Transcript of Module 2B Public Hearing on 28 February 2024.

(10.00 am)

Lady Hallett: Mr Poole.

Mr Poole: My Lady, before we start our evidence this morning, we need to swear in our interpreters for the duration of our hearings.

(Interpreters sworn/affirmed)

Mr Poole: Can you please give us your full name?

The Witness: My name is Elizabeth Ann Grant.

1. Ms Elizabeth Grant

MS ELIZABETH GRANT (sworn).

Questions From Lead Counsel to the Inquiry for Module 2B

Lady Hallett: Ms Grant, I know this is going to be difficult for you. If at any stage you need a break, just say. Thank you so much for coming to help.

Mr Poole: Ms Grant, whilst you give your evidence, could you try to keep your voice up as much as possible, so we can hear you, but also because it’s being recorded, clearly into the microphone. Also if I ask you a question that isn’t clear, which might be possible, then please ask me to repeat it.

Ms Grant, you are a representative of Covid Bereaved

Families for Justice Cymru, and you have been good enough to provide the Inquiry with a statement, which we have at INQ000412150. You signed that statement on 21 February. Are the contents of that statement true to the best of your knowledge and belief?

Ms Elizabeth Grant: They are correct, yeah.

Lead 2B: Ms Grant, Covid Bereaved Families for Justice Cymru has also provided a response to the Inquiry’s impact questionnaire, which we can find at INQ000099719. Is that a document with which you’re familiar?

Ms Elizabeth Grant: It is.

Lead 2B: Ms Grant, in due course I will ask you some questions about Covid Bereaved Families for Justice Cymru group, which continues to provide great assistance to this Inquiry. I would like to start your evidence, though, if I may, by asking some questions about your mother, Betty, who very sadly passed away on 19 April 2020 at the age of 86. May I pass on the Inquiry’s condolences for your loss.

Ms Elizabeth Grant: Thank you.

Lead 2B: I understand that your mother and father retired in around 1988, having owned a number of retail businesses?

Ms Elizabeth Grant: Semi-retired, yes.

Lead 2B: Then in retirement they moved, I think, from Cornwall to Tintern in South Wales.

We understand that your mother suffered with vascular dementia, which was first diagnosed in 2016, and also arthritis, which affected her mobility. But despite those conditions, I understand that she was able to lead a very active life, I believe she represented Cornwall and Monmouthshire at bowls in her retirement?

Ms Elizabeth Grant: She did.

Lead 2B: There came a time when your mother suffered a fall that required her to be admitted to hospital; is that right?

Ms Elizabeth Grant: Yes, that’s correct.

Lead 2B: I think on 13 January 2020, that fall resulted in her sustaining a broken hip, and she was admitted to hospital then; is that right?

Ms Elizabeth Grant: Yes, that’s right.

Lead 2B: Having undergone an operation to repair her hip, your mother was discharged from hospital and placed on a community ward in a community hospital, and that was 28 January 2020; is that right?

Ms Elizabeth Grant: Correct.

Lead 2B: Your mother was then discharged home on 24 February 2020. Did there come a time when your mother had to be readmitted to hospital?

Ms Elizabeth Grant: Yes, yes, she was readmitted shortly afterwards. She had stopped eating and stopped drinking, my father was getting concerned, he was her main carer, and called the ambulance.

Lead 2B: I think that was on 2 March, when she went back into hospital. Were you aware of any steps that were taken to protect your mother from Covid when she was readmitted to hospital, and make sure that she remained infection-free?

Ms Elizabeth Grant: Not aware of anything, no.

Lead 2B: Was your mother, for example, tested for Covid on her admission to hospital?

Ms Elizabeth Grant: No.

Lead 2B: After about a week in hospital, we understand that your mother was deemed medically fit and safe for discharge. That was 10 March. However, she was not discharged home. Can you tell us why that was?

Ms Elizabeth Grant: The hospital insisted on a package of care of four times daily two carers, bearing in mind that there were three very capable adults at the property to look after her. As Covid struck, sickness and suchlike of staff, there was no care package to have offered.

Lead 2B: So, rather than being discharged home, am I right that your mother was discharged to a community hospital on 12 March?

