Transcript of Module 2B Public Hearing on 27 February 2024

(10.00 am)

(Proceedings delayed)

(10.10 am)

1. Opening Remarks by the Chair

Lady Hallett: Good morning. Do we still have a problem?

Mr Poole: No, my Lady, it’s been resolved.

Lady Hallett: Thank you very much.

Good morning, everyone here with us at the hearing centre in Cardiff and to those who are following online. We are holding the hearings on the outskirts of Cardiff, which I know is not ideal for everyone, but our priority was to get these hearings on, and we have provided transport for those who need it to and from the city centre, and I’m sure that we shall be well looked after here at the hotel, and the team, the Inquiry team and the staff here, will do their utmost to ensure that every possible need is catered – well, maybe not every possible need, but most needs are catered for.

Today we begin the substantive hearings into Module 2B, core decision-making in Wales. I know that some had hoped for an independent Welsh Inquiry, but that, as everyone knows, is not a decision for me. I can promise, however, that the UK Inquiry will do its utmost to investigate and analyse fully and fairly the most significant issues that concern the people of Wales.

It’s probably appropriate that we begin these hearings in Wales in a week that includes St David’s Day, but also includes the National Day of Reflection, on Sunday, when we remember those who lost their lives during the pandemic. And it is because we have to remember those who died and those who suffered that the Inquiry has impact films at the beginning of each module, and we shall begin this module in the same way, with an impact film where people describe their suffering.

It is extremely moving, as its predecessors were, and it reminds us all why we are here. It lasts for about 20 minutes or just over, so if you do not want to watch the impact film, and you’re following online, please press pause. If you’re here with us in the hearing room, please leave, and we’ll make sure you have proper notice, when the film is concluded, to come back into the room.

After the impact film has been played, Mr Tom Poole King’s Counsel, Leading Counsel to the Inquiry for this module, will explain the issues that we shall be examining during the course of the next three weeks, and he will be followed by those core participants who wish to make oral submissions today. Tomorrow we shall begin with the evidence. We start with the evidence of some of those who were most impacted by the pandemic.

So I shall now pause, if anybody present in the hearing room wishes to leave, and those online can press pause.

(Pause)

Lady Hallett: Thank you. Could we now play the impact film, please.

(Video played)

Lady Hallett: Thank you. We shall now resume the hearing, streaming of the hearing. As I said, extremely moving.

Mr Poole. Opening statement by LEAD COUNSEL TO THE INQUIRY for

MODULE 2B

Mr Poole: The Inquiry turns today to its examination of the Welsh Government’s core political and administrative decision-making in relation to the pandemic in the period between January 2020 and May 2022.

The purpose of this opening statement is to first explain the scope of this module, Module 2B, how it picks up where Module 1 left off, and how it links to and intersects with Module 2.

Second, to provide some context to the evidence that your Ladyship will hear regarding the stark reality of the pandemic in Wales.

Third, summarise but not repeat the evidence that the Inquiry has already heard in Modules 1 and 2, both the context and also substance, and also for the benefit of those who might be turning to the Inquiry for the first time today.

Fourth, to give a narrative chronology of key events and decisions that impacted on Wales during the pandemic.

And finally, to highlight some of the key issues that will be explored in evidence over the next three weeks here in Cardiff.

So the scope of this module.

In these hearings, the Inquiry will analyse the core decisions which were taken in the discharge of the Welsh Government’s duty of protecting the lives of the people of Wales. In so doing, we will enquire into, probe and challenge these core decisions to see if they were made on the best information, after proper consultation, as part of a well ordered process, and without undue delay or unnecessary prevarication.

As part of this Inquiry, we will be looking at the threat posed to the people of Wales, not just the threats of harm and actual harm caused by the virus, but also of the countermeasures adopted by the Welsh Government designed to protect against them.

We will question key decision-makers, including the First Minister, and other members of the Welsh Cabinet, and the advice received from political and scientific advisers that informed Wales’ strategic response to the crisis that wrought devastation across the country.

In Module 1, the Inquiry considered the state of the UK’s emergency preparedness, response and resilience structures at the time just before Covid arrived in the UK, in January 2020. Module 1 covered the role that both the UK Government and the Welsh Government had in planning for a civil emergency such as the pandemic. The question posed in Module 1, namely whether the right groundwork had been laid and the extent to which civil contingencies framework anticipated a pandemic of this nature, was not only a necessary prior question but one that provides important context for the decisions which the Welsh Government had to make as the pandemic took hold.

In Module 2, the Inquiry examined the effectiveness of the UK Government’s strategic response to the pandemic. In so doing, the Inquiry received detailed evidence from government ministers, senior civil servants and other advisers relating to key UK Government decisions which had both direct and indirect effects on the management of the pandemic in Wales.

This module, Module 2B, is focused on the decision-making of the Welsh Government, which was the predominant means by which the pandemic was managed here in Wales. It would be artificial, however, for the evidence of Welsh ministers and their advisers to be heard in complete isolation. The reality of the devolution settlement, coupled with the sweeping nature of the pandemic which affected all aspects of society, resulted in both the UK and Welsh Governments having control over the management of the pandemic in Wales.

Though this module’s predominant focus will be on the evidence of Welsh ministers and their political and scientific advisers, an examination of the management of the pandemic in Wales will entail an examination of the Welsh Government’s perspective on key decisions and structures within the UK Government, as well as an analysis of intergovernmental structures and relations between the four governments of the UK.

To an extent, this has already been examined with the UK Government ministers and experts in Module 2, but this module will also examine specific aspects of intergovernmental relations. My Lady, this will not be a re-run of the evidence heard by you already in Module 2, but will draw upon that evidence and seek to look at key aspects of the interrelationship between the UK and Welsh Governments insofar as relevant to the Welsh Government’s strategic response to the pandemic.

The more detailed scrutiny of the Welsh NHS response, the care sector, children and education, shielding, vaccines, PPE, procurement, test and trace, financial and business support, and many other matters, is for later modules. However, the general epidemiological flow of the pandemic, the spread of infection, death and morbidity caused in its wake and the core high level political decisions which were taken by the Welsh Government to try to combat the virus will be examined in detail in this module.

Of course, there will be exploration of the broad reasons why core decisions were taken or not taken in such fields as health, social care and education, but the detailed examination of the merits of that process and of the operational impact of such decisions is outside the scope of this module.

How is the Inquiry to measure how well the Welsh Government discharged its duty of safeguarding the life and health of its citizens? The virus left in its wake of course not just death but injury, incalculable hardship and misery, as those heartfelt and horrendous recollections of a few moments ago remind us.

However, if the protection of life is the pre-eminent duty which every government owes to its people, then the numbers of those who died is the marker against which the Welsh Government’s response must be judged. This is the simple metric which matters most. Death was the inevitable consequence of a runaway high-consequence infectious disease and prevention of death should arguably have been the Welsh Government’s primary obligation.

The number of deaths across Wales, calculated by whether Covid-19 is mentioned on the death certificate, is now over 12,300. That is by any measure a shocking figure and a terrible loss of life. The testimonies which we have just heard remind us that each represents the loss of an individual, often in circumstances that made their death even harder to bear for their families and friends, and which multiplied their grief many times over.

Such loss of life demands the question: did it have to be that way? That question must be enquired into and answered by this Inquiry. Those who suffered infection, hardship and bereavement in Wales, of whom there are very many in number, are absolutely entitled to nothing less.

The consequences of the lockdowns were of course grievous too. In societal terms there was an explosion of mental health disorders, an entire generation of educational prospects were harmed, and pre-existing societal inequalities were seriously exacerbated. Non-Covid health conditions went untreated and undiagnosed. In economic terms, there was a 10% fall in GDP in 2020, public finances were severely damaged and massive debts were incurred. Were these dreadful consequences avoidable?

A related vital issue in this module is the position of the vulnerable and at-risk groups and the extent to which the Welsh Government assessed the likely impacts upon them of its contemplated non-pharmaceutical interventions. Given the importance of this issue and because it lies at the core of this module, I introduce it now and will return to it later.

How was the danger to health posed by the virus weighed up against the risk of societal and economic damage to vulnerable and at-risk groups? To what extent was the possibility of serious long-term health consequences arising from the imposition of NPIs foreseen and addressed?

My Lady, tomorrow you will hear from representative witnesses of Covid Bereaved Families for Justice Cymru, you will hear evidence relating to the impact of the pandemic from organisations and individuals such as the Disability Rights Taskforce, Race Council Wales, the Children’s Commissioner for Wales and the Older People’s Commissioner for Wales. Their evidence will address pre-existing structural inequalities that vulnerable and at-risk groups faced before January 2020 and the exacerbation of those inequalities caused by the pandemic and the measures taken to combat it, in particular the lockdowns.

I’ve referred to the Welsh Government’s core decision-making, and I must emphasise that the focus of Module 2B is on the important strategic decisions that were made, in essence the Cardiff Bay decision-making that had the potential for the widest effect, had the greatest impact, and which caused the greatest public concern.

To this end your Ladyship will be hearing from key decision-makers, such as the First Minister, Mark Drakeford, the former health and social services minister, Vaughan Gething, and a range of scientific advisers. These will include senior figures from Public Health Wales, a key body in Wales’ public health response to the virus. You will also hear from Sir Frank Atherton, Wales’ Chief Medical Officer, Dr Robert Orford, Wales’ Chief Scientific Adviser for Health, and Dr Andrew Goodall, former permanent secretary of the Welsh Civil Service and NHS Wales’ chiefexecutive.

As I will come to deal with in more detail later, Wales formed its own scientific and technical advisory group in late February 2020, the Technical Advisory Group, known as TAG, supported by the Technical Advisory Cell, known as TAC. TAG comprised a number of scientific and technical experts who provided scientific advice and guidance to the Welsh Government in response to the pandemic. The Inquiry has obtained statements from a number of them, some of whom also sat on UK advisory groups such as SAGE, SPI-M, and SPI-B, about which your Ladyship has already heard evidence in Module 2.

Later this week your Ladyship will hear oral evidence from a number of TAG members, including experts in the fields of epidemiology, modelling, behavioural science and public health.

With that introduction, may I now say something about the stark reality of the pandemic in Wales?

Could we please have INQ000412042 on the screen, please.

These first charts from the official Covid dashboard show deaths where Covid-19 was mentioned as one of the causes of death on the death certificate for Wales and the whole of the UK. As the top chart shows, in Wales the peak of the first wave was 12 April 2020, with 73 deaths occurring on that day, the peak of the second wave was 11 January 2021, with 83 deaths, smaller waves occurred from late 2021 onwards, the highest peaking on 15 September 2021, with 21 deaths.

We can have the following chart, please.

Based on ONS data, this shows all the deaths that occurred in Wales, not just caused by Covid. The grey area shows those deaths not involving Covid. The blue area shows the number of deaths involving Covid, and then the combined areas show the total deaths at that time in Wales. The black dashboard line is the five-year average for that period. So the areas of the graph, both colours, above that black dashed line indicate excess deaths, in other words the increased number of weekly deaths that could have reasonably been expected had the pandemic not happened.

As this chart shows, the peak of deaths in the first wave was considerably higher, reaching almost 1,150 a week, nearly 73% more than the five-year average.

Having said that, the peak was only slightly lower in the second wave, but it lasted for a longer period, leading to over 900 more excess deaths in the second wave than the first wave.

We can have the next chart, please.

These charts show the daily count of how many Covid patients were in hospital across Wales in the UK from 1 April 2020.

In Wales, the peak of the first wave was the week commencing 15 April 2020, with 884 patients in hospital, 150 of them in mechanical ventilation beds.

