2. Dr Tracey Cooper
DR TRACEY COOPER (affirmed).
Questions From Counsel to the Inquiry
Lady Hallett: I’m sorry if we’ve kept you waiting, I’m afraid we’re not going to finish you before we have to break for lunch.
The Witness: Not at all, my Lady.
Ms Jung: Dr Cooper, thank you very much for coming today to assist the Inquiry. Can you start by giving the Inquiry your full name, please.
Dr Tracey Cooper: Tracey Ann Cooper.
Counsel Inquiry: Is it right that you have produced two witness statements in this module?
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: The first is at INQ000235212. That is a corporate statement produced in response to a Rule 9 request sent to Public Health Wales.
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: The second is at INQ000276282. That is a witness statement produced in your personal capacity.
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: Are the contents of both of those witness statements true to the best of your knowledge and belief?
Dr Tracey Cooper: They are.
Counsel Inquiry: Is it right that you also provided a witness statement which was the personal witness statement in Module 1? That is at INQ000195849.
Dr Tracey Cooper: That’s true.
Counsel Inquiry: And in Module 1 there was a corporate witness statement on behalf of Public Health Wales, but that was signed by Dr Quentin Sandifer, and that is at INQ000192266.
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: Did you have input into that statement?
Dr Tracey Cooper: I did, yes.
Counsel Inquiry: Are both of those statements for Module 1 true to the best of your knowledge and belief?
Dr Tracey Cooper: They are.
Counsel Inquiry: Thank you.
Moving on to your professional background and role, Dr Cooper, is it right that you are the chief executive of Public Health Wales and that you have been in that role since June 2014?
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: You qualified with a bachelor of medicine from Southampton University in 1990?
Dr Tracey Cooper: That’s right.
Counsel Inquiry: Prior to your appointment as chief executive of Public Health Wales, you worked as the inaugural chief executive of the Health Information and Quality Authority in the Republic of Ireland between August 2006 and May 2014?
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: Before that, you were the deputy head director of operations for the NHS Clinical Governance Support Team, Modernisation Agency, Department of Health England between January 2004 and August 2006?
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: You also have experience of working internationally, including with the World Health Organisation?
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: The International Association of National Public Health Institutes?
Dr Tracey Cooper: Yep.
Counsel Inquiry: And the International Society for Quality in Health Care, of which you were a board member from 2008 to 2015, and president between 2011 and 2013?
Dr Tracey Cooper: I was, yes.
Counsel Inquiry: I want to ask you next about the role of Public Health Wales and a bit about its background.
Dr Tracey Cooper: Yes, so Public Health Wales was established in 2009 and it was part of the health structural reforms in Wales at that time. It was established under a statutory instrument with four main statutory functions. And perhaps if I can summarise them, they are to deliver health protection, microbiology and screening services, to provide health improvement programmes, to undertake data analysis to survey the health of the population, and to undertake research and evaluation about the health of the people of Wales.
Counsel Inquiry: Thank you. And is it right that Public Health Wales is the national public health agency in Wales?
Dr Tracey Cooper: That’s correct, yeah.
Counsel Inquiry: It’s also an NHS Trust?
Dr Tracey Cooper: It is, yes.
Counsel Inquiry: And it’s also a Category 1 responder for the purposes of the Civil Contingencies Act?
Dr Tracey Cooper: It is.
Counsel Inquiry: And therefore plays a key role in relation to the preparation for and response to emergencies and major incidents, which includes pandemics?
Dr Tracey Cooper: Yes.
Counsel Inquiry: Moving on to the role of Public Health Wales in response to the Covid-19 pandemic, please.
In the corporate statement you say that Public Health Wales mounted an unprecedented response to the pandemic, which was part of a Welsh system-wide effort to respond effectively to the challenges faced as the pandemic progressed; is that right?
Dr Tracey Cooper: That’s right, yeah.
Counsel Inquiry: Could you please provide a brief summary of what Public Health Wales’ role was in response to the pandemic, please.
Dr Tracey Cooper: Of course. So early on in the pandemic when, which I’m sure we’ll come on to, we could see what was coming down the line, we mobilised the organisation to the point that by 24 February we’d already made the decision that Covid response was going to be a single priority of the organisation.
So we mobilised the organisation and then we scaled up core functions and activities that were relevant to protecting the public, particularly around our microbiology diagnostic functions, our health protection functions, our population surveillance functions.
We also provided a broad range of technical and professional expertise and advice to the Welsh Government, guidance to partners. We undertook tracking of the course of the virus, and its impact on the population, which changed and evolved through the various phases of the pandemic. And we also undertook research and evaluation not only in relation to the impact of the infectious nature of coronavirus but also the impact it had on the wider socioeconomic health harms.
Counsel Inquiry: Thank you.
Can I ask you about some matters that weren’t covered in that very helpful explanation. What was Public Health Wales’ role in contact tracing?
Dr Tracey Cooper: So, as is normal for public health practice for any public health body, contact tracing is a standard health protection response where there is a health – an infectious disease incident. And so that’s normal, that’s normal place for us, it’s something that we have always done. As in the early days, in January/February, heading into the beginning of March, we were the sole organisation at that point undertaking contact tracing, mainly, initially, for people who were coming back into the country, returning travellers. As the geographic case definition increased, there were more people who were coming back into the country.
So we early on, around about end of January, we established a contact tracing cell, which means other – in a normal small incident it would just be a number of our team. When we establish a cell it’s because we need to have an expanded group of experts to respond to, and expanded activity.
And so, through the course of February and March, our teams – we just were pouring more and more staff into the national contact tracing cell, tracing over 100 contacts that were coming in. And so that – and at the time we were the sole organisation doing that contact tracing.
Counsel Inquiry: What about in relation to quarantine of the people that you were tracing?
Dr Tracey Cooper: Yes, so part of that, the conversation was about – was giving people information and advice around self-isolation. So anyone who was – had returned from a high-risk country or anyone who was a potential contact of a potential case or a case, the standard advice would be given around isolating for a period of time, ten days and then 14 days it moved on to, and the active tracking then of any contacts they had come into contact with before that point. And of course we weren’t in a position to physically go out and check whether people were actually doing what the advice was.
Counsel Inquiry: Did you have any role in relation to ports and borders?
Dr Tracey Cooper: We did. So the Welsh Government asked us advice over the first couple of months, particularly around about June, in my recollection, as there were discussions happening, I understand, from a UK Government perspective, around what does international travel look like, and what further prohibitions needed to be put in place. So we established a port and borders cell.
That activity then expanded as restrictions were brought into international travel, and we became an organisation that received the data from the Home Office around returning travellers and would contact individuals, give them tailored advice. That operation then changed over the time of the pandemic and I think, January ‘21, Cardiff Council then took over the function of receiving that data and then liaising with returning travellers.
Counsel Inquiry: Is it fair to say that the role and responsibilities of Public Health Wales during the pandemic were very broad ranging? Were the roles and responsibilities always clear to you throughout and as between Public Health Wales, the Welsh Government and other responders?
Dr Tracey Cooper: I think that was a challenge. That was a challenge I would say in the first year. When we worked with colleagues across Wales to develop the health protection response plan, which was submitted to the Welsh Government on 12(?) May, that is a comprehensive plan that really clearly articulates the respective roles and responsibilities of the different players who were really important, including local authorities, health boards, ourselves, Welsh Government, also colleagues in third sector and others. I think from that point onwards, it was much easier, and clearer.
Up until that point, we did find ourselves on occasion, as many national public health bodies did, we know working beyond our skillset or our mandate, and some of that was because that was no pre-existing organisation or entity doing an action that was needed and so, you know, we were stepping in to try and help.
Counsel Inquiry: Is an example of where Public Health Wales acted outside of scope in relation to establishment of the National Contact Centre in February 2020?
Dr Tracey Cooper: It is. We, again, as a normal core function for health protection for us we have an out-of-hours, an in-hours system that we – a process that we call AWARe, which is notification of any health protection emergency. So we’ve always had a facility that allows partners to contact us for advice, but that’s really more about incident by incident.
What we found very early on as we went through January and particularly into early February is that we were having more and more contacts of professionals and individuals seeking advice, not just because they had members of staff or members of the services they were providing needing support, but they were concerned about what was happening. So we brought some of our team together, initially with a handful of staff, and that very, very rapidly grew into setting up a National Contact Centre. And the function of that primarily was to provide advice, and we extended the hours through to about 8 am to about 10 pm, I think was the peak for us, to professionals, managers, for people from schools, from care homes, from care facilities, from businesses. So that was the purpose of the National Contact Centre.
Counsel Inquiry: Thank you.
Just before we break for lunch, are there any other examples of where Public Health Wales acted outside of scope during the pandemic?
Dr Tracey Cooper: There are. So around about 1 April in 2020, one of my team was contacted by Deloittes, company. Deloittes had been commissioned by UK Government to help establish mass population sampling centres, and we’d been informed that a mass population sampling centre – so where multiples of the population can go through, have the swabs done, a little bit like a normal process experience – and one such mass centre had been established at Cardiff City Stadium.
Unfortunately neither ourselves or the Welsh Government knew about that. And so literally over the course of about four or five days the team developed standard operating procedures, worked through the process, the end-to-end process, and I think by 7 April we were up and running, delivering it. The reason being that it was there and of course we couldn’t not use it, but it hadn’t been planned. So we ran that for about 60 days. The team did amazingly, actually, and we then handed that over safely to Cardiff University health board.
Meanwhile, Deloittes were really helpful. We subsequently then worked with them closely in setting up other large population sampling centres, together with the local authorities and health boards. So that was an area that we wouldn’t have expected, ourselves, to do.
Counsel Inquiry: Just to give us an idea of the strain on your resources, what was the capacity of staff working in the National Contact Centre and in that mass sampling centre?
Dr Tracey Cooper: Well, in the National Contact Centre we – I think the peak we had at maximum was about 800 calls a day. And that waxed and waned through different phases of the pandemic and then we were able to transfer that into a different, much more reduced contact centre. But when we were establishing that, very literally overnight, we took over half of our – fourth floor of an office. We then rolled it into Swansea and we rolled it into North Wales so that we could have some resilience. And our IT team ensured that, later on, we could – people could be call handlers from – working from home.
But it required the development of new processes, new training, a new governing model. And so we had, if I recall, through shifts, probably about 30, 40 people working at National Contact Centre.
In relation to the sampling centre, it – on 18 March, unfortunately we had to make the decision to suspend our – the majority of our national screening services, with the minister’s approval, because of going into the delay phase and the impact that had, whilst we maintained some of those screening services. So quite a lot of our screening team were able to mobilise into the sampling centre but nevertheless I think at any given time running that we probably had about 20 people, and then others that were involved across the organisation in different elements of that end-to-end process.
Ms Jung: Thank you.
My Lady, would that be a convenient time to break?
Lady Hallett: Certainly.
Just one question. Did I hear you correctly that somebody decided to set up a mass population sampling centre in Cardiff without telling the Government of Wales or Public Health Wales?
Dr Tracey Cooper: Indeed, my Lady.
Lady Hallett: Right.
Dr Tracey Cooper: It turned out –
Lady Hallett: Do we know who that was?
Dr Tracey Cooper: – to be helpful. I don’t know.
Ms Jung: Was it Deloitte?
Dr Tracey Cooper: I think it was part of – well, Deloitte had been asked to set it up. I think it was part of the intention to create that – the mass sampling, obviously the swab, and the mass testing across the UK. I don’t know who made the decision though.
Ms Jung: Thank you.
Lady Hallett: Extraordinary.
Right, I shall return at 1.45.
(12.45 pm)
(The short adjournment)
(1.45 pm)
Lady Hallett: Ms Jung.
Ms Jung: Thank you, my Lady.
Dr Cooper, I’d like to explore with you next the different ways in which Public Health Wales provided advice to the Welsh Government during the pandemic.
Can we start, please, by confirming that Public Health Wales did not take part in any informal or private communications such as WhatsApp groups with ministers or senior servants that informed significant decision-making –
Dr Tracey Cooper: No.
Counsel Inquiry: – and as such doesn’t hold any records?
Dr Tracey Cooper: No.
Counsel Inquiry: You say that in the context of Covid-19 the requests for advice from the government increased significantly. When did that increase happen, was it gradually over the whole time, or did it ramp up after a certain time?
Dr Tracey Cooper: I would say from around about middle of February, it started to, to increase. We were already providing information through our engagement predominantly with the Chief Medical Officer at that point, and our teams were attending daily incident management teams with the rest of the UK counterparts, so there was situational awareness, information coming through that we were sharing but really from probably the second half of February, and then from early March it really rose exponentially.
Counsel Inquiry: Thank you.
Can I ask you about advice notes, please. You say in your statement that the first formal advice note to the Welsh Government was on 12 October 2020. How was advice provided by Public Health Wales prior to that, so in the period between January 2020 and October 2020?
Dr Tracey Cooper: So we were continuing to provide multiple pieces of advice between that time, and the reason perhaps to differentiate this from 12 October is that was the first time we put in place a process that was more systematic with Welsh Government, because there were so many requests coming in that we wanted to create something that was more of a definitive position.
