans that raises Covid-19 is 28 January, so I was certainly alerting Cabinet colleagues at that point to this matter. But I can’t recall at that point if there was specific public messaging.
Lead 2A: Cabinet colleagues were, of course, members of the public, but telling Cabinet colleagues is absolutely not public messaging, is it?
Ms Jeane Freeman: No, no, it’s not.
Lead 2A: So, I mean, you will know that we’ve heard evidence around the way in which the outbreak at the Nike conference was handled in terms of public messaging, but in effect there was no public messaging of the threat until the first case was announced on 1 March; isn’t that right?
Ms Jeane Freeman: I believe that is correct. There was a lot of work going on to reach four nation agreement around the first four nation plan, and a lot of agreement around – or work going on to reach collective agreement, where we could, about the information that we would base our plan on, but also the information that would be used to communicate with the public.
Lead 2A: It was subsequently, as I understand it, an important principle of the Scottish Government’s public communication policy that there be honesty and truthfulness about what was going on with the people; is that fair?
Ms Jeane Freeman: Yes, that’s correct.
Lead 2A: Why was there not a similar approach to alerting people to the threat in particular in light of the fact that Professor Woolhouse had already alerted you to the fact that it was tremendously important?
Ms Jeane Freeman: Well, to be fair, Professor Woolhouse had alerted Dr Calderwood to that fact. We were not –
Lead 2A: Were you not aware of that?
Ms Jeane Freeman: As I said earlier, I don’t recall seeing his correspondence, as such. I do recall Dr Calderwood telling me about hearing from Professor Woolhouse and broadly what he was saying, along with others that she was also hearing from, and I think we know that the scientific community and the academic community was engaged in constant discussion, where there was not always agreement – understandably so, I mean, science is an iterative process. So we understood the emerging seriousness of the problem, as I think I’ve already indicated, but you have to be clear of your ground before you communicate that more widely. It’s not overly helpful to people to say “We think there might be a problem but we can’t really tell you at this point exactly the size of it”.
Lead 2A: Is it your position that you were aware that recommendations were being made, a recommendation had been made by Professor Woolhouse or others that public messaging was tremendously important as at towards the end of January?
Ms Jeane Freeman: I don’t recall specifically being made aware of that, but I am personally very aware of public messaging being important.
Lead 2A: Could I then look, please, at another document, which is INQ000238707.
This is, I think, as we’ve clarified with other witnesses, effectively a Cabinet minute, which tend to be called, in Scottish Government, “conclusions”, as I picked up from other similar documents.
This is minutes effectively of the Scottish Cabinet meeting on 28 January 2020. Could I look at page 5, please – if we actually, sorry, look at page 4 first.
As far as coronavirus outbreak is concerned, you presented a paper about this at this particular Cabinet meeting; is that right?
Ms Jeane Freeman: No, this is the Scans note.
Lead 2A: Yes, but you’re speaking to the Cabinet meeting about that?
Ms Jeane Freeman: Yes.
Lead 2A: On page 5, please, paragraph 17, over the page:
“In discussion the following points were made:
“(a) The rate at which the virus was spreading in China was alarming, as was the suggestion from Chinese officials that the virus might be infectious in its incubation period, before symptoms began to show. If confirmed, this would make controlling the virus much more challenging. It would be important for Scottish Government messaging to be consistent with the latest evidence concerning how the virus spread.”
What was your understanding at that stage of the significance, first of all, of human-to-human transmission, which we had seen in the previous correspondence from Professor Woolhouse, and this apparent development that there may be transmission in the incubation period before symptoms began to show, as regards the difficulties that one might experience in any response?
Ms Jeane Freeman: Yes, so that was emerging information. I mean, we had had, I think on 24 January, pretty categoric advice from policy officials but based on – yeah, 24 January, clear advice with respect to the scientific knowledge at that time that people carrying the virus are only infectious to others when experiencing symptoms. So that was pretty categoric advice that there was no asymptomatic transmission. That, of course, began to change as various experts in the field understood the virus better.
Lead 2A: You used the expression a moment ago that science is an iterative process, and no doubt that’s the case. Is it not very important in moments like this to understand that if one waits to see a hard scientific conclusion that it’s likely to be too late to do anything about it?
Ms Jeane Freeman: It is important to not wait unnecessarily for a hard scientific conclusion, as you put it, and I think as the pandemic progressed we increasingly understood the importance of acting fast, but at this time it still felt like there was a degree of uncertainty around about exactly the nature of this virus in terms of how it would behave, and therefore what did we need to do.
Lead 2A: So the conclusions about what one should do at this stage were based on what you felt; is that right?
Ms Jeane Freeman: But also – no, not entirely, I don’t think that is fair. We also had the benefit of the CMO’s advice from her discussions with her colleagues in the rest of the UK, and with Professor Van-Tam of course, as the Chief Scientist, and others. So we had the benefit of her advice that this was an emerging serious situation.
Lead 2A: Just to be clear, I think the advisory systems of which we’re aware at this stage were predominantly Chief Medical Officer to Chief Medical Officer, so it would have been Dr Calderwood dealing with Professor Whitty?
Ms Jeane Freeman: Yes.
Lead 2A: And you mentioned the Chief Scientific Officer, that at the time would have been Sir Patrick Vallance.
Ms Jeane Freeman: Yes.
Lead 2A: Who I think was also heavily –
Ms Jeane Freeman: Yes.
Lead 2A: – at this time. So those would be –
Ms Jeane Freeman: Yes.
Lead 2A: Is that – am I right in thinking that –
Ms Jeane Freeman: Yes, you are –
Lead 2A: – Van-Tam –
Ms Jeane Freeman: Yes, you are, my apologies.
Lead 2A: It’s said at paragraph (b):
“It was likely that, in time, the virus would reach the UK. The Scottish Government was putting in place appropriate measures in all parts of the country, to minimise the risk of contracting the virus and to control the spread of any outbreak.”
Which of the measures that Professor Woolhouse mentioned in his prior email that would achieve those aims were the Scottish Government putting in place? What were these appropriate measures?
Ms Jeane Freeman: So we would – we were beginning at that point to look in some detail at what we might need to do in terms of our NHS in order to increase capacity in the health service, as well as increasing kit, like ventilators. We were looking at what this might mean for our PPE procurement, and we were also actively looking at our testing capacity and what we needed to do to increase that.
Lead 2A: Subject to the limitations that we explained a moment ago?
Ms Jeane Freeman: Yes, but also how could we get round those limitations, what was available in Scotland by way of private sector testing, and there were one or two facilities, as I recall, perhaps more, like that in Scotland, of limited capacity but nonetheless they existed, and whether or not we could contract with them to provide their service to the NHS.
Lead 2A: I wanted to ask you about that, actually, the private sector. Did it become – did it turn out that there were any private sector facilities for undertaking testing or any of the other processes required within the private sector?
Ms Jeane Freeman: So from my memory, there was at least one, possibly two, private testing facilities. I think one subsequently was also used by St Andrews University, but I may be wrong about that. We also –
Lead 2A: (inaudible) over this period in particular.
Ms Jeane Freeman: Yeah. Over this period, I think there were one or two. We also were, of course, looking at private health facilities in terms of bed space, not for Covid but for other procedures, and whether or not we could, if you like, buy up those beds for the NHS.
Lead 2A: Because, as I think you’ve candidly accepted, there were issues with the NHS’s capacity to undertake testing and ultimately tracing –
Ms Jeane Freeman: Yes.
Lead 2A: – which existed at that time?
Ms Jeane Freeman: Yes.
Lead 2A: It might be suggested that greater efforts should have been made in light of the apparent urgency and severity of the threat to access testing and tracing capacity in the private sector.
Ms Jeane Freeman: My understanding is that what the private sector could provide was testing. Contact tracing is a skilled exercise that was undertaken by our public health colleagues and, as I’ve already said, we already had a network, a local network, through our local incident management teams, public health incident management teams, that worked on contact tracing continuously where there was a requirement for that, and so we wanted to use that expertise to expand the contact tracing capacity. But to do that you need to expand testing.
Lead 2A: And did these forays into the private sector in this period result in any further testing being done beyond the capacity that you’ve already mentioned?