The peak of the second wave in Wales was the week of 13 January 2021, with 1,949 patients in hospital.

In the same week, Wales hit the peak of mechanical ventilation beds, with 145 people intubated and ventilated due to severe Covid.

Now, it’s important to note that these graphs do not show the number of staff per bed or how many empty beds were available to take all of these patients, but, as we can see on the charts, the Omicron variant led to further large peaks in hospitalised patients as high as 1,059 on 13 April 2022, although far fewer of these patients needed admission to ICU or died of Covid than in the initial waves.

Up to September 2022 there were 41,839 Covid-related admissions across Wales. That figure is now well in excess of 43,000.

We can have the next chart, please, which shows the reported number of new infections per day across Wales and the whole of the UK.

As can be seen, the peak of the first wave in Wales was 9 April 20, with 391 newly confirmed cases. However, under-reporting of cases was particularly severe in the first wave and, as with excess deaths, we’ll explore the limitations of this data in evidence later this week.

The Alpha variant first emerged in Kent around September 2020 and by the time of the peak of the second wave in Wales it was responsible for the vast majority of infections nationally. The next wave, primarily of the Delta variant, peaked on 14 July 2021 in Wales with 1,206 confirmed cases.

That was followed by the huge Omicron wave which in Wales peaked on 29 December 2021 with 16,252 confirmed cases. It is worth noting that by this time around 7.5% of confirmed cases were thought to be reinfections.

We can have the next chart, please.

This shows the results of the ONS Infection Survey for England, Wales, Scotland and Northern Ireland. It gives a much more accurate estimate of the true proportion of the population who are infected with the virus at that time by taking a representative sample. It also identifies people with no symptoms, who account for more than a third of those infected. It did not start reporting data until after the first wave was over, and antibody surveillance has shown that approximately 6% of the UK population had been infected by July 2020, ten-fold higher than the reported positive tests.

Results were available for England in May 2020, for Wales in early August, and for Northern Ireland in September and Scotland in October. These were all shown by the coloured arrows.

Despite what we saw on the previous chart, at the peak of the second wave, there were probably over 44,000 people infected in Wales, and at the peak of the Omicron wave, namely 29 December 2021, it was around 160,000 people.

The ONS have also published an estimate that 1.7 million people in total across Wales were infected from the time they started the survey until February 2022. This equated to 56% of the Welsh population, and many more have been infected since.

My Lady, you will hear evidence later this week from Professor Ian Diamond, the UK’s National Statistician and Stephanie Howarth, Chief Statistician at the Welsh Government, who will present evidence relating to the way the pandemic affected Wales, the number of infections and deaths, the way that infection and death rates ebbed and flowed over time and the way that the pandemic affected different sectors of Welsh society differently.

Their evidence will expand on the summary I’ve sought to give and provide a more detailed analysis of the data and what it tells us about the devastating impact of the pandemic on the people of Wales.

I will in due course present a summary of the evidence which the Inquiry has gathered so far concerning the key events and decisions taken in the management of the pandemic in Wales, but before doing so I propose to summarise some of the key evidence already heard by the Inquiry which forms the backdrop to the evidence which we will hear in this module.

Whilst doing my best to avoid unnecessary repetition, I’m also sensitive to the fact that some core participants and members of the wider public audience here in Wales might well be tuning into the Inquiry for the first time and therefore not have had the context of other evidence which did not have a Welsh focus.

Module 1, preparedness evidence.

As already mentioned, in Module 1 the Inquiry considered the state of the UK’s emergency preparedness, response and resilience structures prior to the arrival of the virus in January 2020. Module 1 considered the whole of the UK, looking both at UK-wide systems for handling an emergency, which also applied to Wales, but also the systems which existed within Wales.

Module 1 heard detailed Welsh-specific evidence, including from the First Minister, the former Minister for Health and Social Services, the director for local government in Wales, and the Chief Medical Officer for Wales.

As evidence in Module 1 showed, there was prior to the pandemic no Welsh National Risk Register to take into account the specific circumstances in Wales. Although the risk of pandemic influenza was included in the risk register of the Welsh Government’s Health and Social Services Group, it was not identified as an important cross-government issue.

The evidence appears to be that the Welsh Government had not assessed how a pandemic had the potential to impact the individual profile of Wales and its population based, for example, on grounds of resources, age, socioeconomic status or underlying health.

It is of course a matter for my Lady how Welsh preparedness affected the Welsh Government’s strategic response to the pandemic.

In Module 1 your Ladyship heard evidence from Professor Clare Bambra and Sir Michael Marmot on health inequalities. This evidence provides an important backdrop to the evidence that you will hear about the reaction to the emergency health crisis in Wales from January 2020. Their evidence was to the effect that there is a clear socio-spatial gradient in health in the UK: the more deprived local authorities have worse health than the less deprived. For example, ONS data shows that for 2017 to 2019 male life expectancy was highest in Monmouthshire, at 81.5 years, and lowest in Blaenau Gwent, at 76.5 years. That is a difference in life expectancy of 4.9 years.

These health inequalities are also evident at a smaller neighbourhood scale. In Wales the gap in life expectancy between the most and least deprived areas was nine years for men and seven and a half years for women.

You also heard evidence, my Lady, about the Well-being of Future Generations (Wales) Act, which was passed in 2015, and focused on “improving the social, economic, environmental and cultural wellbeing of Wales”. The Act puts a well-being duty on public bodies, which means the bodies covered by the Act must work to improve the economic, social, environmental and cultural well-being of Wales. However, it was concluded by Professors Bambra and Marmot that, with some exceptions, the specialist structures concerned with risk management and civil emergency planning did not properly consider societal, economic and health impacts in light of pre-existing inequalities. In their opinion:

“The UK Government and the devolved administrations and relevant public health bodies did not systematically or comprehensively assess pre-existing social and economic inequalities and the vulnerabilities of different groups during a pandemic in their planning or risk assessment processes.”

Turning next to some of the relevant evidence adduced in Module 2.

As indicated in previous preliminary hearings for this module, a number of experts were jointly instructed by Modules 2, 2A, 2B and 2C to report on pre-existing structural discrimination against groups with protected characteristics in UK society. In October last year the experts gave oral evidence during the Module 2 public hearings to supplement their written reports. The experts are not being called again in this module, but given the relevance of their evidence to matters which will be canvassed with witnesses that will be called in this module, I propose to briefly summarise their expert evidence insofar as relevant to Wales and the scope of Module 2B.

Professor James Nazroo and Professor Laia Bécares gave evidence on pre-pandemic inequalities by race and ageing, including the role of structural racism. Professors Nazroo and Bécares expressed the view that while ethnic minority populations are smaller and more geographically concentrated in Wales compared to England, and data was generally limited in relation to Wales alone, the data which they accessed indicated that processes of racialisation and racism are equally relevant across all four nations of the UK. There is no evidence to suggest that they operate differently in the different nations.

They expressed the view that ethnic inequalities in health in the UK are longstanding and persistent, they have been researched and documented for several decades, and that ethnic inequalities in health are most pronounced at older ages in the UK.

Professor Nazroo also provided expert evidence on pre-pandemic structural discrimination against elderly people. He was of the view that the evidence produced in his report about later life and ageism and the conclusions drawn are relevant, again, to each nation of the UK.

Professor Nazroo identified that people living in care homes were a population who were at particular risk of complications or death if they experienced a respiratory viral infection. This is particularly the case for those living in nursing homes because of their higher level for medical need. He opined that residents in care homes were also at much greater risk of infection compared to those living in private accommodation, because of close quarter living arrangements and other factors.

As had been the case in his report on racism, Professor Nazroo identified a number of missed opportunities in the UK-wide response to the pandemic as regards the particular needs of older groups. He expressed the view that an investigation of which groups of older people were at particular risk of infection, complications and mortality, and that greater risk of adverse consequences of NPI control measures would have allowed targeted protections to be put in place.

Professor Thomas Shakespeare and Professor Nick Watson gave evidence on pre-pandemic inequalities associated with disabilities. Professors Shakespeare and Watson reported that in 2020, 22% of the UK’s population reported a disability. Of the four nations, the figure was highest in Wales, at 28%. In oral evidence Professor Shakespeare commented that:

“I think that, generally speaking, people in Scotland and Wales tend to have a higher rate of disability than people in England, because disability is related to deprivation, there’s a strong poverty gradient, and therefore you can see that Wales has got the highest figure.”

Professors Shakespeare and Watson opined that evidence supported the proposition that disabled people tended to be more likely to be unemployed or paid less in employment, live in worse socioeconomic conditions and poorer housing, which in turn increased the likelihood of respiratory illness.

Their analysis showed that the increased vulnerabilities to Covid faced by disabled people led to disproportionate impact, particularly on people with intellectual disabilities.

Professor Bécares also provided expertise on pre-pandemic inequalities for members of the LGBTQ+ community. Professor Bécares reported that it was known prior to the pandemic that LGBTQ+ people reported worse general health than their heterosexual peers. Like others, Professor Bécares reported significant missed opportunities in the management of the pandemic across the UK. She expressed the view that, due to increased prevalence of pre-existing physical and mental health conditions, LGBTQ+ people, particularly disabled people, minoritised ethnic people, young and older people, should have been identified as a vulnerable group and measures should have been adopted to reduce their risk of infection.

Dr Clare Wenham gave evidence on pre-pandemic gender inequalities. Dr Wenham opined that the disproportionate of epidemics and pandemics on women was established prior to Covid-19. This included the effects of changes to health services, in particular sexual and reproductive health, and increases in domestic violence.

Women were also known to suffer worse economic impacts as they disproportionately held roles involving face-to-face contact, which also involved being exposed to an increased risk of contracting the virus, and tended to bear the economic impacts of sickness as they tended to bear childcare responsibilities. She presented an evidence-based analysis that gender inequality and discrimination was pervasive across UK society prior to the onset of the Covid-19 pandemic.

Professor David Taylor-Robinson gave evidence on pre-pandemic childhood inequalities. Professor Taylor-Robinson reported that in the five years pre-pandemic there was concern regarding deteriorating child health in the UK which had been preceded by a period of improvement. This was linked in large part to socioeconomic inequalities that have been exacerbated by the pandemic.

As regards missed opportunities and impacts of the pandemic, Professor Taylor-Robinson provided a detailed view of the shortcomings. Although children were not considered a vulnerable group in terms of susceptibility to the virus itself, children were susceptible to the wider impact of disruption to the broader determinants of health, and so children’s health and well-being should have been considered in strategies to contain or delay the spread of the virus.

Also amongst those who suffered and indeed continue to suffer from Covid are the victims of the syndrome known as Long Covid. By March 2023, the ONS estimated that 1.9 million people were suffering from self-reported Long Covid. As such, further expert evidence was heard in Module 2 from Professor Chris Brightling and Dr Rachael Evans in relation to Long Covid. In their report the experts concluded that Long Covid was foreseeable, that it remains a major health problem, and there was and is minimal focus on preparedness for long-term consequences of viral outbreaks such as the pandemic and insufficient surveillance for Long Covid planned at the outset of the pandemic.

Expert evidence was also heard in Module 2 in the form of written reports and subsequent oral testimony from Professor Ailsa Henderson and Professor Thomas Hale. Both experts were instructed to provide evidence on behalf of Module 2B, as well as Modules 2, 2A and 2C.

Professor Henderson provided a detailed history of devolution in Wales, Scotland and Northern Ireland, which I do not intend to rehearse here. In this regard, my Lady, you will hear evidence later this week from Professor Daniel Wincott, professor of law and society in the School of Law and Politics at Cardiff University. Professor Wincott will give evidence on political decision-making in the management of the pandemic in Wales. His evidence will supplement and expand on that already given by Professor Henderson.

