Transcript of Module 2B Public Hearing on 05 March 2024.

(10.00 am)

Mr Poole: Can I call Dr Andrew Goodall.

1. Dr Andrew Goodall

DR ANDREW GOODALL (sworn).

Questions From Lead Counsel to the Inquiry for Module 2B

Mr Poole: If you could start, please, by giving us your full name.

Dr Andrew Goodall: Bore da, good morning, I’m Andrew Goodall.

Lead 2B: Dr Goodall, if I can ask you whilst you are giving your evidence just to keep your voice up so we can hear you, but also, importantly, so your evidence can be recorded. If I do ask you a question you don’t understand, please ask me to rephrase it.

Thank you for attending today and assisting the Inquiry. You have kindly provided a total of five witness statements to this module. The first witness statement, dealing with the Welsh Government, is dated 21 September 2023. The second witness statement, dealing with the Welsh Treasury, is dated 22 September 2023. Your third witness statement deals with the Health and Social Services Group, and that’s dated 29 September last year. Your fourth witness statement deals with the NHS in Wales and is dated 4 December last year. And then your fifth witness statement, which is your personal witness statement, is dated 8 January of this year.

Each of those statements is signed by you with a statement of truth. Can you confirm that the contents of each of those statements is true to the best of your knowledge and belief?

Dr Andrew Goodall: Yes, I can confirm that.

Lead 2B: You’ve also kindly provided three witness statements to Module 1 of the Inquiry and you also gave evidence in Module 1 on 3 July 2023. That’s correct, isn’t it?

Dr Andrew Goodall: That’s correct.

Lead 2B: I think it would be fair to say, Dr Goodall, you have gone above and beyond to provide us with as much information as you possibly can about the workings of the Welsh Government and, importantly for us this morning, the NHS in Wales, for which we are very grateful.

In terms of your professional background, you have a law degree from Essex University, a PhD in health service management from Cardiff Business School, Cardiff University; is that right?

Dr Andrew Goodall: Yes, that’s correct.

Lead 2B: Between 2009 and 2014 you were the chief executive of the Aneurin Bevan University board. Since June 2014 you have been the director general, Health and Social Services and also the chief executive, NHS Wales, and then in September 2021 you were appointed to the role of the Welsh Government permanent secretary. You took over that post in November 2021, taking over from Dame Shan Morgan, who we heard from yesterday afternoon. Is all of that correct?

Dr Andrew Goodall: Yes.

Lead 2B: Dr Goodall, although you are currently the permanent secretary to the Welsh Government, the focus of my questioning this morning will be on your role as director general of the Health and Social Services and also chief executive NHS Wales during the pandemic. If I can start then with some questions about those two roles, I will come on to the responsibilities of both of those roles in a bit more detail a bit later on, but can you just explain to us how it came to be that you held both roles at the same time?

Dr Andrew Goodall: In Welsh Government the NHS Wales chief executive role is also the director general of Health and Social Services, so it’s a role that is located in the civil service, but it has the responsibilities for the NHS through leadership and oversight responsibilities. Within that role it’s really important to say that the director general responsibilities are supporting ministers of course, but it means that the NHS in practical terms is line managed by Welsh Government.

Lead 2B: So would it be right in saying that the NHS Wales role is essentially an outward facing role whereas the director general role is primarily inward facing?

Dr Andrew Goodall: Yes, that’s right. I oversaw all of the health organisations in Wales, but in many respects I acted as the NHS voice and I would have been speaking, for example, more publicly on a range of areas in that NHS role and then internally looking to support ministers in their advice.

Lead 2B: I’d like to ask you now about the structure and the operation of the NHS in Wales. Now, as we all know, healthcare is obviously a devolved matter, so as a consequence of that the Welsh Government has overarching responsibility for the NHS in Wales; that’s right, isn’t it?

Dr Andrew Goodall: Yes, that’s correct.

Lead 2B: So in practical terms during the pandemic did this mean that decisions concerning and impacting the NHS in Wales were taken by the Welsh Government without having to have recourse to Westminster?

Dr Andrew Goodall: Yes, they were taken at Welsh Government level.

Lead 2B: Can we, please, look at INQ000177485.

This is a, as it says at the top, governance map of NHS Wales. Just before we start looking at this map, I’m right in saying there’s no legal entity called NHS Wales, is there? That’s really a shorthand to describe a number of different entities that all comprise the NHS in Wales?

Dr Andrew Goodall: Yes, NHS Wales is established through the 12 statutory organisations that exist, but because of the line management responsibilities of Welsh Government, it is a shorthand description.

Lead 2B: If we focus then on the top half of this page, we see right at the very top the Welsh Government, we see the director general, chief executive role to the left. We then see the minister with responsibility for Health and Social Services, so that’s Mr Gething at the start of the pandemic and later Eluned Morgan, and we see the Health and Social Services Group, which we’ll hear a bit more about later about in your evidence.

Below that we have three NHS trusts, seven health boards, two special health authorities, which again, as shown in this diagram, are collectively known as the NHS bodies.

Those bodies and those who they contract with to provide a range of primary and secondary and tertiary care and community services, that is what, as you’ve just described, comprises the NHS in Wales?

Dr Andrew Goodall: Yes, that’s correct.

Lead 2B: In terms of funding, the NHS Wales is funded by the Welsh Government; is that right?

Dr Andrew Goodall: Yes, correct.

Lead 2B: What is the role of the NHS Wales executive board? Now I think it’s known as the NHS Wales leadership board.

Dr Andrew Goodall: Every organisation has its own statutory responsibilities, the NHS executive board was a way in which I was able to bring colleagues together from across the NHS, the chief executives of those individual bodies, alongside my own internal director team sitting within the Health and Social Services Group. So it allowed us to have an oversight role on the system leadership and to bring the collective understanding of delivery and actions across Wales together. It also allowed us the time to, whilst recognising operational issues, look forward for the NHS in Wales and make sure that we had future plans and strategies.

Lead 2B: What duties does NHS Wales have in respect of the public sector equality duty and completing equality impact assessments?

Dr Andrew Goodall: There’s a duty for Welsh Government on equality impact assessments, but every organisation would also have its own equality responsibilities under that legislation, so the 12 individual health organisations would have their own responsibilities too.

Lead 2B: I move on to next your role as the director general of the Health and Social Services Group. Can you perhaps sensibly start with just tell us, what is the Health and Social Services Group?

Dr Andrew Goodall: The Health and Social Services Group is one of the departments within Welsh Government. We organise ourselves around ministerial responsibilities and portfolios. It means that we are able to divide up the civil servants in Welsh Government, and allow ourselves to give appropriate support and advice to ministers.

Obviously there are individual directors and teams who sit within that group as well and they have their own individual responsibilities also, but fundamentally it’s about supporting ministers in the role, and in this case it was the health minister, who of course, as you’ve said, was Vaughan Gething at the time.

Lead 2B: So as well as providing a sort of leadership role for the NHS, does it provide a link also between the NHS bodies that we’ve just been looking at and the Welsh Government?

Dr Andrew Goodall: Yes, it acts as an immediate contact point, so irrespective of my own NHS Wales chief executive role, you would find civil servants interacting very regularly and daily with a range of organisation, in Wales and indeed professional bodies as well. So it was to bring together that understanding in health intelligence in Wales and to use that to support our policymaking.

Lead 2B: In your personal witness statement you list your many responsibilities as director general of the HSSG during the pandemic. If I may, just to highlight a few that are of direct relevance to this module, is it right that you were responsible for enabling intergovernmental decision-making for health and social care?

Dr Andrew Goodall: Yes.

Lead 2B: Overseeing how health and social care policy decisions were made, communicated and implemented?

Dr Andrew Goodall: Yes.

Lead 2B: Overseeing the availability and use of data and evidence in decision-making?

Dr Andrew Goodall: Yes.

Lead 2B: Overseeing preparedness, NHS capacity and the ability to increase capacity and resilience?

Dr Andrew Goodall: Yes.

Lead 2B: And overseeing the pandemic response in all health settings, so that includes in respect of infection prevention, control, triage, critical care capacity, patient discharge, the approach to palliative care, workforce testing and inspections?

Dr Andrew Goodall: Yes.

Lead 2B: And you also contributed to evidence which informed decisions on the use of lockdowns and other NPIs?

Dr Andrew Goodall: Yes.

Lead 2B: In your role as director general, you were also part of the permanent secretary’s senior team. Did this bring any additional benefits to discharging either of your roles as director general or chief executive of the NHS?

Dr Andrew Goodall: Given that I was located in the civil service and a director general, it meant that I was able to bring conversations about health into the wider Welsh Government structures, so working alongside my other director general colleagues, also working in support of other ministers, so there were genuinely advantages about being part of that senior leadership team. But I did have to look outward to the NHS and provide support there, but it also meant that I was able to access support and indeed support others within the Welsh Government team too.

Lady Hallett: Can I just interrupt? You’re both going very quickly and I don’t want to end up with complaints from the stenographer.

Mr Poole: My Lady, I will try to slow down my questions.

Dr Goodall, what was the relationship between yourself and the Minister for Health and Social Services?

Dr Andrew Goodall: I reported directly to the Minister for Health and Social Services in respect of my oversight of the NHS and my director general responsibilities, so he was my lead minister. It meant that I had frequent daily, sometimes throughout a day, contact with the minister, and it was an important relationship to be able to respond to his requirements and make sure that my policy teams were supporting ministers appropriately.

Lead 2B: If we can, please, have on screen INQ000083227. I’m grateful.

This is an organisational chart with which the Inquiry is now very familiar. We can see you as one of the four director generals. Below you we can see the prominent individual within the HSSG. We see the CMO, Dr Atherton, sits within the HSSG.

Not shown on this chart, did the Chief Scientific Adviser for Health, so Dr Orford, did he sit within the HSSG?

Dr Andrew Goodall: He was located within the Health and Social Services Group in a deputy director role prior to the pandemic.

Lead 2B: And the CMO and the Chief Scientific Adviser for Health, who were they accountable to?

Dr Andrew Goodall: The Chief Medical Officer was accountable to myself. Frank also had a director of health protection role sitting in my structures. The deputy director role, which was the Chief Scientific Adviser for Health, reported to one of my directors, so pre-pandemic this was Frances Duffy, who is listed on your screen, the director of Primary Care and Innovation.

Lead 2B: Taking them in turn, perhaps dealing with Dr Atherton first, can you briefly describe your relationship with Dr Atherton throughout the pandemic, specifically in your capacity as director general?

Dr Andrew Goodall: Frank had a lead role as our Chief Medical Officer. I was always mindful that he had a Cabinet adviser role irrespective of the line management to myself, so that afforded him a different level of contact within the organisation. I was his line manager, so I was there to support the role of the population health team, and Frank and I had very regular contact, both individually and collectively, as you would expect, through the pandemic. Often many times through the day. Often we were located working within our Cathays Park offices with the very limited staff that were available as well. But it was a very frequent contact, as you would expect, with Frank.

Lead 2B: And Dr Orford, your contact and relationship with him during the pandemic?

Dr Andrew Goodall: So through the pandemic it was very much enhanced from my previous contacts with Rob, which would have happened through his previous role, but of course given the extraordinary role that he discharged for us through the pandemic response I saw Rob, again, very frequently, including around collective meetings like Cabinet and other collective meetings of civil servants, but also that gave me a change to be supporting Rob in his individual role as the Chief Scientific Adviser for Health.

Lead 2B: Now, Professor Peter Halligan was the Chief Scientific Adviser for Wales during the pandemic and I think you’ve said in one of your witness statements you had limited contact with him. Why was that?

Dr Andrew Goodall: I had limited contact. He reported to a different director general, firstly, not in the health context, so – because of the science and innovation brief. As this started off as a health-led response, Rob’s role progressed and as we converted from that health-led role we ended up using Rob actually in that more focused Chief Scientific Adviser health role because it linked to the understanding of the pandemic response, and he discharged that very effectively through the pandemic.

Lead 2B: Dr Goodall, if I can ask you again, please slow down your natural pace of speech, just so the stenographer can capture all of your evidence. I’m sure it’s my fault as well.

In your personal statement you say this about Dr Orford, you say:

“… Rob at times found it difficult to secure the same access to UK-wide networks, UK-level intelligence and the benefits of collaboration and information exchanges with the other UK Chief Scientific Advisers that Peter benefitted from, in terms of future health pandemic planning …”

And you say this:

“… I believe that it is vital that the significance of the Chief Scientific Adviser for Health’s role in Wales is formally recognised and embedded in UK-level preparation and response structures.”

So in the event of a future pandemic, this is something that you would like to see changed; is that right?

Dr Andrew Goodall: Yes, I would agree. Of course that’s in the context of a health response, but I think that’s an essential requirement, if – the devolved administration voices to be properly around the table to and make sure that we have that bridge in place.

Lead 2B: The Chief Nursing Officer for Wales was also directly accountable to you in your director general role. Can you briefly describe your relationship with the various individuals that have held that role during your time as director general in the pandemic.