Ms Elizabeth Grant: She was.

Lead 2B: Are you aware whether your mother was tested for Covid on discharge from hospital or on admission to the community hospital?

Ms Elizabeth Grant: She wasn’t.

Lead 2B: Do you know whether your mother was placed on a non-Covid ward at the community hospital?

Ms Elizabeth Grant: The community hospital, to my knowledge, just has one large ward.

Lead 2B: Were you able to visit your mother when she was not community hospital?

Ms Elizabeth Grant: Yes. Yes, I did.

Lead 2B: When you visited your mother, were you aware of the use of PPE?

Ms Elizabeth Grant: No.

Lead 2B: In the sense that there was no PPE?

Ms Elizabeth Grant: No PPE.

Lead 2B: Now, upon the country entering lockdown on 23 March, the community hospital was closed for visitors. I understand you were able to speak to your mother the day before that, 22 March, which was also Mother’s Day; is that right?

Ms Elizabeth Grant: Yes, they’d restricted visiting, so my father was going in daily prior, but because it was Mother’s Day my brother facilitated a video call to me with her.

Lead 2B: Did there come a time when your mother tested positive for Covid in hospital?

Ms Elizabeth Grant: Yes.

Lead 2B: I think you say in your statement that on 31 March your mother’s temperature spiked, she was tested the same day and then returned a positive test the following day, 1 April?

Ms Elizabeth Grant: Yes.

Lead 2B: That must have come as an awful shock. Were you kept informed of your mother’s condition following that positive test?

Ms Elizabeth Grant: Unfortunately not, no.

Lead 2B: Is it your belief that your mother contracted Covid whilst in hospital?

Ms Elizabeth Grant: Yes. Without a shadow of a doubt.

Lead 2B: And given your mother’s vascular dementia, I understand that you, along with your brother and father, were your mother’s attorneys under a lasting power of attorney. We understand that attempts were made to have your mother discharged, but that was not permitted, is this right, until she had 12 clear days without a temperature spike?

Ms Elizabeth Grant: It was described to us as ten plus two without another spike in temperature.

Lead 2B: Yes. Then on 17 April 2020 your mother was eventually discharged?

Ms Elizabeth Grant: On my insistence, yes.

Lead 2B: Is it right that you travelled from your home in Bath to Chepstow to support your father and help with your mother following her discharge?

Ms Elizabeth Grant: I did, yes.

Lead 2B: Can you describe to us, was that straightforward, given obviously Bath was in England, Chepstow in Wales, and in lockdown?

Ms Elizabeth Grant: Messaging was very confusing. To go by the English guidance at the time, you could travel for care, but I had no clue whether that was the same in Wales, so I actually decided to – I mean, nothing would have stopped me, I hasten to add, but I did ring the police, 101, and ask for advice.

Lead 2B: And what advice were you given by the police?

Ms Elizabeth Grant: Very vague. Didn’t really know categorically, but if I was stopped then just to say that was where I was going and for what reason.

Lead 2B: What professional support, if any, did your mother receive when she was discharged from hospital?

Ms Elizabeth Grant: They did kindly put in place St David’s Hospice carers to come and visit, which they did on one occasion.

Lead 2B: And having been discharged on 17 April, two days later, on 19 April, your mother tragically passed away?

Ms Elizabeth Grant: She did.

Lead 2B: Following your mother’s passing, I think you had to return to Bath, leaving your father in Tintern. That must have been an incredibly difficult time.

Ms Elizabeth Grant: I was very fortunate inasmuch as the three capable adults were my father, brother and sister-in-law, so I knew he wasn’t alone, but I found I had to process what had gone on and what – what we’d witnessed, and again I wasn’t 100% sure whether I should remain there because of the regulations or the guidance, so I went back.

Lead 2B: Now, I don’t want to go into the detail of it all, but as a result of the things that you have raised, you have been engaged in a long course of dealing with the hospital and with the health services in Wales in order to find out some of the answers to the questions that you’ve posed; is that right?

Ms Elizabeth Grant: That’s correct.

