Transcript of Module 2C Public Hearing on 7 May 2024.
(10.00 am)
Lady Hallett: Good morning.
Ms Dobbin: Good morning. My Lady, please may I call the
first witness for today, please, Mr Pengelly.
1. Mr Richard Pengelly
MR RICHARD PENGELLY (sworn).
Questions From Lead Counsel to the Inquiry for Module 2C
Lady Hallett: Ms Dobbin.
Ms Dobbin: Thank you.
Can I ask you to give your full name to the Inquiry,
please.
Mr Richard Pengelly: It’s Richard Pengelly.
Lead 2C: Mr Pengelly, I think you have a witness statement in
front of you, I think it comes to about 113 pages, and
that you’ve signed that statement at the very end. Is
that correct?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: Are you content that that witness statement is true to
the best of your knowledge and belief?
Mr Richard Pengelly: I am, yes.
Lead 2C: Thank you.
Mr Pengelly, I think it’s right that you became the
permanent secretary to the Department of Health in
Northern Ireland in 2014?
Mr Richard Pengelly: Yes, July 2014.
Lead 2C: I think that you then moved posts to become the permanent secretary to the Department of Justice in 2022; is that right?
Mr Richard Pengelly: April 2022. And then subsequently, three weeks ago, I’ve moved again to become chief executive of the Education Authority in Northern Ireland.
Lead 2C: I didn’t know that, so thank you very much.
I think it’s right, then, that your tenure at the Department of Health lasted some eight years and spanned periods of time when power-sharing arrangements were both extant or suspended; is that right?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: Just in terms of the role of the permanent secretary to the Department of Health in Northern Ireland and what that encompasses, is it right to characterise it as essentially tripartite, in that, first of all, you obviously have the statutory responsibilities of leading that department and ensuring that it fulfils its statutory obligations? Is that right?
Mr Richard Pengelly: Yes, but just with the caveat that I would be leading the department subject to the direction and control of a minister when in place.
Lead 2C: Yes, of course. And I think that –
Lady Hallett: Mr Pengelly, I’m sorry to interrupt – I’m sorry, Ms Dobbin – you slightly drop your voice in the
middle –
Mr Richard Pengelly: I’m sorry.
Lady Hallett: It’s just you’re softly spoken, not a bad
thing, but we need to, all, hear everything you say.
Thank you.
Ms Dobbin: Then the other very distinct part of your role
was that you were the chief executive of the health and
social care services as well. Is that also correct, or
the right way to characterise it?
Mr Richard Pengelly: That’s correct, but just by way of explanation, unlike
the position in England where the National Health
Service has a legal entity, what we call HSC in
Northern Ireland, the health and social care system,
it’s a number of individual organisations, there isn’t
the individual legal entity. So I’m chief executive –
it’s a sort of virtual chief executive post, if that
makes sense.
Lead 2C: All right. Just so we’re clear about this, and I will
ask you about it in a bit more detail as we go through
your evidence, but, first of all, I think it’s right
that within the Department of Health in
Northern Ireland, it’s essentially an umbrella for
a number of social care services as well; is that right?
Mr Richard Pengelly: Yes, our five regional, what we call health and social
care trusts will provide both healthcare and commission social care on behalf of the population.
Lead 2C: Can you just help me with whether or not the department also then had responsibility for other social care services, for example like social work, so adult social services and children’s social services as well?
Mr Richard Pengelly: Yes, the department would hold the policy remit for all social services, and that would be delivered through what we call arm’s length bodies, like the health and social care trusts, but the – so one of my senior colleagues would have been the chief social services officer, he’s a professional social worker by background and would act as the head of profession for the social work profession across the public sector.
Lead 2C: Nonetheless, in terms of the nexus between you and those organisations, you are – nonetheless you remained the permanent secretary with oversight –
Mr Richard Pengelly: Yes.
Lead 2C: – of all of that full gamut, as it were, of social services as well?
Mr Richard Pengelly: Yes, that’s right.
Lead 2C: Then the other part of your role was that much more akin to what might be expected of a permanent secretary in that you were the principal policy adviser as well to the minister; is that also correct?
Mr Richard Pengelly: That is, yes.
Lead 2C: And obviously during the pandemic that was Minister Swann; yes?
Mr Richard Pengelly: Yes.
Lead 2C: What you’ve said in your statement – and, sorry, I’m just going back, if I may, to the period before January 2020 – that in that period of time between 2017 and 2020, that you exercised your functions in accordance with section 3 of the Northern Ireland (Executive Formation and Exercise of Functions) Act 2018; is that –
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: We haven’t touched upon that Act yet in the Inquiry, but I think it’s right that that was enacted so as to give senior officials like you further powers in the event that power-sharing was suspended; is that right?
Mr Richard Pengelly: Yes, essentially it gave permanent secretaries the power to take decisions that would normally have been taken by ministers, but we wouldn’t have created the new policy or departed from a policy set by previous ministers. So it was the sort of operational decisions that would normally go to a minister but within a fixed policy environment.
Lead 2C: I think that broadly the Act gave you a power to discharge functions in the public interest; is that correct?
Mr Richard Pengelly: Yes, any time we exercised the power or a decision-making power that would have previously gone to ministers, it was a public interest test had to be applied.
Lead 2C: What was the limit, then, on that power, that said you couldn’t, for example, enact new policy or take decisions that, for example, might be controversial?
Mr Richard Pengelly: The key element was the public interest test. It was a rule of thumb that we couldn’t get into new policy because policy really is the preserve of elected representatives, but it was taking decisions. So maybe it best to illustrate by way of some examples. New and emerging drugs, even very high cost drugs that come on the market that normally would be for a minister to decide: does the cost justify the benefit? So I would have taken decisions about commissioning new drugs. I suspect we’ll come on to the transformation agenda, but some decisions within the transformation agenda too.
Lead 2C: All right. It’s really just trying to understand what the limits of your powers were, because as the Act puts it in terms of the public interest, so would you have received advice, then, on an ongoing basis as to the extent to which you could enact new – well, let me – I’m jumping ahead. Could you in fact enact new legislation during the period of suspension, or was that something that –
Mr Richard Pengelly: We didn’t do legislation. Typically if colleagues were putting forward advice that would normally have gone to a minister, that would come to me for a decision, but it would include the addition of a public interest test that weighed up the pros and cons from the public perspective of either taking or not taking the decision. There was, again, a general rule of thumb that if the decision could await the return of ministers, it should wait, so there had really to be a pressing nature associated with the decision, but fundamentally was it in the public interest to take this decision, or sometimes is it in the public interest to not, because not taking a decision is in itself a decision.
Lead 2C: Yes, I understand.
Just in terms of that idea as to whether or not a decision could await a minister coming back, how – that must be quite difficult to judge if you have no idea whether or not power-sharing will be resumed within a given period of time?
Mr Richard Pengelly: It is, and so certain decisions would have been subject to regular review, because at various times the mood music was political talks were reaching the point where, you know, there was the prospect of a return. In those cases a decision was becoming urgent, we might think we can pause for a couple of weeks but if it hasn’t – if the ministers haven’t returned within a couple of weeks, at that stage we might have to take the decision.
Lead 2C: All right. We’ll come back, because obviously I’m asking you this because it relates very much to health services and the need for reform in Northern Ireland before 2020. I’ll come back to that, if I may.
I just wanted to touch on another very distinct aspect, as you’ve said, about Northern Ireland services which is the integration of health and social care services. Again, if I can just make sure I’ve understood it properly, that arises in the conventional sense of having integrated services in that the Department of Health oversaw primary care, hospital care, other specialist health services; correct?
Mr Richard Pengelly: Yes.
Lead 2C: But then also had responsibility and oversight of things like care homes and nursing homes as well?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: And then, as we’ve said, all of the full range of other Social Services –
Mr Richard Pengelly: Yes.
Lead 2C: – as well.
The benefit of that, as it might be understood, is that when you have oversight of the whole system, you’re able, for example, to foresee where there are weaknesses, for example, in social care –
Mr Richard Pengelly: Yeah.
Lead 2C: – and how that impacts then on health services; is that right?
Mr Richard Pengelly: Yes. It also – I’m at the risk of jumping ahead. When we get into the issue of care homes during the pandemic, the integrated nature would have been very helpful, but we may come on to that in a bit more detail later.
Lead 2C: Yes.
Mr Richard Pengelly: It also allows health and social care trusts to take a broader population assessment. One of the big issues in the provision of healthcare through emergency departments is what’s called the back door of the hospital. We tend to get queues at the front door where people come to emergency departments and we have the four-hour and 12-hour waits. The back door of the emergency department is where people can be admitted into the hospital.
Lead 2C: Yes.
Mr Richard Pengelly: But creating space in a hospital sometimes requires the discharge of patients from hospital into the community, so the oversight of care and residential homes by an integrated health and social care trust can smooth that path too and try to assist. We haven’t been spectacularly successful given the wider pressures on our system, which again we may touch on later.
Lead 2C: I am going to back to that, because I think it’s important to make clear, so, for example, the concept of bed blocking ought in theory, in an integrated system, to be something that’s much easier to overcome, because you understand where there’s capacity in the social care system; correct?
Mr Richard Pengelly: Yes, and I think the practical outworking is we certainly have better transparency about the issue but sometimes having the levers to actually reach into a care home and create the space and there is an issue too about personal choice. Space sometimes arises in a care home that would make visiting by the family, for example, very difficult, so issues still remain that are common to both an integrated and a non-integrated system.
Lead 2C: I think in fact when we look at the Bengoa report in 2016, effectively – and I’m summarising – he said that any – that any integration was more illusory than real. Is that a fair way to summarise it?
Mr Richard Pengelly: I think that’s very fair, and certainly if I cast my mind back to the latter part of 2014 and 2015, at times I made the comment to senior colleagues that I noticed quite often in Northern Ireland we wore it as a badge of pride that uniquely we had an integrated system. At times I struggled to see the real manifestation of that in terms of tangible benefits for patients. So I think that’s a very fair assessment by Bengoa.
Lead 2C: All right. So certainly this Inquiry shouldn’t proceed on the basis that when it came to responding to the pandemic, that Northern Ireland by virtue of its integrated system was in a better position than other parts of the United Kingdom?
Mr Richard Pengelly: I think if we take the holistic view of the provision of health and social care, given other pressures, I don’t think we were in a markedly better position, but if I look at the specific issue of the relationship with care homes, particularly for issues like the provision of PPE and the – some considerable hours of nursing time were made available into residential and care homes by trusts because of the long-standing relationship that existed. So there were very, very practical benefits that flowed from the integrated nature of our system.
Lead 2C: All right, we’ll come back and look at care homes in slightly more detail, but just understanding the pressures then that existed in terms of health services in Northern Ireland – I will come to the Bengoa report in a little more detail – but I think it’s right that one of the principal issues that were affecting Northern Ireland was the sheer length of its waiting lists –
Mr Richard Pengelly: Yes.
Lead 2C: – and the lengths of time that people were waiting for elective care as well; is that right?
Mr Richard Pengelly: That’s right, and maybe just a little bit of background, the timeline and that. If we go back to about 2013, the position in Northern Ireland was pretty much in equilibrium. There weren’t outrageously long waiting lists either in terms of numbers waiting or the length of time that individuals had been waiting. But it’s important to understand that that position had been reached by what we call waiting list initiatives. That was – so there was a misalignment between the capacity of the system and the demands that were being placed on the system, but that mismatch was being met through one-off money that was provided through what’s called the in-year monitoring process, where the Executive in the course of a financial year finds itself a certain – say another sector doesn’t spend a bit of money that they’d planned to spend, that would come back to the Executive for reallocation. Back in 2013, and the year or two before it, a lot of that money would have been routinely reallocated in health service, who would have purchased waiting list initiatives from the independent sector, and that’s what kept the waiting list position in equilibrium.
Lead 2C: Okay.
Mr Richard Pengelly: As we moved into 2014, the financial position changed. That additional in-year money was no longer available and you can track the escalation of waiting lists from 2013 onwards through to about 2020.
Lead 2C: Yes, because I think in your witness statement you say, I think, the waiting lists in Northern Ireland pre-2005 were in fact the longest in the UK, the situation improved until 2013 –
Mr Richard Pengelly: Yes.
Lead 2C: – but then steadily deteriorated after 2013, and I think what you’ve said in paragraph 37 of your statement and what you have cited, but I want to make sure that you agree with it, that in terms of evidence that was put before Northern Ireland Affairs Committee it was said that Northern Ireland currently – and, sorry, I should say this was in 2018 to 2019 – Northern Ireland currently has the worst performing health service in the UK, with none of the waiting list targets currently being met.
Mr Richard Pengelly: I think from memory that the statement about “worst performing in the UK” was, I think, made by the BMA at that stage. Certainly numerically none of our targets were being met, but the qualitative assessment in terms of how that stood in comparison to other parts of the UK I think was a more subjective judgement, because some of the waiting lists are articulated slightly differently, but, I mean, the BMA is a respected organisation and there they are, it’s a professional perspective.
Lead 2C: Well, I wanted to check, because you cited it in your witness statement, and I wanted to understand the extent to which you were citing it, because it was evidence that – or information that you accepted. But if I can just take the objective evidence in terms of whether or not Northern Ireland had the worst waiting lists as compared to the United Kingdom, was that correct in 2018 to 2019?
Mr Richard Pengelly: Yes, our numbers were higher, but, as I say, some of the waiting list targets are articulated slightly differently, so it’s more of a subjective comparison as opposed to everyone using exactly identical metrics. But I wouldn’t argue that we were in a markedly better position than anyone else. I certainly wouldn’t push back the assessment that, you know, we were the poorest performing region of the UK.
Lead 2C: I think that the statistics, and again you’ve set this out in your statement, was that, at that time, the waiting lists were 400,550 people. That’s out of a population of 1.9 million people. So before the pandemic that looks very high?
Mr Richard Pengelly: It is. But just the one caveat to that is some individuals will be on more than one waiting list, you know, if they have a couple of different conditions. So it’s not that if you’ve lined up the full population, 400,000 of them would be on a waiting list. There was 400,000 waits.
Lead 2C: I understand.
Mr Richard Pengelly: And that will be similar for other jurisdictions. So it’s not saying that it alters the comparison.
Lead 2C: And I think that the statistics then, and again perhaps this isn’t surprising, but those statistics have gotten worse since the pandemic as well?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: So that there’s now over – it’s over half a million waits, as you have characterised it.
Just in – so we understand, then, the position from 2013 got progressively worse in terms of waiting times, but in terms, then, of your ability to address those issues during the period of suspension, I think what you’ve set out in your statement was there was a limited ability to undertake the radical transformation that would have been required; is that correct?