So prior to that we were asked for advice from different policy leads around sampling, testing, infection prevention and control, the provision of – the requests for those advice came through emails, they came – we were asked to provide advice during meetings. One particular example is when the Chief Medical Officer wrote to me on 22 April asking us to develop the health protection response plan, which obviously was a plan that we put forward, and our information back took the guise of advice that my team may give during meetings through to us putting documented advice in where requested, where it would be a briefing note or it would be an advice note that pre-dated, if you like, the new model that we were doing from October.
So that didn’t mean we didn’t provide advice before October, we provided a multiplicity of advice. It was just the system was more refined when we got to October.
Counsel Inquiry: Thank you. Could I ask you to slow down just a little bit –
Dr Tracey Cooper: Sorry. Sorry.
Counsel Inquiry: – so that the transcriber can keep up. Thank you.
So is it fair to say that in the period up to October 2020 there were multiple requests from multiple contacts on multiple topics, and is it fair to say that a record would not have been kept of all of those requests and of all of the advice provided by Public Health Wales –
Dr Tracey Cooper: Not in a –
Counsel Inquiry: – in that initial period?
Dr Tracey Cooper: And that was one of the reasons why we moved to the October model. Not in a systematised, tracked way – obviously every individual has got the records and we’ve pulled a lot together for the Inquiry, but as far as a registered approach going forward, that was one of the learning points for us, that we really needed that to happen and to elevate the level of advice that we were giving in the way that we were imparting it.
Counsel Inquiry: So is it fair to say that Public Health Wales does not have a comprehensive record of all of the advice it provided during the pandemic?
Dr Tracey Cooper: Not – not from the beginning, and really from October onwards.
Counsel Inquiry: And would you accept that that initial period was a crucial period in the pandemic?
Dr Tracey Cooper: Yes, it was a very crucial period.
Counsel Inquiry: Can I ask you, please, about your contact with ministers. In your corporate statement, you say that the advice provided to the Welsh Government by Public Health Wales appeared to be well received, and that you understood that the advice was incorporated into the decision-making process. Are you able to say with any certainty what advice was accepted or rejected or what weight the government placed on certain pieces of advice?
Dr Tracey Cooper: It’s a really good question. I think on occasion we could because we could triangulate it back to the advice that we were giving. So, for example, I mentioned the Public Health Protection Response Plan. That became the operational model for what was then published on 13 May, which was Test, Trace, Protect strategy. So we could see the derivative of that from the advice that we’d given.
We knew that particularly when we were – got into that more formative advice process from October, we knew that TAG was including our advice either as copied and pasted into advice or as an appendix into the advice they were providing to Cabinet, particularly around looking at consideration of NPIs, restrictions, that – really from that autumn point onwards. However, to – we weren’t able to track every single piece of advice, and whether or not that was taken on. Obviously we were one part of the advice suite that ministers were considering in order to make decisions, so they would weigh up other elements that – so to varying degrees, would include ours, I would have anticipated.
Counsel Inquiry: Is it right to say that in those forums it would be a case of Public Health Wales being one of a number of people providing advice and then the decision being made at a later date in a different place?
Dr Tracey Cooper: Yes, and really typical examples of that is when we – when Wales went into the local restriction time, the First Minister would convene a group of the respective leaders, chief executives for local authorities, chairs and chief execs of health boards and other key partners, in considering what the situational awareness was in order to consider going into a local lockdown. The decision wasn’t made at the meeting; we would provide advice, but the decision was made after the meeting. So it was predominantly more of a multi-agency approach, yes.
Counsel Inquiry: In Module 2A, Professor Nick Phin gave evidence, he was director of public health services for Public Health Scotland in January 2021, but at the start of the pandemic he was deputy director of the national infection service within Public Health England, and so from his experience of working within both those organisations he was able to provide some interesting perspectives about the way in which things were approached differently in those two nations.
With regard to Public Health Scotland, what he said was that there were minimal opportunities to provide ministers with a first-hand account of the thoughts of senior staff in Public Health Scotland, or to make them aware of the practical implications of policy decisions. He said the main mechanism by which Public Health Scotland was able to provide advice to Scottish Government was through the National Incident Management Team.
Is that similar to what happened with Public Health Wales?
Dr Tracey Cooper: No, I would say we were – whilst we didn’t make the decisions, obviously Welsh Government ministers made the decisions, we worked very closely with them. So I, all the way through, obviously was working, as my team was, very closely with the Chief Medical Officer, and so the Chief Medical Officer was obviously able to share at direct hand any comments into ministers, similarly with Andrew Goodall as director general.
But we also attended a considerable number of meetings with ministers and we’ve shared in the statement some of the key ones, but there are others, where we were able to give – share our thoughts on what the latest evidence was, not only for Wales but other countries.
There were also specific periods where, for example, we had a number of outbreaks in food and meat production factories where ministers would set – there were a number of meetings where there were a number of ministers attending those meetings, and other partners, where, again at first-hand, we were able to share the information.
And from about October in 2020, myself and my chair reverted to what was happening pre-Covid, where we would have normally around about bi-monthly meetings with the minister for health – as Public Health Wales and the minister for health with the director general or the Chief Medical Officer. So we were able by the time we got to October to revert back to those, which was helpful because we could give a – quite a specific element of our views, but also increasingly the broader harm impact of Covid.
Counsel Inquiry: Professor Phin said that in relation to Public Health England, that he was involved in face-to-face discussions with ministers, he was in the room providing direct advice, advising on what introducing policy could mean on the ground, what the relevant issues were that had to be thought through, and he said he thought being in the same room advising and pointing out the implications was really important. Do you agree with that?
Dr Tracey Cooper: Absolutely.
Counsel Inquiry: And you say that Public Health Wales did have that direct line to ministers?
Dr Tracey Cooper: We did, certainly up until that – that – the Christmas time, I would say, or before September, the majority of those occasions were with others, and we would share information in advance. So we may be asked for briefing notes for the Chief Medical Officer or the director general to share, but I think one pivotal moment was on 19 December 2020 when two of my team were asked to join Cabinet meeting to give direct advice. And obviously we were in the Kent variant phase at that point, and we’d preceded that by issuing a number of advice notes, and so Dr Chris Williams, who you met last week, and Catherine Moore, one of our senior clinical scientists, virologists, who submitted a Rule 9 statement, attended that meeting directly with the Cabinet to give that first-hand advice. So I wouldn’t say there was a time where we – when we were in that position, we were invited to understand.
Similarly in August 2020 the First Minister invited us to attend a Cabinet meeting, myself and one of my former directors, director of policy and international health, to share the international learning that was happening. Unfortunately there were technology problems so we couldn’t do the direct engagement with them, but that was – it makes such a difference to be in the room, yes.
Counsel Inquiry: Is it fair to say that there were specific occasions where you did have direct meetings with ministers, but was that direct line always open throughout the pandemic?
Dr Tracey Cooper: Well –
Counsel Inquiry: Can I work through an example?
Dr Tracey Cooper: Yes, please do.
Counsel Inquiry: So Professor Nick Phin said that in Scotland there was a situation where the government had decided that they should be checking up on people to make sure that they were maintaining quarantine and that that led to a reasonably robust exchange between the chief executive of Public Health Scotland and the Scottish Government, where Public Health Scotland were saying it just wasn’t a feasible option.
Am I right in understanding that something similar happened in Wales, where Dr Sandifer says that he received an email from the Welsh Government on 31 May 2020 with an expectation that Public Health Wales would write to all overseas travellers by recorded delivery letter, followed by telephone contact for monitoring, and he had to write back pointing out the difficulties with that. First of all, Public Health Wales could not access the passenger locator form database held by the Home Office; and, secondly, did not have the operational requirements to be able to send out 150 recorded delivery letters a day followed by daily phone calls, 14 days for each arrival.
Is that the kind of misunderstanding that could have been avoided if ministers had been in the room with Dr Sandifer or others leading the response?
Dr Tracey Cooper: Well, that’s a really good example, and perhaps you can clarify with Dr Sandifer tomorrow, but my recollection, if I recall correctly, is that Quentin, Dr Sandifer, was invited to a discussion with the First Minister on this precise issue, and expressed the logistical challenges of it. And again, I think please check with Dr – with Quentin tomorrow, but I think we were saying we didn’t have a problem in doing it, but actually the process was too cumbersome and not realistic, that we would prefer to do it by email in a safe, information-governed way. And I understand that the First Minister accepted that.
Counsel Inquiry: Thank you.
I want to move on, please, to multi-agency meetings that Public Health Wales was involved in, starting with meetings with the Chief Medical Officer for Wales, and I’m going to try to deal with these broadly chronologically from when they were established.
So you say that informal catch-up meetings happened with the Chief Medical Officer for Wales, starting from 26 January 2020. What did you mean by informal catch-up meetings?
Dr Tracey Cooper: So these really took the nature of a quick half hour, what we were learning internationally, what were the concerns we had, where was Wales at. No decisions were made at those meetings, and they were very similar to what we’d have done pre-Covid in quite a relaxed catch-up way. And on occasion the Chief Medical Officer may ask us to provide advice to him on X, but they were not – they weren’t formal structured agenda – we wouldn’t share an agenda, it was very much a rapid situational – sit rep, if you like.
Counsel Inquiry: Bearing in mind that Public Health Wales got its first briefing through Public Health England on 8 January, do you think that those meetings with the Chief Medical Officer should have started earlier?
Dr Tracey Cooper: Well, my understanding, and again Quentin is closer to this than me, so in – my understanding is that, and I think the first meeting with Public Health England was the 7th, we issued a briefing to the NHS on the 8th, and then again on the 10th.
But the team, under the auspices of Quentin, were already very close in communications with the first – with the Chief Medical Officer, so it wasn’t that no engagement happened, it was the fact that we, from 26 January, we start – we just scheduled into the diary, whether we needed them or not, a quick half hour situational report.
Prior to that there was just constant engagement between the team, the Chief Medical Officer and officers working in the Chief Medical Officer’s office, so really from that point in time we were – we were working in synchrony with him.
Counsel Inquiry: Albeit these were quick half-hour sessions, were they recorded?
Dr Tracey Cooper: No.
Counsel Inquiry: Do you think they should have been recorded?
Dr Tracey Cooper: I think if we were to run this again, just having a tracker – as I say, there was no agenda beforehand and there weren’t decisions made, that’s not the purpose, and they were happening so quickly, but I do think it’s helpful to have a tracker, even if it’s just “these are areas we discussed and Public Health Wales was requested to do X”. The situation was happening so, so quickly, but I think that’s an important learning point.
Counsel Inquiry: Can I ask you about the Public Health Wales, Welsh Government, Wales Ambulance Service s NHS Trust meetings. So these were daily informal catch-ups, is this right, starting on 28 January 2020 up until 3 March 2020?
Dr Tracey Cooper: As far as I’m aware. I wasn’t directly involved in them, but yes, as far as I’m aware.
Counsel Inquiry: Do you know what the purpose of those meetings were?
Dr Tracey Cooper: Yes, I think it was very much, we worked very closely, as Category 1 responders, and Welsh Ambulance service trust is a key responder, so when we’re into an incident we engage with them regularly, and at that time – it was at the beginning of that time Covid was deemed to be a high-consequence infectious disease, and so the transportation for the ambulance service of patients who are, who have a – potential or have a high-consequence infectious disease is significant for them logistically. So my understanding is those meetings were set up originally to work through with them how they would go about undertaking that transport, and then of course subsequently it was de-designated as a high-consequence infection, and so they fell away and the next phase of the pandemic kicked in, if you like.
Counsel Inquiry: Albeit Covid-19 was designated formally as a high-consequence infectious disease, is it right that from the very outset it was at least out of an abundance of caution treated as if it was?
Dr Tracey Cooper: Yes.
Counsel Inquiry: Bearing that in mind, do you think that the meetings with the ambulance trust should have happened earlier, to warn them about potential cases coming in?
Dr Tracey Cooper: We were briefing the ambulance trust as with the rest of the NHS, so when we sent the briefing out on the 8th and the 10th, we sent it out to the NHS, and that’s all of the organisations.
So again, whilst the date of a meeting was X date, there were multiple engagements happening with the ambulance service. And I can remember personally on a Sunday being in our offices in early February where we had a potential case and being on a conference call, because I was helping in the contact centre, because the ambulance service were trying to work out the logistics with the health board. So they were aware of it, of the risks of Covid, at the same time as we were when we briefed the NHS.
Counsel Inquiry: And talking about the NHS, the Health and Social Services Group coronavirus planning and response group we dealt with that with Dr Goodall this morning, but that group started on 20 February 2020. You’ve told us that prior to that you were in contact with the NHS –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – the ambulance trust; is that right?
The First Minister, Mark Drakeford, has said in his statement that at times the relationship between the Health and Social Services Group in Welsh Government and Public Health Wales was difficult.
Do you agree with that?