Professor Hale reported on international data relating to the Covid-19 pandemic, in particular in analysing the effectiveness of the decision-making of the UK Government and the governments of the devolved administrations in comparison to other countries.

Professor Hale opined that as far as the stringency, speed and effect of the UK response to Covid was concerned, the UK was slower than the average country to adopt distributor measures across nearly every domain of response. Tragically, Professor Hale reported that Wales had the 30th highest death rate per capita globally and it was 57th in the world for stringency of its restrictions, with the highest number of days with a stringency index of above 70 out of all four nations of the UK.

Turning to the factual witness evidence in Module 2, the bulk of hearing time was taken up hearing evidence from UK Government ministers, senior civil servants and political advisers and scientific and medical advisers relating to key UK Government decisions. Time of course does not permit me to summarise that evidence here. We will, however, endeavour to put key themes arising out of that evidence to witnesses giving evidence in this module, as time allows, in order to see their responses to matters which involved them and had an effect on the management of the pandemic in Wales.

Before turning to the chronology of key events and core decisions, I propose to say something about the evidence available to this module as to the impact of the pandemic on the people of Wales and their experiences.

As mentioned earlier, the impact of the pandemic will not be examined in detail in this module. The detail of the varied and considerable impacts on Welsh society deserve close attention, and they will be given this at a later stage of the Inquiry, not least by the Inquiry’s Every Story Matters listening project. Impact, however, does have a part to play in this module. The evidence heard by the Inquiry to this point shows that those in more vulnerable positions in society did worse. My Lady will hear evidence tomorrow about attempts made by certain groups to draw to the attention of the Welsh Government the significant harms which were experienced by different sectors of Welsh society. The extent to which the information about the significant impacts was properly taken into account by the Welsh Government when managing the pandemic is very much part of what we are here to consider in this module.

As was the case in Module 2, the extent to which the Welsh Government identified and assessed the likely impacts on these groups is a key part of this module’s scope. We intend to consider both those who were at risk because of previous health conditions, as set out in the evidence given by Professors Bambra and Marmot to which I’ve referred, and also those who were vulnerable due to protected characteristics such as age, sex, disability, ethnicity and sexual orientation, as well as those who needed particular consideration due to both.

In addition to the moving accounts given in the impact film and the evidence that will be heard over the next three weeks, the Inquiry has received 53 Rule 9 responses from UK-wide and Wales-specific impact organisations evidencing the real impact of the pandemic on older groups, those in receipt of care, children and young people, ethnic minorities, women and disabled people.

Having summarised some of the key themes arising from the evidence heard in Modules 1 and 2 and some of the evidence, I propose to move next to the chronology of key events and decisions.

As already stated, this module picks up where Module 1 left off, namely January 2020. At this stage, as Module 1 evidence shows, the Welsh Government’s ability to react to the early emerging signs of danger was largely bound to the emergency structures at UK Government level. The evidence, however, shows that as the pandemic progressed the Welsh Government pursued its own strategies to fight the virus, its own regulations and restrictions, and its own mechanisms for communicating with the public about them.

The Inquiry has already looked at the key questions in Module 2 of whether the UK Government reacted with sufficient speed in the early months of 2020 on learning of the emergence of the virus in China and whether it was provided with the right information to enable it to do so.

These questions apply equally in this module when looking at the Welsh Government response.

Given the Welsh Government’s later adoption of an autonomous approach, ought it to have taken heed earlier of advice and information received directly from experts or via the UK Government systems to which it had access, such as COBR and SAGE?

Given the demographic characteristics of the Welsh population, specifically the differences in health and age profiles in Wales, and its pre-existing autonomous structures to deal with public health emergencies, ought the Welsh Government to have done more to make plans to deal with the virus earlier?

Ought it to have done more to seek to influence decision-makers in key positions within UK Government in the best interests of the people of Wales?

Had the Welsh Government taken a different approach, might it have been able in the critical early months of January and February to alter the course of the pandemic significantly? This is of central importance, because some argue that had it reacted with greater urgency and to greater effect in January and February, it might not have been forced into making the extraordinarily far-reaching decisions that it later felt itself obliged to take in lockstep with the UK Government and the governments of Scotland and Northern Ireland.

My Lady, is that an appropriate point?

Lady Hallett: I was just wondering, as we started later, but I suspect it is probably the best moment to pause.

For those haven’t followed our proceedings before, we take a break, usually every hour and a quarter or so, for the sake of the stenographer, but we also have translators, or interpreters, and so we need to break for them as well.

Very well, I shall return at – I can’t see what the time is – 11.25.

(11.11 am)

(A short break)

(11.28 am)

Lady Hallett: Sorry if I’m slightly late, I was warming up. I hope everybody is slightly warmer now. I’m afraid in Scotland we did end up freezing people for a while, so … as long as you don’t get too warm. Please tell me if it now gets too hot and we can try to change it again.

Mr Poole.

Mr Poole: Thank you, my Lady.

So we move to January 2020. Evidence heard by your Ladyship in Module 2 indicates that from the very early days of January 2020, UK Government scientists and medical officers were already communicating with each other, public health bodies in the devolved administrations and a handful of external scientists and academics about a new viral pneumonia outbreak. On 8 January 2020 Public Health Wales issued a briefing concerning a cluster of pneumonia cases of unknown aetiology in Wuhan City, China. It recommended that any patients presenting with pneumonia who had travelled to China in the 14 days prior to the onset of symptoms should have a detailed travel and exposure history taken. This briefing went to the Welsh Government. On 9 January the World Health Organisation issued a statement. It did not recommend any specific measures for travellers and advised against application of any travel or trade restrictions on China. On 11 January Chinese media reported the first death from the novel coronavirus. On 13 January the UK scientific body NERVTAG met for the first time. It noted that the last official report from China had noted 41 cases of illness due to the novel coronavirus. Of the hospitalised patients, two had been discharged, seven were severely ill and one had died. It also noted that it had been stated that there had been no “significant” human-to-human transmission, which implied there may be some evidence of limited human-to-human transmission.

On 16 January the novel coronavirus was classified as a high-consequence infectious disease, requiring barrier care and the use of limited specialist units. Professor Neil Ferguson and his colleagues at Imperial College calculated that Wuhan was likely to have been harbouring more than 1,100 cases by 6 January, more than ten times the official figure, and they sent their report to the UK Chief Scientific Adviser, the UK Chief Medical Officer and others.

On 21 January the WHO published its first Novel Coronavirus 2019 report and tweeted that it was now very clear that there was at least some human-to-human transmission. The reported number of confirmed global cases had risen to 283 and there were six reported deaths worldwide.

NERVTAG met again, noting that there was clear evidence of person-to-person transmission, but that the degree of transmissibility was not clear. The case fatality rate was also not clear, as most of the cases had not yet reached conclusion in either death or recovery, not all cases were being tested or reported, and there was a delay in the external reporting.

On the same day, 21 January, a meeting of the NHS Wales executive board took place, at which Dr Andrew Goodall reflected on the pressure that the NHS in Wales had been under at the turn of the year. He noted that many would have felt the system was at a difficult tipping point, requiring system-wide actions. Dr Atherton provided an update on the Wuhan coronavirus in China and advised that plans for isolation and ambulances would be sent shortly in the event that the virus came to the UK. Dr Atherton noted that this area would become of increasing importance.

On 22 January the first Scientific Advisory Group for Emergencies (SAGE) was activated on a precautionary basis, ie without formal activation by COBR.

If we can, please, have the SAGE minutes on screen. They are INQ000309706. At point 7 the minutes record:

“There is evidence of person-to-person transmission. It is unknown whether transmission is sustainable.”

Then at point 12:

“There is no evidence yet on whether individuals are infectious prior to showing symptoms.”

Point 13:

“There is no evidence that individuals are more infectious when symptoms are more severe, but that is likely.”

On the same day, 22 January, Public Health England raised the current threat level from very low to low, stating that:

“The risk to the UK population has been assessed as low, based on the emerging evidence regarding case numbers, potential sources and human to human transmission.”

The second report from Imperial College estimated that there were 4,000 cases in Wuhan and advised that self-sustaining human-to-human transmission should not be ruled out.

Although there was no Welsh representative present at the precautionary SAGE meeting of 22 January, the minutes of that meeting were shared with the Welsh scientific adviser for health, Dr Rob Orford, on 24 January, and passed on to the Chief Medical Officer for Wales, Sir Frank Atherton and Andrew Goodall, among others.

Also on 22 January, Dr Quentin Sandifer, who between January and November 2020 was the lead strategic director in Public Health Wales for Covid-19, invoked the Public Health Wales Emergency Response Plan at enhanced level.

On 23 January, public transport, including outbound trains and flights, were suspended in Wuhan. The WHO issued a statement announced that its emergency committee had been unable to agree that the event constituted a public health emergency of international concern.

In London, the Secretary of State for Health and Social Care, Matt Hancock, was told by the UK CMO that there was a 50/50 chance that the Wuhan quarantine would not work. In other words, there was a 50/50 chance that there was no practical means by which the further escape of the virus could be prevented, a 50/50 chance of a global outbreak.

Imperial College’s third report, which was shared with the UK Government, estimated that the basic reproduction number, the R number, was above 1, indicating self-sustaining human-to-human transmission, and most likely in the range of 2 to 3. This implied that control measures needed to block well over 60% of transmission to be effective in controlling the outbreak.

On 24 January, COBR met for the first time, chaired by Mr Hancock as the Secretary of State for the lead government department. The Welsh Government was represented at this meeting by Vaughan Gething as Minister for Health and Social Services.

COBR agreed a series of actions to be put in place for when certain trigger points were reached, and that these trigger points would be shared quickly with the chief medical officers of all four nations.

Also on 24 January, France reported the first confirmed Covid-19 cases in the WHO European region and The Lancet published an article entitled “A novel coronavirus outbreak of global health concern”, which reported that the detection of infection in at least one household cluster in China and infections in healthcare workers caring for patients with Covid-19 indicated human-to-human transmission and thus the risk of much wider spread of the disease.

The article stated:

“… we need to be wary of the current outbreak turning into a sustained epidemic or even a pandemic. … Every effort should be given to understand and control the disease, and the time to act is now.”

It was also on this date, 24 January, that Dr Atherton advised the First Minister that there was a significant risk that the virus would arrive in Wales, and Mr Gething issued a statement saying that the Welsh Government was closely monitoring the emergence of a novel coronavirus.

On 25 January the WHO regional director for Europe issued a public statement outlining the importance of being ready at local and at national levels for detecting cases, testing samples and clinical management. Officials in the UK starting putting preparations in place for the repatriation of UK nationals from Wuhan and surrounding areas.

On 27 January the WHO Novel Coronavirus Situation Report reported 80 deaths in China, but none outside. An extraordinary meeting of the UK SPI-M-O committee took place. No Welsh scientists were in attendance at this meeting. Current epidemiological work was discussed and the need for further data and the commencement of modelling work agreed.

On 28 January, SAGE, having now been formally convened, met again. There was no Welsh representative present at this meeting. SAGE was informed that 50% of new cases in China were now occurring outside Wuhan, and that a specific test should be ready by the end of the week, with capacity to run 400 to 500 tests per day.

SAGE debated the epidemiological characteristics of the virus, including the reproduction rate, which was estimated to be between 2 and 3, that the doubling rate was estimated to be between three to four days, and that there was limited evidence of asymptomatic transmission.

The reasonable worst-case scenario was assessed by SAGE to be similar to that for pandemic influenza, where no vaccine or specific treatment was available.