Lead 2B: Is it right that following your mother’s passing you received medical notes from the community hospital and discovered an incomplete Do Not Attempt Cardiopulmonary Resuscitation order had been placed on your mother?

Ms Elizabeth Grant: Yes.

Lead 2B: Would this have been something that your mother wanted or agreed to?

Ms Elizabeth Grant: No. I’d actually had a conversation with a – in previous months, a hard conversation but one I felt to broach, and, you know, she – she wanted to feel that everybody was going to do everything for her, so she didn’t want that against her, no.

Lead 2B: Am I right there was also a note not to transfer your mother to an acute hospital; were you aware of that at the time?

Ms Elizabeth Grant: No, we weren’t. There was no communication from the hospital at all.

Lead 2B: As regards your mother’s funeral arrangements, you say in your statement that you were given a choice of either ten people to attend a funeral in Lydney, Gloucestershire, or five people to attend the funeral in Wales, and I think you opted for a direct funeral and cremation at Lydney, which took place on 7 May 2020. Can you tell us who was able to attend your mother’s funeral?

Ms Elizabeth Grant: A direct funeral, there isn’t anybody to attend. We couldn’t, as a family, decide who those ten people would be, so dad had the final decision and he decided to do a direct funeral and then have a celebration of her life when the lockdown restrictions had lifted.

Lead 2B: And I think you say on 25 September 2020 you were able to hold that celebration at your mother’s bowls club?

Ms Elizabeth Grant: 2021.

Lead 2B: 2021, I’m sorry.

Ms Elizabeth Grant: Where she is laid to rest.

Lead 2B: Was it as a result of your mother’s death and the way in which she contracted Covid and was dealt with in hospital that you came into contact with some of the people via Facebook, I think, that had similar experience of the Covid pandemic in Wales?

Ms Elizabeth Grant: A few groups, a few – bubble of Facebook groups had popped up, support groups, and it was – it’s difficult, because I know statistics are very helpful, but I actually thought at the time that these thousands and thousands of deaths on the dashboard were in – they were desensitising people to the fact that they were actually people, they were loved people; they just had become statistics, numbers. So I actually reached out on a Facebook platform for anybody in Wales that had lost somebody in the hospitals and the health board, and that’s when Anna-Louise responded, and I think that’s where it all sort of started.

Lead 2B: And so that’s yourself, Anna-Louise Marsh-Rees and Sam Smith?

Ms Elizabeth Grant: Yes.

Lead 2B: I think the three of you formed Covid Bereaved Families for Justice Cymru, and that was 15 July 2021; is that right?

Ms Elizabeth Grant: Yes.

Lead 2B: Obviously it has evolved over time, but I understand that the group represents people from many different backgrounds who have had many varied experiences of the Covid pandemic in Wales; is that right?

Ms Elizabeth Grant: To a point, yes, yes.

Lead 2B: The group represents, obviously, as the name would suggest, a number of people who have had different experiences of bereavement?

Ms Elizabeth Grant: Yes.

Lead 2B: Does Covid Bereaved Families for Justice Cymru represent just the bereaved or does it represent others and provide support to them? So, for example, key workers or public sector workers, or those that have suffered in other ways in the course of the pandemic.

Ms Elizabeth Grant: I would say it’s specifically bereaved.

Lead 2B: Is it right to say that the group has a wide variety of people and experiences upon which it can draw to form views and raise concerns about the Covid pandemic in Wales?

Ms Elizabeth Grant: Yes, lived experiences, yes.

Lead 2B: And those lived experiences, they come from people from different parts of Wales?

Ms Elizabeth Grant: Yes, north, south –

Lead 2B: And within – sorry.

Ms Elizabeth Grant: East, west, yes.

Lead 2B: And within the group there are people whose relatives and loved ones have died at different ages?

Ms Elizabeth Grant: Yes.

Lead 2B: And it represents people such as Amanda Provis, who we will hear from in a moment, who have suffered bereavement at different stages of the pandemic as well?

Ms Elizabeth Grant: That’s correct, yes.

Lead 2B: Now, plainly the group was started after some of the first major decisions in the pandemic had been taken by the Welsh Government and whilst the pandemic was, of course, still raging. What was the primary aim of the group, as you saw it, when you first started it?