Mr Richard Pengelly: Yes, there’s – the position, there’s a nuance to the position in terms of the period 2017 to 2020. There is a narrative that exists in the community that, for those three years – the Executive agreed – the Bengoa report was published I think in about October 2016 –
Lead 2C: Yes.
Mr Richard Pengelly: – and then that became an input into the health minister developing the Delivering Together transformation strategy, which was a ten-year transformation strategy, which was then taken to the Executive and it received Executive agreement.
There is a narrative that that then sat on the shelf gathering dust for three years while there were no ministers. The reality is that document at the point of agreement set out 18 actions – the first wave of actions, there were 18 actions. Prior to the return of ministers, all 18 actions had been delivered, so we were able to progress.
What didn’t happen was the development and evolution of the next set of actions. The advantage we had – and we touched earlier that in the absence of ministers we couldn’t create new policy – through a quirk of timing, prior to the collapse of the Executive we had cross-party agreement to a new Delivering Together transformation strategy, so that allowed me the framework to take decisions that, in the absence of that strategy, I wouldn’t have been able to take.
So some work was taken forward, but – for example, some of that work would have been consultation on a new model of stroke care, we undertook that work – we couldn’t take it to the next stage, which would be decisions as regards what a new model of stroke provision would look like.
So it’s just that nuance that some work progressed but not all the work we would have like to progress had ministers been in place.
Lead 2C: So I think there’s two points that you make in your statement. I think the first one is the budgetary constraints that you operated under during that period because of the absence of power-sharing. So there wasn’t – I think is this right, you had to operate under one-year budgets; is that correct?
Mr Richard Pengelly: One-year budgets, but also in the position that we weren’t actually getting confirmation of our budget until quite late in each financial year, which makes financial planning even more difficult than just a one-year budget on its own. So that was a very, very challenging financial position.
Lead 2C: Then I think the second point, which is related to the evidence you’ve given, that you were able to take reforms so far –
Mr Richard Pengelly: Yes.
Lead 2C: – that the radical reform did require the –
Mr Richard Pengelly: Yes.
Lead 2C: – authority of ministers –
Mr Richard Pengelly: It did.
Lead 2C: – in order to take it one step further.
The reason I’m asking you all of this, Mr Pengelly, is obviously the question of the extent to which the fragility of the health service impacted on the response the pandemic thereafter, so after January 2020, is important.
Can I ask for your view on that and the extent to which it may have conditioned the response –
Mr Richard Pengelly: Yes.
Lead 2C: – of what ministers were able to do?
Mr Richard Pengelly: I think there are two very clear dimensions: there’s the system and there’s the people in the system.
The system was, whatever language I choose, certainly suboptimal. The structure of our system wasn’t, and isn’t yet, right for the services we’re trying to provide to the population of Northern Ireland. And reform at that stage, the reform programme, was focusing on reconfiguration of services in many cases. So that didn’t happen.
So we certainly entered – we entered the pandemic with a configuration of services that wasn’t as good as it could have been. I think had an Executive been in place for three years it wouldn’t have been perfect but it would have been better than it was at the point we entered the pandemic.
The other big point to make in terms of people, the first number of years that I was in health, if we look at emergency department activity as a real measure of the temperature of the health system, and four-hour breaches and 12-hour breaches, people waiting longer than 12 hours for admission or discharge, in the early years of my tenure, there was a real seasonality to that, that we had extreme winter pressures, and then from about the spring through to the autumn the system fell back into a good state. The important bit of that was it meant that staff across the system, particularly in emergency departments but throughout the system, they actually got some meaningful downtime and some respite.
By the time we entered the pandemic, as a combination culmination of the growing pressures in the system flowing from an ageing population, the lack of transformation, there is virtually no discernible seasonality, particularly in emergency departments, now. 12-hour breaches are a manifestation every month.
So we entered the pandemic with a very, very tired workforce. Up to the point of the pandemic the continual provision of high quality health and social care was reliant on the goodwill of staff. That is still the case.
But that is not a finite well of goodwill, and people are tired. They have been going above and beyond. And I certainly would not tolerate any criticism of staff in our health and social care system for the way they performed, but it’s important to make the point that they entered the pandemic with a degree of fatigue flowing from the state of health and social care.
Lead 2C: Is it correct that you actually had real workforce pressures in any event, for example because of shortages in staff across both hospitals and social care as well?
Mr Richard Pengelly: Yes, we were carrying large numbers of vacancies. And at the tail end, towards the end of 2019, there was industrial action from our nursing colleagues in terms of the pay position. That – that was part of a vicious circle, leading to more vacancies with our nursing colleagues, because other jurisdictions were more attractive to them as a proposition to work in. So – and that was true too of medical colleagues. So there were vacancies flowing from both the pay system and from workload pressures, which just compounded the problem.
Lead 2C: All right. So just in terms of coming into the pandemic then and that issue of how the response might have been conditioned, would it be right to characterise health services in Northern Ireland in January 2020 as being extremely fragile or is that putting it too high?
Mr Richard Pengelly: I don’t think it’s putting it too high. I think we were in a very difficult space, because – you’ve mentioned that the figure in and around that time of waits was in excess of 400,000, we were routinely missing the 12-hour targets for emergency department, red flag targets were being missed. So it was a service that was under intense pressure, and the pressure was growing on a daily basis, notwithstanding what was coming through Covid. So I think to describe it as fragile is entirely legitimate.
Lead 2C: Did it also mean, then, and I know this might be taken as read but it might nonetheless be important to say it, that there were a large number of people with unaddressed health needs as well in Northern Ireland?
Mr Richard Pengelly: I think that’s fair, given the numbers waiting, yes.
Lead 2C: So did that mean, at the start of the pandemic, obviously, when there was – and we’ll come to look at the specifics of this – obviously when there were concerns about health services being overwhelmed, was that concern particularly acute in Northern Ireland, given the fragility of the health service; in other words that there was very little capacity in Northern Ireland to shoulder the burden of the oncoming pandemic?
Mr Richard Pengelly: Yeah, I think that’s fair. And again, the two components to it – the typical metric for hospital capacity is that ideally a hospital should run at no more than about 85% capacity, to create a bit of churn in the system. I think all our hospitals were routinely running well in excess of 85%. But that’s, again, with the workforce condition and the number of vacancies and the tired workforce. So I think all those issues contributed to the service not being as resilient as it otherwise would have been had other changes been in place.
Lead 2C: All right. So just, if I may, then move on to the beginning of the pandemic and the burgeoning awareness of it in Northern Ireland. I think we know, and I won’t take you to your statement about this, that within the Department of Health a silver command was set up on 22 January 2020.
Mr Richard Pengelly: That was silver command for – it wasn’t within the department, that was the wider health and social care system. I think that was led by colleagues in Health and Social Care Board and the Public Health Agency.
Lead 2C: Yes, sorry, it’s probably important that I establish this first. I understand that that was – that’s an operational response –
Mr Richard Pengelly: Yes –
Lead 2C: – is that correct?
Mr Richard Pengelly: – that’s right.
Lead 2C: Did you have a role in instituting that or saying “This is the right time to stand up” –
Mr Richard Pengelly: The decision would have been taken at the Health and Social Care Board and PHA, but departmental colleagues, particularly in the Chief Medical Officers’ group, would have been in constant dialogue with colleagues in those organisations about that decision.
Lead 2C: Before we move on to that group, it’s probably important just to establish that in terms of the management of the Department of Health, the CMO in Northern Ireland is actually part of the top management team; is that correct?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: So he is part and parcel of the management structure of the department in terms of its day-to-day work; is that correct?
Mr Richard Pengelly: That’s right, yes.
Lead 2C: So he isn’t an independent adviser like Professor Sir Chris Whitty is, he doesn’t have an independent role within government, for example?
Mr Richard Pengelly: It’s not independent, but his professional advice is independent, it’s not subject to any form of oversight by the likes of myself or the ministers, but he provides independent medical advice. He also – he holds a policy remit as well, but the CMO advice has an independent aspect to it, if I’m making that clear.
Lead 2C: So, again, to be clear, from your perspective as permanent secretary, he is there to provide advice, so in the conventional sense –
Mr Richard Pengelly: Yes.
Lead 2C: – of a medical adviser or –
Mr Richard Pengelly: Yes.
Lead 2C: – a CMO, but separate to that is also part of the management structure?
Mr Richard Pengelly: Yes, that’s correct.
Lead 2C: And within the management structure, then, what is the remit of the CMO?
Mr Richard Pengelly: It’s broader healthcare. There’s areas of healthcare policy. The CMO would have been the senior sponsor for the Public Health Agency, and the public health dimension in there. He would have input into other policy areas that other senior colleagues were working on. So quite – he’d also senior oversight of RQIA, which is the regulator for Health and Social Care.
Lead 2C: All right. We’ll come back probably and touch on all those different points.
But just coming back, then, to the standing of the silver command, so did that take place independently of you, you weren’t involved in that decision?
Mr Richard Pengelly: I wasn’t involved in that decision.
Lead 2C: Do you know what prompted that decision to be made?
Mr Richard Pengelly: It was – I think it was prompted by the request for the development and evolution of surge plans because of the awareness of the growing threat of the Covid as maturing into a pandemic, the dialogue from the Chief Medical Officers’ group with colleagues, and both the board and the PHA.
Lead 2C: At that point in time, is that an understanding that you would have shared then?
Mr Richard Pengelly: Yes, yes.
Lead 2C: All right, and I think we can see, and perhaps if we bring this up on screen, please, this is INQ000308458, please, and if we could go to page 12.
In terms of the risk presented to Northern Ireland by travel, and specifically from Wuhan itself, I think this demonstrates that on 25 January in fact Northern Ireland had a number of visitors from there, I think there was a coach of people; yes?
Mr Richard Pengelly: Yes, that’s right.
Lead 2C: So I think we can see that the PHA were despatched to go and provide advice?
Mr Richard Pengelly: Yes, I think – and I think I remember the conversation that, you know, in the absence of any other legislative mechanism, there was no further intervention that could happen at that stage as distinct from any – there wasn’t a professional view(?) about what was needed, but colleagues from the public health side of PHA went and provided advice to the group. I think they were – they arrived off the boat late in the evening, checked into a hotel, and were up very early the next morning and on the bus on the road to Dublin, so it wasn’t a long stay.
Lead 2C: I think we can see from your messages that it’s right in fact that no-one had any power –
Mr Richard Pengelly: No.
Lead 2C: – to do anything about the visitors because in fact they were – they reported that they were asymptomatic –
Mr Richard Pengelly: Yes.
Lead 2C: – so there was nothing more to be done, and I think the visitors then made their way to the Republic of Ireland.
Mr Richard Pengelly: I believe I’m right in saying that one of the conversations I had was when PHA colleagues were calling to give them some advice, the question: what would happen if our colleague noticed that one or more of them was symptomatic? That turned out not to be the case, so they had reported themselves as being asymptomatic, and I think that was confirmed, to the best of my recollection, by the colleague who called with them.
Lead 2C: But nonetheless any idea that this pandemic was something happening on the other side of the world –
Mr Richard Pengelly: Yes.
Lead 2C: – and presented no threat to Northern Ireland was very clearly dispelled –
Mr Richard Pengelly: Yes.
Lead 2C: – at this point in time.
We know, and the Inquiry has seen, that on 25 January there was an email from Professor Woolhouse, and that the Northern Ireland CMO was a recipient of it, setting out concerns about modelling done in Scotland and about the potential overwhelming of the Scottish medical system.
Was that information about which you were aware at the time, or did you understand that to be a concern at that point?
Mr Richard Pengelly: I understood it to be a concern, even at that stage, at the end of January.
Lead 2C: Yes.
Mr Richard Pengelly: But it – and colleagues were always very careful to point out this wasn’t a prediction, it was scenario planning at that stage, but that was certainly one of the causes for concern, that that was a possible trajectory that we were embarking on.
Lead 2C: We’ll come to that issue of prediction versus scenario, I think, as we go through your evidence. But just coming back again to the information that was known about that time, we also know that on 28 January Professor Whitty sent an email to Downing Street about the two scenarios that he foresaw might play out, either that China would control – there would be a large outbreak, but China would control the outbreak, or the reasonable worst-case scenario which was that there would be a large outbreak and China wouldn’t be able to control it.
Again, was that something that you were familiar with, or did you have that understanding at the end of January?
Mr Richard Pengelly: I can’t recall specifically seeing the text of the email, but I do recall, and dialogue with the Chief Medical Officer at the time, that that was the sort of message he was conveying to us, that – of those two available scenarios, and the latter more concerning scenario about overwhelming of the service.
Lead 2C: All right, and I think in fact we can see that from WhatsApp messages that we’ve looked at already in the Inquiry.
And perhaps if we could go to this, please, INQ000308436, and it’s the last entry on page 2.
I think this is the message to you from Sir David Sterling effectively, I think, the main part of it being that the message that was being conveyed to Northern Ireland officials was that China had lost control.
Mr Richard Pengelly: Yep.
Lead 2C: And I think if we go over the page, that was a message that you had received as well.
Mr Richard Pengelly: Yep.
Lead 2C: We see your response at the top. I won’t read all of it out, but:
“At one level, very worrying, although at peak time here will present ‘only’ …”
You have put that in parenthesis:
“… as bad flu as opposed to anything more sinister.”
And then you said that most people don’t appreciate how bad a flu it is.
Lady Hallett: Can I just go back for a second, Mr Pengelly: when people in your position, and many others around you and in the rest of the UK, were told that the two scenarios were China contains or global pandemic, didn’t anybody stop and say: well, wait a minute, we know that visitors from Wuhan, the centre of where the disease has started, have been visiting, as you’ve just described, Northern Ireland, so doesn’t that indicate that back in January people should have been questioning whether China had – could ever contain it, because their people were travelling the world?
Mr Richard Pengelly: I think that’s a very fair point. I mean, my understanding was that that was why the assessment was that the second of the two scenarios was seen as the most likely situation, that it wouldn’t be contained within China.
Lady Hallett: My point is that that should have come earlier than February, it should have come in January, because you all knew that people were travelling the world –
Mr Richard Pengelly: I think in January we were starting to plan on that basis, certainly within – I think it was 27 January that in the Department of Health we activated our own gold arrangements, so that certainly pre-dated this exchange.
Lady Hallett: Sorry to interrupt.
Ms Dobbin: I don’t think we get any sense, Mr Pengelly, from this message of the sort of alarm that might be expected, it being understood that the second of the scenarios was, first of all, in fact playing out, and that individuals from that part of China had in fact been in Northern Ireland, so no protection in Northern Ireland on the basis of travel?
Mr Richard Pengelly: Well, the travel bit is obviously outwith the devolved space.
Lead 2C: Of course.
Mr Richard Pengelly: So that wasn’t an issue for us. But as I say, by 6 February, you know, we had been in activation mode of our own gold arrangements for over a week by that stage, so the preparatory and planning work was kicking into overdrive in the department at that stage.