SAGE agreed that a rapid change in the UK Government’s approach would be required in the event of sustained human-to-human transmission outside China or a severe case in the UK.

On 29 January, New England Journal of Medicine published an article by the Chinese Covid-19 Outbreak Joint Field Epidemiology Investigation Team. The article estimated, based on research of the first 425 cases, that the basic reproduction number was 2.2. That is to say, one person will infect, on average, 2.2 other non-immune people. And they stated that there was evidence of human-to-human transmission that had occurred among close contacts since the middle of December 2019.

The same day COBR met again and an update was provided on the UK’s reasonable worst-case scenario planning. The Welsh Government was represented at this meeting by Mr Gething, along with Dr Atherton. The minutes record in part that the UK should prepare for the reasonable worst-case scenario, and that the real risk to the UK comes from China losing control of the situation rather than flights.

On 30 January the WHO declared a public health emergency of international concern. On this day too the first case of infection with the virus in the UK was confirmed: two members of the same family, one a 23-year old Chinese student who had travelled back to York from the family home in Hubei.

On 31 January the novel coronavirus was discussed by the UK Government Cabinet for the first time. The evidence suggests that Covid was not discussed by the Welsh Cabinet until nearly a whole month later, on 25 February.

On 31 January the UK CMO publicly confirmed that two patients in the UK, members of the same family, had tested positive for Covid. By the end of January it appears – it is of course a matter for you, my Lady – that it was clear that a fatal respiratory disease was spreading across the world and, to quote the advice given by Dr Atherton to the First Minister on 24 January, there was a significant risk the virus would arrive in Wales.

A number of questions arise. Was the fact that the virus would most likely spread to Wales properly appreciated by the Welsh Government? Were the consequences of the lack of any control measures adequately understood? Does the fact that Covid was not discussed by the Welsh Cabinet throughout January indicate that the threat posed by the virus was not taken as seriously as it ought to have been, or that the Welsh Government thought the UK Government had things under control and there was no need to take independent action? Was there a lack of national strategic leadership and co-ordination from the Welsh Government in this crucial early period? Should consideration have been given, even at this relatively early stage, not just to gearing up NHS preparedness but to declaring a major incident for health in Wales and standing up the Emergency Coordination Centre?

During February, the evidence suggests that the virus was still not a priority of the Welsh Government.

On 2 February the WHO gave a technical briefing. In the UK, a public information campaign was launched by the UK DHSC, advising the population to adopt respiratory and hand hygiene behaviours. The Welsh Government announced that it was working with Public Health Wales to support the campaign. A group of UK senior ministers, the ministerial quad, met for the first time.

At the SAGE meeting of 4 February the UK CMO, Deputy CMO and CSA and certain other scientists, including representatives of the Imperial and London School of Hygiene and Tropical Medicine teams agreed that UK-only China-focused measures would likely only achieve minor delays in slowing UK transmission, but that impacts would be greater if multiple countries took concerted action. There was no Welsh representative at this SAGE meeting.

If we can, please, have INQ000074895 on the screen, please.

We can see there a consensus statement from SPI-M-O dated 3 February. At paragraph 1, it reads:

“The number of confirmed cases of 2019-nCoV in China is estimated to be at least 10 times higher than the number currently [estimated].”

Then at paragraph 7, please:

“It is unclear whether outbreaks can be contained by isolation and contact tracing. If a high proportion of asymptomatic cases are infectious, then containment is unlikely video these policies. Countries with less effective healthcare systems are less likely to be able to contain sustained outbreaks.”

On 6 February it was announced that the first UK national had caught Covid-19 in Asia and had travelled back to the UK via the Alps. SAGE was advised of a third UK case of a positive test. Public Health England announced the development of novel coronavirus diagnostic test.

On 10 February the team of epidemiologists at Imperial College provided a first estimate of the severity of the virus giving an overall case fatality rate in all infections, so symptomatic or asymptomatic, of around 1%. That is to say, 1 in 100 of every confirmed case, as opposed to those who are infected, will die.

SPI-M-O estimated that the number of confirmed Covid-19 cases in China was ten times higher than the number currently confirmed.

If we can, please, have INQ000237386 on the screen.

The minutes of this meeting also state – if we look at paragraph 7:

“It is a realistic probability that outbreaks outside China cannot be contained by isolation and contact tracing. If a high proportion of asymptomatic cases are infectious, then containment is unlikely via these policies.”

Then if we go down to paragraph 13, please:

“It is a realistic probability that there is already sustained transmission in the UK, or that it will become established in the coming weeks.”

The sixth meeting of SAGE, on 11 February, which was attended by Dr Orford, noted that it was not possible for the UK to accelerate diagnostic capability to include Covid-19 alongside regular flu testing in time for the onset of winter flu season 2020/2021.

On 12 February a ministerial tabletop exercise was held in London. Mr Gething and Dr Atherton took part on behalf of the Welsh Government. The evidence suggests that this exercise focused on the likely impact on the NHS and there was no discussion about infection control measures.

Also on 12 February, the first meeting of the Welsh Government countermeasures group took place, the purpose of this group was to monitor and advise on pandemic stocks and ensure that they are deployed according to ministerial agreement.

On 13 February the seventh meeting of SAGE took place, again attended by Dr Orford. It debated, in the context of a discussion of how to delay the peak of the epidemic (as opposed to seeking to suppress the spread of the virus), the impact of mass school closures, restricting mass gatherings and mask wearing. It advised that travel restrictions within the UK and prevention of mass gatherings would not be effective in limiting transmission.

The SAGE planning assumptions, which advised that Covid-19 would likely infect 80% of the population, in contrast to pandemic influenza that would infect 50% of the population, was shared with the Welsh Government.

If we can, please, have INQ000320721 on the screen.

We can see in that bottom email that the SAGE planning assumptions prompted Reg Kilpatrick to email Dr Atherton, stating, among other things:

“This material needs to be shared internally and rapidly. The DGs need to be aware and so does the Perm [the Permanent Secretary, Shan Morgan] both for information and to underline the potential seriousness of the issue …

“One key lesson from the last two years of dealing with Brexit is that without the free flow of information to trusted individuals within Welsh Government, we will always find ourselves unable to match the UK government in our preparedness; or to have a reasonable and informed discussion about what our next steps should be. And of course we will put our Ministers in a weak – or negligible – negotiating position if we are unable to brief quickly and comprehensively.”

SPI-M-O on 17 February noted that the current estimates of the average case fatality rate seen to date were in the range of 0.25% to 4%. The minutes state.

“There were differing views within the group about the likelihood of sustained transmission in the UK both currently and in the near future. Some believe it [will be] a realistic possibility that sustained transmission in the UK will become established in the coming weeks while others believe this likelihood is higher and there may already be sustained transmission.”

The fourth meeting of COBR was held on 18 February. This meeting was attended by the First Minister, as well as Dr Atherton. The UK CMO noted that escalation to a global pandemic and isolation of the majority of cases to China both remained realistic possibilities. Nine positive cases had been confirmed at this point in the UK.

SPI-M-O noted on 19 February that the magnitude of the impact certain school closures would have on the UK epidemic of Covid-19 was very uncertain and that detailed forecast of the likely impact would only be possible once there had been several weeks of sustained transmission within the UK.

On 21 February news emerged of a cluster of locally transmitted cases in Lombardy, Italy. A lockdown began in Italy covering ten municipalities of the province of Lodi in Lombardy and one in the province of Padua.

On 22 February UK passengers from the cruise ship the Diamond Princess arrived back in the UK. The Diamond Princess had been quarantined on 3 February by the Japanese Government after a passenger from Hong Kong tested positive for Covid-19 after having earlier left the ship on 25 January. Of the 2,600 passengers and 1,000 crew, over 500 people became infected. Early reports showed, however, that around 18% of the people infected had showed no symptoms.

On 23 February the UK DHSC confirmed a total of 13 Covid-19 cases in UK. The tenth meeting of SAGE, on 25 February, discussed a report from Imperial College which addressed measures for closing schools and universities, home isolation of cases for seven days, home isolation of other members of the household of index cases for 14 days, and mass social distancing, to try to achieve a reduction of 75% of all interpersonal contacts other than in the home, school, university or workplace, and a 25% reduction in the workplace.

The report noted that aggressive NPIs may have a substantial impact on Covid-19 transmission, potentially dramatically slowing epidemic growth, but that when lifted transmission would resume giving rise to another full peak in the winter months. SAGE therefore focused thereafter on modelling and examining a flattening the peak strategy, namely a mitigation of the viral outbreak, as opposed to a suppression strategy.

Also on 25 February the Welsh Cabinet convened and discussed the virus for the first time. Mr Gething updated the Cabinet that the worldwide response was still in the containment stage.

At the COBR meeting on 26 February attended by Mr Gething and Dr Atherton, the UK Deputy CMO reported that official data from China showed that case numbers were continuing to increase. Internationally, case numbers in South Korea, Iran and Italy highlighted clear person-to-person transmission and sustained human-to-human transmission in Italy, which received a high number of travellers to and from the UK. The conclusion was that it is still difficult to predict when or if case numbers would increase in the UK.

On 27 February SAGE endorsed planning assumptions of an overall 1% case fatality rate and that 80% of the UK population may become infected.

Also on 27 February TAC was set up, which – along with TAG, led by Fliss Bennee and Dr Orford. As mentioned earlier, the purpose of TAG and TAC was to provide scientific and technical information interpreted for Wales in adherence to the advice provided by SAGE. We intend in this module to examine the reasons why this new advisory group was set up, why it was thought necessary, how it worked alongside SAGE, why it was constituted as it was, how it operated as an advisory body, and how effective it was in guiding the Welsh Government’s pandemic response.

We will also examine the role of TAG and TAC in the overall divergence of Welsh Government policy from the priorities and strategy of the UK Government, the reasons for that, and the reasonableness of such divergence in the context of a global viral pandemic.

I will return to the theme of divergence in due course.

Returning then to the chronology. On 28 February, four years ago tomorrow, the first case of Covid-19 in Wales was reported. An adult returning from northern Italy with links to Swansea’s Bishop Gore School.

On 29 February the total number of confirmed cases in the UK rose to 23. Dr Orford also emailed colleagues at Public Health Wales stating that he had not received a read-out from the latest SAGE meeting, which concerned him.

By the end of February the evidence suggests that there was a growing awareness of the threat the new virus posed to Wales. As such, a number of questions arise. Given this increasing appreciation of the imminent threat of the new virus, what powers did the Welsh Government have to impose its own suppression strategies before the national lockdown on 23 March? Why did Welsh ministers not seek to persuade the UK Government of the need to take swifter decisive action? What more ought the Welsh Government have done in February 2020 to seek the mitigate the effect of the new virus spreading across Wales?

On Monday 2 March the Prime Minister chaired a COBR meeting for the first time. The First Minister and Mr Gething attended. The WHO raised its alert to “very high”. In Wales the First Minister established the Covid-19 core group, and at the First Minister’s regular Monday press briefing the First Minister mentioned coronavirus for the first time and reported the first confirmed case in Wales.

The First Minister said that the Welsh Government had been working hard to prepare for the arrival of the novel virus in Wales for many weeks, and that Wales and the UK were well prepared for these types of incidents, with robust infection control measures in place to protect the public.

On 3 March a multi-agency tabletop exercise was held in Wales. The aim of the exercise was to explore the multi-agency response to a request to put an urban setting in lockdown in response to Covid-19.

Also on 3 March, TAC provided an update note for Dr Atherton which advised that a reasonable worst-case scenario for Wales would see 1.25 million people symptomatic and 162,500 people hospitalised, and infections during the peak week of 250,000.