Dr Andrew Goodall: Yes, I again had regular contact, I was the line manager of all of my directors in my group, whilst they were discharging professional roles. I had frequent contact with them collectively around the table, with colleagues individually where needed, and was available to give them the support that was required.

With all of the directors in my group, however, I had a very high regard for their abilities and their responsibilities, so it was important that they understood that they could actually act at their own initiative and independently where required.

Lead 2B: What responsibilities did you and the HSSG more widely have regarding the care sector in Wales?

Dr Andrew Goodall: Within the director general role, we oversee the policy development of social care in Wales, we have a supervisory role. Legal responsibilities for delivering social care services lie with local authorities, but obviously at the national level we oversee the policy development and ministers are supported to make policy decisions, and there was a Deputy Minister for Social Services in place during the pandemic response.

Lead 2B: So I think it would be right from what you’ve just said that the Minister for Health and Social Services, and by extension HSSG, their responsibility really lies in matters of policy only, whereas operational delivery of care services in Wales, that’s the responsibility of Welsh local authorities; is that right?

Dr Andrew Goodall: Indeed, and it was distinct from the NHS role, which, as I said earlier, it was a line management responsibility for the NHS.

Lead 2B: We know that there are 22 local authorities in Wales. Does that complicate the delivery of care services in Wales? Was that your experience, for example, during the pandemic?

Dr Andrew Goodall: There were national voices for local government. Of course every individual statutory organisation needed to discharge its own responsibilities. I was very reliant on the local relationships between local health boards, which had a more regional template, to work very closely with local authorities. But we were able to often get those organisations in a room, both from representatives but actually collectively as well in Wales, and there were very close and effective relationships in place with the local authorities as well. So I don’t think that really was a problem, but obviously they are significant numbers of organisations to be involved.

Lead 2B: In March 2020 you asked Albert Heaney to take up the post of deputy director general for Health and Social Services. Was that always the plan or was that linked to the pandemic response?

Dr Andrew Goodall: No, that was genuinely linked to the pandemic response, because as we were manoeuvering our way through the response and making progress, I obviously was having to discharge that leadership responsibility for the NHS. But given the policy responsibilities that we held in Wales, it felt really important to make sure that I was able to have that care voice very clearly at the highest level of my group structures and Albert was able to discharge that.

And one of the reasons for doing that was when we were attending meetings Albert was often alongside me and sitting, for example, with ministers, so it just meant that there was a very direct voice that we could use there in support of my role but actually in support of the policy expertise.

Lead 2B: In your view would there be benefit from further alignment between the NHS and the care sector in Wales? Is that something that is perhaps already under way or envisaged for the future?

Dr Andrew Goodall: Our strategy for Wales, we launched this back in June 2018, is actually to align health and social services in Wales, so actually there is a very clear strategy already in place to do that, and I was part of the development of that plan alongside the minister for health and social care. So we have a very clear future plan about our intentions.

I think that worked to good effect during the pandemic response as well. But I do think that we have to make sure that we are overseeing appropriately at a national level, because we are very reliant on the local relationships that are in place between local health boards in particular and with the local authority organisations, so there is an operational responsibility to get right.

Lead 2B: Having now looked at both roles that you held, would you say in your experience that there was a benefit to one person holding both roles?

Dr Andrew Goodall: My personal view as experienced through the pandemic was that it genuinely helped us, it brought a voice of the NHS very intimately into government at a really critical moment of a health – pandemic response, and I hope I was able to discharge that professionally.

I think there were lots of advantages of being able to bring the system oversight much closer between ministers and the NHS, so I always felt I was able to represent a very proper view, not just of organisations in Wales but actually of healthcare professional voices, of unions and of other representatives as well.

But it’s not only my experience of the pandemic response, my view is that that is something that helped me through the whole of my tenure, and I had to make a decision with my successor about whether I was going to retain that, because this has been the pattern over the last two decades, and in October 2021 I determined that I would keep that responsibility together because I think it had worked very effectively, and visibly so in the pandemic response.

Lead 2B: Did one of your roles during the pandemic though take priority over the other?

Dr Andrew Goodall: I think whilst there is a balance in looking to support ministers and the director general role, in the middle of a health pandemic inevitably, if you are the NHS Wales chief executive, that has to take a different level of responsibility and oversight. So if I was saying where was the balance, I think I had to step more into the NHS space during the pandemic response, but I don’t think that let at all down the access or the availability of advice and expertise for the director general side. I’ve always been very corporately visible, and I think ministers would say that whilst I was supporting the NHS that I was always available to them whenever they needed for the internal policy development too.

Lead 2B: Could we, please, have a look at INQ000182389.

This is an email that you sent on 21 March 2020 asking Jo-Anne Daniels to take on the role of Covid-19 director. If we just have a look at, I think it’s the fifth paragraph, second line – third line in fact, you say:

“I have to protect my nhs role … [Document read] … would wish into government areas.”

What do you mean by being “drawn more than [you] … wish into government areas”?

Dr Andrew Goodall: I think at that point, which I think was just ahead of the lockdown itself, I was getting drawn in more so into some of the broader interface and policy issues with other government areas, so whilst this was a health-led response, it was actually quite a critical point for the NHS, both in terms of the development of plans and capacity.

I was discharging a visible role in Wales in terms of needing to lead that responsibility with my other health service colleagues as well, and I needed to work out whether there was a better way of giving some of that protection while still having the reporting lines to myself. In fact, having approached Jo-Anne at this time, there are a number of things that had actually happened during – towards the end of March that actually helped me to make sure that that support was available. You’ve already referred to Albert Heaney taking on the deputy director general role. That helped to consolidate support underneath me. Our planning and response mechanisms were working really well and we had military planners in place as well as the broader Welsh Government. So whilst I was having that conversation with Jo-Anne, I think probably the situation actually improved more.

In the end I actually used Jo-Anne just a few weeks later for her to act as the director of test, trace and protect, which is a fundamental objective for us to achieve in Wales, and again she discharged that quite well. But it didn’t mean I was removed from the process, it was just trying to make sure I could really show that I was visibly available for the NHS.

Lead 2B: Now, you’ve just referred in your answer to senior military planners. As I understand it, senior military planners were embedded within the HSSG and also other NHS bodies in the course of the pandemic. Can you just briefly describe, what role did they play?

Dr Andrew Goodall: Yeah, they really played an extraordinary role and came in very early to our response. So they were available in March. They provided a reference point and support for us on logistics and planning. They helped us with the way in which we could ensure that we had the right decision-making mechanisms in place. But importantly, as you said, they weren’t just available for us in our national role, they actually committed their time and support in every individual health organisation in Wales, and that was used to very good effect on some of the planning for capacity for field hospitals and even, later on, around vaccination areas as well when we were putting in the vaccination systems in Wales.

Lead 2B: So in the event of a future pandemic, the use of senior military planners, that is something you would encourage again?

Dr Andrew Goodall: I would really encourage it. We were really impressed with all of the colleagues that came to join us in those teams and I think they were essential, particularly at those early stages, to help us with the way in which we were responding to the pandemic.

Lead 2B: I’d like to talk to you now about some other various groups that were formed and you attended over the course of the pandemic. We heard yesterday from Dame Shan Morgan a bit about ExCovid. Now, did you have a specific role in ExCovid?

Dr Andrew Goodall: I was a director general attending it. Of course I was there with my oversight and leadership of the health response and of the NHS. In terms of the format of the meetings, I would tend to have a role to give an update on my sense of the pandemic progress, at different stages, of course, during the pandemic response, but also to give an update on the NHS response, whether it was about capacity or the difficulties that the system was experiencing.

Lead 2B: In your personal witness statement you say that prior to the pandemic you established weekly executive director team meetings, so they’re meetings of the directors in the Health and Social Services Group, and you say that this was to bring together information, identify leadership actions and make decisions across the group’s functions and responsibilities. Then you go on to explain that at the start of the pandemic you established the executive directors team contingency group. What was the purpose of that group?

Dr Andrew Goodall: So we had a weekly pattern to meet as directors so that we were able to oversee particularly the information that was feeding up from our planning and response mechanisms that were in place.

The reason for introducing the directors contingency group meeting, it was actually something that was introduced later in the pandemic response, in October 2020. At that point, whilst there was still an intensity about the pandemic response, we also had some broader health responsibilities to discharge, not least as we were returning to some level of normal activity. So that group meant that we were able to protect the pandemic response discussions from some of those wider responsibilities for the health group as well.

So there’s an intensity about a pandemic response, but of course you have all of the normal and all the statutory responsibilities to discharge for the NHS system.

Lead 2B: I understand.

Also at the start of the pandemic, is it right that you established the Health and Social Services Covid-19 planning and response group?

Dr Andrew Goodall: Yes, that had its first meeting on 20 February. It was actually established in response to Frank in his health lead at that time, I think it was in early February, just asking us to make sure that we were putting in a different set of response arrangements. And I think, again, that worked very well really from the outset, to give us a focal point for our attention.

Importantly, though, it gave us a way in which we could anchor ourselves to voices from the NHS system and the care system itself, who we brought into that infrastructure too.

Lead 2B: Could we, please, have a look at INQ000083237. Thank you.

So we’re looking here – yes, at page 2, we can see this is the HSSG planning and response structure chart. So at the top we can see the Minister for Health and Social Services. Beneath the minister we have you, your deputy Mr Heaney, the CMO, Chief Nursing Officer, chair of the Covid-19 planning and response group.

That’s not the EDT contingency group we have already discussed, is it, because that came into place later, in October?

Dr Andrew Goodall: That was later, in October, but we had an internal EDT group which was also part of arrangements actually meeting more regularly than weekly, where it just allowed us to bring together some sense of the conversations that were obviously happening at speed in March. That was the core group that was invited but all of the directors were available if they were able to.

Lead 2B: I think you say in one of your witness statements you describe this as an informal group and you say “an informal summary or action points were taken by my office but not for the purposes of recording discussions or circulation”. One might ask: well, what was the point of those informal summaries or action points?

Dr Andrew Goodall: That we were able to just share intelligence in a rapidly moving environment. Often those meetings were taking place daily. We would revert to the weekly mechanism to make sure we’re able to discharge those broader decision-making and, yes, there were notes of those meetings that were available if required.

Lead 2B: Below that informal group we have the Covid-19 planning and response group, and I think, as you’ve just said, the first meeting of that was on 20 February 2020, so that’s some eight days before the first case in Wales –

Dr Andrew Goodall: Yes.

Lead 2B: – of Covid. Do you think that was early enough for that group to have met or do you think that group should have met earlier?

Dr Andrew Goodall: I think that was early enough at the time in terms of how the virus was progressing. Through February, the overall UK assessment was – was low, it changed to moderate at the end of February. At the beginning of February we were mobilising a whole series of mechanisms that were in line with our response plans, establishing the health desk, the emergency co-ordinating centre being established, the health countermeasures group, and all of those happened really in that first fortnight of February. At the time there was no Welsh case. I think, at the beginning of February, there had been a single English case, from a UK level. So we were mobilising and progressing, keeping an eye on the progress of the virus, and all of these were pretty essential mechanisms that we were putting in place.

Lead 2B: We can see in the bottom of this diagram, reporting in to the HSSG planning and response group, we have seven subgroups in total. To the left of the group we can see the HSSG planning and response cell, which I understand, can you confirm, that was set up and established in March 2020; is that right?

Dr Andrew Goodall: That was March 2020, and was just really a subgroup of arrangements, so again it just took on a co-ordinating role. Again, some of the individuals, like Samia for example, were critical in that, but it was just a small group of people to make sure that the actions were followed through from all of the work that those different groups were doing.

Lead 2B: Again you say in, I think it’s your personal witness statement, that:

“As well as establishing the HSS Planning and Response Group to bring system leaders closer to decision making in Government … I established more frequent calls with system leaders to discuss pandemic preparation.”

Just to be clear, reference to “system leaders”, does that mean NHS chief executives?

Dr Andrew Goodall: Yes, NHS chief executives, although there were times when there was a broader audience, so as an example chairs of health organisations tended to also join those meetings at least once a week, just for completeness and to be up to speed with all of the information.

Lead 2B: Now, from what we have been discussing and what we can see on the screen still, there seems to be an awful lot of different groups and different channels of communication. At the time, or indeed looking back now, do you think any of this could have been simplified or would it have benefitted from being simplified in any way?

Dr Andrew Goodall: I think the core of the planning and response group was really important. We needed to make sure we were able to bring together our own areas for action and attention from a health service and from a social care perspective, and that needed to be overseen irrespective of how Welsh Government oversaw its own structures. We were using as much as possible, however, some of our normal mechanisms, so chief executive calls across Wales on a weekly basis were a familiar mechanism that everybody knew, we just made them more frequent.

I think the seven subgroups were really essential to break up the individual areas, and I think what was really important in those, that it was bringing people with real expertise from our system into those areas to advise on the policy that we needed to take forward. So the service voice and the frontline staff voice was embedded through these different mechanisms, so I would hold on to those particular issues.