Ms Jeane Freeman: We – from memory we did use at least one lab. But whether or not we used – I don’t believe we used it in this time period, which is January, but we –
Lead 2A: I was talking about the period that you were talking about, where you gave figures for January, February and March and April.
Ms Jeane Freeman: Yes.
Lead 2A: Over that period were private facilities used?
Ms Jeane Freeman: Yes, yes.
Lead 2A: To what extent, therefore, did they boost the numbers that you have talked –
Ms Jeane Freeman: Their numbers were very small but we were not in the business of cavilling at small numbers, we needed all the capacity we could get.
Lead 2A: Thank you.
Just before we take this away, there’s one aspect of this I just wanted to follow up with you. You’ve mentioned already the collaboration with people like Patrick Vallance and Chris Whitty, this minute records at paragraph (e):
“While there had been good collaborative working between the UK’s Chief Medical Officers, the UK Government had not been sufficiently responsive to requests from Scottish Government for information (including about UK nationals currently in China) and had not fulfilled a number of the commitments it had made at the Cabinet Office Briefing Room meeting held on 24 January. This point would need to be raised urgently at senior official level.”
This is something we’ve seen from other witnesses, that there seemed at this a period and, if I recall the evidence going forward, to be issues with access to information which the Scottish Government needed from the UK Government. Can you recall what the details of this were? Can you elaborate on what sort of information was lacking and how that was impeding Scotland’s response?
Ms Jeane Freeman: So the particular meeting that’s referred to there is the first – I believe the first COBR meeting which was chaired by Mr Hancock and which I and the Scottish Chief Medical Officer attended.
My feeling at that meeting was that there wasn’t sufficient urgency from the UK Government, and I do recall raising in that meeting or querying their intention to focus on flights into the UK from Wuhan, and suggesting that international travellers often travelled via hub centres like Schipol or Dubai, and that we should be looking at flights from there too if we were talking about trying to ensure that we knew whether the virus was coming in via any of those routes, and that not being considered the right thing to do. I believed that was wrong, and said so. But of course that was not within my purview as a Scottish Health Secretary.
And there were times then, and subsequently, when Scottish Government officials were frustrated by slow information or the absence of information. To be entirely fair, in my dealings with Mr Hancock subsequent to that COBR meeting, where I think we had a bit of a disagreement, but subsequent to that COBR meeting I found that if I spoke to him directly on matters then we could resolve them.
Lead 2A: In the period between January and March 2020, did this information flow issue from the UK Government constitute an impediment to Scotland’s preparation and understanding in connection with the pandemic?
Ms Jeane Freeman: None that I was aware of.
Mr Dawson: Thank you.
If that’s an appropriate moment, my Lady.
Lady Hallett: Certainly.
Just before we break, Ms Freeman, looking at (b), Mr Dawson asked you about what measures were put in place. The statement in the minutes is that the Scottish Government was putting in place appropriate measures. When you answered his question I wrote down your words, not literally verbatim, but that “we were beginning to look at” or “were looking at”. Given that you were still at very early stages, was putting in place appropriate measures something of an overstatement?
Ms Jeane Freeman: No, I don’t believe it is, because I think that as we looked at things we agreed things pretty quickly. So looking at, for example, would it be possible to use private laboratories to increase our testing capacity – so usually, under the leadership of Mr Connaghan, those phone calls would be made, he would come and tell me, I would agree, “Go contract them”. So looking at and doing were often a matter of a day, hours, between one and the other.
Lady Hallett: Thank you.
Mr Dawson: Thank you, my Lady.
Lady Hallett: Break now until 3.15, please.
(3.00 pm)
(A short break)
(3.15 pm)
Lady Hallett: Mr Dawson.
Mr Dawson: Ms Freeman, I’d like to move on just a little bit in the timeline into February. We understand that on 12 February 2020 there was a ministerial tabletop exercise called Exercise Nimbus which took place. The intention of this exercise was to test the decision-making process by COBR, in response to a fictional scenario drawn from the real reasonable worst-case scenario pandemic influenza plans.
Now, we understand that you did not attend this and one of your junior ministers –
Ms Jeane Freeman: Yes, that’s correct.
Lead 2A: Do you have any understanding as to – we have various documents about this, but, broadly speaking, do you understand what the significance of this exercise was in pandemic planning for the real pandemic, given that it was a hypothetical exercise, though based in a hypothesis that was actually quite close to reality?
Ms Jeane Freeman: Yeah, so I understood it to be an attempt, if you like, to almost update or double check planning against the flu pandemic, the potential of the flu pandemic, which had informed most of government planning prior to Covid-19.
Lead 2A: Given the circumstances and the severity of the circumstances in reality that you’ve just understood was your – you just explained was your apprehension of the Professor Woolhouse and other medical information you were privy to, was it not important that you attend that in order to make sure that Scotland’s position was as up to date as it possibly could be in the planning?
Ms Jeane Freeman: I think it was important that a Scottish minister attended and that’s why Mr Fitzpatrick did. I can’t recall – I don’t have my diary with me – as to what else I was doing at that time, but I would have made a decision that whatever else that was required my personal attention more than this did, and I of course had confidence in my health minister to attend, to ensure that any points that we wanted raised were raised, and to feed back to me on the outcome of that.
Lead 2A: The minutes or the note of the meeting record the exploration, I think, of a whole load of different agencies and departments of the UK Government that might need to be engaged in a response, so “For this part we need to engage with this part of government”. There is only one reference that we could find to the Scottish Government, which is – it says:
“SCOTTISH GOVERNMENT (SG) outlined that they had activated their response and were thinking about the same issues. There had been good collaboration across CMOs. They emphasised that everyone had to be clear about priorities before decisions were made.”
Now, to be clear, as I understand it, this is a hypothetical position of the Scottish Government in a hypothetical exercise, although one would have expected, would one not, if the purpose of this exercise was trying to update the planning and apply it more to the potential real life situation that was evolving, that the Scottish Government would have had more to contribute and say than simply that?
Ms Jeane Freeman: I’m not sure if that would be fair. It wasn’t the Scottish Government responding hypothetically, it was the Scottish Government saying that, for example, our Resilience Room had been set up, and the purpose – one of the purposes of our Resilience Room is to draw together different relevant parts of government to focus on and co-ordinate action in response to. So it would do that on flooding, for example, it did it when there was the attack on Glasgow Airport, and it was stood up for Covid.
So it brings – if you like, it co-ordinates the different parts of the Scottish Government. So we don’t need to go through a big list of different bits of Scottish Government that need to do things, the Resilience Room does that.
Lead 2A: But if this exercise – the UK Government seemed to list all the various different things it was going to do. If Scotland was going to play an active part in that, would it not need to be absolutely clear in the updated plan exactly what it was that the Scottish Government was going to be relied upon to do?
Ms Jeane Freeman: Well, it would be clear in the updated Scottish Government plan. And whatever came from that Nimbus Exercise Nimbus would feed back into that and that would include giving me feedback from the exercise itself, so I knew what the UK Government was planning and was able – would be able to check that we were parallelling that, if you like, as well as anything else that we might be doing.
Lead 2A: Was it anticipated at this stage, that if matters did escalate either along the lines of Professor Woolhouse’s predictions or something similar to that, that Scotland’s role would be to allow the UK Government to decide on policy and for it to implement an operational response within Scotland?
Ms Jeane Freeman: No, that wasn’t the understanding on 12 January. The understanding at that point, in my mind, would be that we would see four nations collaboration in response to a virus. And what that means is that as far as possible we would share information, share decision-making, agree the direction and the response that we would take, co-ordinate that where that was possible, but as – and, as it turned out, each of the four nations caveating that approach by saying “But in addition we may diverge one from the other depending on our judgement as to what is right for the population that we serve”.
Lead 2A: If that was the Scottish Government’s position, should it not have set it out as part of Exercise Nimbus?
Ms Jeane Freeman: Arguably so, but it does not appear from the note that we did.
Lead 2A: Thank you.
There was a civil servant, I understand, who worked alongside you called Derek Grieve –
Ms Jeane Freeman: Yes.
Lead 2A: – is that correct? He was the deputy director for health protection division within the directorate of population health; is that correct?
Ms Jeane Freeman: Yes.
