Be prepared - Covid inquiry week 5

As I write, Boris Johnson still hasn't delivered the Whatsapp messages from his old phone, covering more than half the period identified as important to the Covid inquiry. It's now nine days since the Cabinet Office lost its court case and told us it was perfectly happy with that result: "[O]ur judicial review application was valid as it raised issues over the application of the Inquiries Act 2005 that have now been clarified. The court’s judgment is a sensible resolution and will mean that the inquiry chair is able to see the information she may deem relevant, but we can work together to have an arrangement that respects the privacy of individuals and ensures completely irrelevant information is returned and not retained".

Which is what most of us probably thought the law was all along. Baroness Hallett, the inquiry chair, simply said "You have until Monday". Which came and went. The Cabinet Office told us they'd handed everything over, but this wasn't true. The old, suspect phone was still in Johnson's hands and still unopened, despite his declared readiness to see every one of his Whatsapps in Hallett's hands, despite his supposed consultation with security specialists for help with safe access to the device, and despite the passing of six weeks.

Enough time for him to copy all the messages out longhand.

Instead, he decided he'd forgotten the PIN. As ever, he was delighted to help, but put off the inconvenient moment as long as he could get away with. And more. Maybe next Monday. . .

A historian of bugs and drugs

Week 5 of the inquiry was dominated by evidence on pandemic preparedness in Northern Ireland and local authorities, and began with a historical tour d'horizon of public health around the UK by Dr Claas Kirchhelle, self-styled "historian of bugs and drugs".

The inquiry had asked him to look at "the history of public health bodies in England, Wales, Scotland and Northern Ireland... key Emergency Preparedness, Resilience and Response functions and structures... including public health laboratories... and the impact of the changes of public health structures on... the cohesion of the public health system, information sharing, the workforce, and on pandemic preparedness and resilience".

In exchanges with the inquiry's counsel Kate Blackwell (which I've mashed together to produce some kind of narrative), Kirchhelle took us through "1939 to 2002... the post-war evolution of United Kingdom public health arrangements and infrastructures prior to the major health security oriented regulatory reconfigurations that took place following the 1990s BSE crisis and also the 2001 attacks on the World Trade Center", then "2002 to 2010... 'Centralisation and Fragmentation'... new integrated health protection bodies at the level of the UK and also the devolved nations, local health services and evolving pandemic preparedness amidst the 2003 and 2009 outbreaks of SARS CoV-1 and swine flu" and "2010 to 2019... 'Austerity and Localism'... new doctrines of localism amidst austerity-related cuts to local public health budgets and the influence of new molecular technologies on laboratory infrastructures".

It's a story of re-organisations, restructurings and devolution, with new market structures in health spreading to public health laboratories: "From the 1990s onwards, the Public Health Laboratory Service had sole management of the laboratories and charged health authorities and GPs for diagnostic tests [with] formalised charging arrangement[s] significantly complicat[ing] the very effective yet quite informal arrangements of the post-war period".

Then "the 'painful birth' [of the Health Protection Agency, in 2003] is a quote... from the first executive of the HPA... following the 9/11 attacks, but also following a request by the UK's government, the then UK [Chief Medical Officer] Liam Donaldson reconceptualised health protection in a very American CDC-led style, where you would integrate and combine responsibilities for infection control, radioactive and chemical hazard control, into one big agency that could, in a kind of command and control system, gather the intelligence and swoop in... should there be problems at the local level".

The Health Protection Agency received "£116 million of funding from the Department of Health... in... its first year in existence, then that rose to £193 million... following the 2009 swine flu outbreak, and then went back down to £142 million in the 2012/2013 budgetary year. That differing rise and fall was also mirrored in staffing levels... a classic example of yo-yo funding for public health in and outside crises... once the immediate perception of a crisis has passed, funding tends to go down".

And finally to "the period of time that this Inquiry is concerned with, and it's really 2009 or 2010 up to the time that Covid hit... in 2012, in England, we saw the most complex political restructuring of health and public health services that had happened in decades, or perhaps ever. The primary care trusts were abolished and public health competencies were transferred back to local authorities, as had been the case before [the PCTs'] creation... the HPA was replaced by what is described as a super-organisation, in the form of Public Health England... the rationale [was] to integrate health protection and health improvement functions... similar reforms in the devolved administrations... health improvement during this time is becoming very big in international health, and the UK is in line with the trends there".