TAC advised that if Covid followed the same patterns as seasonal flu then Wales would see a one to two-week lag in epidemic peak compared to areas of England.

On the same day, 3 March, the UK Government’s coronavirus action plan was published. This plan set out the UK Government’s broad strategic approach, namely contain, delay, research, mitigate. However, by the beginning of March, it appears that containment had failed. In this regard, this module will look at what input the Welsh Government had into this action plan and what consideration was given to Welsh considerations, risks and requirements.

On 4 March Mr Gething chaired a Welsh Cabinet meeting which discussed a SAGE report from the previous day summarising the current understanding of the virus, namely that 80% of the population would be infected, 80% would have mild symptoms and the remaining 20% would likely require hospitalisation. That would equate to around 160,000 people in Wales requiring some form of hospitalisation. Of those, 133,000 would require oxygen, and 14,000 ventilator support. The same modelling suggested somewhere in the region of 25,000 deaths.

On 5 March the Health Protection (Notification) (Wales) (Amendment) Regulations 2020 were made, which made Covid-19 a notifiable disease in Wales. The first death of a patient with Covid-19 in England was also announced. SAGE recommended implementation of individual home isolation and whole family isolation, followed by social isolation of over 65s and those with underlying medical conditions. The issue of mass gatherings was also debated again, and SAGE concluded that there was no evidence that banning very large gatherings would reduce transmission .

On 6 March the Welsh Government Coronavirus Planning and Response Group met. Public Health Wales provided an operations update and reported that the current modelling predicted that the epidemic will peak around 10-12 weeks after it has begun. The reasonable worst-case scenario model predicted an infection rate of 80% across Wales, with a hospitalisation rate of 30% and a fatality rate of 1%. In a worst-case scenario situation it was estimated that 50,000 beds would be needed to satisfy demand at peak times, which would see over 6,000 hospitalisations per day.

It should be noted that in Wales the average daily available hospital beds is around 10,000. Peak demand would therefore exceed this capacity by approximately five-fold. The demand for ventilation would be considerably higher than capacity, approximately 50-fold, a point which was noted by Dr Orford in an email to Public Health Wales on 7 March.

Also on 7 March the England versus Wales Men’s Six Nations rugby match took place at Twickenham Stadium in London, attended by 81,000 people, including the then Prime Minister, Mr Johnson.

On 9 March the eighth meeting of COBR took place, chaired by the Prime Minister and attended by the First Minister, Mr Gething and the Welsh CMO. The merits of seeking to delay the peak of the Covid-19 outbreak until the summer were debated. The same day a national lockdown was announced in Italy and the Welsh CMO issued a statement confirming two more people in Wales had tested positive for coronavirus.

The following day, 10 March, the Welsh Cabinet met. The First Minister provided an update on Covid and said, with six cases in Wales, now was not the time to introduce more restrictive measures on movement. If they were used prematurely, it would likely lead to the population being less receptive to messages at a time when the spread of the virus was more virulent.

On 11 March the WHO declared Covid-19 a pandemic. Wales had its first case of community transmission when a patient at Caerphilly with no travel history tested positive for Covid-19. Dr Atherton provided an update to a meeting of the Welsh Government Covid-19 core group. Dr Atherton confirmed that there were 15 known cases in Wales with some community transmission. Wales remained in its containment phase of its management strategy, and it would be up to COBR to decide whether to move to the delay phase. Dr Atherton advised that given the events in Italy there was a need to prepare for the reasonable worst-case scenario.

Also on 11 March, Dr Atherton provided the First Minister with a technical briefing on mass gatherings and behavioural and social interventions.

Could we, please, have INQ000271613 on the screen.

We can see there, in the first paragraph:

“In the event of a severe epidemic, the NHS will be unable to meet all demands placed on it. In the reasonable worst-case scenario, demand on beds is likely to overtake supply well before the peak is reached. Currently the [reasonable worst-case] is also considered within the bounds of a likely scenario.”

If we can move to paragraph 3, please:

“Applying behavioural interventions could be helpful in containing an epidemic … or changing the shape of the epidemiological curve, potentially making the response of the NHS and other sectors more sustainable.”

Then, at paragraph 4, the first objective is to “contain”:

“… (note – this is unlikely to be achievable) …”

This briefing also discussed behavioural control measures and noted that restrictions of mass gatherings would likely reduce infection-related deaths by 2%, whereas self-isolation of those with symptoms would have a greater impact, likely reducing deaths by 11%.

Also on 11 March, Public Health Wales produced an evidential summary of the key considerations to guide any decision on the declaration of a major incident for health in Wales. Public Health Wales concluded that objectively the demographic characteristics of the Welsh population and specifically the age profile of the population over 65, health and economic status, and dependency responsibilities, are such that Wales may experience disproportionate levels of impact from Covid.

On 12 March a patient at Wrexham Maelor Hospital tested positive for Covid-19. This was the first case in North Wales.

COBR met again on 12 March, attended by the First Minister. The UK CSA provided a situation update. The number of cases in the UK was increasing. It was estimated that there were 5,000 to 10,000 cases within the UK. Numbers would increase quickly. SAGE advice was that the UK was approximately four weeks behind Italy and expected the UK to follow a similar trajectory in terms of the number of cases. COBR minutes note that the UK Government’s strategy was to seek to change the shape of the curve as opposed to completely suppress the spread, as that wasn’t going to be possible and could lead to a larger second peak.

Accordingly, the UK moved from “contain” to “delay”, meaning that rather than trying to stop the virus altogether, the government’s strategy switched to trying to manage its spread through the population. Contact tracing was no longer a priority, and testing resources were directed towards hospitalised patients instead of being used to identify new cases in the community.

The UK CMOs also raised the risk to the UK from “moderate” to “high”, and new advice was also issued advising self-isolation for seven days if someone developed a high temperature or a new continuous cough.

On 12 March COBR also debated the cancellation of mass gatherings. COBR minutes note that the Scottish Government was minded to advise against gatherings of more than 500 people, to ensure frontline emergency workers were able to prioritise the response to the pandemic. The UK Government took the decision not to prohibit mass gatherings at this stage.

Following COBR, the First Minister announced that the annual Welsh Labour conference, due to be held in Llandudno at the end of March, was postponed. This prompted Lee Waters, the Welsh Government Deputy Minister for Economy and Transport, to send a WhatsApp stating:

“I do think it’s an odd signal to send that we’re cancelling conference but allowing 70,000 to gather in Cardiff on Saturday.”

70,000 people gathering in Cardiff was a reference to the Six Nations Men’s rugby match between Wales and Scotland due to take place on Saturday, 14 March 2020, at the Principality Stadium in Cardiff. In fact, the match was called off by the Welsh Rugby Union at lunchtime on Friday, 13 March (the day before kick-off), but not before 20,000 Scottish rugby facts had travelled from Scotland to Cardiff.

An issue for the Inquiry is whether mass gatherings should have been banned earlier, and a specific issue for this module is whether the Welsh Government ought to have advised against the Wales and Scotland rugby match and other mass gatherings in Wales, such as two Stereophonics concerts held at the Motorpoint Arena in Cardiff on 14 and 15 March going ahead.

It is right to say that the scientific advice in early March had indicated that the benefits of such a ban were not particularly significant. But gatherings were not without some risk and a ban would have reinforced other social distancing good practice, as well as ensuring frontline emergency workers were able to prioritise the response to the pandemic.

On Friday 13 March the Welsh Coronavirus Planning and Response Group met. Dr Orford advised that the reasonable worst-case scenario had been reassessed and estimated a mortality figure of around 36,000.

Also on 13 March, Mr Gething made a public statement announcing a framework of actions aimed at allowing health and social care providers in Wales to make decisions to assist with timely preparations for the expected number of confirmed cases of Covid. This framework included measures such as the suspension of non-urgent outpatients and surgical care in Wales, the expedition of vulnerable patients from acute and community hospitals, and the suspension of the current protocol which gave patients the right to choice of a care home.

The care sector is for a later module, but it is convenient to examine in part one of the major decisions affecting the care sector in this module, given the debate over the extent to which core decision-makers were aware of it and of its catastrophic consequences. It is this decision to discharge hospital patients into social care.

There is evidence that more than 1,000 Welsh patients were discharged from hospital to care homes without a test during March and April 2020. As of 5 June, ONS figures suggest that nearly a third of Wales Covid-19 deaths had been within care homes. There is no doubt that there was a massive failure of infection control, contributed at least in part to the influx of infected but untested patients. The Welsh Government’s position is that it was advised that testing would not be effective for those who were asymptomatic, and there was in any event a lack of testing capacity. It is an issue for the Inquiry whether this belief could have been genuinely or sensibly held. There is clear evidence that by early April 2020 it was known that only testing those with symptoms missed up to half of care home infections.

Was there clinical or scientific advice that testing would not work? Was there a lack of capacity? Did a greater number of infections come from staff and were they contributed to by PPE shortages? Was isolation the proper route?

Final resolution of these issues is a matter for the later care module. However, evidence will be called in this module to explore the broad reasons why core decisions were taken in this regard and why it was not until 29 April 2020 that the Welsh Government policy changed to testing all patients discharged from hospital to a care home, regardless of whether they were showing symptoms. This was nearly two weeks later than the change in policy in England.

Returning to the chronology and Saturday 14 March, a national lockdown was announced in Spain and an open letter from scientists was published expressing concern over further delay in the imposition of social distancing measures.

If we can, please, have INQ000309816 on the screen.

This is an email sent from the Welsh HSSG on 15 March recording the actions from a meeting of TAC earlier that day.

We can look at item 3, please.

This notes that the initial ballpark estimate is that Wales is two to three weeks on the curve, approximately eight to nine weeks from the peak, and three weeks from outstripping intensive care capacity in Wales.

If we could go over the page to page 2 and the first item on page 2. There is a general concern that further delay in implementing household quarantine and protection of vulnerable could affect Wales more than England.

Then Dr Orford agrees to include a recommendation in the COBR briefing that the introduction of these interventions in Wales should be with immediate effect.

COBR met on 16 March, attended by the First Minister. The UK CMO advised that the UK was on the cusp of the fast upward swing of infections. There had been 35 confirmed deaths in the UK, including the first Covid-19-related death recorded in Wales that day, in Wrexham Maelor Hospital.

COBR agreed that a stricter package of measures should be implemented, including self-isolation, household quarantining and shielding older groups and over 70s. The Stay Home, Protect the NHS, Save Lives campaign was launched.

TAC advice to the Welsh Government was that with these social interventions in place there would be a 66% reduction in the reasonable worst-case scenario.

Following this COBR meeting, four ministerial implementation groups, or MIGs, were established to aid collective government decision-making.

On Tuesday 17 March France and the Netherlands announced national lockdowns. In the UK, the Coronavirus Bill 2020 was published. The UK Government advised against all international travel and the National Assembly for Wales was closed to the public.

On Wednesday 18 March the Covid-19 core group met. Dr Atherton advised that the virus was probably circulating in the community. There were 136 reported cases in Wales and two recorded deaths.

Scientific advice had strengthened in its predictions that, despite the low numbers, a far more significant surge in patients suffering from the virus would have become apparent in the weeks ahead.

Levels of infection in the south east of England were already elevated and advice suggested that the same pattern would become apparent in Wales with a time lag of at least seven days between Wales and England. Dr Orford advised that modelling suggested the UK was four weeks into the curve and it was expected to be another 11 weeks before the spread of the virus peaked, whereas the NHS in Wales was four to five weeks away from maximum capacity.

The decision was taken to close schools in Wales early for Easter. Kirsty Williams, Minister for Education, made this announcement the same day.