Lead 2A: We have looked already at some notes he kept in his notebook over this period, and they are at INQ000346137. He attended a number of key meetings around this period with you and was generally engaged in the Scottish response; is that fair?
Ms Jeane Freeman: Yes.
Lead 2A: Page 14, he says – this is the Wednesday 26 February we understand it:
“Attended COBR (M) meeting with Cab Sec.”
That would be you?
Ms Jeane Freeman: Yes.
Lead 2A: And:
“It’s clear all [departments] in UK [Government] are fully engaged [and] mobilised in a way that the SG simply isn’t.”
Then in the next day it refers to someone trying to encourage them but with “no real engagement”.
“They then spent 20 [minutes] talking about internal SG comms. Completely amazed!”
Then on page 18, this skips forward a week or so to Thursday 5 March, where he says that:
“I attended Directors meeting [I think this was the top] … Laid it out thickly but few believe this is going to be serious.”
It appears here that Mr Grieve is suggesting that within his department, within your department – directorate I should say, that there was a general lack of awareness of the severity of the situation, in contradistinction, it would appear, to the position in the UK Government.
Ms Jeane Freeman: Well, certainly if that’s the case, it is in contradistinction to the position of health ministers, myself included, or the First Minister or the Deputy First Minister for that matter. It’s clearly Mr Grieve’s feeling and view, and I’m not going to cavil against that. I think he was reasonably frustrated that other parts of the directorate – it’s a very big directorate – were – appeared to him to be taking a view that this was a public health matter and therefore not for them. And that was probably fair in those early days, but of course the directorate had to come together fairly quickly because in the same way as we had to redeploy NHS staff to respond to Covid, we had to redeploy – not I personally, obviously, the senior civil service had to redeploy civil servants to strengthen parts of the directorate that were responding directly to the pandemic.
Lead 2A: And officials required to take forward practical actions based on the threat, such as the testing programme, et cetera, that we discussed earlier?
Ms Jeane Freeman: Yes.
Lead 2A: And these would be the officials that he’s talking about who had have required to take those important practical actions forward on your instruction or otherwise?
Ms Jeane Freeman: Well, they would be under the leadership of the director-general at that time, and also of Mr Connaghan, and both of those individual I had a great deal of confidence in their ability to corral individuals to take the action – not just take the action that we required them to but to do so speedily. And of course Mr Connaghan was in daily contact with our NHS boards as well, where a lot of the action had to take place too.
Lead 2A: You may recall, I hope you recall, that two international rugby matches took place towards the end of February or were due to take place towards the end of February in Italy: the Scotland men’s international rugby team played in Rome on 22 February; the women’s international rugby team had been due to have a match on 23 February, also in Italy, which was eventually cancelled due to local concerns about Covid.
Was this a matter that was on your radar at the time in particular in light of concerns about the spreading virus in northern Italy?
Ms Jeane Freeman: Yes – excuse me – yes, it was.
Lead 2A: What advice did you receive about the dangers that might be created by groups of people – not just, of course, the teams and people themselves, but the supporters that would be going to the game, possibly going to Italy and coming back to Scotland subsequently?
Ms Jeane Freeman: Yes, so the advice I received which came from the CMO, but also was advice, through her, from Health Protection Scotland, and I believe some of this was at least discussed at SGoRR meetings, was that the risk of spread in an outdoor setting was less than that when people were indoors, that people were already coming here, and if we cancelled the actual match more of them would concentrate or congregate for longer in an indoor setting, where the risk was higher.
Lead 2A: I wonder whether we might be at slight cross-purposes here, Ms Freeman, I wonder whether the response you’re giving relates to a later rugby match that was taking place in Scotland. What I’m talking is, in the international season the matches take place every week or two weeks.
Ms Jeane Freeman: Okay.
Lead 2A: We’ll get on to that in a moment. But what I was asking about was matches that took place towards the end of February – or one took place, one was due to take place – of the Scotland men’s and women’s teams in Italy –
Ms Jeane Freeman: Ah, yes.
Lead 2A: – so away matches. So I wondered whether that was a matter that had been brought to your attention, because of course a number of people would go to those matches, supporters as well as those actually participating, and they would come back to Scotland subsequently. So was that a matter that you received –
Ms Jeane Freeman: Yes.
Lead 2A: – advice about?
Ms Jeane Freeman: Yes, my apologies, yes, I was aware of those matches, and of the risk, if you like, of people returning from those matches, but also people returning from skiing holidays, for example, which often took place around about that time.
Lead 2A: We’re aware from the PHS report into the circumstances of the Nike conference that somewhere in the region of – there were somewhere in the region of 300 entry points for Covid – in reality, subsequently found out – that came from continental Europe, and therefore would it not, at least in hindsight, be something upon which you might have a comment as regards the advisability of sending large groups of people to northern Italy, which was the very area that was associated with outbreaks at that time?
Ms Jeane Freeman: I’m not quite sure what you’re asking –
Lead 2A: What I’m asking you –
Ms Jeane Freeman: – we should have stopped people going –
Lead 2A: Yes.
Ms Jeane Freeman: We could have issued advice to people not to go. We couldn’t actually stop people going. And in a similar vein, people returning, we would require that information to come from the UK Government so that we could, had we had the capacity, have tested them on their return. So it was not something entirely at the hand of the Scottish Government.
Lead 2A: When you say that you could have advised but not could have stopped them, what was your understanding of the powers of the Scottish Government at that time with regard to controlling its borders in that way?
Ms Jeane Freeman: So my understanding at that time was that the Scottish Government – that the UK Government controlled the borders into the UK, and –
Lead 2A: For all purposes? For all purposes?
Ms Jeane Freeman: Yes.
Lead 2A: Thank you.
Ms Jeane Freeman: And the Scottish Government’s responsibility was for public health measures inside Scotland.
Lead 2A: Thank you.
There is subsequently a meeting on – of the Cabinet on 3 March. There is just one aspect of that – we might not have to go to the minutes for this. There is a record on page 5, this is on 3 March. Again, this is updating again with further information that’s becoming apparent, similar to the minute we looked at before.
It says there that:
“COVID-19 would also have a differential impact on different groups within society, such as the most vulnerable and older people (unlike influenza, the new coronavirus appeared not to pose a serious risk to young people but had a disproportionately serious effect on those in their 70s, 80s and over).”
That’s very helpfully been put up.
Just to be clear, is that, does that reflect your understanding of the risk profile, if you like, as the science was showing at that point?
Ms Jeane Freeman: Yes.
Lead 2A: That’s 3 March.
Ms Jeane Freeman: Yes, it does.
Lead 2A: Thank you.
Could I also please, in that minute, go to paragraph 15. Just to be clear, it’s INQ000232901. Page 4. Thank you very much. Just the top paragraph there, Ms Freeman, it says:
“Although Containment remained the highest priority, it was likely that the response to the outbreak would move into the Delay phase in the near future. The objective during that phase would be to maximise the NHS’s ability to cope with the outbreak by spreading the number of cases over a longer period. Ideally, it would be best to delay the spread of the disease into the summer months, when it was thought that the medical effects might be less severe (although this was as yet not proven). Delay would also bring nearer the time when research into a possible vaccine might be closer to bearing fruit.
“16. During the Delay phase, the authorities’ principal tool was likely to be ‘social distancing’, which could include restrictions on large scale gatherings such as sporting fixtures or cultural events, but it would be important not to implement such measures prematurely.”
And at paragraph 19 on page 4 it says:
“(c) It appeared likely that, over the next few months, there would be a relatively slow increase in the number of cases from the current very low base, given the efforts that were being put into containment. At present, there was little evidence of community transmission in the UK, and new cases tended to be in ‘clusters’ – hence the continued importance of contact tracing as one of the main containment strategies it was, however, likely that containment would reach its practical limits over coming weeks.”
So do we take it from this that as at 3 March the Scottish Government was under the impression, first of all, that it would be important not to implement measures prematurely?
Ms Jeane Freeman: Yes.