Dr Tracey Cooper: Without an example – it would be helpful if there was an example. I – and, I mean, having read that paragraph, the beginning of the paragraph is in the context of data, I think, that’s right, data and modelling –
Counsel Inquiry: He goes on to say, if it assists, that during the pandemic – he says “We needed it to be more in the delivery space, such as ramping up testing capacity, but it struggled to be so effective”. And then he goes on to say that as ministers you only hear about what goes wrong.
Dr Tracey Cooper: So if I could perhaps cover the first element, around the – the beginning of that paragraph –
Counsel Inquiry: Yes.
Dr Tracey Cooper: – around data, and then perhaps make a comment around scaling up services, particularly testing.
So there were times early on, I would say, earlier on, where there was such a rapidity of questions and requests for data, understandably, from colleagues in Welsh Government, from ministers – and I mean multiple times in an hour, through the day – and we had put all of our data analysts from across the organisation into our Communicable Disease Surveillance Centre, and so to keep up with those was a challenge.
Sometimes, on occasion, there were the same question coming from different parts of the Health and Social Services Group, and later in the pandemic we created a group that could co-ordinate that better, and we tried a number of times with that. And also there were times where through the course of the pandemic we were asked to add additional fields to the population surveillance dashboard that we’d published, which expanded rapidly. Sorry.
And I can remember an engagement with Andrew Goodall, I think it was probably in the summer, where we’d been asked to add a significant number of additional fields, and it just logistically wasn’t possible in the time they asked for if we wanted to have the quality of the data integrity. Because in order to do it we had to test the source data. So we had to negotiate on occasion.
So that’s what I’m assuming. That’s how I interpret the First Minister’s comments. I would say that there was some frustrations from our side as well and every few months we tried to create that – a better control system.
The meeting I referred to was, I think, from September/October. A number of our team met weekly with the Chief Statistician for health so that they could plan in advance as we were getting into adding vaccinations, as we were getting more knowledge, and again that system helps improve that co-ordination.
In relation to the First Minister’s comments about the delivery elements –
Counsel Inquiry: Yes.
Dr Tracey Cooper: – of the organisation, so going into Covid we had around 2,000 staff. Two-thirds of those staff were in our public health services directorate that Dr Sandifer led at that time, and that directorate delivers all of the microbiology for Wales, with the exception of two health boards, all of the eight national screening programmes for Wales, and all of the health protection service – technical service for Wales. So service delivery was a big part of the organisation.
The challenge around testing, and I don’t know whether you want me to explore that now –
Counsel Inquiry: Well, I was going to ask you if it was Public Health Wales’ view that it was for that organisation to be carrying out mass testing?
Dr Tracey Cooper: So if I may, so the end-to-end process of getting a result from a test begins with sampling, which is the swab. So without the swab being taken, the swab doesn’t arrive, we can’t do the test and the test result doesn’t come out. So a lot of the time people refer to testing as a catch-all phrase, but actually it’s the taking of the swab and doing the test.
Now, our role predominantly is doing the test, in the lab. That’s what we do. Early in the pandemic, we did do the community swabbing for – as the odd patient case came through, because we were supporting health boards in ramping up their capacity and capability to do that, and that was happening through February. And then I think the Chief Medical Officer wrote on 10 February to health board chief execs clarifying expectations of establishing community testing units, which were the swabbing units.
So our role absolutely wasn’t to do the swabbing part of testing, although we did it for the first two months or so to help health boards. Our role was about the diagnostic elements of testing. And I think you have in the statement that we were really fortunate with our team to have created a domestic test at the end of January, which the Chief Medical Officer then approved at 7 February, and that enabled us to have that domestic resilience in complementary to what was happening in the UK Government.
Now, at that time, every country pretty much in the world was competing for the ability to test, and again, if I may, there are three critical things to testing: one is having the staff; two is having the equipment, the platforms, the machines; and the third is having the chemicals. So if any one of those are significantly dampened, you cannot optimise testing.
So we had – we had the staff to do reasonably high volume testing of – certainly up to 5,000, which we got to at the beginning of May. We had made – we’d had investment from Welsh Government in 2019 to diversify our machines across Wales, which meant that we could use different test kits and we weren’t overly reliant on one or two companies. And in March we procured more of those. The biggest challenge was the chemicals.
Counsel Inquiry: Thank you.
Duncan Selbie, who was the chief executive of Public Health England, told the Inquiry in Module 1 that his understanding was that Public Health England would create and roll out the test, but then it would be rolled out to the NHS, and it was never an assumption, as far as he was concerned, that mass testing would be carried out by Public Health England.
Is that a similar understanding that Public Health Wales had about its role?
Dr Tracey Cooper: We’re designed slightly differently. So within our core functions is actually doing microbiology diagnostics. So –
Counsel Inquiry: On a mass scale?
Dr Tracey Cooper: Well, for the NHS. So if you get admitted through the emergency department with a potential infection, the sample’s taken, and it’s our laboratories based in hospitals that would do that infectious disease testing, and we have some international leading units within that, apart from Aneurin Bevan health board and Cwm Taf Morgannwg health board, who have retained some services, but we work very closely with them.
So we were, if you like, then, the NHS’s testing service for infectious disease, whereas Public Health England have got specialist virology laboratories for, if you like, more the high-consequence infectious diseases.
Counsel Inquiry: Thank you.
Can I ask you about the Public Health Wales health board meetings, please, which started in February 2020. Did those meetings support the early implementation of home and community testing facilities across Wales, you say in the absence of other structured response arrangements?
Dr Tracey Cooper: So I think you may be referring to the additional meetings that my team put in place with directors of public health in health boards. I think those were – we – in addition to that, we were meeting with health boards – oh, sorry.
Counsel Inquiry: I’ve got meetings with health boards starting in February, and then meetings with directors of public health from March –
Dr Tracey Cooper: Yes, sorry. We had so many meetings, apologies.
I think you may be alluding to, in early February I contacted my colleagues, health board chief executives, suggesting that we did one-to-one organisation-to-organisation calls with them. And, yes, that was very much about – and I think I shared the agenda – where they – where we were at as a country, where they felt they were in preparedness, had they done the training for face masks, how advanced were they in setting up their community swabbing.
So we did those very positively with all of the NHS organisations and I think I shared with you the capturing of the output of those as emails that I sent on to the Chief Medical Officer.
Soon after that, we met regularly anyway, as chief executives, with Welsh Government, so that rhythm went in – I think that started at end of February, and then, as I mentioned earlier, the more rapid frequent directors of public health meetings were put in place.
Counsel Inquiry: Thank you.
I’ve got one more group I want to ask you about, it’s the public health strategic co-ordinating support group.
Can you tell us what the purpose of that group was and why it was established?
Dr Tracey Cooper: Yeah, so that – this came out of learning from the Ebola virus disease outbreak, and during – that was 2014/2015, if I recall – during that we were very heavily involved in working with our partners across Wales in anticipation, because it was a real threat at that time, and the local resilience fora were also engaged in anticipation of any potential case that came in.
What we identified, and again Dr Sandifer may be better to elaborate on this because he led on it, what we found at the time was Public Health Wales attending the four local resilience fora, having very similar conversations with them, at a busy time, and also them not hearing the feedback from their colleagues, a similar public health strategic co-ordination group was set up during that time.
And so very early on under Quentin’s leadership was the suggestion “I think we need to have – to do similarly”. So I understand that Quentin and colleagues connected with local resilience fora partners who we’d worked very closely with throughout the years, and it was proposed to establish the Covid public health strategic co-ordinating support group, and that was agreed to, and that started around about 23/25 March.
Counsel Inquiry: 23 March, the date of the first lockdown.
Dr Tracey Cooper: Yes.
Counsel Inquiry: Do you think that, bearing in mind the important role that local resilience fora and the local government played in the response to the pandemic, that they should have been involved at an earlier stage?
Dr Tracey Cooper: Yes, I’m not sure exactly when colleagues in Welsh Government directly through their Civil Contingencies Group engaged with them, so I – it could be that it’s much earlier. I do think, though, we felt that it was on occasion, you know, we were holding the hands of the NHS and running forward at speed, and they were holding back, they were holding the hands as well, that we were in a position where we felt we could see what was highly probable coming down the line, by just observing what was happening internationally, and that it was going to move to a whole-of-society situation.
And so, again, I can’t comment on Welsh Government, when Welsh Government connected through the local resilience fora to engage with them. We, however, were connecting regularly. So on 25 February I asked the team if we could establish – if we could run an exercise for a potential lockdown, and I spoke to the Chief Constable of South Wales Police the following day, and so we brought all the local resilience fora together for that exercise on 3 March to test that out. So they were engaged with us, but I don’t know when it was formal from a Welsh Government route.
Counsel Inquiry: Thank you.
You’ve alluded to it already, but you made a comment just shortly before about there being so many groups. Do you think that the routes through which advice was provided to the Welsh Government could or should have been simplified?
Dr Tracey Cooper: I think in the early months it was – it was – there were – as I said earlier, there were multiple contacts. When systems started to be put in place, when TAG was put in place, I think that really was the point at which advice was much more helpfully streamlined, because there was a system in place, there were designated groups that – subgroups that evolved over time, because the advice was about everything. And so it’s – I think it’s that, it’s that divergent activity. And then structure gets put in place which creates organisation within a very challenged environment.
So the point – from my perspective, I think the point that TAG was established made it earlier. I’m not sure, perhaps if that had been earlier, maybe that would have made it more streamline. Yeah.
Counsel Inquiry: Do you think that all the various groups facilitated effective multi-agency working?
Dr Tracey Cooper: I wasn’t – I didn’t attend a lot of the groups, so I may not be the best to answer. I think – I think it got clearer as the pandemic went on, because it was frenetic in the first couple of months. And then, as I say, as – the health protection response plan helped because it created organisation, it created a structure, a national, a region and a local structure, and Welsh Government then wrapped its own meetings around that. And those were local authorities and health boards. And I think that was probably the first time where there was that coming together of conversations and sharing and decisions of local authorities and health boards in a way of tackling Covid.
Counsel Inquiry: Can we move on to a new topic, please, the provision of data. The Inquiry understands that one of the ways Public Health Wales supported the Welsh Government during the pandemic was through the provision of data. Can you set out, please, the kinds of data that Public Health Wales provided to the government?
Dr Tracey Cooper: Yes, and it changed through the course, as you can imagine, of the pandemic. So to begin with it was very much about looking at the course of the pandemic on how it was impacting on the population. So the impact that cases – number of cases, the positivity elements of it, where those cases were happening. And then over the course of the first six to seven weeks we were able then to create more disaggregated data at a local authority level. So the course of the infection.
We also provided data in relation to genomic analysis, so the genome sequencing of Covid. We were very fortunate in Public Health Wales and Wales in having a very strong pathogen genomics unit that we’d had for a couple of years, so we made the decision to scale that up very early on, and that was pivotal and at times we were third or fourth in the world in the number of genome sequence. So that kind of data not only helped us look at outbreaks to identify where potential source or interrelationships between cases connected to that outbreak were, and inform public health action, but they also allowed us to track the variants and the mutations of coronavirus coming through.
Then, thirdly, we did a lot of work around obviously the vaccination data as vaccination started, and at the outset we really struggled with collecting data relating to ethnicity and data relating to protected characteristics because it wasn’t – it wasn’t collected routinely to the level that we would have wanted in the NHS going into Covid.
So when we set up, with partners – Wales set up the information system for contact tracing in June, that allowed us to add data in there, and similarly when we set up the data system for vaccination, it allowed us to add a lot more data on ethnicity and protected characteristics.
And then finally, just as examples, in the April of 2020 as an organisation we wanted to travel alongside the public on this, so we began a weekly public engagement survey, which was “How are we doing in Wales?” with 600 to 700 people, and we asked our – the population some continuous questions around health and wellbeing, their self-reported state, and also questions in advance of vaccinations or restrictions. And that information was published, we published it – published that all the time, but it also enabled Welsh Government to track that in informing.
And then perhaps, if I may, just finally, what we also set up in April following a discussion with the Chief Medical Officer and myself, we have a World Health Organisation collaborating centre, we wanted to track what was happening internationally so the team collected data and formulated it into a weekly then fortnightly then monthly international horizon scanning and learning report. So we looked at the impact on children and young people, we looked at the impact on disability, we looked at how countries were scaling up the functions of a pandemic, and then finally we did health impact assessments of the impact of Covid on different population groups and the impact of different restrictions on people. So there was some broadly population health data that we fed in as well.
Counsel Inquiry: Thank you. Can I just clarify one thing that you said. Is it right that during the pandemic Public Health Wales did not have access to data in relation to age, sex, ethnicity, level of deprivation, or population density region? Is it the case that all of that is now available?
Dr Tracey Cooper: We had some of that going into the pandemic. We – and again Chris, Dr Chris Williams, who you interviewed last week, is closer to the specifics of it. But we did have the data that was collected on the NHS patient administration system, which has got, you know, age, sex, address, et cetera. And what – the two, I would say, particular challenges, though, is that the specific nature of – you know, the full demographics that represent the nation, we didn’t have that, those pieces of data, and so the team were trying to be creative in trying to assess the impact on black, Asian and minority ethnic people for example, and so we used a piece of software that could provide some sort of proxy in the absence of data.