Lead 2C: I just want, before this disappears from the screen – that obviously Sir Richard was – and he’s been taken to this – recognised at that point in time that the problem would be when it hit care homes and hospitals. Again, was that something that you had a keen appreciation of at that time as well?
Mr Richard Pengelly: Certainly in terms of our planning work and surge work, we were commissioning work from colleagues across the sector in terms of surge plans for both hospitals and care homes.
Lead 2C: In terms of your understanding that this would only be a bad flu, where were you getting that understanding from?
Mr Richard Pengelly: That was just a reflection. And there’s always a risk when a non-expert like myself tries to interpret what medics are saying, but at that early stage there was no sense of what the symptomatic position for Covid would be. I think there was a sense that it could present as flu-like symptoms. And, you know, my language in this was trying to make the point that people often refer to themselves as having flu when they have a cold, and a flu is a much more difficult illness to endure and experience than a cold, so hence the “only as a bad flu”, but at this stage, you know, we were very much in the foothills of understanding how the virus would present itself.
Lead 2C: Is that an understanding you would have had from the Northern Ireland CMO?
Mr Richard Pengelly: I – I assume it’s from conversations that – CMOs about – but, again, there’s always the risk that – you know, it certainly wasn’t a definitive briefing that the CMO gave me about how exactly this would present itself, it was more my, probably clumsy, interpretation of words that the CMO was using.
Lead 2C: I want to move on, if I may, just to, I think it’s right, Mr Pengelly, that the two scenarios presented by Professor Sir Chris Whitty did become integrated into Northern Ireland policy.
So if we can just have a look, please, at INQ000425583.
Can you help me, first of all, we’ve already seen who Ms Redmond is. She’s – she sits within the CMO –
Mr Richard Pengelly: Yeah.
Lead 2C: – group in the Department of Health, and I think she was the director of Population Health.
Mr Richard Pengelly: That’s right.
Lead 2C: We just so some other officials to whom this was being circulated. Can you help as to whether or not they’re also part of the CMO group or –
Mr Richard Pengelly: They all would have been. You see Cathy Harrison is now, currently, the Chief Pharmaceutical Officer. I’m not sure just at that stage whether she had taken a post or was – she was Deputy Chief Pharmaceutical Officer, but she’s a professional pharmacist.
Lead 2C: Okay.
Mr Richard Pengelly: And the other three colleagues are Civil Service policy colleagues.
Lead 2C: All right. And I think we can see at paragraph 8 the integration into the policy position as the Department of Health; is that right?
Mr Richard Pengelly: Yes.
Lead 2C: Again, so there can be no doubt, then, in Northern Ireland, as to the understanding of the position; yes? It was well understood –
Mr Richard Pengelly: Yes.
Lead 2C: – that those were the two scenarios.
So that is on 5 February, and we now know – and again perhaps if I could bring this up – this is 6 February, we’ve seen this already.
It’s INQ000218470.
And this is the letter from Ms Redmond again.
Mr Richard Pengelly: Mm-hm.
Lead 2C: And I think we can see, if we go to page 2, it being advised – and it’s the third paragraph up from the bottom – that the Department of Health was providing advice to other parts of government in Northern Ireland that it wasn’t necessary to activate the contingency arrangements, the central contingency arrangements, at that time; yes?
Mr Richard Pengelly: Yes, but I think just to be clear, and at the risk of speaking for Liz in this, the activation of the NICCMA arrangements can be called for by the lead government department. I – I’m interpreting this form of words as being, at this stage: we in the Department of Health are not calling for the activation, the decision about whether or not to activate it is an issue for TEO.
So I don’t think I would interpret this as us saying “Don’t activate NICCMA”, as opposed to “We are not placing a request”. And the reason for that being that within health we had activated our own gold structure, so we were doing what we needed to do to prepare from a health perspective, and at this point in the cycle we weren’t seeking assistance from anyone else at this stage, but the issue about activation of NICCMA fundamentally was an issue for TEO as lead in civil contingencies.
Lead 2C: The advice goes further than that, though, doesn’t it, because it’s saying – sorry, if we could just bring that back up again – if we look at the second line, so what she says is:
“I do not consider it necessary to activate NICCMA at this time, unless or until the infection appears in [Northern Ireland] and impacts are experienced here.”
So it’s going further. It’s not – this isn’t advice that – you may wish to think about it. This is advice coming from the Department of Health that there isn’t any need to stand these up unless and until the virus was felt in Northern Ireland?
Mr Richard Pengelly: And I absolutely – I take that point in terms of the words that are in front of us. The point I would make is that, from the Department of Health’s perspective, I would be reluctant to offer a view as to what other departments were doing, because we now – now, I didn’t know this at the time, but in terms of preparations for Module 1 and for this, we now know that the assessment in and around this time was that other departments, in terms of plans for sector resilience were around 18 months behind where they could have been. So there was an issue about what other departments needed to do and the extent to which they needed to engage.
I don’t believe it’s for the Department of Health to say: you should or should not stand up the contingency arrangements to deal with those aspects.
I can see that, from the form of words in front of us, you can interpret that. I would attribute that more to loose drafting, that we’re saying what we should be saying is: from the health perspective, we don’t request the stand-up at this point in time.
Lead 2C: I’m going to explore that with you, because there are a series of communications in the same vein as this.
Perhaps if we could go on, please, to look at INQ000185378, and if we just look at page 1.
I think that this is your briefing or an aide memoire for you and for a briefing of other permanent secretaries; is that right?
Mr Richard Pengelly: That’s right, yes.
Lead 2C: Just – you might be able to help us with this, was this part of a regular meeting at which all permanent secretaries would meet in Northern Ireland aside from the pandemic, or was this a special –
Mr Richard Pengelly: No, there’s a – for as long as I’ve been a permanent secretary, Friday morning the permanent secretaries meet for just a regular stocktake. So that’s – that happened pre and post-pandemic.
Lead 2C: I think we can see on this page, on page 1, there’s reference to planning for the reasonable worst-case scenario. So you explained or you were certainly briefed to explain that to colleagues.
Mr Richard Pengelly: Yep.
Lead 2C: If we go to page 3, please, we can see, if we look, first of all, at “Sector Resilience”, that you were giving advice that consideration was needed across departments on sector resilience, and on the basis of the spread; correct?
Mr Richard Pengelly: Yep.
Lead 2C: So in other words, because of the global spread.
And I think if we go to bullet 2, you foresaw that there would be a need for further guidance and co-ordination but again, at 3, that you didn’t consider that it was necessary to set up the central contingency arrangements in Northern Ireland, although you do point out to your colleagues that it’s an evolving situation; yes?
Mr Richard Pengelly: But I would just point out this is the briefing note that I was given as an aide memoire for the meeting, and I suspect there may have been a sense of cut and paste, and the same source material used is Liz’s letter and mine. My interpretation of the position remains, and I – regrettably I can’t recall the exact form of words I used in speaking to this with my permanent secretary colleagues, but my position would be: we’re not calling for the stand-up at the moment, but the issue as to whether or not it stood up remains one for TEO.
Lead 2C: Can I just ask, just to explore that, and I’m going to come on to more communications about this, but why the Department of Health wouldn’t have wanted other departments to stand up arrangements, or wouldn’t have wanted that co-ordinated approach, given that the worst-case scenario was, in fact, eventuating?
Mr Richard Pengelly: But I think, and forgive me if I’m dancing on a pinhead, the point I’m making is I wasn’t calling for it.
Lead 2C: Yes.
Mr Richard Pengelly: It wasn’t that I was saying it shouldn’t happen. I, at that stage, didn’t know the state of preparation. Establishing the arrangements comes at a cost, because it pulls colleagues away from other work. And I’ve talked earlier, particularly in the context of health and social care, the stresses and strains and the pressures that colleagues were under; that was also true across the wider Civil Service in terms of – you know, going back to, I think, the 2014 voluntary redundancy programme that – so there was a sense of shortage across the system.
So the point was: I wasn’t calling for it; that’s not to say that if it was needed it shouldn’t happen, but the assessment needed to take account of what is the value in creating it, at that point in time, as against the cost of bringing the staff together to do that, because it meant that something else wasn’t happening, and I wasn’t in a position to have that transparency across other departments.
Lead 2C: Okay, I think there’s a number of things that are contained within an answer, if I may try to unpick them.
First of all, the Department of Health was the lead department at this stage?
Mr Richard Pengelly: For the health response.
Lead 2C: Yes, well, it was the lead department in terms of the contingency arrangements, wasn’t it –
Mr Richard Pengelly: No, it was the lead government department for the health response to the pandemic.
Lead 2C: Well, perhaps this is just a semantic difference, but in terms of across Northern Ireland, do you accept that it was the lead department in terms of the response to the pandemic?
Mr Richard Pengelly: I would accept it was the lead government department for the health response to the pandemic. If there was other sectoral responses to the outworking of the pandemic, it wasn’t for the Department of Health to lead on those aspects.
Lead 2C: Are you –
Mr Richard Pengelly: We may have had a role in advising and providing expert advice, particularly through the Chief Medical Officer.
Lead 2C: The 2016 protocol that sets out the emergency – or that sets out the contingency arrangements for an emergency in Northern Ireland sets out the concept of a lead department, doesn’t it?
Mr Richard Pengelly: Mm-hm.
Lead 2C: Do you accept that the Department of Health was the lead department for the purposes of those contingency arrangements?
Mr Richard Pengelly: But I would characterise the lead government department role was in the context of the health response to the pandemic. I don’t think it was for the Department of Health to be the lead department for the response from other sectors.
Lead 2C: But –
Lady Hallett: Mr Pengelly, I’m sorry to interrupt, but I heard a lot about this during the course of Module 1 – forgive me, Ms Dobbin – and there is this concept of a lead government department model.
So, for example, in the UK Government, the Health Department, the Health Secretary of State chaired the original COBRs because they were the lead government department. And it wasn’t qualified by “for health”, they led the response in the early days until the Prime Minister became involved and chaired COBR himself.
I’d understood that Northern Ireland was the only other part of the UK where the lead government department model applied and, similarly, is the lead government department model for the response, as Ms Dobbin is putting to you. That was the evidence I thought I’d heard in Module 1.
Mr Richard Pengelly: Forgive me, my Lady, if I’m getting – creating a sense of confusion. We can be the lead government department in terms of articulating the response and the Department of Health cannot dictate or mandate other departments, the sectoral response from another sector –
Lady Hallett: Cannot dictate, but you can lead.
Mr Richard Pengelly: But forgive me, I don’t understand what “lead” means if it doesn’t …
Lady Hallett: Well, as in encouraging others to check that their resilience is better, getting them prepared.
Mr Richard Pengelly: Is that not the role for the central – the civil contingencies role as discharged through the Executive Office? That would be my understanding.
Ms Dobbin: Right. We might come back to the civil contingencies protocol because it’s obviously important that we do understand this.
Just focusing for a moment on your suggestion that in terms of the Department of Health – what really ought to be conveyed here is you’re saying “We were only asking other people to stand up civil contingencies – other departments to stand up civil contingency arrangements”, is that what you are saying?
Mr Richard Pengelly: Yeah, yeah.
Lead 2C: The Department of Health was the department that was – Minister Swann was attending COBR at this point, wasn’t he?
Mr Richard Pengelly: That’s right, yes.
Lead 2C: So he was the person who was integrated into the UK Government response –
Mr Richard Pengelly: Mm-hm.
Lead 2C: – yes? And would have understood, and your department would have understood, then, all of the other parts of the response that were ongoing at central government; yes?
Mr Richard Pengelly: Mm-hm.
Lead 2C: And would have understood the potential consequences of what was coming down the road in terms of the pandemic; yes?
Mr Richard Pengelly: Yes.
Lead 2C: So the Department of Health would have been in a position to send out the message to other departments about what might be required from them in order to be a part of a cross-departmental response; do you accept that?
Mr Richard Pengelly: Yes, very much so, but that message coming from COBR about the UK analysis, at COBR, for example, they wouldn’t have discussed the state of preparedness of Northern Ireland departments, so it would have been at the more macro level. That message, and I know Minister Swann attended, I think I’m right in saying, although I can’t say for certain, I think officials from TEO may have been dialling in to some of the COBR meetings. Notwithstanding that, Minister Swann would have briefed, and I think there were some exchanges about the minister briefing FM and dFM on the emerging position, but even ultimately whether or not – if the correspondence there showed that we were calling, all we would be doing would be putting the request. The TEO is fundamentally a TEO decision in the context of their assessment of the state of readiness of other sectoral partners across Northern Ireland at that stage.
Lead 2C: But you were the department that understood the full potential consequences, yes, of what might be required in order to have an all-society response to the pandemic?
Mr Richard Pengelly: In these very early stages our focus was on evolving the health response and the health consequences of it, so we wouldn’t have been sighted on either the state of – I mean, and fundamentally activation of NICCMA is more into the response phase than the prepare stage. At this early stage in February, we were still a number of weeks away, for example, from the first case in Northern Ireland, which I think was 27 February, so that’s why the health assessment – and we were very much looking at it from the health perspective – we weren’t asking for the activation of the arrangements from the health perspective at that stage, but we weren’t fully sighted on the needs of other departments in Northern Ireland.
Lead 2C: I’ll come back to that, but just in terms of your view that the contingency arrangements are part of a response, is it your position, then, that Ms Redmond was right when she was saying, then, there isn’t a need for contingency arrangements unless and until the virus arrives in Northern Ireland?
Mr Richard Pengelly: I think Ms Redmond’s assessment at that point in time, based on what she knew at that point in time, that we didn’t need to ask for the activation. Liz wasn’t making an assessment about the state of preparedness or the need for a response in other sectors. My assessment is she was speaking from the health perspective. So I can’t offer a view as to whether or not she was right about the state of readiness in other sectors at that point in time. I would argue TEO were the lead for civil contingencies and that was their assessment to make.
Lead 2C: I’m going to come on, because there’s more material to look at on this issue. Perhaps if I could just go, though, to – and I’m just going to check that I have the right INQ number for this. It’s the next document, which is a presentation by Dr Naresh Chada. I have that at INQ000 – I’ve got the right one, thank you.
So this was a presentation given by Dr Chada, who I think is the Deputy Chief CMO?
Mr Richard Pengelly: Yes.
Lead 2C: And I think – is this a document that you’re familiar with, Mr Pengelly?
Mr Richard Pengelly: Yeah, I have seen it in the past – I mean, I wouldn’t be able to recite sections of it, but I certainly have seen it before.
Lead 2C: I don’t think we expect that. Is this a document that you would have seen at the time?
Mr Richard Pengelly: Yes, yes.
Lead 2C: All right.
So if we go, please, if we may, to page 5, really just setting some of this so that I can put it in context, Mr Pengelly, but I think this is a presentation that he gave, I think, to permanent secretaries or people in other departments. Is that your understanding?