Lead 2A: Sorry, I was just going to ask what the basis of that understanding –
Ms Jeane Freeman: So there was continuously all through the response to the pandemic – in as far as the time period that I was involved in it, there was a continuous discussion between – a judgement between what I said earlier about act fast, act decisively, but an argument that said: if you act too quickly, ie prematurely, then you don’t have enough evidence and rationale to convince the public that they should comply with what you were asking them to do, and so the tension, if you like, is between the urging to act fast and act decisively and the other argument that comes that says “But people won’t know why you’re stopping them from doing things, and if they don’t believe it’s a good reason they’re not going to comply with that”. And we don’t want to get into a situation where – we need to be, in public health, in a situation where people believe there is a basis for what you’re asking them to do that is about protecting themselves but also protecting others.
Lead 2A: One of the reflections that Professor Smith, when he gave evidence to the Inquiry, shared with us was that he was under the impression that one of the things that one might do better in the future, if you like, was that greater reliance could be placed on behavioural science in order to try to assist, I think, with the balance that you’re trying to point out. Was the position that it would be important not to implement such measures prematurely based on any scientific advice?
Ms Jeane Freeman: I believe so. I believe it was discussions that – that had been held in SAGE, but also, I believe, between the four chief medical officers. It was certainly part of the discussions that I had with the CMO and with the First Minister. And of course, as you know from a previous witness, we did reach out to gain expertise in terms of behavioural science as we progressed.
Lead 2A: Yes, we’ve heard from Professor Reicher who was a member of SPI-B but also served on the Scottish Covid Advisory Group?
Ms Jeane Freeman: Yes.
Lead 2A: That of course wasn’t constituted in Scotland until later. But your understanding was that there was scientific evidence that would suggest that it was important from a behavioural scientific perspective not to implement such measures prematurely, that was your impression at that time?
Ms Jeane Freeman: My impression at that time was that there had been discussions in those forums.
Lead 2A: Thank you.
As regards the apparent Scottish Cabinet impression that there was a need to spread the number of cases over a long period, ideally it would be best to delay the spread of the disease until the summer months, was there an impression at that stage that that was a goal that was achievable, extending the peak into the summer months?
Ms Jeane Freeman: So that was part of what was considered as the delay phase, where you introduce a number of non-pharmaceutical – NPI – interventions in order to restrict social movement and congregation, and what that does is it spreads out the peak of the expected numbers of the virus. In other words, you lengthen the period when you will have the virus, but you don’t have a peak of numbers, and that – that goes to not – attempting not to overwhelm our National Health Service –
Lead 2A: I see, that was part of your understanding of the strategy – or part of the strategy at that time was to spread out the peak over a longer period into the summer months was the objective; is that right?
Ms Jeane Freeman: As long as you believed it was necessary. So it wasn’t necessarily into the summer months, it was spreaded so that the peak is smooth, the curve is flattened – I think is the phrase I used in Parliament, the curve is flattened – so that we can cope with that.
There was also the view, as I’ve outlined before, that the summer months, when more people are outside, transmission is lower than when we are gathered together in confined spaces.
Lead 2A: Thank you.
The idea, I think, as we see in this paragraph, is that the anticipation was that there would be a relatively slow increase in the number of cases from the current very low base, given the efforts that were being put into containment. So if one followed this practice to try to push the peak into the summer months, there would be a relatively slow increase over that period?
Ms Jeane Freeman: No, not quite. So the thinking that there would be a relatively slow increase in cases was during the containment phase for as long as contact tracing was sufficient to contain the virus. Because contact tracing is trying to capture into one place everyone who might be infected, give them the necessary advice about what they need to do so they don’t infect others, and therefore contain spread in that group, if you like. But there comes a point where that isn’t going to work any longer, which I think the paper refers to, at which point contact tracing isn’t going to work to contain the virus, you need to take other steps.
Lead 2A: Yes. And given the document refers to “given the efforts … put into containment”, that there would be this relatively slow increase, I think, what efforts were being put into containment? I think we’ve already discussed that there weren’t very many; is that right?
Ms Jeane Freeman: No, what we’ve discussed is that the efforts were around contact tracing –
Lead 2A: Yes.
Ms Jeane Freeman: – at that point.
Lead 2A: Yes, but what were the efforts being put into containment then?
Ms Jeane Freeman: Okay, so where cases were notified, then contact tracing contacts the individual and asks them to tell them where they have been in the most recent period. There was a change in that, I think, from “Where have you been from the time when your symptoms first appeared?” Subsequently it was a “Where have you been and who have you been with from one or two days before your symptoms? Who were these people? What were you doing?” And then contacting those individuals and giving them the public health advice about isolating and not contacting others.
Lead 2A: I think we’ve discussed already that there were a number of limitations within the Scottish system of testing and tracing at that time; is that right, yes?
Ms Jeane Freeman: Yes, that’s right, but it is also fair to say that, with reference to the Nike conference, it was contact tracing that prevented the strains of virus prevalent in the individual who were affected from that conference from spreading any further.
Lead 2A: There is some comfort I think being taken in this paragraph from the efforts that were being put into containment; is that right?
Ms Jeane Freeman: I’m not – no. I would have been one of the people “in discussion the following points were made”. At no point in 18 months did I feel comfortable.
Lead 2A: But in that paragraph what’s being suggested, that “given the efforts that were being put into containment”, it’s “likely that, over the next few months, there would be a relatively slow increase in the number of cases from the current very low base”?
Ms Jeane Freeman: Yes.
Lead 2A: So the containment efforts will result in this objective that I think we’ve identified as being to try to squash the sombrero, or whatever one calls it, to get the peak further into the summer, and those eff – some reliance is being placed on those efforts as being something that makes it likely that that will be achievable?
Ms Jeane Freeman: So –
Lead 2A: – what it says on the page.
Ms Jeane Freeman: Yes, I absolutely –
“… a … slow increase in the number of cases from the current very low base, given the efforts …”
And you’re right, it does say “over the next few months”. That was a mistake. The efforts being put into containment would not see us through the next few months, because the virus was transmitting far too quickly for that.
Lead 2A: And the – sorry.
Ms Jeane Freeman: Sorry. Again to be sure that we’re understanding each other, the flattening of the peak is part of the delay phase, that is the point of those non-pharmaceutical interventions is to slow down transmission. Containment is about trying to contain it.
Lead 2A: Thank you.
I’d like to ask you – move on to a slightly different though connected area, which comes in around this period as well, to do with the spread of Covid-19 in care settings. In particular, to be clear, I’m interested in care homes obviously, but I’m also interested in prevention measures that were taken to try and protect people that were having care in their own home.
Ms Jeane Freeman: Yes.
Lead 2A: So we have already established, I think, that it had been known from the minutes from at least early March, if not before, that the elderly were particularly vulnerable to the virus; that was established?
Ms Jeane Freeman: Yes.
Lead 2A: And I think that it had been known, had it not, from sources including the Diamond Princess episode towards the end of February, that elderly people who were put in confined spaces indoors were particularly at risk, as that episode had rather shown. Professor Sridhar I think described it as almost like an experiment that would show you quite a lot that one wouldn’t have wished to have happened, but from which one could derive quite a lot of information.
Is that a fair background to where we were, say, by the beginning of March?
Ms Jeane Freeman: Yes.
Lead 2A: Thank you.
Could I turn, please, to the Cabinet minute from 10 March, which is INQ000238706. One second.
(Pause)
Lead 2A: It’s INQ000078529, sorry, my fault. This is in fact, sorry, the Cabinet meeting from 17 March.
Ms Jeane Freeman: Yeah.
Lead 2A: If we could go to page 3, paragraph 12, please, so there’s some discussion at this Cabinet meeting where it says:
“Social care presented particular problems, including those associated with residents in care homes and similar settings. COSLA had been invited to provide a co-ordination role across Scottish local authorities’ social care services, and bodies such as Scottish Care were already working with COSLA to achieve the best outcomes for those in care.”
This appears, from our analysis, to be the first substantive recognition in Cabinet that there are particular problems associated with residents in care homes and similar settings. The Cabinet minutes contain no further consideration of these problems.
Is it correct to say that around this time there was no urgency or prioritisation of the issues that would be posed for those who were in care, using that broad definition I gave a moment ago?
Ms Jeane Freeman: No, I don’t believe that is correct. Guidance had been issued to care homes on 13 March advising social distancing or physical distancing, visiting restrictions. I had written on 13 March that patients should be screened clinically to ensure that they weren’t being transferred inappropriately to care homes.