The other sector that was really challenged around data was the care home sector, and that was a significant challenge. It got better through the pandemic, but the capturing of the data, that I’m sure care homes capture every day, but there wasn’t a system that really could be relied on for us to help inform action or look at the reality of what was happening in any sort of systematised data way.
Counsel Inquiry: Thank you. Before we leave this topic, could I ask you to look at one document, please.
Dr Tracey Cooper: Of course.
Counsel Inquiry: It’s INQ000299607, and at page 7, paragraph 1.12, this is from “A review of the Health and Social Services Group Response Structure to COVID-19” document, and it says:
“There was a multitude of dashboards being prepared for different purposes sometimes with similar but slightly different data flows. In terms of PHW, this appeared to be done without any regard to what else was happening in the system leading to duplication of similar outputs between [Public Health Wales] and Welsh Government … and creating confusion in the media and to the public.”
Do you have any comments on that?
Dr Tracey Cooper: Yes, I mean, I think we have always – before Covid, we have the function of communicable disease surveillance, so as an organisation we will always track communicable disease. What we were being asked to do was expand that in depth and breadth.
Now, what I can’t say is that every time we expanded it – that there was no time where we expanded it where we didn’t – it wasn’t as a request of Welsh Government. So a lot of our expansion of the dashboards was because, understandably, colleagues in Welsh Government were asking us to do that. I do think, however, that it could have been connected better and should be connected better going forwards, so that – on occasion – and I think Chris may have given this evidence – we were sharing data with Welsh Government having presented it in one way and then the same questions were being presented – the answers to the same questions were being presented in a different way. So I think it would have – you know, going forwards, the complementary skills and agreeing what’s the best way to design or present it would be helpful.
The final comment I would say is that it’s also the data was presented for different audiences. So we were presenting – we were providing data obviously into Welsh Government, but we were also presenting data as much as we could publicly. And I think the knowledge advisory service in Welsh Government was – and I could be wrong – was more around data for Welsh Government interrogation and use. So again, going forward, being clear about how we work together, not to duplicate, but to be better on the question, that’s one of the reasons why we set up the meeting with the Chief Statistician, which started in October 2020, so that we were really clear together and we could plan what that, if you like, the next steps would be and who was responsible for them.
Counsel Inquiry: Thank you. I’m going to move on now to a different topic, which is on capacity and funding.
Dr Sandifer in the Module 1 corporate statement says that at the start of 2020 the health protection services in Public Health Wales were under-powered. Do you agree with that statement?
Dr Tracey Cooper: I would agree, yes.
Counsel Inquiry: In the corporate statement for this module, you describe scaling up Public Health Wales’ response as one of the key challenges that you faced in responding to the pandemic. How was that challenging?
Dr Tracey Cooper: So if I pick the three functions up, before I do, I think it’s fair to say that in 2018 we flagged to the Chief Medical Officer and Welsh Government the concerns that we had that we needed to build more resilience around our health protection, microbiology, surveillance services, and over the course of about six months we did workshops with the NHS and partners, with – together – in tandem with Welsh Government, and then in 2019 we put a business case in to expand health protection, microbiology and surveillance services, in order to build pandemic preparedness and resilience.
And so – and that was approved, in part. And then of course that was – I think that was around about, I could be wrong, September 2019, and then of course Covid hit, so – we were able, though, to avail of additional funding then for new platforms, new pieces of equipment –
Counsel Inquiry: Which we’re going to cover.
Dr Tracey Cooper: Okay.
Counsel Inquiry: So the Inquiry heard in Module 1 about the fragility of the – particularly the microbiology services, and heard that the system for dealing with testing, diagnosis and frontline support was inadequate and not fit for purpose and was struggling to deliver on a day-to-day basis; is that right?
Dr Tracey Cooper: I think in the first few months for us it was a real challenge, not because of the – so much the platforms, because we had diversified them, but the biggest challenge was getting access to the chemicals. That was significant. What I would say is in March we procured additional platforms and then in August we put a business case in for 164 additional staff –
Counsel Inquiry: Yes.
Dr Tracey Cooper: – which were approved, and, you’ll see in the statement, more equipment, but –
Counsel Inquiry: So we’ll address those improvements that were made during the pandemic, but just sticking to the situation as at January 2020, the funding had come in from the government, can you tell us what improvements had actually been made at that stage in terms of the infrastructure or workforce?
Dr Tracey Cooper: Prior to January 2020?
Counsel Inquiry: At the time that the pandemic struck.
Dr Tracey Cooper: Okay, sorry. So we had procured additional pieces of equipment to be based in local hospitals, which means that results could be done rapidly locally without having to be transplanted to another part of Wales to be tested.
Counsel Inquiry: In how many hospitals?
Dr Tracey Cooper: I think we had nine. I will go away and confirm, if that’s okay. I think we had nine what we call “hot labs”, which are rapid diagnostics.
Counsel Inquiry: So you had nine hot labs already in January?
Dr Tracey Cooper: Yes, I will check on the number but I’m pretty sure it was nine. And that allowed for rapid diagnostics.
We also had some additional communicable disease surveillance teams that were starting to be appointed. I think we made – we’d appointed a couple of additional consultants.
We – I’m not sure if we’d managed to appoint any additional Health Protection Team, because it was – by the time it was approved in say September 2019, to mobilise and recruit all of those – obviously it was – we went straight into the pandemic. But nevertheless the diagnostic infrastructure was better but it still would not have been enough at all to scale up to the level that we needed it to.
Counsel Inquiry: Just to clarify, with regard to high-consequence infectious diseases, is it right that they had to be tested in specific labs?
Dr Tracey Cooper: Yes.
Counsel Inquiry: I think level 3 labs?
Dr Tracey Cooper: Yes.
Counsel Inquiry: And is it right that in January 2020 that testing was still being done in England?
Dr Tracey Cooper: Yes.
Counsel Inquiry: So there was no testing capacity within Wales in –
Dr Tracey Cooper: For a –
Counsel Inquiry: – relation to HCIDs?
In your corporate statement, you say, Dr Cooper, that in exercising its role and functions, Public Health Wales was not held back in any way by the funding made available by the Welsh Government. There are no examples of insufficient funding curtailing the ability to fulfil Public Health Wales’ role and functions in a timely manner in relation to the pandemic.
Do you stand by that?
Dr Tracey Cooper: I do. Sometimes on the business cases it took a little bit longer than we’d have liked for them to be approved, but – and on one occasion it was less staff that we were – that we’d asked for, but nevertheless it was a significant increase.
So, yes, I don’t have an issue with – every time we put a business case in, most of the time it was very rapidly approved and – so we were fortunate, actually, in that respect.
Counsel Inquiry: So I do want to explore some examples with you.
It is the case, isn’t it, that when Public Health Wales set out a business case for additional funding, it was granted –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – by the government?
But in terms of timing, on 24 March 2020 you submitted a request for capital funding for Covid-19 testing platforms to be placed at all microbiology laboratories in Wales, and that was to increase testing capacity –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – is that right? And that was granted fairly quickly the next day on 25 March 2020.
Is there a reason why that wasn’t applied for prior to 24 March?
Dr Tracey Cooper: Well, my understanding is – and again – that the 2019, I may need to come back and give you clarity around the specifics of it, but we had purchased additional platforms during 2019, but our team was –
Counsel Inquiry: This is in relation to Covid-19 –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – testing platforms?
Dr Tracey Cooper: Yeah. So the platforms to test Covid-19 are – they’re not unique for Covid-19, so they could test a number of respiratory viruses or other viruses, so you can have a – one piece of equipment that can test a number. So we had to – it was about making sure we could expand those that could test for Covid-19.
So – but we could see what was coming down the line, so similarly we knew we had to scale up our platforms, our staff, our chemicals, and that was – and in March particularly, trying to increase our testing capacity, competing with the global supply chain, was a challenge. And on occasion, whilst we had the approval to purchase them, we struggled to get some equipment from South Korea, and we were in negotiations with Scotland to try and have a charter flight come down. So even though they were approved they were still a challenge to get into the country.
Counsel Inquiry: But it’s right, isn’t it, that in that very crucial initial period, knowing what you knew about what was coming down the line, you knew that there was a need to scale up, so why wasn’t the application for additional funding made earlier?
Dr Tracey Cooper: I don’t know.
Counsel Inquiry: Can we move on to 7 May 2020, when a business case was submitted for the establishment of an additional microbiology testing lab –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – that was the Imperial Park IP5 lab and that primarily focused on delivering serological testing of Covid-19. Can you explain what that is, please.
Dr Tracey Cooper: Yes, so the swab test that people are familiar with is, are – which is something called the antigen, which is that someone has Covid at that time. What – serological is blood tests, and what that blood tests do is it measures whether someone has had Covid within, you know, the last number of months or so.
And so for – the Imperial Park lab initially was for antibodies, serological testing. That did change over time to antigen testing as well.
Counsel Inquiry: How important was that new lab to the response?
Dr Tracey Cooper: That was very – that was very important to us at the time because it allowed us to do very large throughput testing. That was in advance of the Lighthouse labs coming on board, as I’m sure you’re about to …
Counsel Inquiry: Before I do, it’s right, isn’t it, that that new lab became operational in January 2021, and so the same question: why wasn’t additional funding applied for before May 2020 for that important new lab?
Dr Tracey Cooper: And if I may, the reason why there was a delay is that the lab was novated to the Department of Health and Social Care –
Counsel Inquiry: That was later in August?
Dr Tracey Cooper: That’s right, yes.
Counsel Inquiry: But the application for funding was in May.
Dr Tracey Cooper: Yes, I think that is absolutely fair questions. I think from – as we were travelling through the pandemic, and particularly in those early months, while we knew it was coming down the line, we were still – we were still unclear about what the scale was going to be and how long it was going to be for. And putting a business case in really early, when we’ve only got maybe ten cases, is a challenge to seek approval. When the business cases went in in March, it was much clearer that we were – obviously the pandemic had been declared, and so it was a much more logical sequence of approvals. For the May, though – as I say, the business case went in May because we weren’t sure whether we’d be able to avail of the Lighthouse lab capacity at that time, which meant that we really needed to scale up to another level in Wales.
But I think it’s a fair question and I don’t know of the specifics of why for the large lab didn’t we apply earlier, but I think, reflecting on your March one, we wouldn’t have got a business case through with a handful of cases probably if it had been earlier than that.
Counsel Inquiry: You applied for funding for six additional hot labs –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – in August 2020, and at the same time recruited 162 whole-time equivalent staff to the microbiology service at Public Health Wales.
It was known, wasn’t it, that there was a lack of microbiology staff at the beginning of the pandemic? Why did it take so long to apply for additional funding for that additional resource?
Dr Tracey Cooper: Yeah, well, similarly we were trying – we had – we were reasonable with the number of our staff and, as I said, we were able to appoint some in that 2019. The challenge was that the more we were learning about the transmissibility and the impact of cases in Wales, the more the expansive reality of we’re in this for a long time, we’re going to need to grow to a sustainable resource.
So I think Dr Goodall mentioned earlier that initially they thought it would be maybe a 13-week epidemic, but of course by the time we got into heading up again by the middle of the year, so August or so – and that was the tipping point, really, when towards the end of August we saw the rates really kicking up again, and that was Alpha kicking in, then it was clear that this is going to be a rolling pandemic. And so for the government to commit to recurrent resource, expensive resource, for 164 new people, that’s a big recurrent amount. And together with all of the additional investment. Again, earlier on, I think the wisdom was – and I think amongst some, was, well, actually this may be more self-limiting than it became. And then again, as Dr Goodall mentioned this morning, it was clear that they needed to have recurrent infrastructure that was here. So I think that was really the timing that – that spike in August. And the discussions we were having with Welsh Government in August was: how are we going to do rapid turnaround time when we’ve got another wave coming, and Test, Trace, Protect is bedding in but it needs to expand to the next level?
So I think that was really more about the situation at the time.
Counsel Inquiry: Thank you. So that’s microbiology staff?
Dr Tracey Cooper: Yes.
Counsel Inquiry: I just want to do one more example, please, in relation to health protection –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – staff.
There was an application, wasn’t there, in November 2020 to increase resource in that department, and in fact there was some negotiations with the government and it was finally approved in February 2021.
You recruited, didn’t you, an additional 109 whole-time equivalent health protection staff?
Dr Tracey Cooper: Yes.
Counsel Inquiry: Do you think that if that application had been made much earlier, and had been granted much earlier, then you may not have had to suspend some of the other essential services that Public Health Wales was providing, such as screening?
Dr Tracey Cooper: Yeah. Sadly, no. The reason being that the decision for us to suspend screening on 18 March was because we’d moved into the delay phase, and moving into the delay phase, if you recall, moved us into people with symptoms having to self-isolate or contacts of cases having to self-isolate. So that’s the first point.