The issue of school closures and its obvious impact will be addressed in detail in a later module. However, it is necessary to examine in this module how the decisions on schools came to be considered and decided by the Welsh Government and what its general approach was.

From a relatively early stage, the possibility of closing schools was being discussed by SAGE. It was discussed repeatedly at SAGE and SPI-M-O meetings in February, and the possibility was referred to in the “contain” plan of 3 March. The evidence suggests that the Welsh Government’s assumption was that schools would not close and that the focus was on how to keep them open. Only very late in the day, on 18 March, was the decision taken to close schools in Wales. This was two days after it had been agreed at COBR that keeping schools open was very important, particularly as frontline workers would have school-aged children.

These are matters for you, my Lady. What changed between 16 and 18 March? Why wasn’t advance thought given to the possibility of this very major step? Were the serious consequences of closing schools properly considered and debated at Cabinet? The Inquiry will also want to consider not just whether schools should have been closed but for how long and whether it was right to allow non-essential shops to re-open in June 2020 so that children were allowed to go shopping but not go to school.

Returning to the chronology, as of Friday 20 March Wales had 345 confirmed cases of Covid-19 and 12 deaths had been reported. TAC noted an increase of 30-50 confirmed cases per day. It was on this day that COBR agreed that hospitality ought to close that evening across the UK.

COBR minutes note that the UK Government recommended that public health powers would be used as the legal basis for government action responding to the pandemic, rather than the Civil Contingencies Act.

The evidence suggests that the decision led to powers being exercised differently in different parts of the UK. An issue for this module will be the extent to which this was foreseen and the impact, if any, it had on the Welsh Government’s strategic response to the pandemic.

Also on 20 March, the First Minister announced the closure of hospitality, entertainment and leisure businesses across Wales.

On 23 March, with the death toll across the whole of the UK reaching 335 deaths and 35 deaths in Wales, the then Prime Minister announced the nationwide stay-at-home order would come into effect as of midnight and would be reviewed every three weeks thereafter.

The Welsh Government also announced a full national lockdown, closure of hospitality and non-essential retail, a requirement to stay at home, work from home where possible, and restrictions on indoor and outdoor gatherings.

The First Minister’s press conference on 24 March advised the people of Wales to “stay at home to protect yourself and to protect the NHS”.

On the same day Mr Gething sent himself an email recording the stark observations of a Welsh hospital consultant.

If we could, please, have INQ000299062.

The email reads:

“Complete chaos at our hospital. No protection for nurses – very low moral as being asked to care for patient admitted to Orthopaedic wards by medics with respiratory symptoms. Mask not being released.”

We will examine in this module the powers and the strategy of the Welsh Government with regard to the management of the pandemic over this period, the reasons why it acted as it did, how it perceived its role as against that of the UK Government, its access to advice and the limitations on that. We will also ask what more, if anything, could the Welsh Government have done over this initial period January to March 2020 to protect the people of Wales from the virus. What consideration was given to alternative strategies?

April saw the introduction of daily ministerial calls instigated by the First Minister. The first of these calls took place on 6 April.

On 16 April the Welsh Government agreed that the full package of lockdown restrictions should remain in place.

On 24 April the conditional plan for lifting lockdown in Wales was announced, with the Welsh Government publishing Leading Wales out of the Coronavirus pandemic: A Framework for Recovery. The First Minister’s foreword explained that the Welsh plan was based on three pillars: measures and evidence; principles to evaluate changes to the restrictions; and public health response.

On the same day, the Secretary of State for Wales, Simon Hart, wrote to the First Minister noting that the Welsh framework for recovery did not mention the UK Government once and stating that unless the evidence being relied on by the Welsh Government to diverge from a UK-wide plan is explained, then the Welsh Government will be guilty of adding confusion to an already challenging period of recovery.

On 28 April the First Minister wrote to the former Prime Minister attaching the framework of recovery, stating:

“Our view is that steps taken at the end of the current three-week period should necessarily be modest and cautious.”

Notwithstanding this letter, two days later the Prime Minister announced that the UK Government would set out a comprehensive plan the following week for re-opening the economy, schools and travel. This announcement appears to have been made without any consultation with the Welsh Government.

The list of issues for this module pose a number of questions in relation to how the governments of Westminster and Cardiff Bay engaged with each other: what was the extent of co-ordination and communication between the UK Government and the Welsh Government, to what extent did the Welsh Government seek and receive advice from the UK Government and the other devolved administrations? Were key decisions taken by the UK Government after a proper process of advice and/or consultation with the devolved administrations?

The starting point is that the UK Government could not readily exercise direct control over pandemic management throughout Wales. Health is a devolved matter and the UK Government’s decision to use public health legislation and the Coronavirus Act to respond to the pandemic rather than the Civil Contingencies Act confirmed that the response would remain devolved.

As the pandemic progressed, the devolved administrations started to go their own way in terms of imposition of NPIs, a clear example of this being the Welsh firebreak, which we shall look at a little later.

The Welsh Government also took a different approach to local lockdowns. Now, as your Ladyship heard in Module 2, a number of UK Government witnesses, including the former Prime Minister, suggested that this divergence represented a regrettable failure to ensure consistency of approach across the UK. Welsh ministers, on the other hand, insist that divergence was an inevitable consequence of the different way in which the virus spread across Wales and that in implementing policies that diverged from those of the Westminster government, they were simply properly exercising their devolved powers.

These are issues which were explored in Module 2 and also Module 2A in respect of Scotland. They will be further explored in this module from a Welsh perspective.

The evidence suggests that the devolved administrations were not updated on some important UK Government decisions before they were announced publicly. For example, the change in public health messaging from “Stay at Home” to “Stay Alert” in May 2020, which we will come on to in the chronology in a minute. There was also a lack of clarity over which UK Government announcements applied only to people in England, prompting the First Minister to make multiple requests for the UK Government to make this clear in public communications.

The Welsh Government was represented at COBR as a general rule, but, my Lady, as you heard in Module 2, concerns about the former First Minister of Scotland briefing the media afterwards led, apparently, to a general disinclination to want to thrash issues out in that forum and meetings became more scripted and formulaic. Some UK ministers were concerned that the devolved administrations were diverging from UK Government policy for the sake of being different, a point that is strongly denied by Welsh ministers.

In any event, COBR quickly lost its importance and was replaced by the MIGs and then, later, Covid-O and Covid-S. It did not meet between 10 May and 22 September 2020. The devolved administrations were not invited to Covid-S, although they were invited to Covid-O meetings, initially only when UK-wide issues were to be discussed but latterly, from October 2020, on a weekly basis.

Representatives of the devolved administrations were not invited to the 9.15 am Prime Ministerial meetings, which became the dominant UK Government decision-making body and where much of the strategy was mapped out.

The primary historical forum for meetings between UK ministers and First Ministers of the devolved administrations, the JMC, was not used throughout the pandemic. Mr Johnson said in his witness statement in Module 2 that he chose not to meet with the First Ministers of the devolved administrations because in his view this would have been “optically wrong” for fear that this would give a false impression that the UK was a “kind of mini EU of four nations and we were meeting as a ‘council’ in a federal structure”. There is also evidence from within Whitehall that regular meetings with the devolved administrations could be a “potential federalist trojan horse” .

Instead, four nation meetings were held, chaired in the main by Michael Gove, the Chancellor of the Duchy of Lancaster, who also chaired Covid-O. It does not appear that, whilst he did chair some of the meetings, Mr Johnson was prepared to lead this group.

The view of the First Minister and other Welsh ministers is that some of the meetings held between the UK Government and the Welsh Government were little more than opportunities for the Welsh Government to be provided with information about decisions that had already been taken. There was, it seemed to the Welsh Government, insufficient meaningful input into UK Government decision-making.

The UK Government also made unilateral decisions to relax requirements governing international travel, an area of devolved competence, which had the practical effect of obliging the Welsh Government to adopt the same position against its better judgement. The evidence suggests that realistically the Welsh Government could not adopt a position which best addressed the situation in Wales because most international travel into Wales came from England.

As for SAGE, Dr Orford did not attend SAGE until its sixth meeting, on 11 February. Most of the academic representatives on SAGE were from England and more than half of the subcommittees had no representatives from a devolved administration at all. The expert evidence from Professor Henderson is to the effect that there was a predominantly English frame of reference, and a focus on English-only data. The evidence may be that SAGE advice tended, as a result, to consider only the implications on England of the various options that were considered. As a result, SAGE advice tended, according to one attendee, to be translated into different policies by different nations.

The evidence suggests, however, that there was ample communication between the UK Government and the Welsh Government at the health minister and CMO level, and of course in the Covid-O meetings.

As for local government, the written evidence appears to suggest that the Welsh Government actively engaged with local leaders on decision-making. My Lady will, however, wish to consider whether there was any delay on the part of the Welsh Government in engaging with local government, and explore whether there was a missed opportunity for local authorities to have meaningful input into the decisions taken by the Welsh Government that ultimately were the responsibility of local authorities to implement, deliver and enforce.

Returning to the chronology and, as already mentioned, on 10 May 2020 the UK Government updated its coronavirus message from “Stay at Home, Protect the NHS, Save Lives” to “Stay Alert, Control the Virus, Save Lives”. The leaders of the devolved governments in Wales, Scotland and Northern Ireland decided to keep the original slogan. This new messaging represented a significant divergence in strategy on the part of the UK and Welsh Governments, the former signalling a move towards easing the lockdown and the latter sticking with the existing restrictions.

Having decided to keep the “Stay at Home” message, and given that there was very little in the UK Government’s announcements to suggest that the new measures only applied in England, there was a lot of public confusion, particularly for those living in and around the border of England and Wales.

By way of explanation for the Welsh Government’s position, on 11 May the First Minister made a public address to the nation.

If we can please have INQ000090562 on the screen. If we can look at the sixth bullet point, the First Minister said:

“There has been a lot of focus over the weekend about the differences between the way the regulations are being updated in Wales and in other parts of the UK.

“The fundamental direction of travel is the same here as in other parts of the UK – the stay-at-home regulations remain in place …

“However, there are differences in the messaging between Wales and England and I am concerned this may confuse people.”

If we can go to page 2, please, at the top of the page, the First Minister said:

“I want to be clear – in Wales, Welsh rules will apply …

“We will continue to make decisions, which are right for Wales, using information and expert advice about how coronavirus is circulating here to keep us safe.

“The health of the public is paramount. It will inform our decisions and we will continue to inform you as we plan for our future in the weeks ahead.”

Restrictions across the UK were eased over the late spring and early summer of 2020. Some differences between the four nations were simply a matter of timing. For example, garden centres, the first non-essential retail outlets to be permitted to re-open, were allowed to re-open from 12 May in Wales, 13 May in England, 28 May in Northern Ireland and 29 May in Scotland.

There were, however, some more substantive differences in the way lockdown restrictions were eased. Rules on how many people could meet and from how many households varied notably. From 13 May two people from different households were permitted to meet outdoors in England. A week later the Northern Ireland Executive permitted up to six people to meet outdoors. The Scottish and Welsh Governments did not allow meetings between two households until 29 May and 1 June respectively.

There was a similar pattern when one looks at the manner and timing of the re-opening of pubs, cafes and restaurants across the UK. Pubs in Northern Ireland were the first to re-open on 3 July, followed by England on 4 July. Scotland and Wales took a more staged approach, opening outdoor areas first on 6 and 13 July respectively, followed by indoor areas on 15 July and 3 August respectively.