Ms Elizabeth Grant: To find answers, truth, accountability, and basically – with – hopefully with help in the Chair, change for the future.

Lead 2B: And did your group focus on the decision-making which had been taken by the Welsh Government as it affected Wales? So was your group always Wales-centric?

Ms Elizabeth Grant: Yes, yes, definitely.

Lead 2B: I would like to ask you next, if I may, a few questions about a number of the issues that your group have very helpfully raised with us, and I understand also have raised with the Welsh Government, arising out of their lived experiences.

Now, in terms of raising concerns with the Welsh Government, I think at the time of responding to that impact questionnaire we looked at a moment ago, which was late 2022, the group had had five meetings with the First Minister and two meetings with the health minister and Deputy Chief Medical Officer, Dr Chris Jones; is that right?

Ms Elizabeth Grant: That’s correct.

Lead 2B: I think I’m right in saying that since the group was established, you have also had quarterly meetings with the health minister and the Deputy CMO; is that right?

Ms Elizabeth Grant: Yes, although they have stopped that now, yes.

Lead 2B: When did those meetings stop?

Ms Elizabeth Grant: I’m guessing it was the beginning of last year.

Lead 2B: Now, at those meetings, the group raised various issues, and I’d just like to address some of those, if I may.

Now, hospitals, obviously, are at the forefront of any pandemic response and appear to be right at the heart of the greatest areas of concerns expressed by members of your group. What is it about hospital care that your members, in general terms, received, or rather their loved ones received, that’s given rise to the greatest concern?

Ms Elizabeth Grant: Ventilation in hospitals:outline:, procurement and use of PPE, and the right PPE, transfers on Freedom of Information requests, on my part. There was what I would consider a large number of untested patients that were discharged to community hospitals, to care homes and residential homes. It’s – that’s probably the main, is the PPE, use of the right PPE, ventilation in hospitals.

Lead 2B: So PPE, infection control and nosocomial infection. You’re no doubt aware that the figures now show that levels of nosocomial infection in hospitals were extremely high across the whole of the United Kingdom. The virus was, to put it bluntly, rampant across the healthcare sector. Is it the view of members of your group that more could and should have been done by way of infection control to stop the spread of the virus through places where their loved ones were most vulnerable?

Ms Elizabeth Grant: I have only one answer: definitely.

Lead 2B: Is it there a sense held on the part of your members that there was a failure to get on top of the spread of the virus generally before it impacted on individual hospitals and also, obviously, care homes?

Ms Elizabeth Grant: Yes.

Lead 2B: Obviously related to this is the testing of asymptomatic healthcare workers, which is an issue that is highlighted in the response to the impact questionnaire. In that impact questionnaire, your group draws attention to the fact that this, again, was not introduced in Wales until late in the day, and they make the point that this was later than in England. This is a big issue for members of your group; is that right?

Ms Elizabeth Grant: It is.

Lead 2B: I think I’m right in saying, aren’t I, that one of the areas in which your campaign has been successful insofar as the Welsh Government is concerned is that you’ve campaigned successfully for there to be an official inquiry into nosocomial infection in Welsh hospitals; is that right?

Ms Elizabeth Grant: Yes, that’s correct.

Lead 2B: Now, whilst we’re talking about hospitals, do many members of your group raise the issue of the restrictions on their visiting ability to the hospitals where their loved ones were being looked after, and also the general issue, I think that you’ve alluded to in your own evidence, about communications with medical staff?

Ms Elizabeth Grant: I was going to say that the majority, as I do, felt the restrictions were necessary to stop the spread, but as you say, communication within hospitals to families was just non-existent.

Lead 2B: Do many say that they simply didn’t receive sufficient detail or the right level of communication, and of course were denied the ability to visit?

Ms Elizabeth Grant: Obviously the visiting came to a head when people weren’t allowed, in the first wave, to be with their loved ones as a final goodbye, and mum’s hospital didn’t have any wifi facilities so you couldn’t have done any video calling. Very lacking, very lacking in technology in some of the hospitals in Wales.