I think the way in which we could improve some of these mechanisms would have, from my perspective, been trying to clarify some of the individual responsibilities. So there were probably some times in these individual groups – if you can imagine, we’re squashing everything about the NHS into categories, but the NHS on a daily basis is interfacing across many different areas, so I think some of the responsibilities could have been maybe clearer at the outset, and we were able to discharge that I think a bit later in our pandemic response as well. But I would broadly retain the planning and response group structures, I think they did serve us well.

Lead 2B: Perhaps we can just look at then a review that was carried out, I think it was a review from January to September 2020 and then there was a report dated 25 September 2020.

We’ve got it at INQ000083255. I’m grateful.

If we can have a look at page 3, so the HSSG Covid-19 response structure is set out here. Dr Goodall, you’ll be glad to know I’m not going to ask you to talk us through this diagram. If we can have a look at page 5, paragraph 1.2, just reading from para 1.2:

“The H&SSG whole system structure … [Document read] … into the overall planning and response structure.”

So just going back to the question I asked a moment ago, do you think there were too many different groups or cells within the structure? Would you agree with what’s said here, that there was a risk of a duplication of work?

Dr Andrew Goodall: I think the actual seven groups were focused on the right areas for us. I’d already highlighted myself that I felt in those early stages there were some areas where potentially there was duplic – energy that was taking place in the early phase. It was a very fast-moving environment in the pandemic response at that time. Despite the reviews that we undertook, though, we retained the essence of the structure all the way through, so those seven subgroups were – remained. What we tried to target was actually to make sure that people were really clear of their accountability and how they would interact with the different areas of responsibility as well, so – but I accept that. I think in part I probably suggested some of that in my answer just now.

Lead 2B: If we have a look, same document, please, page 13, I think it’s the bottom bullet point under “Suggestions for improvement”, it says there:

“The establishment of the NHS Executive … [Document read] … lead/support the system.”

Can you just explain to us why that’s something that was needed and whether it’s something that has happened or is under way?

Dr Andrew Goodall: Yes, the NHS Executive was a formal programme for government objective. It was part of the manifesto that turned into the government programme. And it was a response to a parliamentary review that had been undertaken saying that we needed to put in an infrastructure for a guiding – a guiding hand, an infrastructure for supporting the direction of the NHS in Wales. So that was in train at the time that the pandemic response came in. In many respects we stepped into that space because of the pandemic response, because the leadership was needed. The NHS Executive technically was deferred while we were going through the pandemic response, but it is now in place in terms of giving an additional level of support to the NHS Wales chief executive role.

Lead 2B: Just again staying on this document, I think it’s this page, in fact, paragraph 4.1 and looking at the fourth line, it reads:

“On occasions, there was lack of clarity on which areas were being led by [Welsh Government] or [Public Health Wales].”

Is that something that you recognise?

Dr Andrew Goodall: Yeah, I think in the early stages, as we were picking up in this very fast-moving environment, we would pick up issues and then be determining where the accountability needed to be in place for that. As the Welsh Government oversight mechanisms really initiated properly during March 2020, I thought that became a lot clearer, but there were at times some areas where we just simply needed to call out where the responsibility was. So as an example on the testing side, Test, Track, Protect was put in place with a director lead who oversaw the programme of testing responsibility from April 2020, and that was an alteration we needed to make just a give real clarity to the system.

Lead 2B: A second review was conducted by the HSSG, it was dated 11 October.

We’ve got that at INQ000083257.

We can see the first page there. If we could, please, go to page 5, and it’s paragraph 6.2.3, and it reads there:

“It was not always clear as to where the ownership of decision-making should lie … [Document read] … HHSG structure fitted with wider Welsh Government ExCovid structure.”

So this is now October 2021, which would suggest that the lack of clarity as to ownership of decision-making that had been identified back in September 2020 remained an issue over a year later; would you agree with that?

Dr Andrew Goodall: I think there was a constant need in our responses to make sure we were able to keep clarifying the lines of accountability. The Health and Social Services Group structures did feed, of course, into ExCovid, because that was through myself, but I think there was a very clear line of accountability about how the Health and Social Services Group fed into the 21-day review cycle which had been established and was in place very significantly throughout the months preceding this as well.

Lead 2B: You were obviously a member of ExCovid. Were the issues that are being identified here regarding decision-making in both HSSG reviews not something that ExCovid ought to have addressed?

Dr Andrew Goodall: They were reported up to ExCovid, so in fact the response I think that you’re referring to here from a Health and Social Services Group perspective, all of our own review mechanisms fed into ExCovid in terms of the lessons learned. But yes, of course, there was a need for us to separate in this the areas that were more operational responsibilities for the NHS as opposed to matters for government.

So if I could give one example of that with your permission, the operating framework for the NHS, which in part was guided by the views that colleagues were developing through here, they were matters that were for me to issue to the NHS in Wales in my NHS Wales chief executive role, they weren’t necessarily matters that would be taken up by the wider Welsh Government body, for example.

Lead 2B: Another point that is raised in this, so sticking with this October 2021 review – yes, it’s same page, right at the top 6.2.1:

“Some HSSG decisions taken during COVID focused on minimising the immediate impact and harm. There is … [Document read] … of this short term decision-making.”

Is this something that you agree with?

Dr Andrew Goodall: I recognise this because of the different phases that we went through, and it was really important that the harms framework that had been established by Welsh Government during the first wave was used as a way of us understanding the wider impacts.

When we were making our initial decisions, not least on behalf of the NHS in that early phase, we were assuming probably a 13-week period of a pandemic response that we would work our way through would have some those immediate areas, but the balance would have worked to ensure that the NHS wasn’t overwhelmed, for example. Over time, what we had to do was to make sure that we were balancing those wider impacts and some of those unintended consequences, so the restoration of NHS activity, for example, the way in which the lockdown decisions were overseen by ministers.

Lead 2B: Just before we leave structures and bodies, TAG and TAC were hosted, as I understand it, out of the HSSG. Did they therefore fall under your oversight as director general?

Dr Andrew Goodall: Yes, they did.

Lead 2B: Did you attend TAG and TAC?

Dr Andrew Goodall: No, they were professional meetings involving colleagues who were able to really focus on the evidence. But whilst it reported up and was a mechanism, I didn’t attend it.

Lead 2B: How were the outputs of TAG and TAC used by you and your colleagues within the HSSG?

Dr Andrew Goodall: We had access to the evidence that they were producing, we were able to use that in our own reflections and tie it into our policy development. The paperwork and the documentation that was produced was issued as part of the Cabinet processes, so also we were able to give advice on that.

There was a later stage when, to support the Technical Advisory Group, we needed to oversee the range of areas that they were being asked to do, so later on deliberately we put in a mechanism as a steering group just to make sure that we could maybe make some judgements about the areas that they were looking at, because they were providing such good evidence that they were getting many requests from a range of different sources.

Lead 2B: I understand. And that steering group, that was yourself, Rob Orford, Fliss Bennee and Dr Atherton, and Reg Kilpatrick; is that right?

Dr Andrew Goodall: Indeed, yes.

Lead 2B: And you’ve touched on it already but what was the purpose of that TAC steering group?

Dr Andrew Goodall: There was such an intensity of work that TAC was undertaking. They were very embedded into the 21-day cycle review process, and ministers really highly relied on them. They were also acting to draw down intelligence from a range of different sources. There was just the potential for moments where the needs of the week or the month ahead would be overtaken by the wide variety of areas. So it was simply a support and screening mechanism for them. I think importantly in helping them to discharge that function we always wanted, however, the members of the Technical Advisory Group to be able to follow evidence that was emerging as well, so obviously they still, at their discretion, were able to follow important pieces of evidence and advice.

Lead 2B: If we can turn next to your engagement with Welsh ministers, it’s right, isn’t it, that you were an attendee at Covid core group?

Dr Andrew Goodall: Yes, from the very start I was an attendee there.

Lead 2B: What was your role within that group?

Dr Andrew Goodall: The First Minister was really keen to make sure that there were appropriate updates around that table, right up to date, and my responsibility was really to give an oversight and update on the NHS preparations, the NHS response and the capacity areas. I would also have the opportunity to speak about care sector issues as well, depending on the discussion, the conversation that was taking place, but it was predominantly around the NHS position because of the way in which the virus was progressing.

Lead 2B: You also routinely attended Cabinet meetings; is that right?

Dr Andrew Goodall: Traditionally I wasn’t a Cabinet attender, I would only go at request, but yes, during the pandemic response I was asked to be a regular attender at the Cabinet meetings.

Lead 2B: And from the minutes of Cabinet meetings that we’ve seen, it appears your role was essentially to brief ministers on key health and social care indicators, and then once the 21-day review cycle was established you would provide advice to ministers on capacity, resilience within the health system that would then inform their assessment as to whether to impose or lift certain NPIs; is that accurate?

Dr Andrew Goodall: Yes, that’s correct. The predominant role when I was asked to contribute tended to be really about the NHS position, and often that would depend on the progress of the virus, but, yes, I was giving a very immediate update, including about how it felt in the NHS, not just on the data and on the evidence.

Lead 2B: I’m right in saying, aren’t I, that you were not a decision-maker in Cabinet? I think you describe yourself in your evidence as a factual voice not a policy one. Is that right?

Dr Andrew Goodall: That’s correct, yes.

Lead 2B: Now, as we’ve touched on, one of your roles was to understand and inform Welsh Government about capacity in the NHS. We’ve heard quite a lot about data collection from local health boards, how that was then analysed by the knowledge and analysis service, alongside Digital Health and Care Wales and also HSSG officials.

Would it be that data that you would be speaking to when addressing Cabinet?

Dr Andrew Goodall: Yes, there was data generally available. Of course we had had to create systems from the very start of the pandemic response, and I wanted to make sure that there was a consistency in the data and information that I was reporting on, but I would tend to give a sit rep report, a traffic light rating of the way in which organisations were responding around Wales, but yes I would use some core data particularly around hospital admissions and critical care admissions.

Lead 2B: I’ll come back a bit later this morning to ask you a bit more about data and modelling, but in your view was capacity of the NHS and ensuring that it would not be overwhelmed, was that the main priority of the Welsh Government’s decision-making throughout the pandemic?

Dr Andrew Goodall: It was certainly important during the first and second waves. I think the balance changed later on in the pandemic response, particularly when we had the benefits of vaccination that was showing us that there was a different outlook for the virus. But making sure that the NHS was able to accommodate any Covid patients in the system, but equally to make sure that broader health services weren’t overwhelmed so they couldn’t discharge – so that they were able to carry on discharging their essential roles was really important. So that protection of the NHS was really important in that early phase but particularly for the first wave and the second wave.

Lead 2B: And even in that first and second wave, do you consider that other factors, so such as the impact on the economy or the impact on mental health, do you think they were adequately balanced against NHS capacity?

Dr Andrew Goodall: I think the public health impact was certainly at the foremost of the Cabinet discussions, and I know for the First Minister personally. When the 21-day review cycle was established, it allowed us to ensure that all of the different respective voices were able to be brought around the table. So whilst I would update or be brought into a conversation, there were other areas that were highlighted around those discussions, again right through the pandemic response, and it was probably, I would say, through 2021 when it felt like the balance had changed and switched away from that more immediate public health harm approach.

Lead 2B: Now, obviously you would be interacting with the Minister for Health and Social Services and the First Minister through Covid core group and also Cabinet meetings, but outside those formal structures can you give us a sense of your interaction with – let’s deal first with the First Minister. During the pandemic, how often would you brief the First Minister?

Dr Andrew Goodall: I would tend, particularly in the areas where things were very fast-moving, to be seeing the First Minister, you know, sometimes on a daily basis. There was a beat and a regularity about some of the more collective meetings that took place that would have just brought us into a general comment. I was available to him if needed. I hope in part it was a benefit that I’d actually worked in support of him when he was in his health minister role, so from a relationship perspective he would have known that he was able to access me for views wherever needed.

Lead 2B: What about the Minister for Health and Social Services?

Dr Andrew Goodall: That was a very regular contact, again depending on the intensity of the pandemic response and what phase we were at, but really would be a daily contact with the health minister about a range of different areas, not least on the data that told us about the progress of the disease but actually on the things that we needed to put in place to support that as well.

Lead 2B: Now, we heard evidence yesterday about the production of ministerial advices. What role did you play, if any, in respect of the ministerial advices?

Dr Andrew Goodall: In my director general role I’m responsible for the oversight of the quality and to ensure that submissions go up. There would be some individual examples of ministerial advice where, given its nature, I would be more involved in it and would act to clear it. Most often the ministerial advice would be able to go up at a director level, even at a deputy director level sometimes, to ensure that the direct request was made to ministers as well. But I had to ensure that the process and the mechanism was in place.

Lead 2B: Can we now turn to the period January to March 2020 and I’ll try to take my questions chronologically, so we start in January 2020.

We heard evidence in the Inquiry in Module 2 from Lord Simon Stevens, who was the chief executive NHS England during the period. His evidence was that he regularly attended COBR in February and March 2020. The Inquiry has also heard evidence from Sir Chris Wormald, permanent secretary of the Department of Health and Social Care, and again his evidence was that he attended all COBR meetings in that period that were chaired by the Secretary of State for Health and then subsequent meetings when they were chaired by the Secretary of State for Health and then the Prime Minister.