Mr Richard Pengelly: That’s my understanding, yes.
Lead 2C: I think if we go to page 6, please, so he’s setting out, isn’t he, what’s happened to date; yes?
Mr Richard Pengelly: Mm-hm.
Lead 2C: Sorry, if I didn’t, forgive me, but I think that the date of this presentation is 13 February, and it was given on 20 February.
Mr Richard Pengelly: Sorry, I’m confused, because the date on it is the 19th – it’s 13 February, three weeks later, sorry.
Lead 2C: I think we can check that, but we understand that it was given –
Mr Richard Pengelly: On the 20th.
Lead 2C: – that it was a presentation that was given on 20 February, but we can orientate ourselves from the –
Mr Richard Pengelly: Sorry, I –
Lead 2C: So we can see him setting out what the position was on 19 February; yes?
Mr Richard Pengelly: Yes.
Lead 2C: So making the point to departments that obviously there had been spread to a number of countries, and by this stage it’s right, isn’t it, Mr Pengelly, that there were a number of cases in the United Kingdom –
Mr Richard Pengelly: Yes.
Lead 2C: – although not yet in Northern Ireland; correct?
Mr Richard Pengelly: That’s right.
Lead 2C: If we just look at page 14, please, so I think this sets out some of the work that was going on in the Department of Health; correct?
Mr Richard Pengelly: Yes, that’s right.
Lead 2C: And I think we can see surge preparations referred to there – I’m going to come back to the surge preparations – and if we go, please, to page 15, so we assume he explained what the reasonable worst-case scenario is; yes?
Mr Richard Pengelly: Yes.
Lead 2C: And if we go to page 16, please, so we can see that he was recommending that they consider their pandemic influenza planning as a starting point; correct?
Mr Richard Pengelly: Yep.
Lead 2C: And that he knows, and he’s communicating, that the elderly and those with existing health conditions would be disproportionately affected; yes?
Mr Richard Pengelly: Yes.
Lead 2C: And were setting out that the planning assumptions predicted excess deaths, massive impacts across government, school closures, rail and road transport issues, and huge costs; correct?
Mr Richard Pengelly: Yes.
Lead 2C: And I think he also set out at page 17 the case fatality rate as well, and the numbers of people who would be potentially affected; correct?
Mr Richard Pengelly: Yes.
Lead 2C: Then at 19 sets out the wider sectorial impacts as well; correct?
Mr Richard Pengelly: Yes.
Lead 2C: So, again, that would tend to suggest that the Department of Health was providing an advisory role to other departments about the potential reach and impact of the pandemic –
Mr Richard Pengelly: Yes, correct.
Lead 2C: – across Northern Ireland, do you agree?
Mr Richard Pengelly: Yes.
Lead 2C: But notwithstanding that, Mr Pengelly, if we go to INQ000425535, please, and again this is another permanent secretaries stakeholder group, and again I think this is an aide memoire prepared for you; yes?
Mr Richard Pengelly: Yes.
Lead 2C: And I think if we go to page 2, please, I think we can see again under “Sector Resilience” the second bullet point deals with – I think that’s largely concerned with the levels of people who would become ill and the people who would be off work; correct?
Mr Richard Pengelly: Yep.
Lead 2C: Doesn’t actually mention – I don’t think this document mentions the fatality rate, for example.
Mr Richard Pengelly: I don’t think so.
Lead 2C: Again, I think if we look at the fifth bullet point down – on page 2, yes – we can see again:
“It is not necessary to activate the contingency arrangements at this time; however …
Again the reference to it being an evolving situation.
In light of everything that Dr Chada had said, why was that still the position, if not the advice, that was being given by you to other permanent secretaries as late as 21 February?
Mr Richard Pengelly: I think, and apologies at the risk of repeating myself, but I again read this, and bearing in mind this was the brief that was given to me as opposed to a record of what I actually said, that our position was we weren’t yet calling for the establishment of the crisis management arrangements, we were focused in terms of health. So we didn’t feel, in terms of the evolving work that we were doing in and around 20 February when this document was produced, that our work needed the support of the NICCMA arrangements. We weren’t in a position – and I recognise that the wording here doesn’t necessarily suggest this, but I don’t believe we were saying the TEO do not establish NICCMA as opposed to we are not calling for its establishment at this stage, because we were focused at this stage on our own evolving preparatory work to the emerging situation. As we said, we will reach that stage, and that’s in the context, as I’ve said, that establishing these arrangements comes at a cost in terms of other work being stood down, and that’s – my view remains that that’s a call that can only be made when you have the transparency about both the work that needs to be done in other sectors and the cost of doing that work in terms of other preparation work, because NICCMA is fundamentally about co-ordinating a response. The building blocks of that are there’s an individual sectoral response and then you start to join the dots across sectors. I still think that the judgement on that at this point in time was one for someone with more line of sight about what was happening in other sectors.
Lead 2C: What might be thought very surprising is the Department of Health is not saying at this time “We are facing the most enormous crisis we’ve ever faced and we really need every government department to co-ordinate because this cannot just be a Department of Health response”.
Mr Richard Pengelly: But I don’t – I’m not suggesting we were saying it in those terms. I think we were saying: we are facing into a crisis and there’s a huge amount of work to be done, let’s be very careful that we don’t initiate arrangements that undermine the sectoral response and the evolution and development of the sectoral response to allow it to be joined across sectors, because establishing the NICCMA arrangements comes at a cost, people need to be relocated from other areas of work, a judgement has to be made that at the point in time on 20 February was that other work of a higher priority than a NICCMA arrangement which will inevitably be required but is it required this week or next week, and that’s the judgement call.
Lead 2C: But all that the civil contingency arrangements foresee is that there will be a cross-departmental approach to an oncoming emergency. Do you agree that that’s what the protocol provides for?
Mr Richard Pengelly: There absolutely has to be a cross-departmental approach, but a cross-departmental approach has to be built upon the foundations of a departmental analysis and response about what is needed, and then we join sectors.
I think I’m – I’m maybe perhaps being very clumsy in the way I’m making it, but I just think when we establish structures and architecture that remove people from other work, we need to be very, very careful and consider where is the immediate priority and value. Is it the work they’re doing today or is it the work that the new structure will be doing tomorrow? Because if that’s not absolutely needed for another week, we should let colleagues stay and do the work they’re doing for this week. We didn’t have a line of sight on that and that was a judgement call that I think TEO had visibility in terms of what was needed at that stage. So we certainly weren’t saying NICCMA wouldn’t ever be needed; it’s always a judgement call about what point you trigger that, because it comes with a cost.
Lead 2C: So, from your perspective as a permanent secretary at this point in time, what did you see as the cross-departmental part of the machinery that was considering planning across the departments and which it understood what planning was taking place and –
Mr Richard Pengelly: Well, I think – I mean, there was planning work happening in each department, certainly, and I can only speak in detail in terms of the Department of Health.
Lead 2C: Yes.
Mr Richard Pengelly: There was the regular dialogue that was happening at the permanent secretary meetings, and we can see both the 7th and 21st – this was clearly an agenda item – I think I’m right in saying that 20 February CCG met for the first time.
Lead 2C: That’s correct, there was an officials’ meeting of CCG, that was the only meeting that took place –
Mr Richard Pengelly: But that in itself would have brought departments together on a cross-departmental basis, so that was happening at this point in time – on this very day.
Lead 2C: Were you at that meeting?
Mr Richard Pengelly: The CCG meeting –
Lead 2C: The CCG meeting.
Mr Richard Pengelly: – on the 20th? I don’t think I was at that meeting.
Lead 2C: We’ve seen the minutes of what was discussed at that meeting and it wasn’t – it was a few topics, it wasn’t – there’s no sense of it having been any sort of very detailed consideration of cross-government plans in Northern Ireland.
Mr Richard Pengelly: Which, if I may, I would pray in aid of the point I’m making, that sometimes creating the architecture doesn’t actually achieve the objective, why very careful thought needs to be given that we don’t precipitously trigger architecture that may not be needed for another week or two. As I say, I don’t think I was at that 20 February CCG meeting.
Lead 2C: There’s an alternative interpretation of events which is that it just wasn’t understood or appreciated at that point in time the gravity of the situation that Northern Ireland faced.
Mr Richard Pengelly: I can see that that’s an alternative interpretation, but I think in terms of the briefings that had been given to permanent secretary groups and the work we were doing in the department, that certainly wasn’t our position on it.
Lead 2C: What I was going to say was that interpretation may have been coloured or informed by the position that was being taken by the Department of Health, which was that there wasn’t any need for contingency arrangements to be stood up at this point in time.
Mr Richard Pengelly: I don’t believe it would have, no.
Ms Dobbin: My Lady, I don’t know if that’s a good time for a break.
Lady Hallett: Yes, of course.
11.30.
(11.11 am)
(A short break)
(11.30 am)
Lady Hallett: Ms Dobbin.
Ms Dobbin: Thank you, my Lady.
Mr Pengelly, I just want to stick, if I may, with the civil contingency arrangements and the point that you made that the Department of Health didn’t, in the correspondence we’ve just seen, or at those points in time, think that it would be assisted by civil contingency arrangements being stood up by the government in Northern Ireland.
It didn’t think it would be assisted by those being stood up, did it, when, on 24 February, WHO published its report on its mission to Wuhan. I don’t know if you remember that? It was at that point that WHO said that there needed to be an all-society response to the pandemic, and that at this point in time, for example, focus needed to be placed on contact tracing and rigorous quarantine. Do you remember that communication?
Mr Richard Pengelly: Very vaguely. I can’t remember the specifics of it.
Lead 2C: All right. But we can be clear that that didn’t prompt any change in approach on the Department of Health in terms of a wider governmental response, did it?
Mr Richard Pengelly: No, I mean, it clearly didn’t because, you know, there wasn’t an immediate call by us to establish the NICCMA arrangements, but it was an evolving piece, and, as I said, it was always a judgement call. And actually clarifying – you know, I’m not sort of clinging desperately to the notion that we got it exactly right about when, I’m just trying to help – explain our thinking about the position at the time.
But we were on a trajectory to clearly needing NICCMA. I think it was early March so, you know, we are talking about the separation of a few days at most here. But in and around 20 February, when Dr Chada made the presentation, 24 February I think –
Lead 2C: WHO, yes.
Mr Richard Pengelly: – you’ve touched on that – we were evolving towards it, but clearly in our minds, at that stage, we hadn’t reached the stage where we’d come out formally and called for the establishment of NICCMA.
Lead 2C: It didn’t change whenever the first case of Covid was detected in Northern Ireland either, did it?
Mr Richard Pengelly: No.
Lead 2C: And –
Mr Richard Pengelly: But I think it did in the very early days of March, I think it – there was – I think there was correspondence from the Chief Medical Officer. He used the phrase, I think, “We need an increasing lean-in to the position”, which led to, I think, the establishment on, I think, 18 March.
Lead 2C: That’s right. But again, that was even after WHO declared that Covid-19 was a global pandemic as well, and that was on 11 March, wasn’t it?
Mr Richard Pengelly: That’s right.
Lead 2C: So even that didn’t promote a whole-government response, did it, in Northern Ireland?
Mr Richard Pengelly: But, again, I think I’m trying to differentiate between – a whole-of-government response is absolutely essential in terms of the fight against the pandemic. When the architecture is formally triggered – because there was dialogue happening at a whole-of-government level, the value proposition of established – formally establishing and trigger these mechanisms on a specific date, I think these are fine judgements and, you know, I think it’s very difficult to say that today is wrong and tomorrow is right. But these were judgements in and around that period.
Lead 2C: Yes, I think what your evidence seems to be suggesting, but you must tell me if I’m wrong, Mr Pengelly, is that you saw these contingency arrangements as primarily responsive to a crisis as opposed to a vitally important part of planning the response to a crisis?
Mr Richard Pengelly: I think there’s an element of that, and if you look at the definition of NICCMA it’s about ensuring that the response phase is working on a cross-sectoral basis. I think that the sharper point I’m trying to make is that I think in the middle of a crisis, when resources and people are stretched to breaking point, we must make sure that anything and everything we do has a value proposition. I don’t fully grasp at this stage that the value proposition of establishing the NICCMA arrangements in early February would have been greater than the cost to other activities that was happening on a sectoral basis, to losing that capacity. At some point we reached a crossover point, and I think it’s a fine judgement about when that crossover point was. Some time between early February and mid-March when it happened, I don’t know specifically.
But I think the focus needs to be on the value proposition rather than – having the architecture in and of itself wouldn’t have delivered value. It was how we used the architecture. And I think there’s other examples of that later in the pandemic.
Lead 2C: All right. I want to pause there just to check that I understand. There’s obviously a distinction between what value you understood at the time there might be in having a formal government contingency response at an early stage.
Does it remain your position that you can’t see that there would have been any value in having that sort of response at a much earlier stage?
Mr Richard Pengelly: No, I think all I’m trying to do is explain our thinking at the time, and our thinking at the time was the work that we were focused on in the Department of Health would not have been facilitated on, for example, when I spoke to my permanent secretary colleagues. We didn’t feel there was a major enhancement to the work we were doing on that day by calling for the establishment of the NICCMA arrangements.
Whether there would have been a value proposition in other sectors, I think I would have to leave that to colleagues who would have a line of sight into the issues in those other sectors.
So, looking back from this remove, I would say, I think, as a rule of thumb, earlier establishment would be better, but I still – but earlier establishment with a clearly defined value proposition. Because I think that the point, and we may have slightly different perspectives on it, but if we reference the 20 February CCG, which I don’t think I was at, that was part of the architecture of bringing folk together, but your reading of the record of that – your interpretation was there wasn’t a lot of value that maybe came out of that meeting. Possibly those colleagues were drawn away from
other work in doing that. And I’m just making that –
and I think in a very clumsy way, that when resources
are stretched we need to ensure that we make the best
use of them at all times, because there is more work
than there is time available. February, when Liz wrote her letter, or on 7 February, 6 Q. Just going back to some fundamentals about all of this,
and just being clear, did the Department of Health
understand in February 2020 that there was going to need
to be a whole-government response to the pandemic?
Mr Richard Pengelly: Absolutely, yes.
Lead 2C: Did it understand that there would be many areas of
overlapping policy responsibility within departments?
Mr Richard Pengelly: Yes, we knew that there would be. I’m sorry, my
hesitation is just I’m not sure we could have
specifically and clearly defined them all at that stage,
but there was an inevitability about those overlaps
existing. I think that’s the point of your question.
Lead 2C: Did you also understand that this wasn’t about –
I think the way you’ve put it in answers is: we wouldn’t
have been assisted by what we were doing, that civil
contingency arrangements aren’t about what we are doing
but it’s about what all of us are doing within
government in order to meet an oncoming emergency?