Lead 2A: This is –
Ms Jeane Freeman: So this Cabinet meeting is after that guidance was issued. So I don’t think it’s fair to say that this is the first time consideration was being given to this situation. That had not been the case, from my perspective as the Health Secretary, or indeed I believe from the First Minister.
Lead 2A: Thank you. Well, we’ll get on to the guidance in a second.
INQ000250859, please. This is a chain of emails from slightly earlier. If we could go to page 4, please, so there’s a chain of emails here relating to contact which it appears has happened on 10 March. It states – this is sent on behalf of the First Minister to the CMO, and it states:
“The First Minister would be grateful for advice on the following issue as a matter of urgency. A friend of the First Minister whose relative is in a care home received the letter below from the home today.
“[First Minister] said it rather makes the point that people are starting to vote with their feet. But it also begs the question of whether we need to issue some additional urgent advice to the care home sector? FM would be grateful for thoughts/advice?”
In fact, without going into the details, it’s a letter where a care home has sent material or a notification to a relative of someone in a care home relating to issues and an escalation of preventative measures which may cause some anxiety.
Is it the case that this email correspondence, which seems to have come to the First Minister from a friend, was the first indication or the first matter which provoked the need to try to issue some guidance?
Ms Jeane Freeman: No, it wasn’t.
Lead 2A: Well, when did the concern about care homes and those in care start within the Scottish Government?
Ms Jeane Freeman: So – excuse me – it started most definitely in – in and around February. The Chief Nursing Officer was the lead official in this, given her responsibility or the responsibility of that post for infection prevention and control, and discussions were beginning with Scottish Care and with COSLA.
You’ll recall, I know, that the care home sector and the care at home sector is not like our National Health Service, it is a mixed economy, local authorities have a significant responsibility for commissioning that service and have a significant locus in that service, as does the Care Inspectorate.
So consideration was being given early on about what we could do in that sector for those residents, bearing in mind this is their home, about how we could institute measures in addition to the national manual of infection prevention and control – which is part of their contract, all providers are required to abide by – what else could we do that would assist them to protect their residents.
And I would like to say at this point – I have said it before, but I want it read into the record here – that I was personally very concerned about our care sector, both our residential care sector and the care at home sector for adults, not all of whom were elderly, and regret very much, and will do for the rest of my life, any deaths that occurred there because of action that the Scottish Government didn’t take or did take but could have done better.
Lead 2A: Thank you.
On the subject of the deaths, of course we know that 50% of the deaths in Scotland in the first wave of the pandemic occurred in care homes.
Ms Jeane Freeman: Yes.
Lead 2A: You mentioned the idiosyncrasies, if you like, of the way in which care – the care sector is organised in Scotland, not part of public service entirely but a combination of public and private delivery. It is the case, however, that the threat to people in care homes which resulted in those deaths is a public health matter for which the Scottish Government had overall responsibility?
Ms Jeane Freeman: Yes, that’s correct.
Lead 2A: And which fell within your remit –
Ms Jeane Freeman: Yes.
Lead 2A: – as Cabinet Secretary?
Ms Jeane Freeman: Yes.
Lead 2A: When you say you were concerned in February, I think you said, about the care sector in the – with the wide definition I’ve given to it, it is correct to say that despite the concern that you’ve indicated that you had, no guidance was issued to that sector until 13 March, which was after the date upon which the email was sent to the First Minister from her friend which indicated there were concerns within the sector; is that correct?
Ms Jeane Freeman: That is correct. Part of the difficulty that Scottish Government – we had in Scottish Government at that point was because of the devolved nature, I think it’s probably fair to say, of the governance and management of that sector, the data that Scottish Government held was limited, about the exact number of care homes, and I believe we actually for the first time got the information from Dr Macaskill in Scottish Care about his membership and about the size and spread of those care homes, in other words the number of residents they might have, their staffing levels and so on. So centrally we had limited data, much more limited than we had about the National Health Service.
Lead 2A: Was it not possible – we’ve heard evidence already about the limitations on the Scottish Government’s access to data in the care sector. Was it not possible to try to get some of that information from the likes of Dr Macaskill, who was engaged in the sector?
Ms Jeane Freeman: Well, as I’ve just said, yes, we did, and officials were actively working to get that information, and of course Dr Macaskill and I had previously worked together before the pandemic, so it was entirely possible and we did converse frequently over the whole period of the pandemic.
Lead 2A: There was a particular concern, I think, from those early stages about the possibility that the transfer of patients into care homes, either from the community or more particularly from hospital settings, may pose a risk to those care homes, given that patients who are – residents who are being transferred may have acquired the virus in another setting. Is that correct?
Ms Jeane Freeman: So there was two-fold concern. One was that patients who were ready to be discharged from hospital because they no longer required hospital-based clinical treatment should not stay in hospital any longer – now, this was a pre-Covid concern – any longer than they needed to, especially if they were elderly or frail, because a longer stay in hospital diminished their muscle capabilities, could produce confusion in those who had not previously experienced that, and so on.
In terms of Covid, the concern was that that made them more vulnerable to acquiring the infection in hospital. Against that was the risk of transferring people to care homes who had not been tested, and what we attempted to do was to put in place additional mitigation measures to the national manual on infection prevention and control which all care homes were required to follow, and those additional mitigation measures are the ones that are set out, initially in the 13 March guidance, but then increased significantly over a relatively short timescale.
Lead 2A: The 13 March guidance, as we’ve seen in documents already, you’ll recall includes guidance that there should be social distancing, essential visits only, that the home should accept admissions to the home if safe, and that the home should be closed if residents test positive. There is no requirement in that for transfers, from either the community or hospital setting, to have a negative test before there is an admission; is that correct?
Ms Jeane Freeman: No, that’s correct, and that partly goes back to our earlier conversation about the availability of testing capacity.
Lead 2A: We’ll get back on to that in a second.
Just as regards these particular measures, you mentioned a moment ago the possibility that residents of care homes who are patients in hospital may suffer from confusion. To what extent were there – was there understanding within the Scottish Government about whether it would be practically possible for social distancing to take place, either as a result of patients suffering, for example, from dementia or other such conditions, and as regards the capacity and ability of care homes to enforce such social distancing in those environments?
Ms Jeane Freeman: So our understanding was that – or my understanding was, primarily through discussions with Dr Macaskill, that it would be possible to do that but we needed to have some flexibility, particularly around patients – or residents, I should say, who suffered from dementia who may find the lack of communal gathering upsetting and distressing, and at some point that feeds into the visiting guidance as well.
Lead 2A: What did the guidance mean when it referred to “essential visits only”?
Ms Jeane Freeman: So “essential visits only” referred to both end of life visits by family, but also those visits that might be necessary from a family member where an individual resident was distressed; it could also mean clinical visits from a local medical practitioner.
Lead 2A: Was consideration given to the difficulty that there might be explaining that requirement to residents of care homes who may have dementia?
Ms Jeane Freeman: Well, yes. But in none of this was there a risk-free choice. In none of this, at any point. So, yes, I understood very well the difficulty and the distress that might be caused to residents, and certainly the distress to their families by asking for physical distancing, the ending of communal dining, the ending of communal association, the ending of some of the external visits that residents do a great deal from, whether that was in terms of physical – physiotherapy, or local schools visiting, or what it might be.
So I understood that, but I also believed to allow that to continue was to increase the risk of transmission of the virus into the care home and transmission of the virus within the care home.
Lead 2A: Did the guidance, either on 13 March or indeed the subsequent one which I think was dated 26 March, include any guidance relating to requirements to minimise the risk of infection from staff in the care homes?
Ms Jeane Freeman: So both sets of guidance, as I recall, covered the use of PPE and guidance to staff on what PPE might be required, and the putting on and the taking off of PPE, particularly if as a staff member you were dealing with more than one resident, you had to take everything off and put on a new set. Clear guidance obviously that’s in the manual but it’s – was repeated about hand washing and so on.
Lead 2A: What was the Scottish Government’s understanding of the availability of that PPE in order to meet those requirements?