Lead 2B: Is there a feeling amongst members of your group that there was an absence of bereavement support, so a lack of financial support but also the structures in place to help people come to terms with the loss of their loved ones?

Ms Elizabeth Grant: We have over, I think it’s 400 members, and not one person has been offered bereavement support.

Lead 2B: So it would be right to say that your members feel there’s a lot more that could be done in terms of providing that support, so both emotionally, financially, but also in terms of practicalities, so, for example, returning the clothes from someone who’s died in hospital; is that a big issue?

Ms Elizabeth Grant: Yes, a lot of people had issues with the details of things like that, yes. I mean, mum came home with – with an item missing. And it matters, when you’re trying to accept what’s gone on.

Lead 2B: Of course.

Now, we’ve mentioned care homes. Is it the case that there are a number of people within your organisation who have experienced bereavement of relatives in care homes in Wales?

Ms Elizabeth Grant: Yes, there are.

Lead 2B: So that is, I assume, a significant cohort, a significant number of people, but also a significant concern for members of your group, is it?

Ms Elizabeth Grant: Yes, because you go back to the untested policy that the government had.

Lead 2B: If we can just look at a passage from the impact questionnaire, please, INQ000099719, and I think we’ve got page 5 up on the screen, and if we can look at (vii) in front of you, we can see there, this is a concern that’s raised by your group:

“Transferring patients from ward to ward, hospital to hospital, hospital to home/care homes untested and/or with Covid. Welsh Government did not start testing hospital to care home patients until 2 weeks after UK changed guidance.”

Ms Elizabeth Grant: We want to know why.

Lead 2B: That’s a reference there, isn’t it, that mandatory testing of all patients prior to discharge to a care home was introduced in England on 16 April but it was not until 29 April 2020 that this change in policy was introduced in Wales; that’s right?

Ms Elizabeth Grant: Yes.

Lead 2B: And as you say you want to know why?

Ms Elizabeth Grant: Why.

Lead 2B: And these were issues that your organisation was raising with the Welsh Government and the First Minister in meetings in late 2021?

Ms Elizabeth Grant: Yes.

Lead 2B: And you still want to know why?

Ms Elizabeth Grant: Yes.

Lead 2B: What role did you understand that the Welsh Government played in this early period, so January to April 2020, as regards care homes?

Ms Elizabeth Grant: It’s – I mean, I watched yesterday, I saw your chronological order of the Welsh Government’s performance, and it does sound like they were caught with their trousers down. And when they realised the impact of the virus on Welsh shores, they sat on their hands.

Lead 2B: Did members of your group who had suffered bereavement around that time, so this early period, January to April 2020, have experience of pressure being applied to them or the individuals who subsequently died to be transferred from hospital to care homes?

Ms Elizabeth Grant: I’m not aware except the fact that you’re dealing with a generation of people, of the elderly and vulnerable, that would hang on – have such respect for anybody in authority, they wouldn’t have challenged anything that an authority person would advise or say what is happening.

Lead 2B: Now, another issue that your group has raised in the context of social restrictions and the use of so-called non-pharmaceutical interventions that were put in place is the issue that you alluded to earlier in your journey from your home to visit your father and mother, so it’s the question of borders and the differences in application and impact between Wales and England. Has that been a significant issue in the views of your members?

Ms Elizabeth Grant: They are, I think I might be one of two or three that live in England.

Lead 2B: You found it hard, though, did you, to understand what the rules were?

Ms Elizabeth Grant: Yes.

Lead 2B: Did you feel there was an unnecessary degree of complexity or confusion?

Ms Elizabeth Grant: It was tantamount to chaos. But yes, there was confusion. It was very difficult to get, when you’re in England, to get any information or it was difficult to get information of what was happening in Wales.

Lead 2B: Another issue raised by your group relates to face masks, and again if we can just look at the impact questionnaire that I think is still on the screen in front of you, but now we’re looking at (viii), the point is made there that the “Welsh Government mandated [the wearing of] masks 2 months after [the] UK Government”.