Mr Richard Pengelly: But I think they’re two very, very different questions,
because the question about do I, as the permanent secretary of health, ask TEO to convene a set of cross-departmental structures, for me to ask them to do it, in the context that they could initiate that without recourse to myself, the value – the question I need to put to myself is: do I need these?
My point is I’m not sighted on the value that there would be for other colleagues in other departments on that specific day about establishing that. And, more importantly, would the value outweigh the cost in terms of the repositioning of resources? I wasn’t sighted on that, so I am not – and I think this is the point about the form of words in both the aide memoire and the 6 February letter. My interpretation now is my position was not that I am saying “Don’t do it”, I am saying “I don’t need it on this given day”. But there’s an inevitable trajectory towards that.
Lead 2C: To take something like children’s social services, for which you had responsibility, there’s a huge overlap, isn’t there, with schools, for example, and with – schools play an integral part, don’t they, in child protection?
Mr Richard Pengelly: Yes.
Lead 2C: And in the wider provision of social services to children; do you agree?
Mr Richard Pengelly: Mm-hm.
Lead 2C: I’m going to take –
Mr Richard Pengelly: Yes.
Lead 2C: – this outside health for a moment because it’s a straightforward example. Both departments would have to work together, wouldn’t they, in order to be able to plan for an oncoming pandemic and, for example, the closure of schools; yes?
Mr Richard Pengelly: Yes.
Lead 2C: So both of those departments would need to meet and have overlapping plans in order to ensure that there weren’t obvious gaps –
Mr Richard Pengelly: Yes.
Lead 2C: – child protection?
Mr Richard Pengelly: But that can happen outwith NICCMA arrangements.
Lead 2C: Was this happening, then, at the time?
Mr Richard Pengelly: I can’t give you a factual answer yes or no in terms – because that’s an operational conversation. I assume it was happening but I can’t speak to the complete accuracy of that.
Lead 2C: Because, I mean, the Inquiry has seen some of the cross-departmental plans that existed in March 2020, and it might be thought that they’re extremely rudimentary. We’ve seen a document that summarises the main points of the plans, and, for example, didn’t foresee that schools might be shut?
Mr Richard Pengelly: Were they the plans produced by individual departments?
Lead 2C: They’re the central summary of the plans that were being produced.
Mr Richard Pengelly: But could I argue then that maybe the departments spending more time on sharpening those plans was, arguably, a better use of their time? If we take children’s social services as an example – I’m sorry, I’m not trying to be argumentative on this point, I’m just trying to ensure that my position is clear.
If we take children’s social services, that is a big area. The NICCMA arrangements, if you pull together all departments, you would have two departments that would be very, very interested and very much part of that bilateral discussion. There’s arguably a number of other departments that are then drawn into a conversation that possibly isn’t the best use of their time. So my point is just one about maximising the time and energy that’s available at a point in time. It’s not a black and white issue about should we or shouldn’t we establish structures.
Lead 2C: Again, if I can just ask you about this, you’ve made the point a number of times that this is all about resources. I’m not quite clear as to why it would have been such a drain on resources to have a formal cross-government approach at an earlier point in time.
Mr Richard Pengelly: At this stage the most valuable commodity we had was people and their time. And certainly – you know, I can only speak with complete accuracy about colleagues in the department, but I had teams of people that were working ridiculously long days, 16, 18-hour days, with no respite at weekends. So anything additional that happened would have been layered on top of that, and it could have pushed them – you know, it could have been the difference between breaking point or not.
My sense was that there was a similar position in some, possibly not all, other departments, so it’s – the resource point is about the impact on people, not about physically spending large sums of money.
Lead 2C: I’m going to move on, Mr Pengelly, if I may, just to understand a bit more then about the planning that had gone on in the Department of Health and to try to understand what structures were on foot in order to be able to respond to the pandemic.
The Inquiry understands from the evidence of the Chief Scientific Adviser, Professor Young, that there was no modelling capacity in Northern Ireland until he came back into office after a period of leave, and that it wasn’t instituted until the end of March 2020; is that correct?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: Why wasn’t there any modelling capacity or provision in Northern Ireland until that individual came back from leave?
Mr Richard Pengelly: Well, modelling capacity along the lines you’re talking about wasn’t a routine activity that we would have had a resource doing that, so the need for it emerged in the course of the pandemic. And I’m making that as – that central modelling capacity, in terms of having line of sight on the pandemic as distinct from various ad hoc modelling work that would have taken place in the Public Health Agency from time to time, that didn’t exist at that point in time because it hadn’t been needed prior to the pandemic.
I think, looking back, had Ian been about, we would have triggered that capacity before the end of March. But the modelling work – and Ian can speak to this in much more detail than I can – the quality of any modelling work is directly proportional to the number of data points you put into that modelling. So any modelling work that was done in late February and early March would have had such a low confidence level attached to it, because of the scarcity of data points; we had one case on 27 February. So it wouldn’t have been possible to do comprehensive modelling work in the early and mid-part of March, until case numbers started to escalate.
So in the absence of our own modelling capacity in the early part of March we were tending to use modelling work that had been done across the water and look at that and its population application to Northern Ireland. That was arguably at least as, possibly more, accurate than any modelling work that could have been done locally, given the low number of data points at that point in time.
Lead 2C: I’ll come separately to look at why there was a lack of data points in Northern Ireland at that time. But obviously all of this was contingent upon an individual not being in office for a period of time, as we understand it, that modelling didn’t happen until he came back, because there wasn’t anyone else to institute it; is that correct?
Mr Richard Pengelly: Well, I’m … I mean, the – I wasn’t involved in the granular discussion about modelling capacity, but I think that the sense I’m trying to make is we didn’t have modelling capacity before then and we knew we would need modelling capacity as we stepped into the pandemic. The – you want to come back to the number of data points. I think this was an issue that was assigned and Ian was asked to lead on it when he came back. My sense isn’t that the Chief Medical Officer, at the early stage of March, was beating the desk in frustration that he needed modelling done and he didn’t have Ian available to do the modelling. There was a recognition that the population-based approach, leaning into the work that was being done in other jurisdictions, was fit for purpose at that point in time. That’s more my understanding of the position than being part of those conversations.
Lead 2C: All right. We can take that up with the CMO.
But the fact that Northern Ireland didn’t have a Chief Scientific Adviser until the end of March might be thought extremely surprising, to say the least, that Northern Ireland completely lacked that input until such a late stage.
Mr Richard Pengelly: I think that’s a fair comment, and Ian had been off on a period of absence, and when he returned – I think he was off from early February through to March. He’d been in post before that but had been off for a period of absence for a few weeks.
Lead 2C: We understand from his witness statement that he went off in mid-February, but it doesn’t appear that he had any role in the Northern Ireland response before that.
Now, obviously we can ask him about that, but that does go to a formal question about the structures available in Northern Ireland. I mean, can you, as permanent secretary, explain why the Chief Scientific Adviser –
Mr Richard Pengelly: I can’t offer a great deal of insight into the work that Ian was doing prior to his departure in February, I think it was – I mean, there was a lot of work – I think it was a part-time post and it had historically been a part-time post. I think when Ian came back, because of the pressures, it morphed into a full-time post, and I think prior to that it had been leaning more into the R&D space than the scientific officer space.
Lead 2C: Yes. It’s also right that Northern Ireland – or within the Department of Health there was no advisory group in respect of Covid either, or a special pandemic advisory group; is that also correct? And that Professor Young set that up as well when he came back –
Mr Richard Pengelly: Yes, that’s right.
Lead 2C: Again, can you help as to why there was no advisory group within the Department of Health for such a long period of time at the outset of the pandemic?
Mr Richard Pengelly: I don’t know the thinking behind that. I think it was just because there were so many moving parts, and issues were morphing in the latter part of January through February into March, it was just one of those issues that we were moving to.
Lead 2C: I mean, in terms of your role as permanent secretary, did you not think that these were the sorts of structures that ought to be in place from that early point when you understood just how serious the position was?
Mr Richard Pengelly: The specific question, that structure, clearly hadn’t – it hadn’t occurred to me, that – and I can’t recall at the time was I travelling in the assumption that we had that capacity within the department, or certainly in terms of the relationships and networks that – through the likes of the Chief Medical Officer network or(?) the full four-nation basis, that we were getting the input through that, and I think at that early stage much of our intelligence was coming through that network rather than trying to recreate it. I think – you know, there was a paucity of information at that stage. So something that we grew into, for want of a better term, in March. You know, it doesn’t jar with me as being too uncomfortable.
Lead 2C: All right.
Again I’m just staying within planning and structures for the moment. I just want to ask you, please, if I may, about surge planning, which is something that you’ve already touched on upon.
If we could go to the letter which I think the CMO sent about this. So we can see it. And again, this might be something that you’re familiar with.
This is a letter from the CMO, I understand it’s to Ms Watts, who is one of the people who sits, is that right, within health and social care services?
Mr Richard Pengelly: Valerie, at that stage, would have been chief executive of the Health and Social Care Board and the Public Health Agency on this date.
Lead 2C: These were the two organisations, were they, that were going to be most involved in surge planning?
Mr Richard Pengelly: They, those two organisations comprised health silver and surge – there was a subgroup of health silver working specifically, I think, at surge planning for the trusts.
Lead 2C: All right, and I think if we go to page 2 we can see it’s the paragraph that’s in bold that the CMO wanted to see the details of the planning that had taken place, and that he was looking for that to be provided to him by 13 March.
Mr Richard Pengelly: Mm-hm.
Lead 2C: So I think this letter was on – yes, it’s 17 February. So it certainly doesn’t appear from this letter, Mr Pengelly, but you may understand more about the detail of this, that certainly in terms of surge planning that there was an urgency about it or any concerns at this point in time about Northern Ireland’s capacity?
Mr Richard Pengelly: My sense was that there was an urgency about it, but there was also realisation that it was an extensive and complex piece of work. So I think, forgive me, if your urgency point is related to the gap between the date of the letter and 13 March –
Lead 2C: Yes.
Mr Richard Pengelly: – I think that’s more a consequence of how much work was required to develop, and because, you know, Michael would obviously want to speak to this, I suspect Michael’s view was, you know, he would rather have good comprehensive surge plans by 13 March than something that’s of poor quality a week or two sooner than that.
Lead 2C: Right.
Just – I’m going to go to the letter, if I may, that was sent – sorry, if we could stay on that letter, I think we also see, I think it may be the page over, so we’d got the CMO also setting out management of the first case of Covid-19 and subsequent cases –
Mr Richard Pengelly: Mm-hm.
Lead 2C: – and he sets out – yes, so it’s the first paragraph:
“It is still our intention that the first [Northern Ireland] case would be transferred to … England.”
Mr Richard Pengelly: Yes.
Lead 2C: So, again, perhaps you can help with that, and he does go on in the second paragraph to say that that might not necessarily be possible, but nonetheless seems to foresee, as I’ve said, in the first paragraph, that the plan at that stage was that –
Mr Richard Pengelly: Yep.
Lead 2C: So is that right, that –
Mr Richard Pengelly: That that was the plan?
Lead 2C: – the planning was that patients would go to England?
Mr Richard Pengelly: No, not – my understanding of it was there was a plan that patients would go to England, it was the plan that the first patient which reflected just the lack of detailed knowledge about the virus at that stage, as a high-consequence infectious disease, we don’t have the facilities in Northern Ireland to deal with that, so the thinking at that stage, the date of this letter, was that the first patient would be taken to a facility in England so that they could be properly monitored and treated whilst our knowledge of the system and our ability to deal with subsequent cases in Northern Ireland evolved. My understanding is in the event we made what’s called a MACA, it’s the military assistance –
Lead 2C: I’m going to come on to that, if I may, I just want to take it in stages –
Mr Richard Pengelly: Sure.
Lead 2C: – so that we can understand this.
I think, sorry, if we could go to the response to that, then; thank you.
So this is the letter that was sent in reply very shortly afterwards. Again, we see it’s obviously the reply to that letter. And if we go to page 4, and again it sets out in some detail management of the first Covid case, and sets out again in the paragraphs that follow, I think it’s right that there was possibly a ward that might be able to care for someone in the event that they couldn’t be transferred to England; is that right?
Mr Richard Pengelly: Yes, there’s an infectious disease ward in the Royal Victoria Hospital.
Lead 2C: I think at the penultimate paragraph from the bottom, that that provision was potentially not available at that point in time, because there was someone who was very poorly already on that ward?
Mr Richard Pengelly: I think that’s right, yes.
Lead 2C: So, I mean, certainly that was the position, wasn’t it, by 20 February –
Mr Richard Pengelly: Correct.
Lead 2C: – that that was still the planning?
Mr Richard Pengelly: Yes.
Lead 2C: And obviously this seems to presume that there would be one person as opposed to a number of people who might all get ill at the same time as each other?
Mr Richard Pengelly: Yeah, I’m not sure, because I think this was more into the medical space in terms of, you know, the medical care for the individual patient or patients, and the learning that needed to flow from that to clinicians locally. I’m not sure, you know – if the question is if it had been, for example, a family of four individuals that tested positive at the same time, would all four be transferred or would just one of them be transferred for the purposes of learning, as I say, that was more the medical assessment of the care which obviously wouldn’t sit on my desk as an administrative –
Lead 2C: I don’t think these letters read as though it’s just about learning, it appears to be about whether or not specialist facilities were available in order to care for people.
Mr Richard Pengelly: But I think it was learning – as I say, I wasn’t involved with it because these are more medical matters so I wasn’t involved in the conversation about this point. My subsequent understanding was it was more about the first case and given that we were very much in the early learning curve about the proper treatment of the individual and how the symptoms would present and the risk of cross-infection to colleagues, that the plan was – but I think the point you’re making is if that’s one patient, if that was very swiftly followed by a cascade of other patients, it’s a very different scenario than one patient, with a pause for –
Lead 2C: Yes.
Mr Richard Pengelly: – a number of days or weeks.
Lead 2C: Forgive me, Mr Pengelly, this is not about clinical cases because there weren’t any in Northern Ireland at this point, this issue was about planning and trying to understand the plans that had been made within the Department of Health, and trying to understand what surge plans existed.
Mr Richard Pengelly: I accept that, but just – this is planning, but this is planning for the clinical care of a patient and the transfer of a patient.
Lead 2C: Yes, but it’s not – it seems to foresee that the first patient would have to be transferred to England; do you agree?
Mr Richard Pengelly: My understanding – and, as I said, it’s my subsequent understanding, was that a decision was taken that we would transfer –
Lead 2C: Yes.
Mr Richard Pengelly: – it wasn’t so much borne out of necessity as opposed to given the lack of knowledge about the way the virus would present itself in a patient in the first episode.
Lead 2C: Can I just look, then, because you’re right that a request was made, if we could please go to INQ000278481.