Ms Jeane Freeman: So up until, pre-Covid, care homes and the social – the adult social care at home sector, that mix of, I think, 80% private providers, 20% local authorities and the rest were third sector, independent providers, all of them were responsible for the provision of their own PPE and for their contracts. But Mr Macaskill primarily, but not only him, drew my attention to the problem that at that point some were having with sourcing PPE. Because this is a global pandemic, the demand for PPE is very high, the price is soaring, and the orders that they had were pretty low value orders in terms of the amount, so they were getting squeezed. And it was at that point, I think 19 March, when we introduced the triage service. In other words, we decide – I decided that our national procurement service which procured in volume PPE for our NHS would now procure PPE, additional amounts of PPE, to try and help the social care sector, because (a) it was a known provider and purchaser of PPE, it did it in high volume, it had known suppliers who would want to continue to be suppliers post the pandemic, so the chances of being knocked off their list, if you like, or pushed down the list for delivery was lower, and they had the strength, if you like, to increase their PPE volume so that we could begin to offer it not just to the social care sector but also to primary care in the community –
Lead 2A: That – sorry.
Ms Jeane Freeman: – including our pharmacies and so on.
Lead 2A: That initiative was instigated on 19 March, did you say, and that will have taken some time to feed PPE into the system because there would need to be negotiations about availability; although of course you say that the Scottish Government is using its purchasing power, it would be necessary to actually procure that, as you say, in a global pandemic?
Ms Jeane Freeman: No, NSS, our national services, which is the procurement arm of the NHS in Scotland, had stockpiles of PPE, and so introducing that on 19 March meant that they could provide from their stockpiles PPE to care homes, and that triage service.
Now, as we subsequently see, it was changed later because it was a reactive service so it relied on care homes to ask for what they needed. But the national – or NSS, the procurement arm, could already provide from its stockpile. What it then had to do was increase its orders coming in, in order to keep the stockpile at the level that was needed.
Lead 2A: As at the date of the 13 March guidance, I think you’ve described that the guidance pointed out that PPE would be necessary for staff in order to minimise the risk of infection, how it should be used in order to try to achieve that aim. So the requirement for it was known, but as far as the guidance was concerned the position at that date was: you’re on your own?
Ms Jeane Freeman: I wouldn’t put it as bluntly as that, Mr Dawson, because that implies a careless attitude on my part or anyone else’s, and we certainly didn’t have that. What that reflects is the pre-pandemic position, and as soon as it was made clear to me that that pre-pandemic position was struggling to produce the level of PPE in the quantity or of the type that was required, by Dr Macaskill and others, then we acted to change that so that the national procurement service for the NHS could provide PPE to our care sector, both adult social care at home but also residential care.
Lead 2A: I wonder if I could draw your attention to an email which was received, as I understand it, by Scottish Care from one of its members on – dated 25 March 2020. It’s INQ000249952. This email – as I say, dated 25 March – sets out a number of the issues which one of the members of Scottish Care is having at that time.
Now, we’ve looked at this before, but I’d particularly like to take you to the passage under the slightly understated comment, “A few worrying points”, just below where we are at the moment, and over to the next page, please.
So these are – this is what this particular care home is being told, and just over to the next page, it says:
“… ‘as long as staff wear the appropriate PPE’ …”
Which is effectively shorthand for that element of the guidance. It says:
“… That’s not possible. No Care Home has the appropriate equipment. None. A low grade face mask, a plastic apron and a pair of latex gloves is not the appropriate equipment for barrier nursing a potential carrier transferred from a high risk area in the middle of a deadly, highly contagious Pandemic by a Care Assistant with no training in High Risk Infectious Diseases in a Care Home not equipped or designed for such.”
Does that, Ms Freeman, adequately explain the difficulties that were being experienced with the guidance, the difficulties that were being experienced with PPE, and frankly the completely unrealistic expectation of the Scottish Government as regards this particular sector and the risk to the residents of care homes?
Ms Jeane Freeman: I think what it tells us is that there were serious issues being raised that needed to be taken seriously. PPE guidance did not come – I did not write PPE guidance. For the very reasons we’ve touched on before, PPE guidance came through our Chief Nursing Officer Directorate, based on their clinical understanding of infection prevention and control, informed by all the emerging and constantly emerging information about the nature of the virus. So PPE guidance changed over time, and the guidance that would have been in that issued on those various dates reflects the advice that I was being given about the kind of PPE that was needed.
Now, there were instances raised with me, not least in terms of care at home, about PPE and (a) the availability of it and (b) the lack of allowing those care at home staff to exercise their professional judgement about what they needed, that I sought to resolve and sought to resolve quickly.
But wherever issues were raised, whether they were directly with me, whether it was through the PPE helpline, whether it came from Dr Macaskill, through his members, or any other route, then my response was to double-check what the concern was and, if there was a problem in terms of receiving PPE or the adequacy of PPE, to try and resolve that.
Lead 2A: But these are more than just simple practical issues. These are – this is an indication which has been presented by Dr Macaskill in his evidence, as I understand it accepted, this was from one care home but representative of problems experienced across the sector, that it was simply not possible, as it says here, for that type of system to be instituted within a care home, which of course is not the same as a hospital.
Ms Jeane Freeman: No, it is not, it is a resident’s home. But what was not being suggested to me at that point, from Dr Macaskill or anyone else, was an alternative to those mitigating measures that I had to put in place until our testing capacity increased to the level that we could undertake testing prior to discharge or admission to care homes.
Lead 2A: Another consequence of the policies, the guidance which Dr Macaskill of Scottish Care pointed out in his evidence was that the 13 March guidance caused confusion within the care sector, which led to the belief that individual residents who were Covid-19 positive should not be transferred to hospitals. He talked of a presumption of a blanket ban on care homes transferring residents who had tested positive to hospitals, which meant that they were unable to access required medical care.
Was this an issue that was brought to your attention?
Ms Jeane Freeman: It was, and I believe our CMO acted on that, and having read the guidance I can understand why that concern was raised. What was intended, as I understood it, by the particular paragraph was that, as it is – as I have recently experienced, indeed – it is not always appropriate for an elderly person who is seriously ill to be transferred to hospital, where the risk of that transfer increases to their health, than to be provided care in their own home. That is what that paragraph intended to convey. The manner in which it is written, I can see why it would be taken precisely as people were concerned.
Lead 2A: What did you do in response, as regards that particular aspect of the guidance?
Ms Jeane Freeman: So I asked our CMO first of all to describe to me what was meant by that, and then to make sure, through her channels and her reach, that it was clear what was intended by that, that it was a clinical judgement whether an individual should be transferred from any setting into hospital, just as it is a clinical judgement whether or not an individual is ready for discharge. It’s not for anyone else to make those judgements.
Lead 2A: To be clear, you’re referring on a number of occasions to advice from the CMO or the Chief Nursing Officer; ultimately you and the Scottish Government are responsible for the guidance. Do you accept that?
Ms Jeane Freeman: I do, I have never caviled from that in any respect. I was the Cabinet Secretary for Health –
Lead 2A: Yes.
Ms Jeane Freeman: – so I am and was responsible.
Lead 2A: Thank you.
We understand from his evidence, again, that you met with Dr Macaskill on 18 March; do you recall that?
Ms Jeane Freeman: Yes, I did.
Lead 2A: Could we have a look, please, at INQ000261341, page 2, and I’d like to address the testing aspect.
Before we go to the text, just to clarify, I’ve read out to you the broad provisions of the 13 March guidance, and is it correct to say that neither the 13 March nor the 26 March guidance contained any requirement for there to be a negative test or indeed more than one negative test before a patient was moved from a care home – from a hospital into a care home?
Ms Jeane Freeman: That’s correct. The 26 March guidance introduced the isolation period, and I think Dr Macaskill refers to the aspect of it which is seven days –
Lead 2A: Yes.
Ms Jeane Freeman: – in what we’re about to look at.
Lead 2A: Well, I simply want to confirm with you that the guidance did not require there to be negative tests before hospital discharge, and indeed no test was required for admission to a care home from community either?
Ms Jeane Freeman: That’s correct.
Lead 2A: That changed subsequently –
Ms Jeane Freeman: Yes.
Lead 2A: – in the 28 April guidance –
Ms Jeane Freeman: Yes.
Lead 2A: – where there was a requirement in fact for two negative tests, is that right, just to put this into context?