 

This tale of reshaping and upending is far too long to reproduce here. You can watch the evidence session (first two and a half hours), read the transcript, or take a look at Dr Kirchhelle's report.

Local authorities - poor relations?

Don't bother trying to make sense of this.

"Councils were expected to lead a response in their community to a whole range of issues. We were learning of the issues and the expected response in the afternoon press conferences in the same way as the rest of the nation."

This is a picture of the Covid period itself rather than the preparatory years this module of the inquiry is supposed to be concerned with, but it illustrates the story told during a three-hander on Wednesday 12 July (day 19 transcript - search for Mark Lloyd - or video - from 1 hour 26 minutes; again my narrative puts together lines from Blackwell and her witness). The words are from Mark Lloyd, Chief Executive of the Local Government Association, who was supported by Chris Llewellyn and Alison Allen of the Welsh and Northern Ireland LGAs, and the fact that Lloyd's words present most of the narrative seems to illustrate our less than perfect devolution.

"[G]overnment has increasingly looked to local resilience forums" (one of the many elements of UK pandemic preparedness which are not so much illustrated in as splattered across the organogram above) "to respond to a range of issues that one wouldn't naturally describe as an emergency," suggested Mr Lloyd. "So EU exit, for example, the death of the monarch, for example. So we need to be clear about what they're for."

Lloyd continued with examples from Covid, preparation for no-deal Brexit, and more generally: "Councils were expected to lead a response in their community to a whole range of issues. We were learning of the issues and the expected response in the afternoon press conferences in the same way as the rest of the nation... When it came to port authorities trying to access information about the likely impact on their transport infrastructure of a no-deal exit from the EU, we could not access, without extreme pressure, data from the relevant government agency."

"... We have some parts of the country where the coterminosity between a local resilience for[um], police force area and local authorities is tidy. There are parts of the country where that is not the case... Historically... the funding of the local resilience fora fell to the local partners. That changed during EU exit preparation when some resources came in. During the [decade before Covid] local authorities were subject to significant financial pressures... the resources that councils were able to invest in local resilience fora decreased by some 35%."

"... local government is all about the well-being of its place, including public health, and by bringing the public health function firmly back into local governments, it ensured that in everything we do around tackling homelessness, the work we do around employment and jobs, the things that we do to support anybody that has any kind of vulnerability, we started to view that through the public health lens. So not only did we move the relatively small public health teams in, we turned councils in their entirety into public health organisations. That's a great big win."

How much the local structures are really included in national preparation for a pandemic is a concern. Apart from a few local fora which actually took part, the pandemic flu exercise Cygnus was "kept secret from local government" and its conclusions and recommendations were not published until the preparation of this inquiry, which "is particularly concerning... given that... one of the overarching findings of the report was that the United Kingdom was not equipped for a pandemic... [A]t the moment it's seen as a top-down approach to these kinds of events and local government is brought in as a participant on a small scale rather than at the core of the exercise".

Similarly exercise Alice, which attempted to simulate a coronavirus outbreak. The Local Government Association "did not become aware of Exercise Alice taking place until the autumn of last year, 2022... Alice was a desktop exercise exploring the consequence of the UK experiencing a SARS, MERS outbreak. The local government family, I think that applies to the whole of the nation, didn't become aware of the exercise having taken place, nor its conclusions, until the report became known through the work of this Inquiry... it was the first time when issues like quarantine featured in planning. It would have changed what we were doing in our local planning to have knowledge of that kind of intent".

"... the local-national interface... is a shared endeavour to manage the nation through events, like the tragic event of a pandemic. If we're not sighted on the recommendations like the 22 set out in Exercise Cygnus, like recommendation 21 around excess death management and the consequences for us at a local level, we're not planning in the way that we should be."

Lady Hallett intervened: "Does that mean that no local bodies were involved in Exercise Alice?" and Lloyd repeated, "... in Cygnus there was the engagement of eight local resilience fora. To the best of my knowledge there was no local government involvement in... Exercise Alice". Hallett mused, "So no input and then you're not even told what the recommendations are?"