The second point – which meant that we may not have the staff to run our screening services and screening participants may not be able to attend.
The second point was, with the Minister for Health and Social Services’ announcement on 13 March, it meant that the re-profiling of NHS services took place pretty much with immediate effect. Now, many of our screening programmes, we commission services from the NHS to deliver elements of those pathways, which ceased at that point. So that was the reason why, unfortunately, we had to suspend screening services.
Counsel Inquiry: Do you think that any of the delays that we have just covered had an impact on the response to the pandemic?
Dr Tracey Cooper: I think the microbiology – there was a natural cons – flow to that, which travelled through the course of the pandemic. I think though with health protection, I – when we moved into the health protection response plan, that made life easier for us because we now had a much more clearly demarcated role.
However, as we were going into a series of other waves and clearly – our – the scaling up of keeping on top of outbreaks and surveillance meant that we had to expand. And also at that time, if you’ve seen the cover letter, we knew that Covid had such a significant harm on the broader population health that we needed to be moving to a point where we could reactivate our other non-service related activities, because everybody was mobilised in whole or in part, and so, without additional health protection people to replace others in the organisation who had moved into those roles, we weren’t able to actually start to kick back in on our broader statutory functions around protecting the public.
Counsel Inquiry: Finally on this topic, are you satisfied that the current capacity is such that you are able to scale up resources sufficiently and quickly in the event of another pandemic?
Dr Tracey Cooper: I’m really relieved to be able to say I – we’re in a much better position, and we were actually able to get 122 additional staff into our health protection, the others were vaccination leads. So we’re – I mean, 300 additional staff into health protection microbiology over the last couple of years puts us into a much better position.
Counsel Inquiry: Thank you.
The next topic is the initial period between January and March 2020, and we’re going to be dealing with the details and the chronology of events with Dr Sandifer tomorrow, but there are a few issues that I would like to deal with, with you, please, starting with the Public Health Wales emergency response plan.
It’s right, isn’t it, that on 22 January 2020 Public Health Wales invoked that plan and the response level was set at an enhanced level?
Dr Tracey Cooper: That’s correct.
Counsel Inquiry: If we can display the handbook, please, it’s INQ000056285.
And at pdf page 16, we can see there the Public Health Wales response levels. We’ve just covered that the level that was set on 22 January was at the enhanced level and it says there that an enhanced response is:
“– where … [Document read] … above those provided by normal operational capacity.”
And that type of incident is responded to by a silver group.
Can you help us as to what kinds of incidents may require co-ordination and resources above those provided by normal operational capacity?
Dr Tracey Cooper: Yes, of course. So where we are requiring additional resources into the response to an incident, where we have significant business continuity elements across the organisation such that other parts need to be mobilised in, and where we are being asked such a volume of demand from partners, that actually we need to move into another level of organisation around that.
Counsel Inquiry: Sorry to interrupt, but can you give us examples of the types of incidents where that sort of level of response might be appropriate?
Dr Tracey Cooper: So, for example, if we – during the Ebola virus disease. Now, we fortunately didn’t have a case in Wales but we had a highly probable case in Wales, and we reacted by obviously setting up our incident management team and were ready and prepared that if that had been a case, we would have gone into an enhanced level of response, which includes setting up a gold command.
When we were responding to NATO – so in 2014 NATO came to Newport, and in 2017 we had the UEFA Champions League cup final. So in – during NATO we had our gold equivalent running. We had our silver equivalent running in the preparation and planning for NATO.
Counsel Inquiry: And we can see that a major incident, the scale of the incident response required for that is a more significant mobilisation of resources and a level of strategic response –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – is that right?
Can we look at page 19, please. We can see there that when the enhanced response is activated, that would require notifying the executive, appointing a tactical incident manager, and establishing a silver group.
Would that normally be done at the same time as activating the enhanced level response?
Dr Tracey Cooper: Yes.
Counsel Inquiry: And then for a major incident, you’d appoint a strategic director as well as a tactical incident manager, and you would establish a silver group and a gold group if needed.
Dr Tracey Cooper: And if I could say, under “enhanced”, that’s – obviously that’s also an option of – under our enhanced level, is appointing a strategic director in gold group.
Counsel Inquiry: Just briefly, could you please explain to us the difference between a gold group and a silver group?
Dr Tracey Cooper: Of course. So our gold group is the strategic leadership group of the organisation in responding to an incident, so it sets the objectives, it sets the overall arching(sic) response plan, it considers information coming through and adapts accordingly, and it identifies actions that the organisation needs to take.
The silver group takes that direction from gold and enacts those actions, in essence, so mobilising the organisation, setting up cells or whatever that’s needed.
Counsel Inquiry: Thank you.
Can we go to the previous page, please.
We can see there the escalation from a bronze group up to a silver group up to a gold group within Public Health Wales. To the right-hand side we can see that a strategic co-ordinating group might feed in. Is that a multi-agency –
Dr Tracey Cooper: Yes, we feed into it.
Counsel Inquiry: I think the arrows go both ways.
Dr Tracey Cooper: I know, it’s probably –
Counsel Inquiry: But is that normally led by the police?
Dr Tracey Cooper: It is traditionally, yes, it’s part of the civil contingencies mechanism.
Counsel Inquiry: And the tactical co-ordinating group?
Dr Tracey Cooper: Similarly. So in the same way, if there was a multi-agency incident, like a factory fire, our strategic director would attend the strategic co-ordination group and our tactical or incident director would attend the tactical co-ordinating group as part of local resilience forum mechanism.
Counsel Inquiry: And what’s the Emergency Coordination Centre (Wales)?
Dr Tracey Cooper: So that is the Welsh Government’s units centre that it’s – that it chooses as part of the civil contingencies approach as to whether – when and whether or not it establishes it. Its primary function is to assimilate data from partners across the country, to present that for government, for ministers, but also to be a centre of information to support ministers attending COBR. So it’s – if you like, it’s an intelligence cell that provides some co-ordination of situational awareness.
Counsel Inquiry: So is it the government’s way of nationally co-ordinating a multi-agency –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – response to a major incident?
Dr Tracey Cooper: Yes. And on occasion the ECC(W) may establish a strategic, national strategic co-ordination group itself. So if there was a national power outage, for example, we’d expect a national SCG running out of ECC(W), and so the respective levels would participate in that and would feed information down and feed information back.
Counsel Inquiry: Does Public Health Wales have any say in whether that particular group is set up by the government or not?
Dr Tracey Cooper: No, I mean, we – the decision is that of ministers to establish, if – I think if I’m correct in saying, and that goes through their civil contingencies process.
I think I’m correct in saying that a Category 1 responder can suggest or propose or feed in suggestions around ECC(W) being set up, but the actual decision to establish it is that for government.
Counsel Inquiry: So the enhanced level response internally within Public Health Wales was set up on 22 January, but it’s right, isn’t it, that the silver group wasn’t set up until 28 January? Is there a reason why it wasn’t set up on the same day?
Dr Tracey Cooper: No, I think it was probably more about ascertaining the information and understanding what was happening. What was unusual for us, though, and it’s worth pointing out, is that Quentin and I had the discussion and Quentin became strategic director on the 22nd, and we had our first incident management team –
Counsel Inquiry: I think it may have been the 28th – forgive me for interrupting. I think he was appointed the lead strategic director on 28 January.
Dr Tracey Cooper: No, he was – yeah, sorry, so he was appointed strategic director on 22 January. What happened at the following week is that we added two other members of the executive team so to give some resilience to strategic directors. And just – just for formality, Quentin became the lead strategic director, but he was – he was designated as strategic director on the 22nd.
And then we had the incident management team for the incident on the 23rd, which then helped influence what the resources would be required for silver to mobilise on the 28th. So there wasn’t a delay, it was just the running of the order.
Counsel Inquiry: So you’ve told us that a gold group sets the strategic leadership and objectives in relation to a major incident. Why was the gold group not set up until 25 March?
Dr Tracey Cooper: So –
Counsel Inquiry: Sorry, 25 February.
Dr Tracey Cooper: Yeah. So bearing in mind we’d set up our incident management team and the silver group before we had had any cases in Wales, so we were on a daily incident management teams with the rest of the UK, we were obviously seeing – trying to help support, mobilise the NHS, and more and more information was coming to light, because it was still really – whilst it was very busy, it was still very, very early in understanding coronavirus and the transmission.
And then on 24 February we had a strategic stocktake meeting with the Chief Medical Officer on a Monday, following a meeting that I’d had with our incident director on the Sunday just to say: okay, let’s just take stock here, where are we at in Wales? What’s happening across the world?
We were still yet to have the first case in Wales, which wasn’t until, as you know, the 27th, and it was announced on the 28th, and out of that meeting we said: actually, now is the time for us to set up a – establish a gold group. Which met on the 25th.
That didn’t – that preceding time Quentin, as strategic director, was still directing the response, so I don’t think that there was any disadvantage in us not having that until the 25th. I think it was really more about the timing of escalation of the response.
Counsel Inquiry: Is it right that on 27 February you attended the Welsh Government health and social care leadership meeting?
Dr Tracey Cooper: Yes.
Counsel Inquiry: Am I right in understanding that that didn’t have anything to do with the Covid-19 response?
Dr Tracey Cooper: That’s a Welsh Government meeting, and obviously Welsh Government sets the agenda for that meeting.
Counsel Inquiry: So it wasn’t to do with Covid-19?
Dr Tracey Cooper: Well, the agenda was – the – Covid-19 wasn’t on the agenda to begin with. It subsequently became so because the Chief Medical Officer and I did a session.
Counsel Inquiry: Well, I was going to ask you about your informal meeting during the lunch hour with the director general for Health and Social Services on that day.
You say you shared your concerns with him on that day about the need to scale up services and the importance of preparing and co-ordinating the NHS in Wales for what was to come. First of all, is it right that no minutes were taken of that –
Dr Tracey Cooper: No, it was literally over, grabbing food over lunch.
Counsel Inquiry: Did he appear to you to understand the seriousness and the urgency of what you were explaining to him?
Dr Tracey Cooper: Well, what we shared was pretty sobering. I know that the Chief Medical Officer had been engaging with the director general before that, as had I, with email exchanges. So I’m assuming that the Chief Medical Officer, as Dr Goodall said this morning, would have been keeping him appraised.
We were significantly concerned at that point, and during the meeting we went through where we think – where we thought the NHS needed to be, and then in the afternoon, you’ll see in the agenda, I was talking about something really not important in the context of Covid and so we changed – the Chief Medical Officer and I changed that early afternoon and he and I presented to the group, which comprised chairs and chief executives across the NHS, and shared very sobering facts around where globally, Europe, Italy, Wales were at, and in fact that night was the first case in Wales, and it was very much about “act now”.
Having said that, NHS organisations had already been – we’d been working really, really closely with them up to that, but I think people found it difficult to actually tangibly recognise that this was – this was coming.
Counsel Inquiry: You say there that on the 28th the first case confirmed in Wales was announced. On 2 March 2020 you sent a letter to the Minister for Health and Social Services, Mr Gething, and told him that:
“The organisation continues to be at an enhanced level of response in keeping with the other four nations’ public health agencies … [Document read] … incident and services were being structured accordingly.”
Why didn’t you escalate the response level to major? Why did you feel like you had to keep in keeping with the other nations?
Dr Tracey Cooper: It wasn’t just in keeping with the other nations, but also in keeping with the NHS. So the rhythm that was happening was really more about business continuity than major incident. That letter followed the decision of the board on – and apologies, I think I said the 24th this morning, but it was 28 February, to mobilise the organisation into this, and so really by that time it made no – how – whatever we’d labelled it, we’d mobilised the whole organisation.
So we refused – we reviewed the level, the incident level, every time we had a gold meeting, and there were times where we had really quite big debates about it, and we reached the point – in fact, out of it we provided some more decision-making guidance, because we’d stopped all other services. Whether we’d have declared it as a major incident, which has different connotations for the rest of the country if the public health institute has declared a major incident and others aren’t at the rhythm of that. Regardless of that, that wasn’t the reason why we didn’t do it. We were already behaving as if we were in a major incident, because the whole of the organisation had been mobilised in to responding to Covid.
Counsel Inquiry: Do you think the Welsh Government would have taken it more seriously if you had escalated it to a major incident?
Dr Tracey Cooper: I don’t think our declaration of anything would have, to be honest, made any difference because there was just such a lot of … I mean, whatever one particular organisation had done or declared, I think in the grand scheme of things it was moving so fast, that really wasn’t particularly significant to others.
Ms Jung: Thank you.
My Lady, would that be a convenient time for a break?
Lady Hallett: Yes, certainly.
Ms Jung: And just to confirm that Dr Cooper is the last witness for today.
Lady Hallett: Very well.
I’m sorry we’re going to have to keep you a bit longer, but I promise you we will finish –
The Witness: That’s all right.
Lady Hallett: – your evidence today.
I shall return – perfect timing, Ms Jung – at 3.15.