Now, that’s a reference to the fact that on 11 May 2020 the UK Government advised the public to consider wearing face masks in enclosed public spaces, so shops, trains, buses, in order to help reduce the spread of Covid. This guidance later, in England, became mandatory, but it wasn’t until 11 September 2020 that all residents in Wales, those over the age of 11, were required to wear face coverings in indoor public spaces; is that what this point is –

Ms Elizabeth Grant: Yes, it is, yes.

Lead 2B: And is that an area of concern for members of your group? Is that something that you’ve asked the Welsh Government to explain?

Ms Elizabeth Grant: I’m not sure we’ve actually asked them directly to explain, but again it’s a question of why and what science were they using.

Lead 2B: Now, you will have heard reference to so-called “superspreader” events.

Ms Elizabeth Grant: Yes.

Lead 2B: And this is another issue that’s been raised by your group, and you have, I understand, raised it with the Welsh Government.

Now, in particular, you’ve asked why the Welsh Government was content to allow the Six Nations rugby match between Wales and Scotland, which was due to be played here in Cardiff in the Principality Stadium, to go ahead on 14 March. Now, we know it was eventually cancelled by the Welsh Rugby Union the day before the match, but that was not before 20,000 Scottish rugby fans had arrived in Cardiff.

Now, in light of what was known at the time and the approach being taken by other countries, and I referred yesterday in the opening to Scotland advising against gatherings of more than 500 people, is this something that members of your organisation again want answers to?

Ms Elizabeth Grant: Yes, yes, it’s the big picture.

Lead 2B: Is your group also campaigning and do its primary aims also include aspects of hospital/care home nursing treatment? So, for example, I think you referred to PPE, respirators, ventilators and so on and so forth, for the purposes of health and social care staff. That is a big concern?

We’ve touched on the broad issue of communications between hospitals but also communications from care homes. That is another issue?

Ms Elizabeth Grant: Yes.

Lead 2B: And, importantly, the whole issue of the arrangements which were then put in place for dealing with loved ones at the end, the way in which, again, communications and hospital staff and care homes and the way in which loved ones were buried and had their funerals conducted, that is an important issue –

Ms Elizabeth Grant: Yes.

Lead 2B: – for members of your group?

Ms Elizabeth Grant: There’s extra layers to the grief of that as well that keeps getting added. Bodies were mislaid, we have members of that experience. We have knowledge of members of staff within a particular health board that was going around into morgues and on ICU, documenting and photographing – photography of dying people and of people that were on ventilators that was later exhibited and made a book out of. Which is another layer that adds to what you’re trying to cope with, because you’re immediately thinking: is that my mum? Is that – you know, as I say, it was – you know, it’s – it was just unnecessary.

Lead 2B: And presumably, and not least because, of course, on account of your mother’s death, the issue with DNA Cardiopulmonary Resuscitation notices being given, end-of-life care is obviously a vital topic for your group; is that right?

Ms Elizabeth Grant: Yes.

Mr Poole: Thank you very much, Ms Grant, I know it can’t have been easy, but I have no further questions for you.

Thank you.

The Witness: Thank you, my Lady.

Lady Hallett: Thank you very much indeed for helping us. I understand that there was a request – I think, given the distances in this building, I think I’ll just stay here, so if anybody from Bereaved Cymru needs to go to talk to Ms Grant, please do. If they don’t mind, I’ll just stay here. It causes quite an upheaval when I leave.

(The witness withdrew)

Lady Hallett: Are you all right, Ms Grant, you don’t want to talk to anybody from – are you sure? I can see you’re in good hands.

(Pause)

Lady Hallett: Is the next witness on their way?

Mr Poole: My Lady, yes, I think –

Lady Hallett: We don’t need a break, Ms Grant’s all right.

Mr Poole: Oh, she’s just taking a break – we’re just –

Lady Hallett: No, we’re not having a break, everything’s okay.

Mr Poole: I think we’re just waiting for the witness to come back, my Lady, thank you.

Lady Hallett: Oh, I see what you mean, she had been in the hearing room, I follow.

(Pause)

Lady Hallett: Are you okay?

The Witness: Yeah.

Mr Poole: May I ask you to start by stating your full name, please.

The Witness: Amanda Jane Provis.