As we’ve discussed, your role, your dual role aligned with their two roles in England. Did you attend or were you invited to attend COBR meetings in that period, January to February 2020?

Dr Andrew Goodall: Yeah, I wasn’t directly invited. The First Minister or the minister attending would decide which official they would wish alongside them, but there was a constraint on attendance numbers, so, from a Welsh Government perspective, whilst it might have been helpful to attend, ultimately there was a limit on the numbers who could accompany the minister or the First Minister.

Lead 2B: And that was the same even when the COBR meetings became remote, was it?

Dr Andrew Goodall: So later, when the COBR meetings were extended, I was able to sit on – at least on a couple of those to be able to listen in. That would allow me to give some advice to ministers and certainly pick up some of those issues outside. I found that personally very helpful to be part of that, because I was obviously leading, alongside others, the health response in Wales. So I think probably if there was a way of sitting around that table it would be good to be there, but most importantly I think, the minister and the First Minister should be able to decide which officials join them in those types of settings.

Lead 2B: Was it your sense at the time that UK Government officials were privy then to more information than perhaps you were in January/February 2020, or is that not a position that you would take?

Dr Andrew Goodall: It’s quite possible at a direct level. I of course, as you would expect, would have feedback from those COBR meetings on issues that were relevant at that time, but it’s sometimes different, sitting in the room, hearing the presentations, and of course COBR has some limitations on the way in which information can be distributed, so I – I was generally made aware of the outcomes. There were probably some examples, not least during February, where it would have been helpful to have had some of the information more directly for use.

Lead 2B: Were there meetings though between you and your counterparts in the UK Government to keep you sort of abreast of the situation that was developing in January and February?

Dr Andrew Goodall: We had generally good contact with officials in the Department of Health and Social Care, so from an officials’ perspective we were able to link, but some of the COBR oversight mechanisms were confidential and not for onward reporting, so it would tend to suppress some of the data that could be made available unfortunately.

From an officials’ perspective though I found that those networks worked pretty effectively really but obviously they needed to progress themselves during January, February and March.

Lead 2B: In terms of your personal initial understanding in respect of Covid, you say in your personal witness statement that from around 28 January 2020 you were copied into daily briefings that were provided to the Minister for Health and Social Services and remained in close contact with Frank Atherton throughout that period. Now, you were, in fact, in a meeting of NHS Wales executive board on 21 January –

Dr Andrew Goodall: Yes.

Lead 2B: – when Dr Atherton gave an update on coronavirus.

If we can, please, have the minutes of that meeting, it’s INQ000262076, and if we could, please, have a look at page 3. I think it’s the second paragraph.

It starts:

“FA …”

So Frank Atherton – yes, sorry, four lines in:

“[Frank Atherton] stated that colleagues need to think about their plans for isolation and … [Document read] … This area would become of increasing importance.”

Did work on isolation begin at this stage, as recommended by the CMO? Just to remind you, this is 21 January 2020.

Dr Andrew Goodall: Work was initiated in terms of that advice there. Frank actually put advice more formally in writing at the beginning of February, so whilst this was a general update, when the position had moved from “very low” to “low” he made sure that that was dealt with more significantly, just to make sure that the system had that on record. But this was a chief executives meeting and an NHS executive board and I would have expected the chief executives would’ve gone away from that meeting and they would have been at that point starting to think about their business continuity plans.

Lead 2B: What was your main focus in January in respect of this new virus that you’re hearing about?

Dr Andrew Goodall: I think keeping up with the intelligence on it, any understanding of it, and looking at the international progression of it. I think the assessment of the UK chief medical officers was really important in that respect, and in January it had shifted from “very low” to “low”, but we were starting to just try and have an understanding of the international outlook, so the introduction of the 28 January daily update was a really important part of giving wider information across Welsh Government. Whilst it was to the health minister it was widely copied to a range of ministers and different officials as well, and that actually allowed us to track not just the situation in the UK but it actually gave us a real feel of the international progress that was happening as well. But also at that stage we were really at the early stages of mobilising rather than pressing any particular buttons, because we were trying to assess when the translation into Wales and the UK would happen.

Lady Hallett: Can I just go back – sorry to interrupt – go back to one of your answers, Dr Goodall.

Dr Andrew Goodall: Please.

Lady Hallett: Forgive me for becoming cynical about some expressions, but as you know I’ve heard quite a lot of evidence about plans being work-initiating, developing, and you said “work was initiated”. What do you mean? What happened?

Dr Andrew Goodall: Yeah, from a perspective of updating the chief executives, I think it was just simply that there would be awareness of this and doing it. From a practical level, it was Frank’s letter, I think it was of 5 February, that was actually putting in a formal requirement for the isolation and tracing, so from that perspective the formal ask into the system was there.

Lady Hallett: So no work was initiated, you just became aware of the problem that might come; is that the answer?

Dr Andrew Goodall: I think there it was more awareness of it, definitely, at that stage and – yes.

Lady Hallett: It’s just we need to be careful with the use of language. “Work was initiated” suggests that plans were put in place to do something as opposed to merely becoming aware.

Dr Andrew Goodall: No, if I go to the testing, the setting up of the testing units example, I think that’s why it was very important that by early February Frank had actually that that place as a very formal ask from Welsh Government at that stage, so – sorry, to clarify.

Lady Hallett: Thank you.

Mr Poole: As we move into February, if we can have a look at a document INQ000320718.

This is, just to explain to you – 13 February there’s an email that you were sent by Reg Kilpatrick sharing the SAGE planning assumptions. These are those SAGE planning assumptions. If we can have a look at the first row, we can see incubation period estimated 1-14 days, significantly longer than the pan flu reasonable worst-case scenario. If we have a look at the third row, the basic reproduction rate is estimated to be 2-3 in Wuhan. Fourth row, doubling rate in China was just 4-5 days. If we go to the seventh row, asymptomatic transmission could not be ruled out.

Now if we go over the page, please, to page 2, we see the first row there: 80% of the population could possibly be infected. Then, the fourth row on that page, 4% of the population could require hospitalisation.

So these planning assumptions were being given a couple of weeks after the first Covid case in England, which was 29 January, but at this point in Wales there had not been a case. That was to come later on, on 28 February. So Wales, it might be said, was in the unique position of having no confirmed cases at this stage but being privy to these planning assumptions. What steps were you taking at this stage prior to there being confirmation of a positive case in Wales?

Dr Andrew Goodall: This tied into a number of things that were going on in February. I think the day before this in particular had come in to us was the point where Frank had asked for the planning and response group to be set up and established, and so we had put that in place at this time.

We had obviously, through our business continuity plans and our pandemic flu planning, looked at the range of areas that are set out on the left-hand side, so we had been highlighting, through weekly calls with chief executives, about the business continuity arrangements more generally, there were a range of areas that were put in place here, like the health desk and just stepping up the response, the emergency co-ordinating arena as well, all of which were fitting with what we would do.

From an NHS perspective we knew that there were difficulties that were based around the pandemic flu assumptions. But there were still some limitations on what we could share more generally with the NHS at this stage. So one of the constraints for us, and even marked at the top here, is about the ability to sort of forward this on in the system. We were having to translate that information but weren’t able to be supported to widely share it with the NHS at that point.

I think a trigger point for us with the NHS response, irrespective of this having come in earlier, was when the reasonable worst-case scenarios were worked through at the beginning of March, and that allowed us to more formally show the scenarios that the NHS needed to plan for and come to terms with as well.

So … but at this stage obviously this was feeding in with some of the business continuity and business – sorry, pandemic flu plan preparedness.

Lady Hallett: I’m sorry to interrupt. Again, what did you do? Apart from set up groups, talk about business continuity with weekly calls, what did you do?

Dr Andrew Goodall: We were working our way through plans on this, but the NHS capacity plans were only really instigated at the beginning of March, my Lady.

Lady Hallett: So you were working through weekly NHS capacity plans. What does that mean you were doing?

Dr Andrew Goodall: So during February, chief executives of health organisations had been asked to revisit their continuity plans, their capacity plans. There was some correspondence that was in the system that was asking them to get prepared at this early phase for a need for response. But what we weren’t doing at that point was translating it into formal capacity plans for the NHS in Wales. That was something that took place in early March.

Lady Hallett: Sorry to interrupt.

Mr Poole: The First Minister in his written evidence to this module has described that in January and February Covid was not the top priority for the Welsh Government. Would it be fair to say that these planning assumptions were simply not taken seriously enough at this point in time, and it wasn’t until you get into the early stage, the early weeks of March, that things really started to happen in Wales? Would that be fair?

Dr Andrew Goodall: Yeah, we were mobilising various actions at this time, but I agree with you that there was a change certainly in our response in Wales. That was in the last week of February, and certainly into early March. The Cabinet meeting that took place was a sign of that changing based on the COBR meetings that had taken place through February and the availability of those reasonable worst-case scenarios for us to plan for at the beginning of March was also a key point as well. So there was a change that happened at that point in terms of our response. And of course in early March we were also looking at the progress of the virus, you know, more internationally and there were some real concerns being expressed by the NHS in early March that we were again taking account of at that time.

Lead 2B: Just sticking with these planning assumptions, I think it was a point that I took you to on the previous page, on the first page, it was the seventh row where it said asymptomatic transmission not be ruled out. I mean, does this show that by 13 February you had clear information, as it says there, that asymptomatic transmission could not be ruled out? Did that not set alarm bells ringing for the levels of infection control that would be needed in closed settings such as hospitals, such as care homes?

Dr Andrew Goodall: That wasn’t necessarily triggered at that time based on that advice, but of course we needed to track the infection control and looking at the available knowledge and information as the virus progressed, but I don’t recall it being triggered at that particular time.

Lead 2B: When did the risk of asymptomatic transmission first start to really factor into decision-making, can you recall that?

Dr Andrew Goodall: I remember, probably from an asymptomatic perspective, the focus of our early testing regime was on symptomatic individuals with some other priorities that were laid out, but it was – probably midway through April was when it – started to see that there was some emerging evidence that showed that asymptomatic transmission was a problem. Our approach and our testing was really focused on that symptomatic side, particularly during those very frenetic early weeks of the response.

Lead 2B: Just taking a step to one side, did you actively engage at this stage with the care sector to seek their views on decisions that might need to be taken in response to the pandemic?

Dr Andrew Goodall: The planning and response cell had a social care subgroup, and that was the focus of our engagement with the care home system. It allowed us to understand their assessment of issues, also to raise any concerns and areas, often where they were seeking, of course, to know what the evidence and the support that would be made available to them was. So yes, there were mechanisms for that ability. And equally there was an opportunity for ministers to be engaged as well. But the planning and response cell was a good starting point, I think.

Lead 2B: The day after confirmation of the first case in Wales, so that was the 28th, so we’re now talking about 29 February, you emailed Tracey Cooper of Public Health Wales and you said it “would be useful to just keep in touch on levels of contact and calls you were fielding given your enhanced arrangements”, and then there was a response that she would keep you in touch and asked if it would help if she’d give you a daily status report, to which you responded:

“Yes that would help … [Document read] … a feel for public concerns and pressures on your teams and the system.”

Just help us, what information were you seeking from Public Health Wales at this stage, at the end of February, and did you get what you wanted?

Dr Andrew Goodall: Yeah, Public Health Wales had been very plugged in from January in terms of helping us with the understanding of the progress of the virus, and that carried on through February. It was very much tied into the updates that would go up to ministers. All I was really asking for from Tracey at that stage was I was aware of the intensity and the growing activity that they were undertaking in their tracing service and I just wanted to have some informal understanding from her about how that was going to give her some support for her team.

I’d visited the team as well to understand their response as well, and so it wasn’t really about an alternative data source, it was more just checking in whether there was anything that was worth me knowing, because Tracey is an accountable officer and chief executives in Wales reported to me.

Lead 2B: As we move into March, I’d like to just show you a paragraph in your – I think it’s your personal witness statement, so it’s INQ000396873, paragraph 303 – thank you very much.

And I think this is in answer to a question I asked a moment ago. You’ve described this really as the trigger point. This is when you were discussing reasonable worst-case scenarios, so you say:

“In March 2020, modelling for NHS Wales projected a necessity for 900 critical care and an additional 10,000 system-wide beds at the point of peak demand. It should be borne in mind that the existing capacity within NHS Wales was only 152 critical care and 7,839 system-wide beds as at the end of January 2020. This scenario was based on a 40% reasonable worst case scenario and, given the then rate of transfer, it was anticipated that Wales would see peaks in demand over the next 3-4 weeks. This reasonable worst case scenario modelling indicated that NHS Wales’ capacity would be significantly exceeded, as over half the population of Wales would become symptomatic, with a high proportion of those contracting the virus requiring hospital care, including ventilation, and serious infection resulting in excess deaths.”

My question is this, Dr Goodall: wasn’t this obvious from the SAGE planning assumptions that we have just looked at in February?