(3.00 pm)
(A short break)
(3.15 pm)
Ms Jung: Thank you, my Lady.
Dr Cooper, you say in your statement that from the second half of February that the Welsh Government stepped up and that there was a key change of tone from the government to when, not if, and there was a commitment to stepping up and oversight across the system in Wales; is that right?
Dr Tracey Cooper: Yes.
Counsel Inquiry: Do you think that that key change of tone from the government came too late?
Dr Tracey Cooper: I think – bearing in mind by the end of January we were seven days a week as an organisation, many of us. We’d been working really, really closely with the Chief Medical Officer, as I mentioned earlier, in a pincer movement often. And there were some elements that – as I described, of holding on to the NHS and running with them, that perhaps would have benefitted from a little bit more performance management, perhaps, just to help people get a bit faster on some of the areas, notwithstanding the fact that they were helping.
So I think – I think it would have benefitted if there had been more proactive engagement earlier –
Lady Hallett: By ministers?
Dr Tracey Cooper: I’m not – it’s – not necessarily ministers, because I’m not sure they would have – there would have been much that they could have done that would be that much different, but I guess it’s the collective of Welsh Government that … I know the Chief Medical Officer had a small team, and there was a lot of transactions happening, a lot of discussion, lots of meetings, and so to have fortified his team to be able to deal with that, but also perhaps to set the battle rhythm. And I put it as one of my lessons learned in my personal statement that: set the battle rhythm early, you can always stand it down.
So I think it would have benefitted from that. I’m not saying necessarily it was health, I think perhaps more of a civil contingencies engagement earlier, back to the “Get the battle rhythm going, you can always stand it down”.
So I think it would have been beneficial if there had been broader engagement, notwithstanding that the Chief Medical Officer was right in the eye of the storm with us.
Ms Jung: So is it fair to say that the Welsh Government’s delay in mobilising and taking control of a national co-ordinated response deprived Wales of precious time to get ready, equip itself and fortify itself for the pandemic?
Dr Tracey Cooper: I’m not sure of the cause and effect. I think there was a lot happening, the first pressure point was always going to be the NHS and social care, and so we were helping ramp up the capacity, the swabbing capacity, et cetera, with the NHS. So I’m not sure of what – whether – what tangible impact it would have had.
However, I think setting the expectation for planning earlier would have helped, because – and I think I shared with the Inquiry a number of emails that literally within a week the world had changed again. So I think it was more around the planning.
I’m not sure I would say that it was quite the cause and effect that Wales was at a detriment to that, I think it was really about expediting activities and perhaps getting the local authorities involved earlier.
Counsel Inquiry: Could I ask for your personal statement to be displayed, please, that’s INQ000276282, at paragraph 98, page 22, please.
At paragraph 98 you say:
“With the exception of the Chief Medical Officer and his team (with whom we were working closely from the point of becoming aware of Covid-19 in early January 2020), in my view the wider Welsh Government did not appear to fully appreciate the seriousness of the threat of Covid-19 until the middle of February 2020, after which, Welsh Government quickly mobilised from that point.”
Do you stand by that?
Dr Tracey Cooper: Yes, and I think in the preceding or following paragraph there was – there was a lot happening at that time, there was the EU transition happening, there was, you know, some environmental challenges, the flooding in Wales, so certainly the civil contingencies team I’m sure would have been very busy anyway. But, yes. I can’t comment on what was happening within Welsh Government, so I could be doing them a great injustice, but I think for us the main contact really was the Chief Medical Officer and the team. That doesn’t mean to say that other activity was happening in Welsh Government on this and I wasn’t aware of it.
Counsel Inquiry: In your view, did Public Health Wales do enough to make the government understand how serious and urgent the situation was?
Dr Tracey Cooper: I think you can always do more. We did a lot. You know, we were literally, with colleagues, mobilising the NHS, we were putting in place plans to try and – we were trying to be two steps ahead as much as we could in those early days, and, you know, obviously the Chief Medical Officer has his own internal engagements going on within Welsh Government, but, look, you can always say you can do more.
I’m not sure what more we could have done. You know, perhaps a formal letter from me. But I’m not sure it would have made that much difference. And I think for me what was quite an important point was when Dr Goodall came and then the minister came to our offices on 11 and 13 March, and they – when you see half a very large office covered with people with high-viz jackets on, a whole National Contact Centre, whiteboards with, you know, tens and tens of people’s contact initials on, or numbers on, suddenly it becomes tangible. And to be honest, I think what was – the challenge was that people couldn’t – they were distanced from it to an extent, perhaps to not – it wasn’t palpable to them. Yeah.
Counsel Inquiry: Thank you.
Can I move on to another topic, it’s the Seren City exercise that you’ve already referred to, the debrief report is at INQ – oh, thank you, it’s already up.
Can we look at page 2, please. We can see there that this exercise was a strategic multi-agency tabletop exercise held on 3 March 2010(sic), and it was commissioned by you, the chief executive of Public Health Wales, and the Chief Constable of the South Wales Police.
Lady Hallett: 2020.
Ms Jung: 2020, thank you, my Lady.
Why did you commission this exercise?
Dr Tracey Cooper: So, as I mentioned earlier, we were – we were watching the world and we – very quickly in January we had a growing sense of seeing the tracking, what was happening globally, Europe, and as I mentioned earlier what was coming, but until it was here it was difficult to get other people in the mindset that it was coming; back to it not being tangible.
So on 25 February I just thought we need to test a lockdown. That wasn’t due to any other intelligence, I didn’t have any intelligence, no one – it’s just it felt logical for us. We’re an organisation that does quite a lot of exercises, so if there’s something happened like Novichok, within a couple of weeks we had an exercise across Wales around Novichok.
So it seemed logical that, if this panned out into the worst-case scenario, we needed to test something. None of us knew what was going to happen, so … and when I spoke to Matt Jukes, the Chief Constable, the following day and said, “Look, what d’you think?” and he said “Yeah, let’s just do it”. So we had a – people were face-to-face, so it was a face-to-face meeting, so it was really based on try and – hoping it would never happen but just to test something that we hadn’t tested in Wales before.
Counsel Inquiry: Did the exercise conclude that a local lockdown was an effective countermeasure?
Dr Tracey Cooper: The exercise wasn’t really set up to say yea or nay, it was really to test: should we be in that situation, where would the gaps be? And so if you looked at some of the observations and the recommendations, one was, for example, about legislation: did we have the powers, should we be in that situation? What about the public engagement, how would that pan out? So it wasn’t a kind of: is it a good thing or not? It was really just to say: what do we need to start thinking about, should this situation arise?
Counsel Inquiry: One of the recommendations was for the Welsh Government to produce a paper on the key lessons identified in the exercise. Do you know if that was produced?
Dr Tracey Cooper: I don’t know.
Counsel Inquiry: Also specified in the debrief was that guidance on PPE was led by PHE, with input from Public Health Wales. What did Public Health Wales’ input amount to?
Dr Tracey Cooper: It was an ongoing input, so we – one of our incident directors was very closely involved all the way through the pandemic, in fact chaired the national infection prevention and control group, and was involved in the nosocomial national group as well. So we provided public health advice to help – not only to contribute to the UK guidance. So for things like infection prevention and control, it was very much a UK-led on around guidance.
As far as the specifics of PPE is concerned, our involvement was always – we weren’t directly involved in procuring PPE, it was providing advice, which one of the incident directors did through the pandemic, and of course the timing of this, 3 March, very soon after this we were on an exponential experience, so the – the extent to which people took on the actions, I think some of the actions became real.
Counsel Inquiry: Bearing in mind the thinking on lockdown as an NPI had started as early as 3 March, do you think that the first lockdown happened early enough?
Dr Tracey Cooper: Well, this was our “Let’s test something”, it wasn’t intended to be policy, but you – I was here with the – your evidence session with Dr Goodall earlier and when he was talking about contact tracing. So I would say there’s two salient points in March, the point of going from containment to delay on 13 March, and then the lockdown.
So that 12/13 March, ourselves and colleagues across the UK, we didn’t have the capacity to cope with all of the contact tracing. It was exponential as more and more countries were put on it. And also we got to the point where we knew there was now community transmission, which meant something needed to change because the model was not sustainable.
Certainly the signals at that time were that this – we are on, you know, a rapid increase curve here, and if you asked me: do I think the lockdown should have been earlier? I think, yes, it probably should have been. I’m not a technical expert so, you know, colleagues would be able to give far more evidence based on that, but it felt as if – at that point of 12 or 13 March, we ended up escalating a series of meetings with the NHS that night, and we happened to be with the minister the following day because he came to our offices, and then of course the NHS re-profiling happened that evening.
So I think if there was a more natural point, it was probably closer to that –
Counsel Inquiry: Thank you.
Dr Tracey Cooper: – than the 23rd.
Counsel Inquiry: Three days after that exercise was the Newport v Benetton Treviso rugby match.
Dr Tracey Cooper: Yes.
Counsel Inquiry: Dr Williams advised in relation to that that he didn’t think the match needed to be cancelled.
It’s right, isn’t it, that in relation to the Wales v Scotland rugby fixture on 13 March, Public Health Wales’ advice was different?
Dr Tracey Cooper: Yeah, I mean, I think it’s difficult because in around that time SAGE, if I can recall – and obviously we weren’t part of – directly as part of SAGE, but there was an evidence that was a bit equivocal about mass events and the contribution to mass events, and so Chris – that was a week, two days after this – Chris’s advice was based on that SAGE advice.
A lot happened between 5 March and by the time we got to 13 March, and our advice was in a conversation with the minister. As we’d outlined in the statement, it was the day before the match was due to take place. I was with one of my other incident directors, Dr Howe, and the discussion came up, and it was really that on the basis that, even though the event itself – there may not be evidence to support the event itself, the concern really was about transport to, socialising after, and so our – it wasn’t a formal advice, but our recommendation was for them to consider cancelling. At that point, as you know, the decision was still for it to go ahead, and then WRU cancelled it.
Counsel Inquiry: In your view, should mass gatherings have been banned earlier in Wales?
Dr Tracey Cooper: I mean, you know, I’m going to play the technical expert card here because I relied on all of my team through this, so I’m not the person to ask.
My personal view, which is a non-technical view, is it’s difficult, isn’t it, when – we hadn’t moved into the lockdown. So actually at that point, unless you’ve had a case or you were symptomatic, the public weren’t – or if you were in a high-risk environment, whether it’s hospital or care home environment, where you were really feeling it, the general public were or weren’t experiencing – when we went into the lockdown, it took it to another level.
So I think at that time I … I think it would be – if the evidence was equivocal, it was quite difficult to make an arbitrary decision. My personal view, though, is about the behaviours, social behaviours. I think that’s the challenge. Because if you say you can do X and you can’t do Y, and Y is something that’s quite large – but you still have to follow some of the evidence. And I think the story particularly of Covid in the first year was – balance of evidence, it’s not – not everything was clear-cut.
Counsel Inquiry: You said that everything was moving along very quickly and changing. In the next couple of days there was the Wales v Scotland Six Nations rugby match, and also two Stereophonics concerts. It’s right, isn’t it, that Public Health Wales was not asked to advise in relation to those events?
Dr Tracey Cooper: No.
Counsel Inquiry: Do you think it should have been?
Dr Tracey Cooper: We weren’t going out seeking to be asked to advise on them, because, to be honest, we were just so busy ourselves. Well, we were asked around the Newport v Treviso, as you’ve outlined, and we gave – we proffered advice around the Scotland/Wales because it was fortuitous with the minister in the office. But I … yeah, I mean, perhaps it would have been helpful. I’m not sure whether it would have changed the decision, to be honest.
Of course big matches are commercial decisions that aren’t a government decision to be made, and in advance of the lockdown – that changed everything, really. So I think it was – I think it would have been a difficult dynamic for them because there was an order to things, and it wasn’t – perhaps it wasn’t quite the time for them to edict a decision by the WRU, for example.
Counsel Inquiry: Can I ask you about the Public Health Protection Response Plan that you were asked to develop by the government, by the Chief Medical Officer, on 22 April 2020.
The plan recognised, didn’t it, that Wales had had to respond rapidly to the pandemic, and that it had had an unprecedented impact on society as a whole, including that many people had died? It said now was the time to prepare for the next phase of the pandemic, was it an opportunity to pause and reflect and learn from past experiences.
So bearing that in mind, to what extent did that response plan take into consideration indirect harms from Covid-19, including for example on mental well-being?
Dr Tracey Cooper: Yeah, so really a key point. So when we moved into the delay phase, and – sorry, moved into lockdown, it did calm things down for us, and it gave us an opportunity to really take stock. We were already starting to think about the next phase before the Chief Medical Officer asked us – in fact that triggered the question – and we’d already been doing work since April on the broader harm.
So I mentioned the international horizon scanning report. We also had already started a health impact assessment on mental well-being for – on social – sorry, on staying at home, social distancing, which was really starting to look at the impact of the first lockdown, which we’d produced in June; we were doing a health impact assessment on home working and agile working, and we had a series of impact assessments happening, so we already knew that the impact was really going to be exponentially significant.