Ms Jeane Freeman: Yes, that’s correct.
Lead 2A: Thank you.
So look at this document, please, this is a document that was prepared for you, a briefing in advance of the meeting that you attended with Dr Macaskill, and in this it is stated under “Testing”:
“They have concerns regarding the current testing arrangements and would like:
“- people tested before they are discharged from hospital to care homes so that care homes feel confident in accepting admissions from hospitals; and
“- testing for frontline social care staff in order to avoid 14 day isolation periods to enable them to return quickly to work.”
Then it says, “Lines to Take”, and outlines various options relating to:
“- Testing for patients/people is currently being triaged into four different categories …
“- Testing for staff – currently neither health or social care staff are being tested unless they fall under categories 1 and 2 [above].”
If we could turn, then, to page 2, paragraph 11, please, it’s the passage starting “If our aim …” Maybe over the page.
(Pause)
Lead 2A: Sorry, just one second.
(Pause)
Lead 2A: Sorry, it’s a different document I’d like to go to, if I could. It’s INQ000222973. Sorry, this is a different paper, which is prepared by Mr Grieve, in fact, for Nicola Sturgeon and you on 18 March, so the same day. So it’s putting it in some context, we’ve seen already that a meeting is being set up, there are a number of things which are going to be discussed, various options are presented. And on page 2, paragraph 11, sorry, it says:
“If our aim is ultimately to contribute to saving lives then we will not be able to limit testing to hospitals. A substantial proportion of those who are likely to be infected by the virus will remain in a community setting, in particular care homes. Colleagues in HPS are currently modelling this demand. What we know is that there are 35,989 residents in 1,142 care homes. Testing a significant proportion or all of these residents would significantly exceed the available capacity in laboratories.”
This paragraph starts with the conditional, “If our aim is ultimately to contribute to saving lives …” Can we take it that that was the aim of –
Ms Jeane Freeman: It absolutely was. I’ve no idea why Mr Grieve would put “if” in that sentence.
Lead 2A: Care home residence has, of course, has been assessed as high risk from early on in the period that we’ve been looking at; is that correct?
Ms Jeane Freeman: Yes.
Lead 2A: And, as far as this is concerned, it seems to identify that lives will be lost if more is not done; is that correct?
Ms Jeane Freeman: Yes.
Lead 2A: And that the issue, the sole issue at this stage is testing capacity; is that right?
Ms Jeane Freeman: The primary issue at that stage is testing capacity, yes.
Lead 2A: As we said earlier, testing capacity is something that effort could have been put into at an earlier stage in order to try and ramp it up beyond the levels we discussed; it could have happened at an earlier stage?
Ms Jeane Freeman: I’m not – I’m not sure I agree with you. There is – you cannot magic out of thin air appropriate buildings, appropriate kit and skilled individuals. A lot of effort was put into increasing our capacity for testing, because even if I hadn’t understood the vulnerabilities in our care homes and other closed settings, I understood the vulnerabilities of those caring for individuals in terms, not only of PPE but of knowing whether or not they were themselves infectious and posing a risk not only to themselves, their families but also to those they cared for, and I believe that we moved as quickly as we could, actually could, to increase our testing capacity. And it has never been put to me that there was testing capacity available somewhere else that we could have used and didn’t use. We did our very best to increase that, and of course managed in the end to do that, and as you’ve noted – we will sure come on to it – in April we were able to introduce testing for admissions. But the whole issue of transmission and health and death in care homes is a complex issue.
If I can just make the point, and even at that point from Mr Grieve, his known number of care homes is inaccurate. There actually were 1,084 care homes, 843 of them had discharges from hospital, 348 of those had outbreaks, 321 had deaths, of those who took discharges from hospital.
What that tells us is that some care homes that received discharges from hospital during this time did not have outbreaks, because the issue is a complex one, not complex in terms of the professionalism, the commitment or the care of care home staff, but complex as a subsequent independent report also reveals in terms of size of care home as well as the availability of PPE and so on.
I am not – and I need to be clear – I am not saying that the discharge from hospital without a test into care homes had no impact. What I am saying is that it was one of the factors, and I think a Public Health Scotland witness that you had before you previously, my Lady, said that it was, but actually in their analysis and the independent analysis the size of the care home was a more significant factor.
So this is a complex issue that testing on its own does not help us understand as well as we need to.
Lead 2A: The figure given to you there that there were 35,989 residents in care homes, what’s the relevance of your figure to your assessment at the time?
Ms Jeane Freeman: That we were worrying about a great number of people who were residents in care homes and who, because of, for many – for many, not all – but for the vast majority, because of their age, their frailty, other conditions they might have, were vulnerable to this virus.
Lead 2A: You do not know or did not know at the time the number of patients, not the total number of residents but the number of patients who would be transferred from hospital to care homes, did you?
Ms Jeane Freeman: No.
Lead 2A: That was the relevant figure that you needed in order to be able to ascertain how many tests you would need?
Ms Jeane Freeman: No, not necessarily, because I would also want to know that people who were being discharged into the community had also been tested.
Lead 2A: But in order to try to – well, you would need to know that figure too, but in order to try and work out the issue of the number of tests that would be required for people who were coming from hospitals – this is the topic that we’re discussing – you would need to know the figure of transfers, not the total number of residents; isn’t that right?
Ms Jeane Freeman: That’s right, yes.
Lead 2A: We know already from other evidence that you did not have access to that information. Did you seek to try to understand the numbers that might be involved, for example, from Dr Macaskill?
Ms Jeane Freeman: I can’t recall if I had that conversation with him. We talked a lot about discharges and admissions to care homes, but I can’t recall if he gave me that number or if we discussed a number.
Lead 2A: We heard some evidence from an individual you’ll be familiar with, Caroline Lamb, who told us that there was a degree of prioritisation of tests within the Test & Protect strategy. She said that she was not involved in the prioritisation discussions for the testing around this time. Were you responsible for deciding who should be prioritised for tests?
Ms Jeane Freeman: No. That was a clinical decision, as it should be, and in the early days the prioritisation was to assist with diagnosis, and there were two other categories I can’t quite recall, I’m sure you have them, but –
Lead 2A: So when you say it was a clinical decision, do you mean that that was a decision you made based on clinical advice from the Chief Medical Officer and perhaps others?
Ms Jeane Freeman: Yes.
Lead 2A: So a prioritisation was given to people other than the residents of care homes who might have been tested, even although it was known that the residents of care homes were within the highest risk category?
Ms Jeane Freeman: Admissions of elderly people to hospitals would also be in that high risk category, and testing them in order to diagnose what needed to be done but also to identify if they were – if they had the virus and protect other patients by appropriate pathways for the individual was also a priority.
Lead 2A: You’ve referred already to the fact that the strategy changed in April. We understand that a deep dive meeting into care took place on 15 April. There’s a reference to that in one of the SGoRR sitreps. You might remember those documents that provide –
Ms Jeane Freeman: I do.
Lead 2A: – information.
What was it that prompted the deep dive meeting to happen on 14 April?
Ms Jeane Freeman: So by that time we had introduced testing for all health and social care staff, and those that we were seeking to return back, perhaps individuals who had retired or those final year medical or nursing students, to ensure that they were tested.
We’d also introduced the – a situation or a requirement that all symptomatic residents were tested where that was appropriate. Bear in mind at this point the test was both – you had to swab both the nose and the back of the throat, so for some individuals that was a very distressing experience, and that’s what “if appropriate” meant.
The deep dive at that point in April was around bringing together all the information we had about what we were doing, what more needed to be done, whether we were able to do it, and then focus the actions around that.
Lead 2A: Was the deep dive meeting indicative of a realisation in the Scottish Government that insufficient efforts had been made to protect those in care homes and many, many residents had died?
Ms Jeane Freeman: There was certainly a realisation of that, but that realisation didn’t suddenly happen on 15 April. I don’t think 15 April was a sudden dawning on the part of Scottish Government, Scottish ministers, myself or the First Minister that this was a serious issue. I think I’ve explained that for some weeks this had been considered by me as a very serious issue, but we were now at a point where it might be possible that our testing capacity was such that we could add that additional measure.