Dr Andrew Goodall: I don’t – I don’t think this was obvious at the time, and in respect of our pandemic flu plans and some of the experiences that we’d been through in both previous exercises but also in swine flu, we wanted to make sure that our response was proportionate, so whatever the ask was and however the virus was progressing, that we were keeping in line with that.

I think it was significant that the first case in Wales was on the 28th and that acted in itself as a trigger. But the reasonable worst-case scenarios, there is a danger of seeing them as the forecast, that they are likely and that they will happen. In fact our swine flu experience told us different. You know, our reflections after that event was that we couldn’t rely necessarily on the reasonable worst-case scenarios and go for it. I think the reality for us in March, though, was that the data that we were seeing progressed both internationally and on a UK basis was genuinely showing that the exponential growth and showing that the reasonable worst-case scenario was actually possible, and I think it was that realisation that of course changed the extent of our planning at that time.

There was a very different mood of the NHS system in early March, based on this exercise, but also based on the experiences that we were seeing internationally as well.

Lead 2B: I mean, leaving reasonable worst-case scenarios to one side, would you not agree that – was it not clear by 29 January 2020, when the first cases were detected in the UK that the virus is now here, it’s in the UK, and in all likelihood there was no way of preventing it spreading to Wales?

Dr Andrew Goodall: I don’t think that was obvious to us in all of the intensity of what we were going through at that time. We were making judgements based on those assessments, “very low” to “low”, “low” to “moderate”, and making – to have judgements. In hindsight, of course that is the case, about wishing to have responded earlier, given the impact the virus had globally as well as of course in the UK, but at that time we were looking to progress in line with our planning, and seeing how we could respond to the assumptions as they emerged as well.

Lead 2B: At what stage do you say it became clear in Wales that if more action was no taken the NHS would simply be overwhelmed? Was it at this point in time, when you were carrying out these reasonable worst-case scenarios?

Dr Andrew Goodall: There was definitely a switch from the last week of February into that first week of March, and through a variety of different sources, including the contact with the NHS, where that felt suddenly very different and the need to step up those responses as well.

Lead 2B: If we could, please, have a look at some minutes, an ExCovid meeting of 10 March. It’s INQ000320939. If we can – thank you – have a look at page 2, and it’s paragraph 2.4.

I think we’re picking it up in the fifth line, yes:

“Andrew Goodall added that if there is a change … [Document read] … likely to be those who stands to gain the most.”

Was there thinking by this stage, so this is 10 March, that choices may need to be taken about which patients received critical care and which didn’t?

Dr Andrew Goodall: It wasn’t necessarily a choice at that time, but very much tied into this week were the planning arrangements for the stepping down of – or the potential stepping down of actions and services in Wales, so routine activities, operations taking place, and that came to a culmination at the end of the week on 13 March. That in itself would mean that there would be a priority for emergency patients going into critical care rather than routine patients if we went down that decision.

However, in February 2022(sic), in the background of our arrangements, we had been updating extreme surge guidance just as part of emergency planning. It was updated again in April. Throughout the whole of the pandemic response we never had a need to introduce that emergency surge guidance, but it would have given criteria to services in Wales in the most difficult of circumstances to make choices, and that wasn’t necessary at this time. But I think this was a reflection that we were already in that week starting to ask the NHS what are the kind of things that would allow you to free up time to prepare, and I think this was probably a reflection of routine activities.

Lead 2B: I think you said February 2022 about updating extreme surge guidance. You obviously mean February 2020?

Dr Andrew Goodall: Sorry, February 2020, yes, thank you for that.

Lead 2B: Was there a discussion at this stage about who would take such decisions? Would this be an individual medical professional who is providing care to a patient, or was this a ministerial decision?

Dr Andrew Goodall: I think at this stage it was seen that it would be an area for individual clinicians, that’s the strength of the NHS as a system, is to make the right decisions for patients. I think it was a recognition that there would be a requirement for us to put in place particular criteria. And I remember as an example, if I could just share it, that we had done some work through the Chief Nursing Officer in Wales just to make sure that criteria that may need to be used in critical care for nursing staff ratios, that they were owned by us nationally, so that there was support for what was going to be done on a local basis as well.

But there was definitely a need for us to recognise that, in the worst examples, we may need to step in with that very kind of salutary and significant advice. Didn’t feel that it was advice that ministers needed to direct but it was advice that ministers needed to be aware of.

Lead 2B: On 12 March you attended a meeting with the NHS Wales chief executives to discuss urgent action needed to be taken to protect the NHS. We’ve got an email from Tracey Cooper the same day, it’s – I’m grateful, it’s already on the screen.

Helpfully, if you have a look at point 6 of that email, and particularly the third line, if I can pick it up from there:

“There is also a unanimous view from the COOs on the call that now is a compelling time – both operationally and clinically on the basis of minimising exposure of current admitted patients in clinical settings to increasing COVID-19 patients, to free up capacity on elective, OPAs, discharging people, clarity around primary care services etc to enable people to rapidly implement capacity plans, prioritise clinical services and enable clinicians to prepare for what is to come which has apparently been an ask of anaesthetists and other clinicians in the system. The ask was for a decision to be made tomorrow (Friday) to proceed on this basis.”

Did this email prompt you to start considering the framework of actions that was to follow or was this framework of actions that we’ll come on in a minute something that was already in hand?

Dr Andrew Goodall: Yeah, it was already in train. We’d started, through conversations the previous week, we were observing some of the international area, the minister had actually asked for advice from the NHS on the weekend preceding this, I recall, just to allow us to understand what actions we could actually take. Health is a devolved responsibility and these were actions that we could take for ourselves at this time. And yes, chief executives were engaged, you know, with myself and others throughout the whole of this week working on a frame of actions and Tracey’s email reflects that and gives a perspective on it.

Lead 2B: If we can, please, have a look – so on 13 March I think you attended a press conference with the First Minister also the Minister for Health and Social Services to explain the actions – it’s a document the Inquiry’s already seen, so it’s a written statement by the Welsh Government. We can see page – on that page, the first page, included measures such as the suspension of non-urgent outpatient and surgical care in Wales (that’s the first point), point 4, expedite discharge of vulnerable patients from acute and community hospitals, and then point 7, suspending the current protocol which gives the right to a choice of home.

Were these directions to be implemented as opposed to options, were these options?

Dr Andrew Goodall: These were directed nationally to assist the capacity requirements for the system. The delivery of them was a local matter. But yes, there was national direction on these, they were intended to give permission to the system to enable its preparations and to ensure that the NHS particularly was not going to be overwhelmed.

Lead 2B: Do you know whether an equality impact assessment was undertaken in respect of this framework?

Dr Andrew Goodall: An equality impact assessment wasn’t taken at this phase. The speed and the exponential growth of the virus meant that we were stepping in very quickly. It was an unprecedented action that we were taking, and we were needing to discharge that responsibility very, very quickly.

There was a COBR meeting that had happened, I recall, on 12 March that the minister had gone to, and that really had made very clear that we would need to go alongside the NHS perspective and to put in place these arrangements.

Lead 2B: Was the care sector in Wales consulted on this framework?

Dr Andrew Goodall: The care sector was consulted on the areas that were highlighted through the cell, and there was liaison on that. Of course that wasn’t an engagement with the overall care sector but with representatives at this time.

Lead 2B: To what extent was it appreciated – so, given the harm that could be caused to those suffering from illness other than Covid that required diagnosis, required prevention, required treatment, was it understood and appreciated at this time that this framework could in fact lead to excess deaths from non-Covid illnesses?

Dr Andrew Goodall: We had a real focus that whilst these were areas that we were stepping aside from to provide the preparation, we’d had very strong advice from the system about the maintenance of essential services in particular, and you may recall that we had an essential services cell within our planning and response arrangements as well. So these were not removing all of the responsibilities of the NHS, but they were allowing some choice around areas that were with more discretion. In winter pressures, for example, there’s often decisions taken by health organisations to step away from some of the routine activities at the greatest area of pressure, and I think they were responsive to that. But we were trying to make sure that there was still a focus on patients being able to access the system going forward.

Again, my Lady, the context here was that we were focusing on planning for a 13-week period of time. If we’d known that the pandemic was going to go on for two and a half years we may well have adjusted some of these decisions, but these were pretty essential to make sure that the NHS was going to be available.

Mr Poole: My Lady, we’re not going to finish this topic, but that shouldn’t stop us taking a break now.

Lady Hallett: Certainly.

As you may remember, Dr Goodall, we take regular breaks. I shall return at 11.30.

(11.15 am)

(A short break)

(11.30 am)

Lady Hallett: Mr Poole.

Mr Poole: Dr Goodall, we were talking about the framework of actions from 13 March, and the Inquiry understands that, broadly speaking, the chief executives of the NHS were in support of that framework of actions; is that right?

Dr Andrew Goodall: Yes, they had developed it through the course of that week and there were some further actions the following week also, which again had the NHS and system sponsorship.

Lead 2B: You say in your evidence about the press conference announcing that framework of actions, you say:

“I recall that this press conference was very visible in Wales and caused some shock among the population.”

Do you think it caused shock because the public were unaware perhaps up to this point in time just how serious the threat posed by Covid was in Wales?

Dr Andrew Goodall: I think it was a shock in part for that reason, although there was some sense in Wales that, in the context of the international experiences that we were seeing, we could see some parts of the population starting to act differently. I think the thing that stuck out for me, though, was that it was the first time that we had put the figures into the public domain about the likely impact in terms of what it would mean, not least deaths in Wales, and the health minister chose to do that as part of the press conference, felt it was really important that that was understood.

Lead 2B: Do you think this should have been something done earlier? Do you think it could have been better managed throughout February and March so it didn’t come as such a shock on 13 March?

Dr Andrew Goodall: I think I’d go back to some of my earlier comments where there are constraints on us about what can be reported, when and how. Things that come through the COBR mechanisms of course have a level of confidentiality around them. I think – looking backwards, I think it would have helped to have been able to be more transparent with the population, certainly through March and maybe at the end of February, but at that time that was a judgement that the minister made at the time and I do think it was the right one.

Lead 2B: Now, that framework of actions we saw a moment ago, those ten points within that framework of actions, they were all within the competence of the Welsh Government, they were all devolved decisions to be taken independently of the UK Government, so the Welsh Government didn’t have to wait for the first Covid case to come to Wales before taking those steps, nor did it have to wait for pandemic status to be announced by the WHO. I mean, generally speaking, had those steps been taken earlier, do you think they could have been undertaken in a safer way?

Dr Andrew Goodall: In hindsight I would say safer. They were themselves an extraordinary and unprecedented set of actions that we had never done before in the NHS, so from that perspective they were of really great significance. Looking backwards, they may have helped us to mobilise and to understand some of those impacts in a different way, but at the time it was also to do something that was in line with the feeling and the evidence that was coming from the NHS itself, and it was really clear in that first week of March that the NHS felt that we were at a different position for planning and preparation.

Lead 2B: Now, one of those directions, I just want to focus on, which is expedite discharge of vulnerable patients from acute and community hospitals, now we know there was a lack of testing in the early stages of the pandemic and the Welsh Government then took decisions about prioritisation of testing, and we’ll come on to that a bit later in your evidence. We also know that there was a period during which asymptomatic people were being discharged from hospitals into care homes without a test. Was this direction, to expedite the discharge of vulnerable patients from hospital, was that a ministerial decision?

Dr Andrew Goodall: That was a ministerial decision in line with the advice that had come up through the system. It was intended to do two things: it was intended to help the NHS to create capacity, because it would have meant that there were patients who were ready for discharge who could be cared for in alternative environments; but the wording of the actions as well was to try to provide support for vulnerable people in those settings, because it was trying to move them to what we hoped was a safer environment.

It was inevitable that the hospitals were going to become the focal point for admissions and the growth of Covid, and we were looking to try to find a way of ensuring that those individuals were also supported as well. But first and foremost it was about how we created capacity for the Welsh NHS.

Lead 2B: Now, concerns seem to have been raised relatively quickly by the local health boards.

If we can see an email, it’s INQ000262195, it’s an email sent by your private secretary on 18 March. If we just focus in on point 1, please:

“Care home sector approaches to admissions – Albert has taken up the concerns raised including … [Document read] … last Friday was about expedited discharge of vulnerable patients.”

Again, a question I asked a moment ago: had the decision been taken to start expediting the discharge of vulnerable patients even a few weeks earlier, do you think that would have allowed for more safeguards? Would it have been appropriate to have put in more safeguards and ultimately save lives at this point in time?

Dr Andrew Goodall: At the time we were responding to the progress of the virus and the discussions with the NHS about supporting it to prepare. With everything that we know now about the pandemic response and looking back, that would have helped us, yes.

Lead 2B: You say in your statement, we don’t need to have it up on screen, I’ll just read the relevant extract, you say:

“At that time, we were not aware of the risks posed by asymptomatic transmission and, as testing capacity was limited, tests were prioritised for those who were symptomatic or who had been in close contact with those were symptomatic, including health and social care workers.”

Now, as we saw from the SAGE planning assumptions from 13 February we looked at a moment ago, which said asymptomatic transmission cannot be ruled out, you also had the figures that were coming from the Diamond Princess cruise ship; you were aware of those, were you?