So when we did the health protection response plan, it – we intended to cover the totality of the population’s health, not solely the response to the pandemic, the infection element of the pandemic, but of course everything’s connected to everything.
So, you know, seen in health protection response plan that we identified elements about the broader harms and then for us as an organisation we then went into rapid plans for us, so stage 1 which was a matter of I think two, three weeks and then a stage 2 and then we changed our operation plan.
They very much focused on the broader harms. And then in August we set up what I called gold 2, which was our population health broader harms group, and we invested £1 million, moved £1 million of internal money to buy in additional capacity to help us fast-track that knowledge around the broader harms for society.
Counsel Inquiry: The plan said that the response to Covid-19 must take into account these wider health and other impacts, but these are not addressed in this plan. Public Health Wales would conduct studies on some of the indirect effects of Covid-19, and it goes on to talk about the survey. A lot of the reports and studies that you talk about and that are exhibited to your statement postdate the publication of the report in May 2020. Are you able to say to what extent those wider health impacts were taken into consideration before the report was published?
Dr Tracey Cooper: By us or –
Counsel Inquiry: Yes, by Public Health –
Dr Tracey Cooper: Yeah, so as I’ve mentioned, you’ve seen our structure, you haven’t shown it, but we have got amazing skills around the table, including world leading experts around the broader harms, health equity, and that’s why we’re a WHO collaborating centre on health equity. So we started that process from April, and that was key for us to not only help rapidly inform Welsh Government’s thinking – and we did a number of themes, we did a health equities theme around the engagement survey, but also we wanted partners to be directly involved in it.
So two things – and I know we’re short of time – after the Public Health Protection Response Plan was produced, we developed an operating framework for NHS and local authorities for its implementation, and then we were subsequently asked by the Welsh Government to give guidance for local prevention and control plans which included a section around taking into account the broader harms, vulnerable people. Our broader harms stuff just continued, we did a lot of work around the broader harms.
We also, really importantly – which we haven’t touched on yet – was the concern around violence against women and domestic sexual violence. So we have two parts of the organisation around adverse childhood experiences and a violence prevention unit that we run with South Wales Police. So already around about May, April/May, we started to do evaluations and surveys around the impact of how children and young people were experiencing violence and adverse childhood experiences, we were doing harm footprint work.
So early on we were looking at what was happening in the broader society.
Counsel Inquiry: In Module 1, Dr Sandifer was taken to the response plan and he accepted that there were only three broad categories of vulnerable people considered in it: those with mobility problems, those with mental health or learning difficulties, and dependents such as children; and he accepted in hindsight that that was not an extensive enough description of who should be considered and categorised as vulnerable.
Do you agree with that?
Dr Tracey Cooper: I do agree with that. In addition I would say that in the detailed text tables about, for example, in the population surveillance there’s quite a detailed breakdown of what’s surveillance. There’s a lot more categories of people, different vulnerable populations included in that as far as our anticipation and intention to broaden our surveillance. But yeah, I absolutely agree with that.
That didn’t mean that we weren’t looking at those different groups, because they – as we’ve talked about earlier, very early on it was clear around the disproportionate impact that was happening. But, yes, the main text I would agree.
Counsel Inquiry: Mr Goodall says, in his fourth statement for this module, that decisions at the start of the Covid-19 pandemic were often made without a formal assessment of the impact on vulnerable people. And in the corporate statement produced by Public Health Wales, it stated that from October 2020 the formal public health advice submissions generally highlighted the need for certain specific at-risk and vulnerable groups to be separately considered targeted or prioritised.
Dr Tracey Cooper: Yes.
Counsel Inquiry: So is it fair to say that prior to October 2020 there wasn’t a sufficient consideration of those people?
Dr Tracey Cooper: I don’t think so, but it probably was manifesting in different ways. So, as I have gone through, we set in train quite a significant – multiple pieces of work to inform decisions around the – so we did – one of the international horizon scanning reports was about the impact on people with disabilities. By the time we got to a vaccination, which is a little bit further, we could look at the impact on people with learning disabilities.
So it didn’t mean that we weren’t looking at it, I think it was – it was a challenge in what data was available as well for us to monitor it, and October – of course before, prior to October, as we discussed earlier, it was a more dispersed process for us in producing advice. So in that October, particularly the 24 October advice note, that allowed us to really central on, you know, short succinct “These are the important things that need to be focused on”, and from that point onwards, really from 12 October, they became very prominent.
Counsel Inquiry: Thank you.
Can I ask you about the advice and guidance provided in relation to care homes –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – and the discharge of patients from hospital.
Can we have a look, please, at INQ000336344. If we look at page 2 of that document, we can see that there is an email, initially, to you stating that there has been contact from a number of care home operators and managers expressing concerns that new residents are not required to be tested for Covid-19 prior to admission, and it says:
“As you are aware, residents in care homes are amongst the most vulnerable … [Document read] … could constitute a significant risk.
“… I would be most grateful if you could advise as to whether … [Document read] … why this will not be the case.”
If we then look at the response from you above that, you say:
“We recognise the challenge for residential care home operators … [Document read] … personal protective equipment by staff.”
You go on to say that:
“New residents, should similarly be assessed for signs or … [Document read] … test new residents prior to admission.”
Now, we know that later Public Health Wales issued guidance which was consistent with that, and then later still the government changed the policy, so that everyone coming out of the hospital was being tested –
Dr Tracey Cooper: Yes.
Counsel Inquiry: – in light of the evidence of asymptomatic transmission.
Do you now accept that your original advice was wrong?
Dr Tracey Cooper: Yeah, it’s – taking it into, I guess, the context at the time, this was before Welsh Government had made decisions around testing in relation to care homes, so there was no policy decision on testing at that point. The reference around testing was that at that point the case definition didn’t include residents in care homes, if you recall, other than people who were symptomatic, and so what was – if someone had a fever or a continuous cough, that was the indication for tests. So the testing world was in a different space, and the other element that was a challenge was that if someone had a negative test, it didn’t mean that they weren’t incubating Covid.
So at this point in time, it was – the move – the world changed significantly as we went through April and into May, and we were – we had about a thousand tests a day, so it was a really challenging time around testing.
Counsel Inquiry: I’m going to ask for one more document to be displayed, please.
It’s INQ000191663.
If we look at the – we can see that this is a PHE care home discussion paper dated 18 April 2020, and the third paragraph, can we see there that it says:
“PHE arranged swabbing of all residents and staff in 6 care homes.
“Results from three … [Document read] … negatives also symptomatic.”
Then below that it says:
“So symptoms poorly predictive of infection (therefore a poor trigger for control measures).”
Did Public Health Wales do any kind of investigation like this by going into care homes and seeing for itself what the rate of positive cases were in symptomatic and asymptomatic cases?
Dr Tracey Cooper: We did further, I think about three or four weeks after this, we did, we looked at a series of care homes that hadn’t had outbreaks and we looked at – when we had more testing capacity or all system testing – all care home testing.
What I would say in relation to this, though, is on 18 April we were – had been routinely testing symptomatic residents in care homes, since we had the tests available, and on 6 April we started testing symptomatic care home workers as part of the critical workers policy, so – because another element of this is about the concern around the spread by staff. So everybody was learning as this was materialising, and this was at the time as well when we were working with Welsh Government to amend the testing policy based on Public Health England’s document on 15 April, which was the adult social care plan in which all residents on discharge would be tested.
So on the 22nd, the policy changed here and I think a letter came out from the Chief Medical Officer and the deputy director general responsible for social care outlining that everyone being discharged would be tested and that there will also be a more prompt response into clusters or incidents in care homes.
So this was quite a critical time that also helped change the Welsh Government testing policy.
Counsel Inquiry: Given that this was such an important group by size, vulnerability and the severity of adverse impact, do you think that that kind of investigation ought to have been done before you were advising that asymptomatic people did not need to be tested?
Dr Tracey Cooper: Well, our – the advice around asymptomatic – the testing of asymptomatic people was advice that was being worked through not only by us but also, as with this, the UK-wide incident management team, and the world was evolving around evidence of – there’s a difference between asymptomatic transmission and someone who has it who is asymptomatic, as you know. So we were learning together on this, and the PHE 6 study, which is what it became known as, it – just because that was England, didn’t mean that we were all learning from that.
So later on in the pandemic, we all did quite a lot of different studies within the countries, but this was just as important to us regardless of which country it had been done, we didn’t necessarily need to fast-track one in Wales to not take this on board, and our challenge was testing capacity.
By the time we got – at this point we had – we’d increased to a couple of thousand, and then in May we were really able to expedite all of testing. So I think on 2 May we did all testing of symptomatic and asymptomatic staff and residents in care homes with a new outbreak. And then two weeks later the same in care homes without an outbreak, because we were concerned – which is back to your question – we were concerned about what was happening in places that hadn’t logged an outbreak that potentially could have transmission that wasn’t being picked up.
Counsel Inquiry: Thank you.
In relation to public health communications, you say in your personal statement that in your view an area that could have been better was in relation to clearer public messaging when there was a clear divergence in restrictions compared to other UK nations.
Can you explain what you meant by –
Dr Tracey Cooper: Yes, I think it was a challenge because regardless of the policy strapline or, you know, the public communication, you’ve also got the media. So in the first few months the UK media tended to default to the decisions that were being made by the UK Government vis-à-vis England. That did improve, and as the months went by they would differentiate, that in – this is what’s happening in Wales, this is what happens in Scotland, Northern Ireland, England, but in the first few months it became really confusing for people.
I think when we – when Wales, when all of the countries started to diverge, particularly coming out of that first lockdown, I think there were a number of occasions where a strapline of a policy created quite a lot of problems in other countries that were still being a bit more cautious. I don’t think there’s any easy answer to solve that.
I think the early engagement with the media is really key because people will tend to default perhaps to the UK rather than the national – so whether there is an opportunity to work more closely with the media at the outset, possibly.
The other elements really was about ensuring – which we worked closely with the Welsh Government on – after a few months, was the behavioural insights messaging. So if you’re going to change your message, you have to perhaps tailor it more to the view of the mood music of the population, and then also further tailor it to different population groups.
So I think there is learning in there for us.
Counsel Inquiry: Thank you.
And finally, on reflection, is there any other learning that you would like to highlight? Is there anything that you think Public Health Wales could have done better?
Dr Tracey Cooper: Oh, I’m sure there’s lots and lots of things that we could have done better. I think the key – three key learning points really. I mentioned – one I mentioned earlier was just get the battle rhythm up and running.
The second I would say is about respective roles and responsibilities, because I think they were muddy for the first few months, and having us all lived through this, I think that has improved. There was a health protection review undertaken that the Chief Medical Officer commissioned that was helpful to that. So I think that’s the second one.
And I think the third one is, you know, very much about the welfare of staff. So for us we spend a lot of time around the welfare and well-being of our staff, and trying to do as much as we can on that. Because, you know, people expect an incident to have a beginning, a middle and an end; this just kept going. And so the sustainability, be it a care home, be it a hospital, be it an organisation like us, yeah, I’m not sure enough has been done to say: okay, well, how do we really, really try and address that? We’ve got more staff now, which is great, but that’s not the same as everywhere.
So I think that’s a – that’s a continued challenge that I think something needs to be factored into what we can do for learning.
Ms Jung: Thank you.
My Lady, those are all my questions. I believe there are some –
Lady Hallett: Thank you very much.
Ms Jung: – questions from core participants.
Lady Hallett: There are.
Ms Shepherd.
Questions From Ms Shepherd
Ms Shepherd: Good afternoon, Dr Cooper. I appear on behalf of Covid-19 Bereaved Families for Justice Cymru, and my question focuses on ventilating indoor spaces and in particular public communications regarding ventilation.
I don’t propose to bring it up on the screen, but in your corporate witness statement you set out some of the public messaging campaigns that Public Health Wales has a role in delivering. These include the wash-your-hands message, the stay-at-home message, and an advertising campaign to encourage pregnant women to get the vaccine.
What’s not on the list is a campaign regarding the importance of ventilation.
Firstly, was Public Health Wales involved in a public messaging campaign about the importance of ventilation as a mitigation against the spread of Covid-19?
Dr Tracey Cooper: I don’t – I can’t recall if we were. Dr Sandifer’s giving evidence tomorrow, so it would be worth asking him. So we may have done, I’m not familiar with it, and we didn’t put it in the statement, so that may have been no.
Ms Shepherd: I just want to provide some context. There’s a document, INQ000220539. Just for context, this is a paper from the Welsh Government, and it just sets out all of the advices that SAGE provided in July of 2020.
At row 39 of that document – I’ll just wait for it to come up. So I don’t know whether it’s possible to get row 39 up, I appreciate it’s an Excel spreadsheet so it’s a bit different. We can see in column – I’ll wait for that to come up.
Dr Tracey Cooper: Yeah.