They can't stop saying "Brexit"

On day 1 Hugo Keith KC - Lead Counsel to the Inquiry - set the scene for the first module, based on evidence gathered, procured and commissioned over the last year. The Telegraph didn't like his winding up.

"Lastly, the pandemic struck the United Kingdom just as it was leaving the European Union. That departure required an enormous amount of planning and preparation, particularly to address what were likely to be the severe consequences of a no-deal exit on food and medicine supplies, travel and transport, business, borders and so on. It is clear that such planning, from 2018 onwards, crowded out and prevented some or perhaps a majority of the improvements that central government itself understood were required to be made to resilience planning and preparedness.

"Did the attention therefore paid to the risks of a no-deal exit, Operation Yellowhammer as it was known, drain the resources and capacity that should have been continuing the fight against the next pandemic, that should have been utilised in preparing the United Kingdom for civil emergency? Or did all that generic and operational planning in fact lead to people being better trained and well marshalled and, in fact, better prepared to deal with Covid, and also to the existence of improved trade medicine and supply links? My Lady, on the evidence so far, but it will be a matter for you, we very much fear that it was the former."

The Telegraph complained of "allegations of bias" (paywalled story, later reproduced), which it had invited. "Jacob Rees-Mogg, the former Brexit Opportunities minister, said: 'The die-hard Remainers think everything is caused by Brexit, which is delusional. Unfortunately, this foolish comment starts the inquiry off on the wrong foot. It ought to stick to relevant facts, not self-indulgent speculations'.”

Several witnesses I've heard have indeed given evidence that transferring people and resources into preparation for no deal (or indeed for Brexit generally, as Gove said this Thursday: "There was a widespread feeling [shortly after Boris Johnson became Prime Minister], and one that I shared, that there had been insufficient focus and urgency in our preparation for EU exit overall, and specifically for a no-deal exit.") meant that, for example, some of the recommendations from Exercise Cygnus could not be pursued. Are these not relevant facts?

Matthew Hancock (day 10) pushed back by observing that the work done on no-deal preparation left his department with a knowledge of medicine supply chains which turned out to be very useful in 2020. Michael Gove (day 20) pushed back more generally, arguing that Operation Yellowhammer gave government much deeper understanding of other supply chains and processes, but finally admitted under questioning from counsel for Covid-19 Bereaved Families For Justice that such understanding didn't extend to everything - PPE, for example.

On Wednesday (day 19) Mark Lloyd - Chief Executive of the Local Government Association , quoted above - restated and answered Keith's initial question. "[T]here's a plus and a minus on this. So the plus, the work on no-deal Brexit preparation actually brought partners together and meant that we were working on issues that provided a helpful starting point for the very, very significant challenges that then came our way. On the negative side, the consequence of that focus so rigorously on no-deal preparation did mean that routine activity, the reviewing of plans, the testing and training, work on pan flu, et cetera, was deferred.

"There is a definite consequence. Local government... is very dynamic and we will move resources around to the issue that's presenting to our community, but we in the main have to do it with the resources that we've got. You've had previous witnesses that talked about the increase in capacity in central government to deal with Yellowhammer. Local government didn't increase its capacity, we had to move staff around. The consequence of moving staff around was some things had to go. Add to that my previous reference to the impact of financial cuts in councils, typically emergency planning staff halved during that decade, so there was less capacity anyway going into no-deal planning."

Nobody who's read my posts in any forum will doubt that I consider leaving the EU to have been the wrong thing to do, but it's daft to suggest that everything bad in today's UK is the fault of Brexit. Just as Rees-Mogg's claim that any negative comment about Brexit (in fact it concerned preparation for the kind of Brexit his government was officially trying to avoid) somehow shows Keith up as a "die-hard Remainer" is a petulant error of logic.

It was the last point in a long, detailed scene setting, perhaps, but the lawyer's passage quoted above is 199 words from a presentation of some 9,275. Were the other 9,000 words not worthy of comment (you'd think a discussion of health inequalities, and whether health and care funding was adequate, might exercise a Conservative newspaper and a former Conservative cabinet minister) or did they not notice the rest as their Brexit klaxon sounded?