Dr Andrew Goodall: Yes, I remember from the reporting in the updates that we had at the time, yes.

Lead 2B: So by the time patients were being discharged from hospitals without tests, would you agree there was evidence that asymptomatic transmission was at the very least a possibility?

Dr Andrew Goodall: I didn’t recall it – I don’t recall it standing out to me necessarily. Obviously I’ve revisited the February guidance at that time and colleagues would have been working their way through. What was important, as we were setting the expectations for the system, was to allow healthcare professionals, public health individuals, to give us the best advice and evidence that was available at that time, and throughout March and April, even with the changing guidance, it was the system and individuals trying to keep up with our knowledge at the time and the changes that were necessary.

So I – it’s difficult to respond to that directly, but we were always trying to spell out what was the latest guidance and evidence available to ourselves.

Lead 2B: If I can just show you, it’s a 8 April document, it’s a Public Health Wales document, guidance, as we see there, “Admission and Care of Residents during COVID-19 Incident in a Residential Care Setting in Wales”.

If we can, please, have a look at page 3, I think it’s the second paragraph, starting:

“The care sector …”

If I pick it up fourth line it says:

“As part of the national effort, the care sector also plays a vital role in accepting patients as they are discharged from hospital – both because recuperation is better in non-acute settings, and because hospitals need to have enough beds to treat acutely sick patients. Residents may also be admitted to a care home from a home setting. Some of these patients may have COVID19, whether symptomatic or asymptomatic. All of these patients can be safely cared for in a care home if this guidance is followed.”

Looking back, do you consider that this was sensible guidance? Care homes obviously are full of people who are particularly vulnerable to the disease, would common sense dictate keeping those who were infected away from such vulnerable people in care homes?

Dr Andrew Goodall: This clearly reflects the knowledge and the evidence at the time, and we would have some expectations for care homes to be able to accommodate isolation procedures. I think this document itself later spells out actually how isolation mechanisms and procedures would work, as you go through the rest of the document as well.

In retrospect, and in hindsight, given what we know now about the asymptomatic, yes of course that could have been targeted differently. One of my own worries for the hospital systems were they were likely to be areas where patients were likely to be exposed to Covid-19, so there was something about trying to ensure that we could find the safest environment for patients who were in our system, rather than just leave people within the hospital environment as well.

But, yes, with the knowledge that we have now, we may well have changed some of these issues at the time.

Lead 2B: Changing topic, if I may, and talk a bit more, as I said I would earlier, about data and modelling. If we can perhaps just have a look, first of all – it’s a TAC advice of 20 March.

We can see it at INQ000083241.

If we could have a look at paragraph 4 of that TAC advice, it says:

“TAC strongly advises … [Document read] …

“ii COVID Hospitalisations.”

Then if we could have a look at the next paragraph, paragraph 5, please:

“TAC recommends … [Document read] … at 3pm each day.”

Was this TAC advice actioned? Was this something that was taken forwards and happened?

Dr Andrew Goodall: As I recall it, it happened. I know that some of the operational data, not least from some of the health boards at the time, was difficult, so there were some issues of consistency as we all started to gather some of these reporting arrangements.

It was really helpful that we had our knowledge and analytical service that was able to act as the quality guardian for some of that data.

From a public perspective the data for the NHS in Wales I think was made available in the third week of April, where we started to actually put some of the data that we’d been using within government more into the public domain, so not least for transparency it was also important.

Having said that, I should say that the press conferences that were being undertaken by ministers, including by myself, we were talking through some of the information that was available and up to speed with and we were following through with that information in the public domain as well.

Lead 2B: If we could just have a look, and sticking with this TAC advice, at page 4, please. It’s the second bullet point on that page. Yes:

“As of 20/03 there has not been a complete set of accurate data from all Health Boards that describes both ICU or Hospitalisations from COVID-19.”

I think, picking up on your previous answer –

Dr Andrew Goodall: Yeah.

Lead 2B: – something you say in your statement on behalf of the HSSG – I’ll just read it to you, we don’t need it displayed, you say:

“So, at the outbreak of the pandemic in March 2020 there was no system that captured a real time (daily) national picture of total beds and occupancy … Having said that, was the picture at a national level there were local systems to capture capacity and occupancy. However, these were inconsistent and varied in ambition, accuracy and output.”

Why had that not been addressed before March 2020? Is that not something that could have usefully been done in late January and February?

Dr Andrew Goodall: I think there were different data systems in place for our organisations. Some of these were new areas that we were highlighting beyond even some of the operational data as well.

Obviously we were tracking and testing for the first time, it was something that was different and needed that reassurance. I can’t answer in a level of detail why that wasn’t, but I do know that some of the health organisations were struggling with some of the definitions and advice and we were supporting them to make sure that they could turn that into a proper and accurate data.

In my own experience we were able to actually use the general data available, even if at times in those early phases it wasn’t perfect, because they allowed us to track the surveillance and the progress of the virus, so I wouldn’t have wanted that sort of approach to make sure it was all fully accurate to stop us from our tracking that was in place.

Lady Hallett: Wouldn’t you need a complete set of accurate data from all health boards in normal circumstance?

Dr Andrew Goodall: In this respect, we were adding in new areas, of course, for the tracking, but at a national level –

Lady Hallett: No, no, in normal circumstances.

Dr Andrew Goodall: In normal circumstances at a national level, we do have a sense of the range of the operational data in the system, but we don’t have all of the system information available at the national level all of the time. A lot of that is dealt with by local health boards in respect of their own operational responsibilities. So we don’t always pull this information into our national setting on a daily basis.

There is some information, like bed occupancy for example, or A&E attendances, that I was able, in my role, to track on a daily basis, but there were some limitations to some of that data as well, my Lady.

Lady Hallett: Don’t you think in the future there ought to be that data available for a person in your role?

Dr Andrew Goodall: In the future I think having access to that operational data – and we were very quickly able to put that in place for the NHS, so it was a – matters of days and weeks when we had a system that I felt was robust and appropriate.

Lady Hallett: So that is now in operation?

Dr Andrew Goodall: We have got –

Lady Hallett: And has lasted since the pandemic?

Dr Andrew Goodall: Yeah, we have retained the systems that we put in place and they are available, and should there be another pandemic, we have learned so much from this one that they would be available into the future as well.

Lady Hallett: Thank you.

Dr Andrew Goodall: It became part of our routine, my Lady.

Mr Poole: Returning to a document that we looked at earlier, which was the review of the HSSG response – it’s INQ000083255, thank you – if we can have a look at page 7, paragraph 1.9, it says – yes, right at the top of the page:

“Data availability and reporting took some time to be … [Document read] … via the PHW Coronavirus Data Dashboard.”

Just help us, what’s meant by hospital transmission data?

Dr Andrew Goodall: Yeah, it’s the nosocomial transmission data. So transmission that is happening across areas within a hospital environment. So it’s not the hospital admission data, for example, it’s not discharge data, but it would be an understanding to be able to track whether there were outbreaks in a hospital environment. So organisations had local systems but it was only really in the summer that we were able to have a proper understanding of that under the kind of definitions and clinical criteria that were in place.

Lead 2B: Why was that not available to the NHS until, as it says here, late July/early August?

Dr Andrew Goodall: It was a limitation from some of the extant reporting systems and we obviously were putting in a wide variety of new requests and new information systems in place at the time. That would have been, of course, helpful and important for us to have earlier.

Lead 2B: Did that not massively put you on the back foot?

Dr Andrew Goodall: It meant that hospitals were having to use other measures to try to track those types of issues. We had outbreak mechanisms and we had local infection control teams who were able to draw the actions and responses together but, certainly from a national perspective, it was the first time we were able to report that on a national basis.

Lead 2B: I want to change topic now, please, Dr Goodall, and ask you a few questions about shielding.

On 19 March 2020 you emailed Mr Gething explaining that there was a problem ensuring that there was an accurate database of vulnerable people. Presumably that was to identify who was to receive a shielding letter; is that right?

Dr Andrew Goodall: Yes, that’s correct.

Lead 2B: Can you briefly outline what was the problem and how was that problem resolved?

Dr Andrew Goodall: There was Chief Medical Officer discussions that had taken place about wanting to ensure that there was support around vulnerability and for particular groups, through clinical criteria, and trying to reconcile different databases that were in place. So the chief medical officers had put a request into the system to identify ways in which we could come up with a list of patients.

Every system, England, Scotland, Northern Ireland or Wales, has a different way in which they align their databases. It was an extraordinarily technical and complex task, as I recall, and I was needing to advise the minister that it was more difficult to operate in practice for all of us across the UK, but we were ensuring that we were able to address it as quickly as possible at that time.

There were conversations about announcements being made about shielding, and I think it reflected an approach where we rather would understand the situation, make the policy decision, and then we knew that we were able to practically implement, and what we were doing at that stage was working through the practicalities.

But I don’t think an exercise like that had ever been done in reconciling data across many different health systems.

Lead 2B: A point that you made in your email to Mr Gething was that the English system had access to a national prescribing database that’s able to support the data run, which you point out we don’t, Wales doesn’t, have the equivalent. Have systems been put in place since that would ensure the system is smoother in the event of a future pandemic?

Dr Andrew Goodall: Yes, so we have commissioned national prescribing systems for Wales now through a national investment as well.

I should say that when we were doing the shielding advice, though, one advantage of the data we eventually produced was that it meant that individual clinicians didn’t need to validate them individually. There was quite a lot of effort required in England for hospital and – consultants and GPs to actually spend time reviewing those. By the end of March, Northern Ireland and Scotland were asking us how we had been able to pull together that database, so I do feel that in very short order we had managed to address those issues and actually come out with a very robust database.

Lead 2B: Different topic, if I may, about disproportionate impact. When did it become clear to you that those from black, Asian and minority ethnic backgrounds working in the healthcare sector were being disproportionately impacted by the pandemic?

Dr Andrew Goodall: We had seen it emerge more generally in April with some of the national reporting. I was mindful at the time that England at that point was ahead of Wales on the progression of the virus, but from a system perspective it was really a discussion I recall, I think, around the – the Cabinet table where it occurred, but it was a letter from Professor Singhal that highlighted to us particular concerns, not least how this impact was affecting healthcare workers.

So Professor Singhal was asking health boards to put in place risk assessments and approaches that would be supportive, obviously had written to myself as part of that process and there had been some engagement very directly with the First Minister of Wales by representatives of ethnic minorities in Wales.

Lead 2B: Now, I think that letter from Professor Singhal, that’s a letter of 17 April.

Dr Andrew Goodall: Correct.

Lead 2B: We heard something about it in the first week of evidence. There was also a letter from Race Council Cymru at about the similar time.

You explain in your witness statement that it was 1 May that you endorsed the use of an existing risk assessment tool developed by the Aneurin Bevan University Health Board as an immediate way forward. We obviously heard evidence, the Inquiry heard evidence, last week from Professor Ogbonna that there was work being carried out in respect of a risk assessment tool that was then presented in late May, and I think it was then rolled out on 27 May.

I mean, do you have any comment on the fact the Aneurin Bevan health board had managed to create its own risk assessment tool in April and yet the Welsh Government’s commissioned risk assessment tool wasn’t finalised until 27 May?

Dr Andrew Goodall: I think what I wanted to do at the time was to make sure that the group, who were a group of experts that we drew together, had urgent but sufficient time to do the work. The reason for my intervention on 1 May was that I gave a national direction to all of the health organisations to start using that risk assessment. One of our advantages in Wales is that we could pick up these local templates and try to use them to expedite.

So there was a delay but that was a reason why I wanted to make sure that the risk assessment was generally available. I do think the work that Professor Singhal and his colleagues did was really exemplary in an urgent context. Its use has been very significant, not just for the NHS and care system in Wales but beyond, and I think ending up with probably about 130,000 uses of the individual risk assessment, you know, and it stayed very similar to that initial version, has been really important to the pandemic response all the way through, and gave confidence.

Lead 2B: Change topic again and ask some questions about PPE, please.

If we could have on screen INQ000303227. This is a WhatsApp group you were in with Shan Morgan, Dame Shan Morgan, Andrew Slade, Tracey Burke. If we can go to page 5, right down at the bottom of that page there’s an email – sorry, there’s a WhatsApp. It’s 20 March. This is from you, just read it:

“Probably worth reflecting on still a public discussion on Ppe – shortages and who to use and access. As an aside sos announcing Ppe is available for all social care is different from our position – we have issued PPe from pandemic stocks to supplement local supply to be everywhere in wales by Monday geographically distributed – our calculations are that there are finite supplies for the weeks ahead that if we don’t have some order in use, would without replenishment at uk level run out – so we need to ensure that thresholds for use are maintained.

“The process feels more and more like announcing a concept and working back ASAP in detail and practicalities – this reflects the speed of events has meant that some of the spirit of sharing has been disappearing so we are finding it happening less simply on speed of decision making and announcements.”

So this is 20 March, did you have concerns that there may come a point in time at which PPE would simply run out in Wales?