Ms Shepherd: There we are. We can see in column E, and it’s in bold actually, it sets out that SAGE endorsed the EMG paper on airborne transmission. So EMG, the Environmental Modelling Group, a subgroup of SAGE. In column F, we can see that it’s a document that was entitled “Role of aerosol transmission in Covid-19”, and this was endorsed by SAGE on 23 July.
At this point, Public Health Wales had access to SAGE advice papers; is that right?
Dr Tracey Cooper: Yes.
Ms Shepherd: What’s said is that:
“SAGE noted its findings … [Document read] … good ventilation.”
So if Public Health Wales didn’t get involved in a public messaging campaign about ventilation, are you able to say why not?
Dr Tracey Cooper: Well, we were – we were involved closely in all of the advice around ventilation, but particularly in places like schools, and in fact we spent a lot of time providing support. The campaign – it’s maybe worth just saying that the campaigns originated in two ways.
So a lot of the strapline campaigns, as I would call them, were Welsh Government. We didn’t design them. We further – we disseminated them but they weren’t – they weren’t our campaigns. We did lead on the campaign to encourage pregnant ladies to get vaccinated, but I think it’s a fair – it’s a fair question.
So I guess my answer is: just because we weren’t in – didn’t do a campaign, doesn’t mean we weren’t involved in it. But I think it’s a fair challenge back to say: well, did we think to do one? I wasn’t involved in all of our technical conversations, so Quentin may be able to enlighten further. But I think it’s a fair question, actually, and maybe that’s something that we need to reflect on.
Ms Shepherd: If I could ask one follow-up question: is the reason why it’s a fair question perhaps because, as understanding about airborne transmission evolved, the focus perhaps needed to move away from washing hands towards ventilation? Is that reasonable?
Dr Tracey Cooper: I think it would be both. I think the hand hygiene was always and will always be a prominent aspect of infection prevention and control. Yeah, I think from the ventilation element there was a lot of guidance on it, and of course it was different in different environments. So whilst you can put, you know, clear principles, the actual public health advice would be different depending on the environments. But I think that’s – it’s a fair question, and so I would say it’s both and – and I’ll take it back to the ranch as well and have the conversation about, you know, is that something that we should think about doing, should we be in this situation again.
Ms Shepherd: Thank you very much, Dr Cooper.
Thank you, my Lady.
Lady Hallett: Thank you, Ms Shepherd.
Ms Foubister.
Questions From Ms Foubister
Ms Foubister: Thank you, my Lady.
Good afternoon, Dr Cooper, I represent John’s Campaign and Care Rights UK.
You’ve explained this afternoon and in your statement about the role of Public Health Wales, including to provide advice on the indirect harms of the pandemic on population health and well-being, and that your advice recognised decisions needing to balance considerations which included the wider harms of interventions.
If I could bring up INQ000251938, this is the witness statement of Dr Chris Williams, who I think you’re familiar with, and when we get there I’m going to turn to page 6, paragraph 25.
What Dr Chris Williams states, about halfway down this paragraph, is he refers to the availability of other viewpoints on the wider questions being very helpful in moving beyond a strictly infection focused assessment of harms and benefits.
Do you agree with that, and do you accept that the focus ought also to have included the wider harms caused by restrictions themselves?
Dr Tracey Cooper: If I can clarify your question, do you mean in relation to what we were doing or in relation to what Wales was doing?
Ms Foubister: So do you agree that there was, at least initially, a strictly infection based focus, and do you agree that that ought to have considered the broader harms?
Dr Tracey Cooper: I think – so if I answer for us, that’s probably easiest.
Ms Foubister: Yes.
Dr Tracey Cooper: So I would say January, February, probably the first part of March, it was absolutely about preventing – protecting the public and preventing infection. I mentioned earlier Professor Mark Bellis is one of our former directors, so Mark very early on in the pandemic – he heads a department of WHO collaboration centre – was saying, “You’ve got to start to think about the broader harms”, which is why in April we started doing that work. And so whilst it wasn’t necessarily appearing in our advice, there was a lot of work that we’d put in train because Mark was particularly focused on it, and I think what Chris is also alluding to is that when we’d got into the more formative advice note stages. Mark would be part of those discussions and we would have quite colourful conversations because it was that balance of our health protection saying, you know, “We need to be really restrictive to prevent spread”, and there’s Mark saying, “Well, there’s the mental well-being and the different aspects of the impacts on the population group”.
So that was – I think that’s probably what Chris is saying. But no, in the – I would say in the – in January, February, March our focus was about trying to prevent the spread of the infection, and then from April we really started to increase our work on the broader harms.
Ms Foubister: I’m going to now look at INQ000056334, and this is a Public Health Wales document from 10 March 2021, so the following year, and at page 4, the second paragraph from the bottom – so this was – the document itself was a briefing note to the Minister for Health and Social Services, and the second paragraph from the bottom refers to:
“Further restrictions … [Document read] … benefits and harms of such actions.”
So why was the understanding of the harms caused by Covid-19 measures still, as of this time, so March 2021, not sufficient?
Dr Tracey Cooper: Again, whether it’s a question for us or a question for Wales, I think where by March 2021 I think there was, to be fair to Welsh Government, a – much more of a recognition around the harms in the way that they were making the decisions, then it was the balance of – around restrictions and the order of letting things or releasing things.
I think for us I’m not sure that’ll ever go away as a statement. I think we know before we got into Covid we were facing challenges and the demographics of society, and then obviously since Covid we’ve had the cost of living crisis, we’ve got the conflict in Ukraine and climate change. So they all superimpose on the broader harms, so I don’t think we can ever do enough on that.
But as far as the restrictions are concerned, it was – we obviously moved into a slightly different world from March 2021, and what we were trying to position Welsh Government to is to have a much more structured way of tracking the numbers as well, because we can talk about it but if you can’t measure it, it’s quite challenging. Later in that year we developed a much broader population health dashboard that included all of the proxies into different parts of society –
Ms Foubister: Just focusing specifically on this timeframe and what this Public Health Wales document is saying, what steps were necessary in order to obtain the kind of more sophisticated understanding identified in this document? What kind of concrete things do you think this document is alluding to?
Dr Tracey Cooper: Yeah, I think it’s measurement, and we kind of go on to say it in the document. So at the time there wasn’t one, that we were aware of, centrally held point that was tracking the broader harms, be they about well-being, be they about impact on health services, be they about morbidity. So Welsh Government no doubt – and I’m not close to it – had the socioeconomic tracking, but we weren’t aware of anything that was actually measuring the specific harms around health and well-being.
Now, some of these take years to measure, to be fair, so it’s not an easy thing to do. But our point really was more about, as we said in October 2020 – we said this again, and this followed the meeting with the minister the previous fortnight – that you’d got to start balancing them, and if the October 24th note that we sent was about getting into a different relationship with the public, in recognition of this, and factoring that into the pacing and the order of restrictions.
So this covered quite a few areas, I would say.
Ms Foubister: Thank you.
Just moving to a slightly different topic around communication, you’ve explained today and in your statement about Public Health Wales’ role about ensuring communication, ensuring the consistency (unclear).
If we could bring up document INQ000181725. While it comes up, I’ll tell you what the document is. It’s – the Older People’s Commissioner, Helena Herklots, produced a report called “Care Home Voices: A snapshot of life in care homes in Wales during Covid-19”, and this is a document from June 2020, so fairly early on. And when we get there, I’ll just refer to page 12 of this document and the first paragraph in particular of page 12.
What this paragraph says is that there were:
“A number of responses from care home managers and staff [highlighting] the difficulties … in accessing crucial information and guidance …”
And particularly the second sentence of this paragraph:
“Particular issues were highlighted about the amount of rapidly changing information that care homes were receiving, often from multiple bodies which was often confusing or contradictory.”
Do you accept that there was sometimes confusing guidance that was contradictory and unclear?
Dr Tracey Cooper: I think it was very confusing for care homes insofar as the guidance was changing very, very quickly and sometimes – there was an occasion where a change to policy was announced and none of us knew it was going to be announced. So our call centres were going wild, and we didn’t know it had been – the decision had been made. So it was a – it was a very busy time, particularly for care homes, I would say, around that February, March, April into May. So I would accept that.
Ms Foubister: And specifically on visiting in care homes, do you accept that there were some deficiencies in visiting guidance and, if so, what kind of thing would be needed to ensure that guidance is clear, consistent and comprehensive in relation to visiting?
Dr Tracey Cooper: I’m not – I can’t recall exactly the specifics around visiting, I’m not as close to it. But we did put guidance – I think guidance was circulated in March, middle of March, around really that trying to reduce the ingress of infection, sorry, from different sources but including visiting, and it probably wasn’t until the middle of March, end of March where that changed.
I think there were areas with care homes that I think we could have been clearer, Welsh Government could have been clearer, and I think we should have earlier on, whilst we set up an enclosed setting cell which was – was the only port of support for the care home sector, I think we should have set up settings based meetings earlier so that we could really understand what the – what was materialising on the ground within care homes. That would have been more helpful to have more or less guidance in; it may not have changed the public health advice. So, yeah, I would recognise that.
Ms Foubister: Just on that, was there a member of the team who was responsible for producing guidance who fully understood the needs of people in care? And if there wasn’t, do you think that that would be something that would be helpful going forward?
Dr Tracey Cooper: We had members – we had a lot of members of the team in our enclosed setting cell, because we accelerated it very quickly, we had people who had quite a strong influence – influence; experience around the care home setting. We did engage with particularly Care Inspectorate Wales, but I would absolutely agree with what you’ve said.
I guess what I’m alluding to is not just in care homes but, having reflected a lot on this, we were working with partners but were – but I think if we were to run this again, I think we should have that settings based, real lived experience people involved early on in the development of guidance. As I say, it may not have changed, it may not change the public health evidence, but I thought this was a really powerful document, by the way, and having read a lot from colleagues in care homes the reality of: well, if you say to do X, do you realise how challenging that is?
And then I guess my final point on this is all the experience that care homes now have around infection prevention and control, it’s how do we help retain and support that for people?
Ms Foubister: Last week we heard from Stephanie Howarth, the Chief Statistician, and she confirmed that the Knowledge and Analytical Services only became involved in data collection analysis after the early stage of the pandemic and that if they had been asked to advise earlier on, they could have avoided various errors and misreporting. Why didn’t Public Health Wales ask KAS to assist at the outset of the pandemic?
Dr Tracey Cooper: We were just exponentially increasing our requests to meet the demands from a data perspective from Welsh Government. I guess – I guess the question is they could have offered, you know, it’s a bit of a two-way, I would suggest. We were working really closely with the Chief Scientific Officer for Health, with the NHS delivery group who were looking at the activity data for the NHS, who we tend to have those connections with. We had worked less so with the knowledge and advisory service, if I’m saying that correct.
So if we’d – perhaps if we’d had a stronger relationship with them, we would have thought to do it. I did see the Chief Statistician for Health’s evidence and the – part of the challenge, the flip side – so if we’d have thought, we’d have done it, but also it would’ve been nice for them to offer. I think it was probably incumbent on both parts.
But the challenge, though, is data’s only as good as it being populated at source, and we had some real challenges on that for health and social care, so –
Ms Foubister: Understood.
Dr Tracey Cooper: – there’s some human behaviours in there.
Ms Foubister: I’ll just move on, because I’ve got one final question and I’m conscious of the time.
Last week, again, we heard from Dr Chris Williams and he said that he was aware that asymptomatic transmission could be as great as 40%, and this is following the Diamond Princess cruise ship data, and he said he couldn’t recall whether he told the Welsh Government but his main role was to keep Public Health Wales updated.
Were you aware, was Public Health Wales told about Dr Williams’ awareness of possible asymptomatic transmission in late February and, if so, what steps were taken by Public Health Wales in relation to that?
Dr Tracey Cooper: Yeah, again, I think Quentin would be closer to it. I wasn’t part of the incident management team. I can’t imagine Chris wouldn’t have shared that, I would have thought, because we’re – everyone shares the evidence because it would be – you know, there’s a duty to. I would have thought – although I didn’t attend the incident management team, which was a national incident management team – that, not just this but anything that came through, there’d have been a discussion at various times, because it was an evolving picture around asymptomatic transmission, that that would have been discussed and debated at the incident management team; and any other further evidence that came through, I would have thought that would have been debated there.
Ms Foubister: Thank you.
Thank you, my Lady.
Lady Hallett: Thank you very much indeed.
Ms Jung, that completes the evidence for today?
Ms Jung: It does, my Lady.
Lady Hallett: Thank you very much indeed, Dr Cooper, very grateful.
I’m afraid I’m not sure I can give you a guarantee that you won’t be asked to help again. I’ll try to limit it. I do understand the impositions that asking people to give evidence makes upon them, apart from anything else providing the statements and things, but we’re very conscious of it and will only call on your help if we need it.
So thank you for what you’ve done so far.
The Witness: Of course. Thank you.
(The witness withdrew)
Lady Hallett: 10 o’clock tomorrow, please.
(4.12 pm)
(The hearing adjourned until 10 am on Wednesday, 6 March 2024)