The general pattern was that England and Northern Ireland eased restrictions and re-opened the economy first, followed next by Scotland, and then Wales. We will examine the extent to which divergence was based on proper advice and a reasonable balancing of the competing considerations, whether there truly was separate Welsh evidence which justified a different Welsh approach, whether points of difference were substantive or merely cosmetic, whether they led to different outcomes, and whether they were to any extent motivated by any factors other than the very best response to the virus for the safety of the people of Wales.

On 4 July the UK Government decided to change its advice on social distancing from 2 metres to 1 metre. The Welsh Government decided not to make this change and retained the 2-metre rule. As with the easing of other restrictions, the decision was of course a balance between the transmission risks and the economic consequences of not changing the rule. At the heart of the debate was the recognition that the scientific advice was that the 2-metre rule provided greater protection but that if the 2-metre rule remained it would be economically hugely damaging. It will be an issue for this module whether the economic impacts as well as the public health impacts were properly debated within Welsh Government.

On 3 August the UK Government introduced the Eat Out to Help Out scheme. Its policy objectives were obvious: to support economic recovery by stimulating consumption in the hospitality sector. However, the Welsh Government was not consulted and, as you heard in Module 2, it doesn’t appear to have been discussed with the UK CMO or CSA, and it was not the subject of advice from SAGE, SPI-M or SPI-B.

The First Minister’s evidence is that had he been consulted he would not have supported the scheme and believed that it was designed by Her Majesty’s Treasury to play well with elements in the Conservative Party and the right-wing press, who were instinctively opposed to public health measures.

Of course this Inquiry is completely politically agnostic in its approach, it has absolutely no personal or political inclination or disinclination towards any of the primary actors in the appalling tale of this pandemic. There has been enough politicisation and polarisation of the public discourse surrounding the government response to the pandemic already.

Furthermore, the evidence as to whether the scheme had a noticeable impact on the rates of infection is unclear. There is, however, a wider, more important point, which was explored in Module 2, with the consequence that other ongoing measures were indirectly weakened. Was it a wise policy, is one of the questions to be asked, when restrictions were still in place?

Issues for this module will be whether the scheme was something that the Welsh Government should have expected to be consulted on, and why, if the Welsh Government did not support the scheme, did it not raise concerns or choose to opt out of the scheme?

On 18 August the Welsh Government published its Coronavirus Control Plan. The plan was designed to tackle the steady increase in cases from late summer 2020 as people returned from holidays abroad and were socialising more at home and with friends. In late August and early September there was a significant increase in cases in the Caerphilly Borough Council area. Initially this was tackled by the local authority, Public Health Wales and the Aneurin Bevan University Health Board putting in place measures such as additional testing capacity, additional protective measures in care homes, and a targeted public appeal reiterating behaviours that people should take to keep safe.

However, those measures were not enough to reduce transmission and on 7 September Mr Gething announced the first local lockdown in Caerphilly.

Throughout September and early October, the Welsh Government responded to subsequent outbreaks by imposing further local health protection areas. These were put in place in Rhondda Cynon Taf, Merthyr Tydfil, Newport, Bridgend and Blaenau Gwent, Swansea, Cardiff, Llanelli, Neath Port Talbot, Bangor and the Vale of Glamorgan.

The First Minister in his written evidence describes these local measures as a failed experiment. The Inquiry has also received written evidence from Professor Michael Gravenor that the Swansea modelling team were not commissioned to model the impact of local lockdowns. Professor Gravenor has told the Inquiry:

“I think this would be a useful area to explore retrospectively, as it was clear at times that there was considerable variation across Wales due to north/south geography and its links to different urban centres in England) and rural-urban contrasts. I would aim for a Wales model to have these explicitly included in [the] future.”

Issues for this module will be why the Welsh Government adopted a local lockdown strategy and why this wasn’t the subject of modelling.

On 14 September the modelling team at the University of Warwick published a paper titled “Circuit Breakers: Implementing (partial) lockdown for two weeks over half term”. The paper concluded that:

“… a well timed and strong lockdown for a two-week period coinciding with half term could have a very notable impact on the number of future cases, hospitalisations and deaths. It provide[d] a useful break if cases are rising too rapidly; however, the impact on deaths is often subject to long delays – so deaths may not decline until after the break.”

On 16 September SPI-M-O’s consensus estimate was that the number of infections in the UK was growing by 2% and 7% per day, and that the doubling time could be as fast as seven days nationally. SPI-M-O agreed that a planned circuit-breaker period where strict NPIs are introduced for two weeks around the October half term has the potential to reduce prevalence and subsequent hospitalisations and deaths reaching high levels whilst balancing non-Covid harms.

With case numbers increasing, on 18 September TAC advised the Welsh Government that the situation was serious and that a package of NPIs on both a local and national scale may be needed to bring the R rate below 1. TAC’s advice was that action would be most effective if implemented early.

On 21 September the 58th SAGE meeting considered a paper entitled “Summary of the effectiveness and harms of different [NPIs]”. Fliss Bennee attend on behalf of TAC. The SAGE minutes provide a shortlist of NPIs that should be considered for immediate introduction, including a circuit-breaker, advice to work from home for all those that can, banning all contact within the home with members of other households, closure of all bars, restaurants, cafes, indoor gyms, and personal services … and all university and college teaching to be online unless face-to-face teaching is absolutely essential.

SAGE noted that Covid-19 incidence was increasing across the country in all age groups and that the effect of the opening of schools, colleges and universities had only just begun to affect this increase. Even so, the latest data suggested that the doubling time for new infections could currently be as short as seven days nationally. Covid-19-related hospitalisations and intensive care bed usage had started to rise. A package of stringent interventions would need to be adopted to reverse the exponential rise in cases.

Four days later, on 25 September, the need for early intervention was reiterated by TAC, advising that:

“If the current measures do not bring R below 1 then further restrictions will be needed to control the epidemic in Wales. The earlier additional measures are introduced, the more effective they will be.”

A week later, on 2 October, TAC gave a rather starker warning. TAC’s advice to the Welsh Government was that:

“Unless measures bring R back below 1, it is possible that infection incidence and hospital admissions may exceed scenario planning levels.”

In other words, unless further steps, such as a circuit-breaker, were Implemented, infection incidence and hospital admissions may exceed scenario planning levels. In short, the NHS in Wales would be overwhelmed.”

Despite this advice, the Welsh Cabinet did not meet to discuss a circuit-breaker until 15 October. The advice from TAC didn’t get any better. A week later, 9 October, TAC advised that there was still exponential growth, with hospital admissions continuing to rise, and that further control measures were needed. For the first time in this wave of infections, the incidence for Wales was higher than 100 cases per 100,000 people, and the total test positivity for Wales as 7.8%. All local authorities had seen more than 25 cases per 100,000 over the past week and had a 2.5% test positivity.

On 12 October Public Health Wales advised Dr Atherton that the reproduction rate in Wales was 1.45 and that restrictions needed to be applied within the next two weeks, and for at least three weeks to achieve a reproduction rate below 1.

Notes from the daily ministerial call of 13 October record the First Minister updating Welsh ministers on the COBR meeting the previous day, during which meeting the UK CSA and CMO advised the Prime Minister that Tier 3 measures would not be enough to reduce the R number below 1, but that a circuit-breaker would. The First Minister invited Welsh ministers to consider a circuit-breaker. Dr Atherton informed the meeting that the four CMOs of the UK supported a circuit-breaker. Public Health Wales, TAC and SAGE all agreed that that was the right approach.

On 15 October, a Welsh circuit-breaker was discussed in Cabinet and an in principle decision was made to introduce a circuit-breaker on 23 October to cover three weekends. This in principle decision was not formally approved until Cabinet met again on Monday 19 October and the First Minister announced that evening that the Welsh firebreak lockdown would take effect from Friday 23 October for two weeks.

Issues for this module to consider will be whether the need for a firebreak lockdown could have been avoided had different decisions in the easing of restrictions been taken in late summer 2020. Given the advice that had been received by the Welsh Government in mid-September that a circuit-breaker was needed and would be most effective if implemented early and deeply, was the delay in implementing a circuit-breaker justified? Why did it take four days to formally make the decision to implement the firebreak lockdown?

The Inquiry will also need to consider whether the funding arrangements between the UK Government and the Welsh Government played any part in the timing and length of the Welsh firebreak. This is because although devolved governments have a direct and immediate responsibility for responding to a pandemic, they do not always have the funding to support decisions if money over and above the Barnett consequential funding is needed.

Her Majesty’s HM Treasury operates on the basis that when the UK Government wishes to implement a policy in England, consequential funding is made available to the devolved governments. The process does not, however, operate in reverse.

Welsh ministers will say that the limitations imposed by these funding arrangements is illustrated by the discussions which led to the Welsh firebreak. The Job Support Scheme, which was to be the successor to the Coronavirus Job Retention Scheme, was due to start on 1 November 2020. Further to the Welsh Cabinet’s decision in principle to introduce a firebreak in Wales, the First Minister asked the Chancellor of the Exchequer to start the scheme earlier in Wales, a request which was declined.

The First Minister described the effect of that decision in his written evidence as one of the most misguided decisions of the whole pandemic, demonstrating in his view that HM Treasury was in effect acting as a Treasury for England, not a Treasury for the UK.

This is denied by UK Government ministers, including the Prime Minister, Mr Sunak, who has provided written evidence to this module stating that Wales received £5.2 billion additional upfront spending by 8 January 2021, and that there was no temporal gap in financial support as the Coronavirus Job Retention Scheme was extended with effect from 31 October 2020.

Returning to the chronology, on 24 November the four nations reached a joint decision on a package of relaxations over the festive period. The core element of this package was a relaxation of mixing in private houses to allow three households to form a bubble from 23 to 27 December. Travel restrictions were also to be lifted across the UK for this period to allow families from across the country to form a bubble.

In order to allow some mixing over the festive period, the Welsh Cabinet met on 27 November to discuss the imposition of NPIs in the pre-Christmas period. The Cabinet minutes note that if the rise in the number of infections was left unchecked it would overwhelm an already stretched NHS, which would lead to a greater spread and higher incidence in older age groups. The Welsh Cabinet agreed that the most appropriate approach was to draw on the Scottish level 3 model, but to create a bespoke solution for Wales.

TAC advice was commissioned. Based on modelling, TAC advised that introducing Tier 3 restrictions, so namely the closure of hospitality and entertainment and a reduction in mixing, prior to the relaxation of restrictions before Christmas, would reduce the number of hospital and ICU beds required for Covid-19 patients and also the number of deaths.

As such, Tier 3 restrictions were introduced in Wales with effect from 4 December.

On 9 December, Dr Atherton updated the Welsh Cabinet on current transmission rates. In summary, the number of cases was continuing to rise, with 2,000 new infections reported the previous day. Infection rates were now greater than prior to the start of the firebreak, whereas in Scotland rates were significantly lower. Cabinet, therefore, agreed in principle that Wales would move to alert level 4 restrictions from 28 December if infection rates did not significantly fall by then.

On the same day Mr Gething received letters from the chairs of two local health boards letting him know their concerns that the health system could be overwhelmed. Dr Goodall also emailed Mr Gething stating that there was a visible increase in overall and confirmed cases and that cases were in fact running ahead of the number that he had shared with Cabinet as his personal worst-case scenario.

The following day, 10 December, Mr Gething was sent information from Public Health Wales containing worrying information about the R number and doubling time. The advice from Public Health Wales was to introduce a suite of additional restrictions, essentially to impose a firebreak prior to Christmas.

At a Cabinet meeting on 10 December, Mr Gething reported that infection rates across Wales now exceeded 370 in every 100,000 people. The decision was taken to move secondary schools and colleges to online learning from Monday 14 December.