Dr Andrew Goodall: Generally that was a concern. We reported as such in the public domain as well. I even recall a press conference where I was asked about supplies that were left, and I think I very openly said that we were within a few days of some individual items at the time. That was later in April.

I think the pandemic stocks that we’d put in place as a contingency allowed us to manoeuvre our way through those first weeks with around 10 million items that had been made available. But absolutely, we needed to ensure that there was a good supply chain in order and we were able to achieve that.

My role was really to secure that supply at a national level, but what we also had to do is very much change the way in which we were issuing supplies across Wales, literally to thousands of sites, rather than the few hundred that would have been the reality for the NHS in Wales.

Lead 2B: Now, PPE was something that was raised by the BMA Cymru on 22 March 2020.

INQ000118526, if we could have that, thank you very much.

So this is an email, in fact a response to an email that you had sent about shielding. However, as we can see under the heading at the top, “PPE”, the BMA say that before they list their comments on the shielding letter they must raise the issue of clarity on PPE guidance for GPs and other doctors/healthcare professionals. So if we’re looking at the second paragraph, second line:

“Whilst I do not feel a public dispute on this would be helpful in Wales, we … [Document read] … in line with the WHO guidance and latest research …”

So there’s a clear suggestion there from the BMA that PPE was not being supplied and guidance not being given in line with WHO guidance. Is that something you agree with?

Dr Andrew Goodall: That’s not how I recall it. We were always really clear about being in line with the WHO guidance. We had healthcare professionals who were working on that advice, but actually this was an area where the UK networks and the frameworks that were in place really helped us, because that guidance was worked through clinically and collectively across the whole of the UK, not just ourselves.

I think it was quite right, however, for the BMA to be insisting on that requirement. This wasn’t just an exchange that I had, I’d had a number of contacts with the BMA over those two weeks or so and it was really important that they were, you know, looking for confidence and reassurance.

I hope that one thing that we did do later that helped with that was that we put PPE supplies very much in the public domain, and one thing earlier that I, again, had authorised with chief executives was to make sure that locally in their own organisations they were able to show their staff about the level of supplies that were actually available, because of the underlying worries that obviously healthcare workers had at the time.

Lead 2B: Did you think there was an unreasonable expectation upon the HSSG to co-ordinate allocations and guidance for PPE in this period, so in March 2020?

Dr Andrew Goodall: I think the health-led aspects absolutely fitted. We had a strength around our NHS shared service arrangements, that gave us the supply line for Wales that meant we could do that with confidence, even if we were expanding at scale very, very quickly.

I think where PPE became a matter of other sectors, that’d become more problematic for us to handle and deal with, because we were so intensively involved in the health response that access to PPE for other professions was an issue.

Having said that, to Shared Services credit – the NHS Wales Shared Services, they were actually able to extend some of the supplies beyond just health and social care to some other areas as well.

Lead 2B: Do you think PPE is an area where there should have been quicker cross-government co-ordination to assist the HSSG, for example?

Dr Andrew Goodall: I think if we look at the outcomes that we achieved in Wales, building on from pandemic preparedness and supplies right through to using the NHS Wales Shared Services, I think it was right that we were left to discharge those arrangements. We obviously needed ministerial support, I think we could have had some broader support for some of the other sectors in Wales – sort of mindful on the Audit Wales review that was done, when they went in and looked at what we’d done. They gave a positive review of the way in which we’d stepped up in Wales and provided that response, certainly through a health and social care setting, but some assistance on maybe some of those broader sectors would have been one of the things that may have helped in retrospect. But I think we were really very focused on the health and care response.

Lead 2B: Move now to some questions about testing. In your personal statement to the Inquiry, you say:

“… throughout March and April 2020, the Welsh testing programme was significantly constrained by the availability of both antigen and antibody tests.”

You go on to say:

“Early testing capacity was clearly an issue, and while Public Health Wales took early action to commence contact tracing and stepped up their gold command arrangements to discharge their first responder function, they were impaired initially by a lack of available tests.”

Then perhaps we can have the next paragraphs of your statements, 332, you can see that on screen:

“In hindsight, if testing capacity had been available, I believe that despite the extraordinary ask it would have represented, maintaining a universal contact tracing system may have more positively affected outcomes over the subsequent weeks of the pandemic. Of course this was revisited and reintroduced later through our Test, Trace, Protect mechanisms, but the decision-making and progress was significantly affected by insufficient testing capacity. Ultimately, our laboratory capacity across the UK did not have the infrastructure in place to rapidly expand; subsequent decisions we made to expand and invest in capacity highlight this weakness in our response arrangements.”

At what stage, Dr Goodall, did it become clear that there was a limited testing capacity in Wales?

Dr Andrew Goodall: I think it was almost immediately clear, because we needed the first test to be available, and of course, as we were looking to track from a surveillance perspective the virus, it became very clear in those immediate weeks about some of those limitations. We didn’t have the laboratory structure available, as I’ve said in there.

Maybe to give a comparison about the early phase, if I can. We had 1,800 tests a day available in mid-March. If you compare it with the testing regime that was taking place when Omicron variant was around, we were up to 200,000 tests a week. And that is a very different position in respect of the testing capacity that we had in place.

Lead 2B: Who decided who should be prioritised for testing?

Dr Andrew Goodall: We took advice there. So, as you would expect, it was done from a healthcare professional perspective, in particular in these early weeks. We had advice and support from Public Health Wales; it was part of the expertise that they held, but it was also relevant to their first responder status as well.

Lead 2B: If we could please have a look at an email chain between Albert Heaney and the office of the Deputy Minister for Health and Social Services. We’ve got it up in front of you, if we could go to page 2, please.

This is on 22 March, email from Lee Waters, he says:

“I’ve been contacted by a care home … [Document read] … Not sure who to direct this to for advice?”

Then Mr Heaney replies, it’s up the email chain, at the first page, he says:

“Thank you … I understand the importance of this matter … [Document read] … discussed with sector leads.”

Then he sets out those four bullet points that we can see on the screen.

Now, it would appear that despite real concerns being raised by care homes, that the Welsh Government were continuing to push for discharge of patients despite knowing there was a lack of testing. Would you agree with that?

Dr Andrew Goodall: It was based on the knowledge and evidence that we had at the time, and we needed to ensure that the overall health and care system was able to maintain patient flow throughout it, because what happens at the front door of a hospital very much is linked to what happens at the discharge end. So you do need numbers of patients to be discharged out of a hospital environment on a daily basis.

Lead 2B: In your letter to Shan Morgan of 13 May – we don’t need to bring it up on display – you acknowledge difficulties with testing capacity and you acknowledge that the minister had promised an expected step-up in testing capacity to 5,000 tests a day, which ultimately the Welsh Government was not able to deliver.

I mean, in the future, what steps could be taken to ensure that the system is simply better equipped to respond to the potential need for mass testing?

Dr Andrew Goodall: I think the learning from the pandemic response, the retention of infrastructure. I think, my Lady, maybe one of the areas that we’ve not touched on today is what do you hold on to in respect of contingency and redundancy. The NHS always runs very hot just in terms of its daily activities, and I think an understanding that there are expectations and requirements that we must hold ready for an environment like this in the system.

It’s difficult because you have to fund it and you have to have it available. But one advantage to us in Wales is that we have retained that laboratory facility that we undertook during the pandemic response.

Lead 2B: We move forward in the chronology to August 2020. I want to show you a letter that Dr Atherton wrote to you on 10 August.

Now, I think I’m right in saying, as the first paragraph would suggest, this was written at your invitation, so you were in fact inviting him to set out his concerns to you; is that right?

Dr Andrew Goodall: Yes, indeed, I think I recall that we’d met at the end of the preceding week, so …

Lead 2B: If we could have a look at the second paragraph, so the letter’s outlining “significant concerns about our ability to manage the next phase of the pandemic in Wales”, and amongst those concerns, if we have a look, please, at paragraph 3 are – it’s:

“[The] TTP programme has been one important reactive element and is now functional but … [Document read] … to staff regional responses.”

Then if we can have a look at the same page but paragraph 5, I think it’s the last paragraph:

“Public Health Wales has proved itself adept at managing community outbreaks and … [Document read] … control using the health protection funding we provided last year.”

Then if we can, please, go over the page to page 2, Dr Atherton here references, I think it’s about six lines up from the bottom of that first paragraph, he references new functions of the Welsh Government that the permanent secretary expects to be resourced from within HSSG, and he welcomes an urgent discussion with you.

Then the last paragraph on page 2, please, Dr Atherton talks about the fragility of staff and says that much work has been unseen and underappreciated by the wider organisation.

So, first of all, were these all concerns that you appreciated at the time and perhaps shared at the time?

Dr Andrew Goodall: Well, firstly I would say in respect of, you know, a lot of the work, I saw it and I appreciated it, and I think it’s really important to say that here, in terms of the way that teams and colleagues stepped up to respond to the pandemic.

I do recall and register this. I know I wanted Frank to be able to say very clearly to me what he thought next steps should be, and I think there are two things that I would respond, with your permission.

Firstly we had actions in train with Public Health Wales. As Frank rightly said, the ability to use some of the health protection funding, but we were also investing in laboratory systems as well.

I think we did approach vaccination differently with our national programme, and resource it, and make sure that was in place.

But the real concern I think for Frank in August was did we have internal recognition of the need for more staff for the Health and Social Services Group. We were a small group of 400 colleagues carrying out these functions. I was able to reassure Frank that a business case had already been provisionally agreed at the end of July, but actually the resourcing meetings that were taking place in August did agree a transfer of significant staff for us to carry out these functions, so we had an additional 70 staff allocated to us through August and September of that year as well. But it was clearly recognising the need for us to know that there was a second wave coming and to make sure that our overall infrastructure was going to be appropriate for that.

Lead 2B: The firebreak, as we know, came into force in Wales on 23 October. In your view, was that the right time for the firebreak?

Dr Andrew Goodall: As I recall the firebreak – firstly, I supported the firebreak, I thought it was essential. I was mindful of it being advice via SAGE. We were testing other mechanisms to give some support to localities through September in particular, with locality approaches. And always mindful of the proportionate nature of the response. If there were geographical areas in Wales with no virus and no examples of it having an impact on their communities, taking a national action could be quite significant for them. So I think seeing whether those local areas worked or not was really important.

Having said that, the firebreak was a really important intervention. It was more limited than maybe ministers had wanted from their discussions around the table, but I do think the firebreak had the impact that was broadly intended because it reset the virus by about 38 days.

Lead 2B: Should it have been longer in your view, from an NHS perspective?

Dr Andrew Goodall: There was definitely support from the NHS for a firebreak to take place, and during the firebreak, because the NHS was always seeing the figures three or four weeks after the decisions that had been taken, we were seeing our data show that more patients were coming into the system at that time.

I think a longer firebreak would have been preferable, but there were genuinely funding limitations from a Welsh Government perspective and ministers of course were very mindful of the wider harms that needed to be determined outside of the NHS itself.

Lead 2B: You provided an update to ExCovid on 6 October. We don’t need to have it displayed, I’ll just read from those minutes:

“On hospital admissions for Covid-19, these are at 550, double on that of a fortnight ago. These are not yet at the level seen in March and April but the infection rate needs to stabilise within the next 2 to 4 weeks or we will see hospitalisations exceed the figures from earlier in the year.”

By the time of the next ExCovid meeting, 13 October – if we can see those minutes, please, INQ000221045 – if we can have a look, please, at page 2, paragraph 2.1, your update here was that:

“There [were] just over 700 patients in hospital with Covid-19, this is a 50% increase in the last 7 days.”

And then in paragraph 2.3:

“NHS plans to deal with an increase … [Document read] … increase, then the chance of patients, visitors or staff taking the virus into hospitals also increases.”

Finally, paragraph 2.4:

“If the number of hospital admissions for Covid-19 … [Document read] … to the numbers seen in the spring.”

So just a few questions arising from those minutes: were you pushing for those measures from 6 October, when you were aware of the worrying statistic about hospital admissions that had doubled in just two weeks?

Dr Andrew Goodall: I was sharing from a factual perspective the information about the NHS, whilst the NHS wasn’t seeing numbers that were like the peak that we’d seen in April. You can see from the two examples that you’ve given how it was clear that there was exponential growth happening, for that 50% increase over a seven-day period was really important, so I wanted to make sure that there was an understanding of what that meant.

NHS capacity was available to accommodate those patients, but there was an outstanding discussion about what we wanted to do with the NHS. Was it to keep providing its general responses or were we looking to just stop the virus completely? And I think I was highlighting that in some of the discussion too. This information was all fed into the Cabinet process that was reviewing the firebreak, of course, as you would expect.

Lead 2B: Do you think the Welsh Government took this information seriously enough? Do you think they acted too slowly?

Dr Andrew Goodall: I think it was taken seriously. I was minded by this time there was a regularity with the 21-day cycles. You know, ministers did have to make decisions that were broader than just the NHS. Any time I was presenting the NHS information it was always taken seriously, but there were other things that ministers need to think around the table, whether it was TAC advice or whether it was some other wider harms at this point, and there were certainly concerns about whether a lockdown being repeated would lead to examples like school closures again, for example, and they were featuring quite strongly around ministerial discussions.