This was when the first case was detected. And as you can see, if we look at the second paragraph, and this was on 27 February, it wasn’t on the basis that there was a requirement for learning, it was rather that there weren’t any beds with the agreed specification available, or that there weren’t any commercial providers who had appropriate equipment.
Mr Richard Pengelly: The point I would make about that is that the issue of whether or not they had beds available on a given day on 27 February, this was a planned transfer because I think the earlier correspondence, was it the 20th February the last one we looked –
Lead 2C: Yes, you’re right.
Mr Richard Pengelly: So there was a plan in place a week before, at least a week before, that the first patient would be transferred. So I don’t know whether again this is the drafting of the letter, I’m not so sure that we could say that the request for military assistance was prompted purely by the fact that there were no beds available on 27 February.
Lead 2C: It certainly reads that way, doesn’t it?
Mr Richard Pengelly: It does.
Lead 2C: Again, just to be clear, and again I emphasise it’s just about understanding –
Mr Richard Pengelly: Of course.
Lead 2C: – it’s not about clinical care, it’s just about understanding the state of preparedness, that it certainly does seem to suggest, doesn’t it, that Northern Ireland wasn’t ready or didn’t have an immediately available level of care that would be required in order to look after someone?
Mr Richard Pengelly: I think the – the answer to your question is I can absolutely see that reading this suggests the point that you have just made. The point I am making is in subsequent discussions with colleagues my understanding is that this was a planned approach for an early patient given the lack of knowledge; it wasn’t that we had grave concerns about our ability to treat patients, and the evolution of surge plans was on the basis that – I mean, we weren’t planning to be transferring all our Covid-positive patients, we were going to be treating them. This was, as I say, my subsequent learning, understanding is it’s about the learning from that.
Lead 2C: Right. Well, we can see that this letter is from Minister Swann. When you say you’ve subsequently learned, is that from the CMO? Does he have –
Mr Richard Pengelly: It’s just in the discussions in the preparations for the Inquiry.
Lead 2C: For the Inquiry.
I’m going to move away, if I may, from that, again just to understand the position that existed around that time in terms of the data that was available in Northern Ireland. You’ve made the point that there wasn’t – that there didn’t appear to be a whole lot of prevalence in Northern Ireland until later in March 2020; correct?
Mr Richard Pengelly: Yes.
Lead 2C: But I think it’s also right that you had very limited testing capacity in Northern Ireland until that point as well?
Mr Richard Pengelly: Yes, I think from memory in the sort of February stage our testing capacity had started off as low as maybe 40 tests per day. I think by mid-March it had grown to about 200 tests per day. So by any measure, you know, and population numbers, it was a low testing capacity.
Lead 2C: I think it’s also right that, in terms of just picking up or in terms of surveillance in the community, asides limited testing, there wasn’t any sort of reach into primary care services in order to understand people who might be going to GPs, for example, with symptoms of coronavirus; is that also correct?
Mr Richard Pengelly: In terms of getting the – because in the absence of a test –
Lead 2C: Yes.
Mr Richard Pengelly: – you know, there was – there would have been ongoing surveillance issues for flu-like – you know, it’s part and parcel of winter planning and flu surveillance, and the initial presentation of Covid could be flu-like symptoms, so I think in the absence of a significant testing capacity, you know, the answer has to be we didn’t know at that early stage.
Lead 2C: Yes. We’ve heard evidence from Dr McClean of the PHA about the use of the Apollo system, but that that was fairly limited –
Mr Richard Pengelly: Yep.
Lead 2C: – in terms of throwing light on Covid-19; do you agree with that assessment?
Mr Richard Pengelly: Yes, yes, absolutely.
Lead 2C: Is it also right that you didn’t have an ability to monitor hospitalisation rates for Covid-19 until May 2020?
Mr Richard Pengelly: Yes, I think that’s right, yes.
Lead 2C: All right. So all in all, in terms of those early stages in Northern Ireland, in fact just a very limited capacity on the part of the Department of Health to understand the prevalence of the virus, save for, I assume, people who were presenting for testing?
Mr Richard Pengelly: Yes.
Lead 2C: Just in terms of understanding some more of the difficulties about the data at that time, perhaps if I could bring up, please, INQ000389819, and page 1, please.
The Inquiry has seen this email, Mr Pengelly, I think four points down. And this is from the Director of Public Health in Northern Ireland, correct –
Mr Richard Pengelly: Yes.
Lead 2C: – Professor van Woerden? I think we understand, but you may understand a bit more about this, that he was effectively pushing back against the Department of Health’s requests for data about deaths in Northern Ireland; is that right?
Mr Richard Pengelly: Yeah, he was, but, I mean, I read this email more as his point – the third bullet point about the misleading data, which –
Lead 2C: Yes.
Mr Richard Pengelly: – I became aware of this email, I think last week it was exhibited, was the first I was aware, certainly it wasn’t a point that the Director of Public Health had ever made specifically to me in the past. My understanding of the position is it was a common case definition that was used across the UK and for comparative purposes the professional view of others, including Chief Medical Officer, Chief Scientific Adviser and colleagues in – other colleagues in Public Health Agency was there was more to be gained from the standardised use of a definition that was common to all jurisdictions than a Northern Ireland unique definition.
Lead 2C: So would you read this now, Mr Pengelly – understanding the point that you only saw it last week – did you understand, then, that Professor van Woerden was essentially pushing back against a position that was commonly understood and not controversial in other parts of the UK?
Mr Richard Pengelly: Well, the couple of points I would make on this were: I would suggest that if the Director of Public Health had felt so strongly about this, he might have made more of it and escalated it either to myself or the minister at that time. I have no knowledge or recollection of that happening. This was a standard definition. It was a common external narrative about the difference in terms of people dying “from” Covid versus people dying “with” Covid.
So what the data that we were producing represented we were very clear about explaining precisely what that was. So I – when I saw this last week, my sense was more it was Hugo pushing back as regards the pressure he was under to try and produce figures that, you know, he – my frustration, and I think there was another email exhibited last week, it was an email I’d sent too, which showed some frustration on my part with him –
Lead 2C: Yes.
Mr Richard Pengelly: – that I felt he just wasn’t responding in the way that I had wanted him to respond to that.
Lead 2C: And, Mr Pengelly, it is right that was a fairly– I don’t want to overstate it, but it was a theme that endured for some time with the Public Health Agency, wasn’t it?
Mr Richard Pengelly: It was a theme that endured for a point in time longer than we would have liked it to endure for. We did move past it, but it was clearly prevalent for longer than it should have been the case.
Lead 2C: If we can just look at some of the issues that arose, because these are obviously important points in terms of understanding some of the difficulties that there were early on in the pandemic.
But if we look, please, at INQ000389810. Thank you.
We’ve also seen this.
And I think if we go to page 4, please.
First, this is Minister Swann’s special adviser, who was I think on behalf of the minister setting out the serious concerns that there were – or, sorry, the concerns there were about serious discrepancies in what the minister was being told. Again, Mr Pengelly, as the Inquiry understands it, it was because Minister Swann was, for example, I think, making public statements –
Mr Richard Pengelly: Yeah.
Lead 2C: – about figures or about testing –
Mr Richard Pengelly: That’s right.
Lead 2C: – and was concerned that he wasn’t being provided with accurate information; is that right?
I think if we look – just looking at that, I think his concern was, wasn’t it, that there were concerns that the PHA surveillance figures in general were not accurate; is that correct?
Mr Richard Pengelly: That’s correct, yes.
Lead 2C: Then I think this is probably the email that you were talking about, but at page 2, where you say that you’re concerned that the PHA just isn’t taking these concerns seriously enough.
Mr Richard Pengelly: That’s correct.
Lead 2C: So again, how serious an issue was this for the minister at this point in time, that he wasn’t being provided and wasn’t conveying accurate information?
Mr Richard Pengelly: It was – I mean, the minister was very sensitive to this issue because his view was that accurate data and reliable data was central, both to taking decisions about our response to the emerging pandemic but also was an issue of public confidence that if we were constantly re-stating figures, the public would have no confidence. I think part of his frustration – so there was a big part of his frustration was on data accuracy. I also think a part of his frustration was that the response when we raised this with the PHA just wasn’t as robust as he would have expected from them in terms of, you know, “We understand the problem and we commit to fixing it rapidly”.
Lead 2C: Yes, and I think if we can, just to complete this, if we could look, please, at INQ000440253. I think if we could go to page 2, please.
So I think that this was the – the name has been redacted, but I think that we can see – and it is from the PHA, I think it’s part of the same theme, isn’t it?
Mr Richard Pengelly: It is, yeah, very much so.
Lead 2C: And I think we caught a glimpse of your response on the first page, that you were “stunned” by the way the PHA had responded; is that correct?
Mr Richard Pengelly: Yes.
Lead 2C: All right.
So in terms of when those issues actually resolved themselves, can you recall when it was that the PHA was actually able to provide accurate data?
Mr Richard Pengelly: I think the issue resolved itself as we moved into April, and our information analysis directorate colleagues within the department assumed responsibility for the collation and publication, and that’s our professional statistical colleagues, and the figures then became published under national statistics conventions with the governance and oversight that associates itself with that.
Lead 2C: Forgive me, Mr Pengelly, I think it’s right that, in fact, the Department of Health effectively took over a number of functions from the PHA at around that time; is that right?
Mr Richard Pengelly: I think we certainly moved the data issue, and I think other functions we worked very, very closely with them as opposed to took them away from PHA, but we maybe stepped into much more command and control-type approach as opposed to the normal relationship between sponsor department and arm’s length body where there’s quite a remove between the two organisations.
Lead 2C: And I think that that also then – did that also become the position about test and trace as well?
Mr Richard Pengelly: Yeah, in terms of oversight, the operational delivery stayed with PHA –
Lead 2C: Yes.
Mr Richard Pengelly: – but the governance and oversight of it, the department stepped in.
Lead 2C: The Inquiry has already seen, and it will hear evidence from Professor Young about this this afternoon, but it is correct, isn’t it, that the PHA in an email exchange said – or, well, I think it is just stated on 20 April 2020 that 500 people were being trained in order to be able to undertake tracing. Is that something that you’re familiar with?
Mr Richard Pengelly: I’m familiar with it, again only over the course of the last week when I saw the email last week; I hadn’t been aware of that before. But just to be clear, my understanding is the email states the 500 figure.
Lead 2C: Yes.
Mr Richard Pengelly: I think there is a disconnect between what the figure states and what actually happened.
Lead 2C: Yes, that’s really what I think the Inquiry is interested in –
Mr Richard Pengelly: Yep.
Lead 2C: – it’s the understanding that in fact it was represented to the Chief Scientific Adviser that 500 people –
Mr Richard Pengelly: Yes.
Lead 2C: – were being trained.
Mr Richard Pengelly: And I don’t think there can be any other interpretation of that email than that was the case.
Lead 2C: And that just wasn’t correct, was it?
Mr Richard Pengelly: As I understand it, it was not the case at all, and I think the number of tracers I think peaked later in the year at about 300.
Lead 2C: Yes.
Mr Richard Pengelly: So I don’t think there was ever a case of 500 being in training.
Lead 2C: Again we’ll pick this point up with Professor Young, but in fact the issue arose again, didn’t it, in the autumn of 2020, when again there was an issue with the PHA in terms of them not understanding why there needed to be greater numbers of people trained?
Mr Richard Pengelly: Yes, I think there was – but I – and, sorry, I’m sure you’ll cover this this afternoon, but my understanding is that Professor Young was very clear in April 2020 about the numbers that would be required as we moved forward. That number, I think, was – I think his number was in the sort of excess of 300, and a number of 50 was quoted in the first draft of the business case later in the year by PHA, which was subsequently amended but the fact that it was 50 is a cause for concern.
Lead 2C: We can pick up the detail with him, but in terms of your role as permanent secretary, what insight or understanding did you have that tracing capacity was not what it was being represented to be?
Mr Richard Pengelly: Well, the specifics of the email and the 500, and that misrepresentation – if that’s the appropriate word for it, and I don’t know the detail – it’s clearly not a reflection of what happened. I wasn’t aware of that. I was aware throughout that period in 2020 that there was frustration in terms of trying to grow testing capacity and that there was a programme work to work with PHA colleagues to both recruit staff and redeploy staff. And then I think at the end of July the proximity app came online which facilitated that, and then in October, I think, the digital self-trace mechanism cam on, so they were components of the overall solution. But there was an intense programme of work. I wasn’t intimately engaged in terms of the operational outworking of that, but I’m aware it was the cause of much focus in terms of the dialogue between colleagues and PHA.
Lead 2C: I think the point is really just the short one of whether or not the Department of Health was fully sighted on the lack of capacity in PHA to undertake tracing or whether or not it was proceeding on a false basis that there was a cadre of tracers trained and ready to go who didn’t in fact exist.
Mr Richard Pengelly: My understanding is that whilst it was never elevated to my desk, senior colleagues in the department were very much aware of the issue about capacity and working with colleagues in PHA to try and address any deficit.
Lead 2C: All right. So if it is a misrepresentation after a fashion it came to light –
Mr Richard Pengelly: Yes.
Lead 2C: – is that correct? All right. Again, in terms of the individuals who have the detailed understanding of that, would that be Professor Young or the Chief Medical Officer?
Mr Richard Pengelly: Yes, they were both involved in this.
Lead 2C: Just in terms of before we leave test and tracing, the Inquiry has seen that on 8 March Northern Ireland was still regarded as being in the contain phase; is that right?
Mr Richard Pengelly: Yes.
Lead 2C: In terms of the decision on 12 March to cease test and tracing, was that a decision that you, as the permanent secretary, made within the Department of Health?
Mr Richard Pengelly: No, that was an issue that flowed from the COBR decision to move nationally from the contain to the delay phase, because there was – the UK-wide plan had been agreed, I think at COBR, a week before, and it included that – it included the point that when we move into the delay phase, the benefits of contact tracing were redundant, it would be stood down. There were other measures in terms of isolation being put in place as part of that. I understand there is some confusion about the nuances of that decision. My explanation is – my understanding of it is that it flowed from the COBR discussion on 12 March.
Lead 2C: Maybe be clear about that: is it that that decision de facto just applied in Northern Ireland, or in terms of did the decision that was made in COBR apply without any individual consideration of –
Mr Richard Pengelly: No, there’s an understanding that – as has been explained to me, there was an understanding at the COBR discussion, at which both central government and the devolved administrations were present, that this was a UK-wide decision that was being taken, and all the devolved administrations were part of that decision.
Lead 2C: But was that – I mean, in Northern Ireland, was there substantive consideration of the question of whether or not there was still merit in test and trace?