It was also a realisation or a growing understanding that the understanding and application of basic infection prevention and control was not necessarily consistent across all residential settings. Again, to be very clear, that is not a criticism by me of any member of staff, but it is the case that in some instances, as the figures I gave you earlier indicate, some of our care homes were responding to the guidance more fully than others, for a variety of reasons that we sought to understand through discussions with Dr Macaskill or individually with some of the providers, and sought to try and help support them to do that.
Lead 2A: Despite that background, the additional measures didn’t come in til 21 April; that’s correct?
Ms Jeane Freeman: That’s correct.
Lead 2A: Those we’ve talked about, the testing element which, as I understand it, is based on a lack of availability of testing until that time, that’s why that changed. Is that right?
Ms Jeane Freeman: Yes.
Lead 2A: As other elements of that guidance included increased oversight in order to try to make sure that the various measures that were required within care homes could be carried out properly, is there any reason why that oversight could not have been put in place much earlier?
Ms Jeane Freeman: Until that point, or until the period running up to that point, I think I mentioned earlier that Scottish Government’s knowledge of and complete understanding of how the adult social care sector operated was not as adequate at the outset as we needed it to be. And so there were some presumptions made that, as we worked through the days, became clear were – could not stand.
One of the presumptions that I made, and I regret this, is that the national manual for basic infection prevention and control was widely understood and practised. I think, again for reasons I’ve indicated and with no criticism at all of individual staff, that was not consistently the case.
Some other areas of our understanding of particularly the care at home sector was not adequate at the outset, and so we had to work through, with Scottish Care of course but also with COSLA, to increase our understanding and identify the deficiencies in how the system was operating, and one of those deficiencies required greater clinical support to the care home setting. Hence that part of the guidance that requires directors of public health – each health board has a director of public health – to take a direct engagement with the care homes in their area, to look at what more support might be needed.
Lead 2A: As had been the case in the early months of the pandemic, Ms Freeman, the Scottish Government’s response to the care home crisis and the need for people who are vulnerable or elderly to be protected was completely inadequate, was it not?
Ms Jeane Freeman: It was not as adequate as I would have wished it to be. I believe it was all that could be done with the resources available to us at that point, and that improved as time passed.
Mr Dawson: Thank you.
Those are my questions. As I understand it, there are some pre-Rule 10s. Thank you, my Lady.
Lady Hallett: There are.
Ms Mitchell.
Questions From Ms Mitchell KC
(Mic not on)
Ms Mitchell: – for asking many questions the Scottish Covid Bereaved wished to have answered.
I appear as instructed by Aamer Anwar & Company on behalf of the Scottish Covid Bereaved.
I’d like to ask you, please, about communication strategy within Scottish Government, in particular misinformation was an important issue in the pandemic, particularly with the prevalence of people getting information from social media which couldn’t be properly regulated.
The First Minister, current First Minister’s written evidence is – has been submitted before this Inquiry, states:
“The Scottish Government did not directly refute misinformation, but instead worked to ensure our own factually correct messages were communicated widely.”
What I would like to know, first of all, was: was this a tactical decision taken by the Scottish Government not to refute misinformation in relation to issues during the pandemic? And secondly, if so, what were the reasons for that tactical decision?
Ms Jeane Freeman: So the principal reason for not directly refuting in that – through social media, if you like – misinformation was really to avoid getting into a “he said, she said” situation. But, for example, in the care sector, there was a lot of concern and anxiety around what was misinformation, for example, about vaccines. And so, rather than have a social media argument about that, with the support of Scottish Care we set up a series of webinars which simply allowed staff to ask questions that they had, concerns that they had. They may have received information that was wrong, they may have just straightforward concerns about vaccine efficacy, around the speed with which vaccines were produced, people had some concerns about whether they were as safe as pre-Covid; and that was the approach that we took to dealing with misinformation, was simply to try and find opportunities where people could ask questions about their concerns, that we could answer those concerns directly to them, and webinars were used a great deal by Scottish Care and ourselves, or open meetings with trade union members where they could – through Zoom or whatever it might be – ask a number of questions rather than have a social media, or any kind of media, tit-for-tat argument which I don’t think would have served anybody particularly well.
Ms Mitchell KC: I’ll move on to my next question.
The Inquiry has already heard evidence given by the First Minister, then Minister or Cabinet Secretary for Health and Mr Swinney, who is still to give evidence, met with the Scottish Covid Bereaved on 17 August 2021. At that meeting, members of the group expressed their concerns about the classification of the three cardinal symptoms of Covid: cough, temperature and the loss of the sense of smell and taste. Their concern was that these three cardinal symptoms were too restrictive, and they were raising that to see whether or not anything could be addressed.
Were you aware of the concerns raised by the Scottish Covid Bereaved in this regard?
Ms Jeane Freeman: Well, of course in August 2021 I was no longer an MSP or in government, but I recall from re-reading the guidance in preparation for today and for my witness statement that there is – and I can’t be certain whether it begins with the first guidance or whether it appears in the second, but there are sections which remind the reader that in elderly people the symptoms may be different, they may manifest themselves in a different way. That could be increased confusion, it could be more falls. So we were alert to the fact that the standard symptoms – that you shouldn’t confine yourself to saying: well, that person hasn’t got a cough and their sense of smell’s fine, so they must be all right, there’s something else happening; you needed to think more widely, particularly if you were dealing with elderly or frail people.
Ms Mitchell KC: Did you play any part in considering the issue of Covid symptoms, for example in discussions with the CMO or Mr Macaskill, or anything of that nature? Did you discuss with them the cardinal symptoms and whether or not they should be expanded?
Ms Jeane Freeman: I do recall, I believe, discussions with Mr Macaskill, because he wanted to ensure that the guidance took account of that. I don’t recall particular discussions with the CMO on that, although we did have discussions about the symptoms that we were alerting the general public to, because I think – in fact I’m sure – the list changed at one point during the pandemic, a new one was introduced.
Ms Mitchell KC: Indeed, and I think when we were asking questions of a witness before, the Inquiry has evidence that that is the case, in 2021 it changed, and indeed the Inquiry has also heard evidence from Mr Macaskill about the issue of the difference in symptoms that were being identified as Covid symptoms, but they were different and not manifesting in the same way in a population which was older, with multiple comorbidities. He says that that was aware to him, late February and certainly early March 2020, but a change didn’t occur til 2021.
Can you tell me, if he raised this with you, why it took so long for changes to be considered?
Ms Jeane Freeman: So, well, before 2021, as I’ve already said, the guidance that was issued to the care sector did mention this, and did raise to be alert that the standard Covid symptoms, if you like, may not manifest themselves in elderly or frail people and they had to look otherwise –
Ms Mitchell KC: That was June 2020, and then the actual symptoms were a year later. But in those early days, was there any consideration given to changing, as it were, those symptoms and advice?
Ms Jeane Freeman: So the symptoms of Covid, from memory, came to us from the four CMO discussions, and I don’t think – I certainly didn’t feel competent to question whether it was a cough or not a cough, or a sense of smell or whatever, but I did discuss with Mr Macaskill prior to June 2020, and I believe the guidance prior to June 2020 did mention that for those who were elderly you had to look beyond the standard symptoms that were being advised to the wider public.
Ms Mitchell: My Lady, those are my questions.
Lady Hallett: Thank you very much, Ms Mitchell.
I think that completes the evidence for today, Mr Dawson.
Thank you very much, Ms Freeman. I appreciate I’ve asked you to attend twice now. I’m not sure I can say I won’t ask you again, so thank you very much for your help.
The Witness: My Lady, if I may just take the opportunity to apologise. The last time I did attend, I did so virtually and we had some internet issues. I just, for the sake of my colleagues at the University of Glasgow, I need to be clear that was not their fault.
Lady Hallett: Right. I think someone was blaming Scotland rather than Glasgow University.
The Witness: I don’t think it was the country’s fault either, but it was certainly –
Lady Hallett: I didn’t think it was the country’s fault.
The Witness: Thank you very much.
Lady Hallett: Thank you.
(The witness withdrew)
Lady Hallett: 10 o’clock tomorrow, please.
Mr Dawson: Thank you, my Lady.
(4.36 pm)
(The hearing adjourned until 10 am on Tuesday, 30 January 2024)