Lead 2B: Now, hospital-based outbreaks, so nosocomial transmission, something that will be covered in much more detail in a later module, but at a very high level, would it be fair to say that there was no firm grip on controlling hospital outbreaks by late October 2020?

Dr Andrew Goodall: I think there were very clear infection control guidelines and practicalities in place. As you would expect, the NHS would have really strong infection control, and with expertise in this area. The real struggle was that as community rates increased you would see rates increase in hospitals inevitably because they would translate across, and we saw that right through the whole of the pandemic response.

So if I could set out that there was a clear framework for infection control but the reality of the virus was much more difficult to handle on the ground.

Lead 2B: Is this something that was avoidable, though, in your view? Should steps have been taken sooner? Should this have been appreciated going into the autumn of 2020?

Dr Andrew Goodall: I think without a mechanism for having staff in the highest level of PPE at all times as if they were in a theatre or critical care environment, which is obviously the most supportive and prevents transmission, we were making sure that we were in line with all of the World Health Organisation codes and actually in line with the UK guidance at this point as well.

The real difficulty is the way in which Covid-19 found ways of working its way into any system. I remember Frank in his Chief Medical Officer role often talking to me about how the virus was always looking for the weaknesses unfortunately, despite all of the preparation and all of the best efforts. I think that was a reality of experience for us throughout the pandemic response.

Mr Poole: Dr Goodall, those are all the questions I’ve got for you, but there are some questions from the core participants, I think.

Lady Hallett: Yes, Ms Harris.

Questions From Ms Harris

Ms Harris: Good morning, my Lady.

Good morning, bore da.

Dr Andrew Goodall: Bore da, good morning.

Ms Harris: I appear on behalf of Covid-19 Bereaved Families for Justice Cymru. I would like to ask you some questions about PPE workstreams, and specifically with regards to the Covid-19 health countermeasures group, which you’ve referred to in your evidence as having the role of operational co-ordination and oversight of the Welsh Government’s pandemic health countermeasures for PPE, consumables and medicines, and that the group monitored distribution arrangements as well as identified and resolved issues associated with supply.

Before I get to the question, if I could highlight some points in the evidence. First of all, the evidence provided by Mr David Goulding that he chaired this group and that the first meeting of the group was on 12 February 2020, and I’d like to ask for this document, please, to be produced up: INQ000298968, which is an email dated 20 February, if that could come up on screen.

Thank you.

That is an email noting the action points arising out of that first meeting of the group on 12 February 2020, and if I could take you to some of those action points, for example, first of all, action 2:

“GD to provide a list of the six PPE products required for Coronavirus.”

Action 3:

“DG to raise at the Clinical Countermeasures Board Coronavirus sub group the absence of long cuff gloves, visors and fluid resistant gowns in the stockpile.”

Action 4:

“HEPU to ascertain whether a [just in case]/[just in time] contract exists for the order of soap.”

If we could go to the next page and to action 10:

“HEPU to clarify the relevant items in the Wales pandemic stockpile and communicate that information to NHS EP leads.”

At action 11 there’s a reference to ascertaining whether there are people trained to fit test.

And if we go to action 15, a number of individuals are allocated “to discuss a concept of operations”.

And we see there are 20 action points all in all.

When considering the question I’d like to ask you about timing, I’d invite you to have in mind the landscape as it was in January 2020, because this group of course started to meet on 12 February 2020.

In January 2020 we had, first of all, 16 January, that the virus was given the initial classification of HCID, high-consequence infectious disease.

We know that Public Health Wales had evoked its emergency response plan at enhanced level by 22 January.

On 24 January or by that time we know that the Chief Medical Officer for Wales had advised the First Minister that there was a significant risk that the virus would arrive in Wales.

On 30 January the World Health Organisation had declared a public health emergency of international concern.

On the 31st it was made public that two patients, they were related to each other, had tested positive for Covid in the UK, and we also know that there had been attendance at two COBR meetings.

And on 29 January, at that COBR meeting, the UK Chief Medical Officer had said that the reasonable worst-case scenario for the virus was similar to that for pandemic influenza, which of course, as we know, signified widespread infection and many thousands of excess deaths on that scenario.

So my question is: do you agree that it was obvious from the very early stage that if the virus arrived in Wales, PPE supplies were bound to be needed and quite possibly very quickly and in large quantities? And given that, do you agree – if you agree with that proposition, do you also agree that the work that the countermeasures group was doing should have started at the very earliest opportunity and earlier than 12 February 2020?

Dr Andrew Goodall: From my perspective, in Wales, the introduction of the health countermeasures group was an early intervention. As I was describing earlier, the assessment at that stage and through February was that this was low impact at that time for the UK, and that drove a lot of our triggers and actions at that point.

The health countermeasures group wasn’t starting with a blank sheet of paper. The advantage that the health countermeasures group had was that it already had availability of up to 10 million PPE items which we had in storage. I think that note rightfully shows that there were areas of operational detail that needed to be worked through, and there was an urgency around doing that at the time.

Pandemic flu preparation was different to some extent from some of the PPE that was required for Covid-19, and I would have expected those gaps to happen. But at the time I felt it was in line with a low impact assessment that at the time there was no evidence of it for Wales.

If I was describing – given the two and a half years that we went through later and the opportunity to set in train some of these things earlier, then that would have helped at that time, but I don’t think it actually changed the nature of the way in which we distributed from the pandemic stock, for example. So that was always available to us to be secured and provided for the different sectors.

Ms Harris: Can I just ask you, do you think it was correct to regard the situation as a low impact assessment at that time?

Dr Andrew Goodall: It was the Chief Medical Officer’s assessment, and we would be putting in place our actions in response in line with that at the time. So I’m responding to how it felt at the time and how we were responding. Of course the pandemic itself was an extraordinary impact on all of us in society over an extended period of time, and that was very different from how we would have been approaching those early days in respect of using our emergency preparedness.

Ms Harris: So you wouldn’t accept that there would have been any benefit from having started this work of co-ordination and oversight and the kind of actions set out in that email at an earlier stage?

Dr Andrew Goodall: I think – given what we know now, I think that would have been helpful to have worked through, but I do think that the way in which we were securing those supplies, working our way through those choices, meant that we were able to secure that national supply for Wales, even if it was under very extreme pressure at times as well.

So I’m not sure it really changed the outcomes at that stage but was part of that early planning and preparation.

Ms Harris: Can I ask you about a comment that appears in the witness statement of Mr Vaughan Gething where he says, and I’m reading a passage from page 138 of his witness statement for this module:

“We underestimated how quickly the PPE … [Document read] … amount of our stockpile was not fit for purpose.”

If I could ask you: does the fact, as I assume you would agree is correct, that a certain part of the stockpile turned out not to be fit for purpose, do you agree that underlines the need for very early active steps to look at availability of supplies of PPE?

Dr Andrew Goodall: It also goes to the point I was making earlier just about contingency and levels, I agree. I agree with the minister’s comments, the way in which the virus then progressed subsequently, despite the fact that we had 13 weeks of supply that was technically available in the pandemic stock, that ran down much quicker than we were expecting, but we were able to pursue both through UK level arrangements and through our own local supply chain a way of maintaining that national supply to be in place.

Lady Hallett: I think you need to go on to one of the next two questions, Ms Harris, I’m afraid. That was a very long introduction to your first question.

Ms Harris: It was indeed, thank you.

Lady Hallett: Most of it wasn’t allowed.

Ms Harris: Thank you.

I’d like to ask you about social care, and we know that, and may I take Dr Goodall very briefly to the document in relation to this, and I do appreciate that I need to be quick.

It is a document at INQ000252549, if that could be pulled up, please. Thank you.

This is a written statement by Mr Vaughan Gething, “Distribution of … (PPE) to social care settings”, and it’s on 19 March, second paragraph:

“I am aware of the concerns … [Document read] … PPE.”

And at the fourth paragraph goes on to say:

“If PPE stock cannot be accessed … [Document read] … if a case of Covid-19 has been confirmed.”

Is it right that that was the first substantial help that was given to social care in relation to PPE and up until then they had been left largely to fend for themselves?

Dr Andrew Goodall: I can’t – I can’t really recall – I can’t recall the run-up to this, but this was reflecting our advice and actions and interventions. I know that on 9 March we had introduced arrangements to make sure we were able to put additional supplies into GPs right across Wales, and we were working our way through how we would want to respond.

Of course individual care homes would have had a level of PPE supplies supported by their local authorities at the time. What this was triggering, I think, really importantly, is that we were going to ensure that we stepped into the difficulties of PPE supply for social care, and we over time expanded that very significantly. Out of 2 billion items that we provided across Wales in the whole of the pandemic response, about 800 million were provided to care homes, so about a third of the overall response, and that felt appropriate.

Ms Harris: But this was –

Lady Hallett: I’m afraid you’ll have to finish there.

Ms Harris: Thank you, my Lady.

Lady Hallett: Sorry.

Ms Foubister.

Questions From Ms Foubister

Ms Foubister: Thank you, my Lady.

Good morning, Dr Goodall, I represent John’s Campaign and Care Rights UK.

I’d like to refer first to your statement of 29 September 2023, which is the one dealing with the Health and Social Services Group.

That’s INQ000319643.

When we get there, I’m going to go to your page 71, paragraph 242.

You note here that you wrote to NHS bodies on 5 May 2020 identifying action that should be taken to ensure cancer services provision, including to put in place support systems to deal with concerns from cancer patients regarding social isolation and shielding.

Why did you raise a concern specific to cancer services?

Dr Andrew Goodall: At that time as we were tracking the virus – I think I’d also written out in April and some work had been done by our cancer network in Wales – we were concerned that the data we were receiving was showing that with the lockdown arrangements in place the numbers of cancer patients accessing services had reduced. So that is patient who are concerned about cancer rather than diagnosed with cancer. And it was just very visible to us in our very early data that we needed to do something more about that. We wanted to make sure that essential services were available for the NHS, even though we had stood down some very individual services across Wales, and cancer was one of those services, not uniquely so.

Ms Foubister: I think some of that data you refer to is at the next document I was going to turn to, which is INQ000300217.

This, when we get there, is an impact assessment document from later on, from November 2020, and I’m going to go to page 20, the first sentence, and also there’s a diagram which we should be able to see at the bottom of the page.

So are you aware, as it states here, that the number of cancer patients on the NHS wait list increased 8.9-fold from the beginning of March to 12 June 2020?

Dr Andrew Goodall: Yes, I did, I was tracking the data because it was an area of concern, yeah.

Ms Foubister: What was the response to your letter of 5 May, the one I referred you to a moment ago?

Dr Andrew Goodall: We were overseeing these arrangements through our essential services group, that local organisations were looking to see how they could recover some of that activity. The Cancer Network in Wales was really helpful in giving support to local organisations but there was always a balance that, whatever the national framework that was in place, organisations needed to bring patients back in safely, so the operational delivery of that was very much with local health boards as organisations.

Ms Foubister: Were your concerns around this taken into account by decision-makers?

Dr Andrew Goodall: I do think that they were taken into account because we were very clear that we needed to maintain a focus on accessing services. But these were numbers as that as your data was showing was a worry, because they were deteriorating. One of our worries were that people, if they weren’t accessing the services now, we would end up with them coming later in their pathway experience and we just wanted to make sure we could intervene as soon as possible, despite how much of the virus was around and about us at the time.

Ms Foubister: So you refer to data on the cancer services, were you aware about serious concerns being raised about the adverse impact of isolation on people with other health conditions such as dementia or Alzheimer’s?

Dr Andrew Goodall: I was aware of that, I think the TAC report that you’ve pulled up actually reflects on that itself in respect of some of those broader impacts, not least on the shielding, irrespective of the impact of lockdowns as well.

We obviously had to focus on those broader harms as we progressed more so through wave 2 into wave 3 of the pandemic response, and we did include reference to those areas within our quarterly operating frameworks that were issued from the NHS.

Ms Foubister: Did you write any equivalent letter to your May letter drawing attention to those concerns for these other health conditions and asking for specific action in relation to those?

Dr Andrew Goodall: I didn’t. There was something very specific about cancer that we saw on the data that we were monitoring. Within our operating frameworks that I was issuing quarterly we were describing these broader areas and the importance of making sure that whenever activity could be recovered that it should be done so.

Ms Foubister: Thank you.

Thank you, my Lady.

Lady Hallett: Thank you very much, Ms Foubister.

I think that completes the questioning for Dr Goodall.

Mr Poole: It does, my Lady, yes.

Lady Hallett: Thank you very much for your help so far, Dr Goodall. I’m sorry, I can’t give you a guarantee that it won’t be the last time. I know that you’ve helped me before in another module and this one, and it may be we’ll call on you again, but thank you very much for your help.

The Witness: Okay, thank you very much. Diolch yn fawr iawn.

(The witness withdrew)

Lady Hallett: Ms Jung.

Ms Jung: My Lady, the next witness is Dr Tracey Cooper.