Mr Richard Pengelly: I – as far as I’m aware, that decision wasn’t taken – to answer your question, it wasn’t the subject of an Executive paper and presentation to the Executive and specific consideration in the context of Northern Ireland, I’m not aware that that was the case. The UK-wide decision at which all the devolved administrations were present was the one – once-for-all decision.
Lead 2C: I’m putting aside the formal mechanism by which such a decision might be made, it’s really just the question of whether or not the substantive or qualitative analysis had taken place in Northern Ireland as to whether there was any merit in continuing to test and trace.
Mr Richard Pengelly: I think there was a – sorry, the short answer is that there wasn’t the detail and substantive analysis, as you have described it there, because it was swept up in that broader decision.
Lead 2C: Because the Inquiry understands that test and trace was still being done in quite low numbers in Northern Ireland, it may have been – it may have put the PHA under pressure, but the numbers were relatively small; is that correct?
Mr Richard Pengelly: They were small, yes, linked to testing capacity too, but there was also a sense, as we moved into March and case numbers grew, that our limited testing capacity needed to pivot more towards clinical testing for people on admission to hospital to see whether they were Covid positive or not, rather than for a test and trace capacity, until such times as we grew testing capacity.
Lead 2C: All right, but no qualitative analysis –
Mr Richard Pengelly: No.
Lead 2C: – as to whether that was the position reached?
I just want to deal, if I may, with some discrete topics that are important, just to understand the – your perspective as permanent secretary. So I’m just going to deal, if I may, with the question of joint modelling with the Republic of Ireland. Northern Ireland and the Republic of Ireland entered into a memorandum of understanding, didn’t they, in March 2020, and they undertook by that informal mechanism, I think, to – if I can put it in these terms – both governments will adopt similar approaches guided by scientific evidence, I think that’s what was said, and that in relation to modelling the participants are committed to working in partnership to predict the likely impact of Covid-19 and enable evidence-based decisions on how best to respond across the island of Ireland.
That was the undertaking in the memorandum, but that didn’t, as we – as the Inquiry understands it, that didn’t in fact result in any capacity to undertake joint modelling, did it?
Mr Richard Pengelly: That’s my understanding too. I mean, the modelling group would have been more in this space, but I think at the time the MoU was signed there was an aspiration, but it wasn’t underpinned by sort of joint modelling as we would understand it.
Lead 2C: Can you help with why, given that that was the expressed intent in March 2020, why that didn’t eventuate or why it didn’t prove possible?
Mr Richard Pengelly: I think Professor Young might give you a much more fulsome answer, but my understanding was that it was down to differences in methodology and approach, and the modelling, there was very different approaches to testing North and South, and I think trying to bring the two different approaches into a joint model would have been very difficult but, as I say, Professor Young I think understands the nuances of that in a way that I don’t.
Lead 2C: But you weren’t involved with your counterpart in the Republic of Ireland to try and discuss what you might be able to do to overcome those kind of barriers?
Mr Richard Pengelly: No, those were more technical discussions insofar as they took place at a sort of modelling group level as opposed to between myself and my counterpart.
Lead 2C: It’s understood from the evidence that’s been provided from the CMO and from others within the Department of Health that it was accepted, or certainly agreed, that Ireland was effectively acting as a single epidemiological unit for the purposes of the virus, so epidemiologically that was the position; is that right?
Mr Richard Pengelly: Yes, but the way they have explained it to me is that it was a single epidemiological unit, it wasn’t the only single epidemiological unit, and certainly the point had been made to me that New Zealand was a single epidemiological unit, that the North and South Islands are much more geographically remote than Ireland is from Great Britain, so there’s an argument that the whole of the U – that the islands, that Great Britain and Ireland were acting also as a single epidemiological unit, so I think there’s many nuances to that point.
Lead 2C: All right, but Ireland, the land mass of Ireland is a small territory and it’s got a small population, hasn’t it, when you take North and South together?
Mr Richard Pengelly: It does, but the big complication is the Common Travel Area.
Lead 2C: Of course.
Mr Richard Pengelly: It is small and discrete but it doesn’t have that ring round it.
Lead 2C: It’s really just trying to understand how important it was or wasn’t to the Department of Health that there wasn’t that capacity to model on an all-island basis and to have that understanding of how –
Mr Richard Pengelly: As I say, I don’t want to speak for Professor Young, but the explanation and any discussions I have had with him was that the modelling that was happening in our jurisdiction, combined with his understanding of what was happening inside as distinct from doing joint modelling, provided information and analysis –
Lead 2C: And those –
Mr Richard Pengelly: – that was helpful to us.
Lead 2C: I’m sorry, I didn’t mean to speak over to you. And was that regarded as sufficient then from the Department of Health’s perspective –
Mr Richard Pengelly: As I understand it, it was. We didn’t feel there was a major deficiency amount.
Lead 2C: All right.
I think you’ve said “as I understand” on a number of occasions; is that because you’re dependent on the views of other people in order to make that point?
Mr Richard Pengelly: Yes, because I’m dependent on the modelling the Chief Scientific Adviser was doing, his analysis of the modelling work that was done was being done, and was it sufficient and fit for purpose to underpin the decisions that we were putting in front of the Executive, and I’m assured it was.
Lead 2C: All right.
I’m going to move on then, we can take those issues up with Professor Young, to the issue that arose last week about the question of the extent to which government in Northern Ireland operates in a compartmentalised way. And the Inquiry saw evidence last week of the frustrations on the part of the First Minister and the deputy First Minister about the Department of Health effectively being not under their control and operating in a way possibly that was causing them difficulty. Was that a tension or an issue that you were aware of at the time?
Mr Richard Pengelly: I was aware of a – what I would describe as a very understandable tension across the Executive, that there was a thirst for analysis and information and data that we all struggled to meet, and part of that was – we’ve talked about some issues, particularly in the early stages, about the adequacy and accuracy of data but even when we addressed those points in mid and late April and the department took over the dashboard and we had the data, the reality was that, on any given day, the decision that we were putting in front of the Executive was underpinned by data that was only emerging overnight. So it was a very understandable frustration about the speed and timeliness of getting data. But I’d struggle to think of what – you know, the alternative would have been to go with an earlier paper that contained data that was maybe 48 hours old, which I don’t – and given the speed at which we were moving.
I’ve heard the frustrations mentioned. I’ve only ever heard the frustrations mentioned in very general terms. I don’t think I can point to any very specific examples of where issues weren’t being brought to the Executive or the department. There was a sense the department that – had access to information analysis that wasn’t being shared, so …
I think the pace we were moving at, I understand the frustration, and I think it’s always going to be present, but I – in terms of – if your question to me was what’s the answer to that problem, I do struggle with it.
Lead 2C: No, I think the question is much more about whether or not you recognise or accept that there was compartmentalised behaviour or action on the part of the Department of Health at the outset of the pandemic such that – we’ve seen already in emails consideration even being given to – or certainly discussion about whether one solution was to remove Minister Swann. Those were the kind of –
Mr Richard Pengelly: Yeah.
Lead 2C: – issues being raised?
Mr Richard Pengelly: I don’t accept – I didn’t see, I didn’t hear and I didn’t experience any compartmentalised behaviour by colleagues in the Department of Health. The issue about the possible removal of Minister Swann, that wasn’t something I was ever aware of. Again, I saw it aired last week.
I think one of the core issues here that – is the sheer pressure that was on individuals, and I’ve touched earlier – if I may, one of the issues that I think came up last week was the request from the Cabinet Office for information from the CMO, and that there was the exchange about – I think there was the email about –
Lead 2C: Yes.
Mr Richard Pengelly: I think just in terms of context for that – I mean, I – having seen the issue aired last week, I looked into some of the paperwork a bit more. The request came across from the Cabinet Office, I’m not sure when but I think just in the course of the day, on the Friday. It made its way onto the Chief Medical Officer’s desk, I think, at about 11 o’clock on the Friday night, while he was still in the office, with the request for a response by lunchtime on the Saturday. And that was after a week of probably being in the office. So I certainly would forgive him for what may have been a rather abrupt response.
In terms of then responding, we ultimately responded I think on Monday the 9th, there’s a large flurry of activity in the duration of Sunday with colleagues. So it wasn’t that this information was readily available and there was a desire that we have it but we’re not sharing it. Many colleagues were involved in a lot of exchanges of information on the Sunday and evolving and preparing the information to facilitate a response that happened on the Monday. So I offer that as one illustration and –
Lead 2C: Can I just stop you there, Mr Pengelly.
Mr Richard Pengelly: Sorry.
Lead 2C: We’ve seen the correspondence. We know that what Cabinet Office was seeking was a response, I think from across Northern Ireland, about some of the measures that were possibly being contemplated at that point in time. I’m not sure that it was clear that it was necessarily just something from the Department of Health to respond to, but that nonetheless the CMO said that Northern Ireland – well, his advice was: don’t respond to this. And as we understand it, it’s because government, the Cabinet Office, pressed for a response that it was ultimately replied to.
Is that your understanding?
Mr Richard Pengelly: My understanding, the – my understanding was that the initial response, given the lateness of the hour and the volume of (inaudible), was maybe a little higher temperature than may otherwise have been the case in more benign times. I think my counterpart at the time in the Department of Education also indicated that he would find it very difficult to respond at all or to respond in a meaningful way.
I think the point I’m making is work was then initiated within the department and it took two days to develop a response that went on the Monday, as distinct from the department wrapping its arms round it and saying: no, we’re absolutely not doing this. And I’m just differentiating that it wasn’t we said that Monday because we wanted to make a point; it took us until Monday to generate the answer.
Lead 2C: This is something we’ll take up with the CMO and look a bit more closely at the communications, but on that point you didn’t see anything wrong or didn’t think it was wrong in principle that the CMO should be replying and telling government in Northern Ireland generally not to respond to the requests from the Cabinet Office?
Mr Richard Pengelly: I think that’s maybe a question of interpretation. I think his view was that we didn’t need to respond. I mean, I don’t think Michael was presenting his response as the definitive answer in that question, and the fact that we did ultimately put a response in.
Lady Hallett: Can I just step in for a second?
A few minutes ago you mentioned the suggestion that a minister, the minister of health should be removed, I think if you read the document fairly, the writer of the document wasn’t suggesting the minister should be removed but it was just one of a number of options which –
Mr Richard Pengelly: Sorry.
Lady Hallett: No, no, I’m not even sure you did use the word “suggest”, but just in case anybody thought you did.
Mr Richard Pengelly: Apologies.
Lady Hallett: No, no, I don’t think you did, I think I’m just being ultra-cautious.
Ms Dobbin: I’m sure it’s more my fault, so I apologise, it was me trying to summarise an email, but quite right, it was just a number of options for discussion.
Can we just, in terms of some of the cultural issues, though, Mr Pengelly, could we, please, look at INQ000305020.
Mr Pengelly, we’re going to come with other witnesses to look at what happened in autumn of 2020 in a good deal more detail, but this is a letter from Minister Swann that was sent, I think, at a point in time when things were obviously of some sensitivity in Northern Ireland in terms of the direction of travel with infection rates and, I think we’ll come with Professor Young, looking at death rates as well.
But in terms of what he was saying there, and it’s in the second paragraph, where he sets out obviously that they had come to a joint decision as an Executive Committee about what would happen, and then the suggestion that a colleague had gone on to the radio to confuse the position.
I think if we look three paragraphs down as well, he refers in that regard to the requirements of the Ministerial Code as well.
I picked this letter out because it encompasses a number of things that obviously the Inquiry has seen a bit of thus far, but can you help us, regards the undermining of Executive decision-making by ministers taking public positions that were different to that decided by the Executive Committee, was that a problem during this period, as far as the Department of Health was concerned?
Mr Richard Pengelly: I think – I think it was a frustration, from memory, with many ministers, that these were very, very difficult decisions, and I think it was rehearsed last week just about the difficulty sometimes of the Executive discussion that leads to the decision.
The frustration that certainly the minister of health was reflecting in this letter, and I think some other ministers shared it, was that if the Executive wrestled with a very difficult decision and reached a conclusion, to then attempt to sell that position to the public in a fragmented way would undermine public confidence in the measure that’s being adopted and subsequently in – particularly if it was a restriction that was being put in place, with adherence to that restriction.
So that – that was an issue that bubbled to the surface a number of times, particularly throughout the autumn of 2020.
Lead 2C: But was it regarded as undermining public confidence at points in time when the position was particularly finely balanced or sensitive as regards the transmission of the virus?
Mr Richard Pengelly: Sorry, I know this wasn’t your exact question, I don’t think there was any quantitative analysis of what it did to public confidence. There was certainly a perception that I heard some ministers make that they felt public confidence and, importantly, adherence with measures put in place would be undermined by colleagues not standing shoulder to shoulder with the decisions taken.
Lead 2C: All right. Well, we can take that point up with ministers.
I just want to finish, I have a topic that I hope I might be able to take you to without needing to go to the documents, and it’s in relation to care homes, Mr Pengelly.
I think it’s right that at the outset of the pandemic, I’m sure you’re familiar with this, but that certainly throughout March 2020, you, in a series of communications, communicated to those who had management or control over the care sector about surge plans and repeated the point that:
“Trusts should … work to maximise and utilise all spare capacity in residential, nursing and domiciliary care.”
And that also trusts were to work to fill up vacant places, I think, in the care sector as quickly as was possible, having regard to the need to, I suppose, free up hospital spaces; is that correct?
Mr Richard Pengelly: Yes.
Lead 2C: And I think it’s also right that you – that it was the position that trusts were expediting discharges where patients had been deemed medically fit in hospital so as to move them into the care sector as well, and that that was the – that was certainly the plan from mid-March to mid-April?
Mr Richard Pengelly: Yes, I think – just a – the delay at that point, just to emphasise the discharge was to be expedited in the case where patients were medically fit to be discharged. It had been an enduring problem in Northern Ireland – we touched earlier on some of the challenges about running emergency departments –
Lead 2C: Yes.
Mr Richard Pengelly: – and admitting patients because beds were filled and “bed blocking”. It’s been an enduring challenge about timely discharge. The reality is my medical colleagues over the years have emphasised on many, many occasions that, particularly for a frail elderly person, being medically fit to be discharged from hospital means that it is quite a dangerous position to put them in by retaining them in hospital past the point – for issues like hospital-acquired infection, notwithstanding Covid, but also there – I think there’s – muscle mass deteriorates at the rate of about 10% a week.
Lead 2C: Yes.
Mr Richard Pengelly: So there are many clinical issues why it’s extremely important for timely discharge.
Lead 2C: But in terms of the testing of individuals who had been in hospital and their move into care homes, I just want to make sure that the Inquiry has this correct.
I’m not going to bring you to this document, but just – I can if you need to.
Mr Richard Pengelly: No, no.
Lead 2C: But certainly what appears to have been the position as at 17 March, so this is both in relation to testing leaving hospital and in care homes, that on 17 March the position was that there was testing of residents in care settings where there had been a potential or a possible cluster of outbreak; is that right?