On 14 December Mr Gething was informed that there was a new variant of Covid-19 circulating in the UK and this new variant was more transmissible.

On 15 December, Public Health Wales advised that level 4 restrictions should be brought in immediately. During a ministerial call that evening Dr Atherton also advised an immediate move to level 4 restrictions and a change to Christmas easing of restrictions.

The following day, 16 December, the First Minister announced that Wales would move into alert level 4, a lockdown from Christmas Day, and that a smaller Christmas was a safer Christmas.

On Saturday 19 December the First Minister updated Cabinet following an earlier meeting with Mr Gove, the First Ministers of Scotland and Northern Ireland, along with the UK CMO and CSA. As a result of a new strain of the virus, the First Minister informed Cabinet that the UK Government would be announcing significant new measures that would see parts of England, including London, move into Tier 4 restrictions, in effect a full lockdown.

In Wales, hospital admissions were running ahead of the reasonable worst-case scenario and there was significant pressure on the social care sector. Rates per 100,000 in some areas of Wales were higher than in some of the English Tier 3 areas that had been moved into Tier 4. In the circumstances, the decision was taken to bring forward alert level 4 restrictions for the whole of Wales from midnight that night. The First Minister describes in his written evidence to this module as this being one of the hardest decisions the Welsh Government faced during the whole pandemic.

Whilst the management of the first lockdown was undertaken largely on a UK basis, with Welsh Government decision-makers relying heavily on the advisory systems available to them via the UK Government, these later outbreaks took place at a time when the Welsh Government’s strategy for the management of the pandemic had diverged from that of the UK Government. Whilst decision-makers may claim, and have claimed, that the early pandemic involved them being overwhelmed by the new virus, in these later parts of the pandemic the Welsh Government had at least the experience of the first wave to call upon in order to ameliorate its response. Issues for this module will be whether the Welsh Government learned from these previous experiences to prepare for and respond better to subsequent waves of the virus in the interest of preventing infection and ultimately saving lives? Whether a further lockdown in Wales was necessary? Should the decision to lock down have been taken earlier?

Moving into 2021, on 6 January, in light of cases remaining very high in most parts of Wales, with rapid increases in North-East Wales, the Welsh Cabinet decided to maintain alert level 4 restrictions across the whole of Wales for another three weeks. Fortunately, as Wales moved into spring 2021, restrictions were able to be eased and schools in Wales were able to resume face-to-face teaching in late February 2021.

Heading into the winter, Omicron emerged as a variant of concern. Such were the concerns that the First Minister and First Minister of Scotland wrote a joint letter on 29 November to the Prime Minister calling for a COBR meeting to discuss the risks posed by Omicron.

On 10 December COBR met for the first time since January. COBR minutes record the UK CMO confirming with high confidence that Omicron was growing rapidly across the UK and infections were likely even for those who had two vaccines. Dr Atherton confirmed that Wales only had a small number of Omicron cases, 13 in total.

COBR met again on 19 December. The Covid-19 Taskforce reported that there had been a number of Covid-19 cases across the UK over the previous five days and that the two days prior broke the record for the highest number of cases in a single day since the start of the pandemic.

Dr Atherton reported that Wales was still experiencing high but stable community transmission of Covid-19 cases and confirmed Omicron were rising, but from a low baseline.

On 21 December, given the increased transmissibility of Omicron, the Welsh Cabinet decided to move to alert level 2 from Boxing Day in order to slow transmission.

Fortunately, by the time of the 21-day review on 13 January 2022 there had been a rapid change in the trajectory of the data, and infection rates in Wales were falling. Gradually, restrictions were eased throughout the spring of 2022, with the last restrictions in Wales lifted in May 2022.

Having given that whistle-stop tour of the key decisions and events of January 2020 through to May 2022, I propose to next explain some of the other key areas that will be explored in evidence in this module.

The Inquiry has already heard evidence in Module 1 about structures which existed at UK Government level and within the Welsh Government to deal with emergencies such as the Covid-19 pandemic. The evidence which has been heard included national entities like COBR, in which it was envisaged that the Welsh Government would play a part, but also local entities, like the Shadow Social Partnership Council, which was set up to bring together employers, employees and the voluntary sector and which met regularly during the pandemic.

As well as existing structures, new entities were created to deal with and respond to the pandemic when it struck. I’ve already mentioned the Covid-19 core group, which consisted of the Welsh ministers and key officials most involved in developing the Welsh Government pandemic response.

In addition, the First Minister established the Star Chamber in March 2020 to oversee and co-ordinate the Welsh Government’s fiscal response to the pandemic. The BAME Covid-19 Advisory Group was also set up under the leadership of Judge Ray Singh, with its two sub-groups chaired by Professor Keshav Singhal and Professor Emmanuel Ogbonna, who your Ladyship will be hearing evidence from tomorrow.

The Inquiry also received evidence about the Disability Equality Forum, which met regularly over the course of the pandemic, chaired by Jane Hutt. Following a meeting of the Disability Equality Forum on 23 June 2020, work began to produce a report about the devastating impact of the pandemic on disabled people. My Lady will be hearing from the author of that report, Professor Debbie Foster, also tomorrow.

As part of the Inquiry’s examination of Welsh Government decision-making, we will be examining the extent to which informal communication such as WhatsApp messaging played a role in core decision-making and how effective and appropriate such means of communication were. To this end, the Inquiry has disclosed hundreds of WhatsApp and text messages from numerous messaging groups, including messages from prominent Welsh Government ministers, including the First Minister, and others in key advisory roles within the Welsh Government. Although it does not appear that text or WhatsApp exchanges were used as an alternative to formal decision-making processes, the messages do shed light on and provide relevant context to some of the key decisions which the Inquiry will be examining in this module.

There are instances where the Inquiry has received evidence that informal communications have been deleted by the participants. The Inquiry will wish to know why and how such messages are now not available for inspection.

The Inquiry has also received copies of Welsh Government policies about the use and retention of informal communications. The Inquiry will wish to know the extent to which these policies have been complied with and compliance with them policed.

The importance of the advice provided to the Welsh Government is a matter upon which I’ve already touched. In this module we will examine the advisory systems which the Welsh ministers had access to in formulating their strategy to combat the virus. In particular, we will look at the extent to which established advisory systems available to the Welsh Government via UK-wide structures such as SAGE and NERVTAG provided Wales with a reasonable opportunity to seek and receive appropriate advice upon which to base its decisions, the circumstances in which Wales came, during the course of a public health emergency, to form its own, new bespoke advisory systems, in the form of TAG and TAC, the operation of those systems, the composition of key advisory bodies, the advice which they provided, the extent to which it was appropriately communicated, understood and acted upon.

The significance of data, and in particular local data and modelling, will be examined as well as whether adequate local data was available to assist in the Welsh Government’s strategic response.

The limited testing capacity at the start of the pandemic meant it was hard to know how the virus was spreading and where. The extent to which systems for data collection and assimilation were adequately improved as the pandemic went on will be considered, as well as the extent to which data was reasonably publicised and explained in order to maximise the public’s understanding of the threat and steps being taken to combat.

The role of cross-border data collection and analysis exercises will also be considered, including the extent to which these worked in the best interests of Wales to make sure that a combination of local data and data beyond Wales was being used efficiently to understand the nature of the threat both generally and specifically to the people of Wales.

The Inquiry will seek to ask how effective the Welsh Government’s public health communications were. Were the rules on meeting outdoors, social distancing and staying local so complex as to be unwieldy and counterproductive? Were the public health communications accessible for vulnerable and minority groups? What, finally, was the impact of alleged or proved breaches of rules and standards by ministers, officials and advisers?

Turning, finally, to the issue of enforcement. The list of issues for this module identifies the following questions: how and by what means were coronavirus laws and regulations enforced in Wales? Why did the Welsh Government decide that criminal sanctions were necessary? When making this decision, what consideration was given to vulnerable and at-risk groups? In general terms, was the enforcement of coronavirus laws and regulations in Wales proportionate?

The Coronavirus Act had its genesis in the draft Pandemic Influenza Bill, work on which was ongoing for some time. Some argue that ministers were able as a result to impose significant restrictions on the public with less parliamentary scrutiny. Was this the case? If so, was this appropriate and understood? Did a lack of clarity in legislation and regulations make it difficult for the Welsh public to know what was criminalised and what was not, and also to lead to uneven enforcement? How was the balance struck between incentivising people to adhere to social restrictions such as self-isolation and punishing them for breaches? Were the rules enforced fairly?

Having been through some of the key events and core decisions, and identified the issues, I now need to make some points about the way in which the Inquiry will approach its task.

At the outset, the Inquiry recognises that there were no easy decisions. The Welsh Government, in common with all other governments, was required to make extremely serious and far-reaching decisions about how it would respond. It faced terrible dilemmas in the knowledge that a wrong or ill-judged step could prove to be extremely damaging, perhaps in entirely unintended ways. Its decisions were literally matters of life and death.

This module will not be attempting to substitute its own judgement for that of the Welsh Government decision-makers. It will be examining instead whether the key decisions were not just open to the decision-makers to take, but well reasoned, that is to say sufficiently well thought out, sufficiently speedy but taken after suitable consideration and thought, and justifiable in the context in which they were made and in light of the knowledge then available.

There may not have been a single right answer in the exercise of the Welsh Government’s high level strategic decision-making, but there could certainly have been bad answers, decisions that were not properly justified or answers that were unnecessarily delayed. Whether there were will have to await the evidence.

The point about knowledge is critical. The Inquiry does not intend to enquire through the distorted lens of hindsight. For this reason, in the particular context of lockdown decision-making, counterfactual scenarios such as how many deaths would have occurred if the government had done or not done that must be treated with particular caution.

The evidence may show that the odds were always stacked against Wales because the demographic characteristics of the Welsh population, in particular the differences in health and age profile in Wales, meant the impact of the virus was always likely to be more acute. But the evidence may also show – we will have to see – that there was actually a failure of technical insight. Was the inevitable spread of the virus after the end of January properly appreciated by the Welsh Government? Were the consequences of the likely lack of control measures adequately understood? Was there a failure to scale up resources? Was there a failure of process? Was there a failure to obtain and consider specialist non-scientific advice, such as societal, economic, education impact and real world events, alongside the advice from TAG, TAC and SAGE? Was a proactive strategy adopted and pursued, or did the Welsh Government simply follow the UK Government’s lead? Was there a failure of leadership and decision-making?

The Inquiry will need to enquire whether there was a lack of national strategic leadership and co-ordination from the Welsh Government in January and February 2020. The Inquiry will enquire into whether the Welsh Government demonstrated sufficient leadership when it came to the events of March 2020, the first lockdown, the re-emergence of the virus in September, the firebreak in October, and the lockdown of January 2021.

Finally, we must pay thanks to the individual efforts and heroism of civil and public servants and health and social care workers who put their lives on the line to battle the pandemic, the scientists, medics and commercial companies who were able to produce life-saving treatments and ultimately vaccines, the local authority workers and volunteers who delivered food and medicine to elderly and vulnerable people and who vaccinated the population, and the emergency services, transport workers, teachers, food and medicinal industry workers and other key workers who kept Wales going through the darkest of days.

Through this Inquiry we seek not only answers but also hope. Never again can a virus be allowed to lead to so many deaths and so much suffering. In the face of unprecedented challenges we must uncover the truth, learn from our experiences and chart a path forward that ensures the safety, well-being and resilience of Wales.

Lady Hallett: Thank you very much indeed, Mr Poole.

We’ll break now, and I shall return at 2 o’clock to hear from Ms Gowman.

(12.58 pm)

(The short adjournment)

(2.00 pm)

Lady Hallett: Ms Gowman.