Mr Richard Pengelly: That’s right, but the caveat is I think the testing at that stage, due to capacity constraints, was restricted to a maximum of five residents where there had been a cluster, as opposed to all residents –
Lead 2C: Yes.
Mr Richard Pengelly: – of the care home.
Lead 2C: And that on 12 April there was an agreement to the extension of testing arrangements so that there was testing of symptomatic residents and staff in care homes if there were two or more breakouts; correct? So it wasn’t until 12 April –
Mr Richard Pengelly: That’s right.
Lead 2C: – that that position was reached.
We can pick this up from an email of 18 April 2020. I won’t take you to it, but again, just in terms of orientating ourselves in the chronology, there was a reference in that email to the position in England, that there was a strategy to discharge from hospitals into care homes, and that it stated that all discharges to care homes should be tested for Covid-19, and the email says:
“… grateful for confirmation you’re ok with that, (think I flagged this was coming - but very happy to chat).”
So that’s an email internal to the Department of Health. And again, is that correct that in and around 18 April it was recognised that individuals going from hospital into care homes should be tested?
Mr Richard Pengelly: The date I have for that is 19 April that that –
Lead 2C: 19 April.
Mr Richard Pengelly: Which also – in terms of testing capacity I think on 19 April our testing capacity moved from 1,000 per day to 1,800 per day, so it wasn’t a capacity issue.
Lead 2C: But is that right that it wasn’t until 18 April that individuals were being tested upon leaving hospital to come into care homes –
Mr Richard Pengelly: That’s right.
Lead 2C: I think it’s also right – and this is a letter from you, I won’t take you to it – but I think from 24 April, all new outbreaks in care homes resulted in individuals being tested; is that right?
Mr Richard Pengelly: Yes, that was – and that was both all residents and staff from 24 April, where there’s a new outbreak.
Lead 2C: And I think, again, it’s also right, Mr Pengelly, that if an individual was tested in hospital from that date, from 19 April onwards, there didn’t have to be a result in order for them to move to a care home –
Mr Richard Pengelly: That’s right.
Lead 2C: – is that right?
Mr Richard Pengelly: That’s right.
Lead 2C: And I think it’s also right that –
Mr Richard Pengelly: Sorry –
Lead 2C: – an individual could also move to a care home if they had tested positive, if there were arrangements for them to be –
Mr Richard Pengelly: For isolation, right.
Can I just add: in terms of the discharge from hospital to care homes, and you may come on to this with other witnesses, there was a point-in-time review we did later in 2020 with Niall Herity, who is a consultant cardiologist, now, he sampled two weeks, but he discovered that 1.1% of patients discharged from hospital to care homes tested positive within the two weeks, 98.9 didn’t test positive, and his analysis of the data was that outbreaks in care homes were much more closely aligned with levels of community transmission than hospital transmission, just by way of context.
Lead 2C: I think that there was also a response, wasn’t there, from the sector to that report that said it didn’t take into account that there was very limited testing in the time period that he was looking at?
Mr Richard Pengelly: That’s reflected in the report, but the point in the report was of those test – it was still only 1.1% and that the data flows, as the pandemic endured, showed that – attract community transmission and I think that was a point-in-time review with a limited dataset. There’s subsequent statistical analysis that shows across the UK care home cases much more closely aligned with community transmission than hospital transmission.
Ms Dobbin: Right, Mr Pengelly, I’m going to stop there because I think there are some questions from other core participants.
Lady Hallett: There are.
Mr Wilcock.
Questions From Mr Wilcock KC
Mr Wilcock: Good afternoon, Mr Pengelly. I represent the Northern Ireland Covid Bereaved Families for Justice and I want to ask you questions on three topics.
Topic 1 is the relationship between the Northern Ireland Commissioner for Older People and your department, and we have heard evidence from Mr Lynch about some of the frustrations he experienced in his dealings with the Department of Health, particularly in relation to care homes. As a starting point, presumably you accept that the Commissioner would have been a valuable source of information on any topic, such as care homes, which was inevitably likely to become a critical issue for older people.
Mr Richard Pengelly: Yes, absolutely.
Mr Wilcock KC: In his statement to the Inquiry, Mr Lynch stated that:
“In the early days of the pandemic I found that there was no single point of contact for me, or anyone from my office, to enable us to provide specialist information or guidance on what I feared would become a critical position for older people.”
And that because of this there seemed to him to be no proper forum for raising his concerns – and he quotes, for example, testing in care homes that you’ve just discussed – and because of this, he felt he had to tell the media that there was a lack of urgency on the part of the Department of Health. Do you have any sympathy with the position the Commissioner found himself in?
Mr Richard Pengelly: The position is – I understand his point about not having a single point of contact, there wasn’t a defined single point of contact, but there were a number of key contacts that the Commissioner utilised and the evidence I have seen is that they were utilised extensively in terms of two of my senior colleagues. There was a large amount of dialogue. This was happening at a point in time. It’s certainly the case that the legitimate issues that the Commissioner was raising from time to time we weren’t able to respond to effectively.
So the two points, sorry, I want to finish with, there was a lot of engagement and dialogue. More engagement and dialogue with a valuable representative of what is a critical group would always have been preferable had it been possible.
Mr Wilcock KC: Dialogue of course works both ways. Why, if you say that you were looking for dialogue, did the department not actively seek the expertise of the Commissioner for Older People rather than just rely on him to approach you, given that he had a direct line of communication with the people in the care homes and their families?
Mr Richard Pengelly: Well, my understanding is we did actively seek him out. The difficulty that the Commissioner faced, and it’s entirely understandable, is that at the pace issues were moving at the times when we shared copies of draft guidance that he didn’t feel he had sufficient time to engage and consider and respond to that, and I understand and sympathise with that point, but that’s different from not engaging at all. The problem that we faced, and colleagues in particular faced, the bulk of this guidance was in the early stages, certainly at the late February and early March, was dealing with issues like infection prevention and control, which were really moving from national standards. The – because as well as speaking to the Commissioner, my colleagues were also speaking directly to other representatives in care homes and to care homes directly. The message they were hearing loud and clear was colleagues in care homes were urgently requesting clear guidance on the emerging latest position, so it was trying to marry those two issues. We didn’t always get it right, and with more time there would have been longer and more fulsome engagement, but just the pace of it overtook us at times.
Mr Wilcock KC: Well, just taking up that topic, whether you always got it right, can I ask you, please – can I ask for INQ000023185, page 2, to be put on screen.
While that’s happening, Mr Pengelly, I’m hoping that’s going to be the index to the Department of Health Covid-19 Emergency Response Strategy which was published on 30 March. Sorry, I think you may have a different reference, which is INQ000130409.
We’ve had the pleasure of having multiple copies of the same documents, as you know, my Lady.
So anyway, that is the index to the emergency response strategy that your department published on 30 March, and I’ve put it on screen to give some idea of what the strategy at the end of March purported to contain.
Now, I imagine you’ve had an opportunity of making yourself familiar with this document before today?
Mr Richard Pengelly: Mm-hm.
Mr Wilcock KC: Do you accept that this document makes no specific mention of the acutely vulnerable status of older people?
Mr Richard Pengelly: Well, I accept that. I haven’t seen the rest of the document before me today, I’ve read the document recently, but I’m happy to accept that point.
Mr Wilcock KC: You’ve told us this morning about text exchanges that you had with the head of the Civil Service nearly two months earlier, on 6 February, in which Sir David Sterling specifically remarked that the problem will be when the pandemic hits care homes and hospitals. And I know he was talking about a different type of pandemic, but the principle remains the same.
Do you accept, therefore, that by 30 March 2020 you and your department were well aware that any response to the Covid pandemic you now knew you were dealing with would have to take account of the acutely vulnerable status of older people?
Mr Richard Pengelly: Yes, and it did.
Mr Wilcock KC: So why is there no mention of it?
Mr Richard Pengelly: Well, this is a very high-level strategic document covering the work of the totality of the sector. As I get – it doesn’t run to much more than about 17 pages. There were separate very complex workstreams looking specifically at the issue of care homes, so I can understand the frustration that it’s not mentioned in the document specifically, but that’s not to say that there wasn’t a focus and energy on work taking place in terms of the care sector.
Mr Wilcock KC: Well, high-level can mean two things – one, it can mean general policy; or, two, it can just mean vague – but either way is it not surprising that this document does not refer within those 17 pages to the importance of infection prevention and control measures in the micro-environments of care homes in particular?
Mr Richard Pengelly: As I said, it’s a high-level strategic document. It doesn’t get into granular detail across every sector. There would be other areas that aren’t mentioned, but that – I must emphasise that’s not to say that there wasn’t comprehensive workstreams happening in parallel with the development of this document within the sector about care homes.
Mr Wilcock KC: Just so I understand your evidence, are you saying that it wasn’t a matter of high-level strategy to prevent and control measures in care homes?
Mr Richard Pengelly: No, I’m not. I’m saying this was a high-level strategy document that painted a high-level picture of elements like understanding the path of the curve and measures to flatten the curve. It didn’t seek to get into every important aspect of work.
The fact that something is not specifically mentioned in there does not mean that it’s not strategically important, and I can’t emphasise that point enough. Care homes were hugely important to us and particularly the care of all residents within care homes, and indeed the staff.
Mr Wilcock KC: Well, I think the public would expect that’s the minimum we could expect from the Department of Health, that care homes would be hugely important, but can you not see why it might be thought that the absence, even if this is a high-level strategic document, of any mention of the importance of controlling Covid within care homes in itself indicates that there was a failure in your department to adequately recognise and plan for the acutely vulnerable position of care homes?
Mr Richard Pengelly: I can certainly acknowledge the frustration of the stakeholders you represent that it’s not specifically mentioned in this, but I just – I emphasise, that is not to suggest that this wasn’t a strategically important issue of great concern for us in the department.
Mr Wilcock KC: Thank you, Mr Pengelly.
Next topic: can we have INQ000145670, page 1, on screen, please.
This is a letter that you wrote, I think, to the chief executives of the Health and Social Care Trusts, which you’ve described as the arm’s length delivery body for the Department of Health earlier on in your evidence, and in this letter on 25 April 2024 entitled “Key Changes To Testing For Covid-19” you wrote in the last paragraph that:
“In advance of discharge from hospital to a care home each patient must be tested for COVID-19, ideally this test will be undertaken 48 hours prior to the patient’s discharge to their identified care home.”
Then rather incongruously you end by saying:
“This testing requirement must not hold up a timely discharge.”
Now, in his evidence to the Inquiry last week, the Commissioner for Older People stated that he thought:
“… it was very clear cut that the policy of discharging people without testing into [care homes] was a potentially disastrous one.”
Now, I used the word “potentially” in view of the answer you gave to Ms Dobbin less than ten minutes ago that, rightly or wrongly, you say not as much damage was done as might have been expected. Do you accept that it was at least a potentially disastrous policy to discharge people into care homes from hospitals bearing in mind the danger of passing on?
Mr Richard Pengelly: Absolutely, it’s potentially dangerous.
Mr Wilcock KC: Right.
Mr Richard Pengelly: – if unmitigated, but I think the point that paragraph is making is it must not hold up a timely discharge because other mitigating measures may be in place; for example, isolation within the care home.
Mr Wilcock KC: Right. Now, Mr Lynch goes on to say that not only was it potentially disastrous but any policy of discharging people without testing into care homes was quite a reckless decision to allow this to happen. Now, you’ve already said that in fact the policy could have allowed it to happen because people were getting discharged at times without tests, and even if they were having tests, the results weren’t in by the time of transfer. You agree with that?
Mr Richard Pengelly: Uh-huh.
Mr Wilcock KC: Even accepting the evidence you’ve told us about this morning about the historical difficulties in Northern Ireland’s fragile health system meaning there
has to be a careful balancing act between hospital
admissions and discharge, do you agree that nevertheless
this striking caveat, that testing must not hold up
a timely discharge, is an example of the recklessness
Mr Lynch was describing?
Mr Richard Pengelly: I don’t agree with the use of the word “reckless”.
I think we – I mean, it’s hugely important to have
regard to the care homes and possibly routes of
infection into care homes, but it’s also of huge
importance to have regard to individuals, and we are
talking about people in all circumstances, but for
an individual who is clinically fit to be discharged
from hospital, particularly, as I said, if they’re
a frail elderly individual, for them to be retained in
hospital beyond that is potentially highly dangerous to
that individual. So the approach here is about trying
to balance a series of risks, and the solution, whilst
imperfect, is hopefully achieving the best alignment of
all those competing factors.
Mr Wilcock KC: Well, it’s not imperfect, it’s completely contradictory,
isn’t it?
Mr Richard Pengelly: Well, I’ve used the word “imperfect”, but I believe it’s
imperfect rather than contradictory.
Mr Wilcock KC: In his statement Mr Lynch goes on to state that he had
been receiving calls during March and April 2020 from care home managers and providers expressing concern and frustration about what they saw as a requirement by their respective HSCTs to admit new residents from hospital without adequate testing for Covid-19.
Other than through Mr Lynch, what mechanisms were in place for care home managers to convey these concerns?
Mr Richard Pengelly: Well, there’s Pauline Shepherd’s organisation, I think it’s IHCP, I think the colleagues in the department were also in very regular dialogue with Pauline about some of the issues that she was raising, and also particularly for some of the larger care homes there was regular dialogue between colleagues in the department and the owners and managers, both of large and small care homes, so there was many points of dialogue.
Mr Wilcock KC: Do you accept that, in spite of the available points of dialogue, the concerns of care home managers and providers were not adequately taken into account when you gave this guidance in this letter?
Mr Richard Pengelly: I mean, I can’t argue with the assertion that this letter didn’t completely deal with the concerns that were clearly prevalent in some care homes, but through issues like pressures on hospital capacity, pressures on testing capacity, there wasn’t a perfect solution to any of these issues. I believe that this letter and the policy we adopted was the best compromise position we
could reach in terms of managing all those competing
tensions.
Mr Wilcock: Thank you very much. I’ve no further
questions.
Lady Hallett: Thank you very much indeed, Mr Wilcock.
Thank you for your help, Mr Pengelly.
The Witness: Thank you.
Lady Hallett: I know you’ve already helped and I do
understand the burden that we place upon witnesses like
you, but I’m afraid I can’t say we won’t call upon you
again because, as you may know, I have a health module
coming up in the autumn. So thank you for your help
today.
The Witness: Thank you.
(The witness withdrew)
Lady Hallett: I shall return at 2 o’clock.
(1.00 pm)
(The short adjournment)
(2.00 pm)
Lady Hallett: Professor Young, I hope you weren’t brought
here this morning “just in case”, and if you were, may
I apologise for keeping you waiting.
The Witness: Not at all.