Introductions

John Puntis, Co-Chair Keep Our NHS Public

While we wait for a government public inquiry, history is being rewritten. Matt Hancock Secretary of State for Health said recently that there were never any shortages of Personal Protective Equipment (PPE). The Prime Minister has said that ‘at all stages we've been guided by the science and we will do the right thing at the right time’. He also said: ‘What I can tell you is that we truly did everything we could and continue to do everything that we can to minimise loss of life and to minimise suffering…’ 

This inquiry will deal with facts. One fact that stands out above all others: deaths from COVID-19 in just over a year exceed 125,000, meaning that the UK death toll (pro rata) is the worst in the world. This session will examine whether this tragic loss of life was avoidable. The government so far has failed to learn from its mistakes, continuing to pour money into an ineffective, privatised and centrally controlled test and trace system. The inquiry will hear evidence and our panel will draw conclusions in due course, and share them with government.

 

Michael Mansfield QC (Chair of Penel) 
The model of a People's Tribunal or Inquiry is a well-trodden path usually adopted by communities and citizens when a government has failed to provide a public inquiry. One has been promised but at the moment it is most unlikely that there will be resource put aside. The normal course of a government judicial inquiry would take several years to set up, have the hearing and report. Such an inquiry may useful historically, but have little or no use for problems that face us now. People want answers now, so that is the purpose of this inquiry.

We have called this a quasi-judicial inquiry in that we are trying to abide by some basic rules, ensuring that witnesses are heard properly in the time available. There are a lot of questions coming in from the public. They will be preserved, and Lorna Hackett, Counsel to the inquiry, will get some of them asked.

 

The government have been notified of this Inquiry and have been told that we will be asking them for responses.
 

 

LINKED WITNESS STATEMENTS CONTAIN ADDITIONAL INFORMATION FROM WITNESSES

 

 

Witness 1: Professor Sir David King, founder and Chair, Centre for Climate Repair at Cambridge;
Chair Independent SAGE
Read witness statement
 

Sir David’s evidence focused on the fatal slowness and confusion of Government responses, in contrast to many other countries. He told the Inquiry about the role of lockdown, the failure to establish Find Test Trace Isolate and Support (FTTIS), their failure to use existing NHS primary care and public health for this function, instead turning to the private sector.

 

Sir David spoke about the Government response on the basis of his experience as Government Chief Scientific Advisor from 2000 to 2007. He was one of the organisers in 2006 of the single biggest global foresight programme looking into a possible pandemic, with 340 experts including from Africa, China and the WHO. The resulting report predicted that before 2030 a global pandemic would emerge from wild animals which, through mutation, would lead to a virus being accommodated to the human body.  They predicted that, due to air travel, within 3 months the virus would be in every country of the world.

 

Independent SAGE reports relevant to Sir David King’s testimony in Session 2:

Statement on the Management Of NHS Test And Trace (30/10/2020)

https://www.independentsage.org/statement-on-the-management-of-nhs-test-and-trace/

 

Final Report on Find, Test, Trace, Isolate And Support System (18/6/2020)

FTTIS-12.42-160620-names-added.pdf (independentsage.org)

 

Overall Strategy Recommendations to the Government (12/5/2020)

https://www.independentsage.org/wp-content/uploads/2020/05/The-Independent-SAGE-Report.pdf

 

Statement on Changes to Government Guidance on Shielding (30/6/2020)

https://www.independentsage.org/independent-sage-statement-on-changes-to-government-guidance-on-shielding/

 

Statement on the New UK Government Covid Measures Announced on 22 September

https://www.independentsage.org/independent-sage-statement-on-the-new-uk-government-covid-measures-announced-on-22nd-september/

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Slow Government reaction

• Details of the pandemic were made available as early as 23 January (2020) by Chinese scientists in the British journal The Lancet, so the whole world could be aware of the infectivity rate, the death rate, etc of this new virus.

• The Prime Minister failed to engage, did not attend the first several meetings of the national emergency committee (Cobra); there was no understanding of the risks involved even up to March 3 (2020). The Deputy Chief Medical Officer said on BBC TV that the public health advice given by the WHO ‘was only for developing countries’.

• Lockdown is a blunt instrument to be used initially before the public health isolation process has been put in place. It was used successfully by China in February 2020 to manage the outbreak in Wuhan, other governments such as Greece used it by 3 March.

• By 7 or 10 March (2020) it was known in the UK that the number of people getting Covid-19 was doubling every three to four days. Yet large public events, such as football games and the Cheltenham horse racing Festival were allowed/encouraged to go ahead.

• Had the UK gone into lockdown on 3 March (2020) instead of 23 March (3 weeks later) the spread of the virus amongst the British population would have been massively less. At least 20,000 lives out of the 35,000 dying in the first wave could have been saved.

• Until very recently, the UK has never managed ports of entry: South Korea, Greece, Australia, New Zealand have managed the pandemic through test trace and isolate, but also through closing borders to incoming people

• There was clear polarisation in cabinet between maintaining the economy and letting the pandemic run to establish ‘herd immunity’. But, as demonstrated in the UK and US,  the longer you wait for a lockdown, the longer the lockdown will be, and the deeper the hit on the economy.

 

Find, Test, Trace, Isolate and Support

• The British Government from the beginning failed to use the standard public response to a pandemic (eg as used in West Africa with Ebola): to test and isolate people who might have the disease.

• One year on, an effective FTTIS system has still not been introduced in the UK. South Korea established a test, trace and isolate system very early on. The total number of deaths in South Korea, to date is still less than 500. Australia and New Zealand also established effective systems.

• The system needs to use locally based organisations: to use ‘shoe leather’ to find infected people; to ask about their ability to isolate eg their economic circumstances; to offer living space, health care and economic support.

• In the middle of the biggest pandemic for over 100 years in this country, the test and trace system, the most important way of managing the pandemic, was given to private companies (including Serco), without any competition, and with no healthcare experience, to run from scratch. ‘I believe that was a disastrous decision’ stated Sir David.

• The UK could have used its national general practice system.  If the FTTIS system had been broken into local areas where people know and trust their GPs, and had been properly funded, the system would have been far more effective.

 

 

Witness 2: Oluwalogbon (Lobby) Akinnola

Leading member of Covid-19 Bereaved Families for Justice representing 2,600 families
Read witness statement

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In his testimony Lobby Akinnola, a scientific researcher by background, told the Inquiry about the circumstances of his father’s death through Covid, about failures of the NHS 111 service, and broader issues of healthcare for black people during the pandemic and beyond.
 

• Lobby’s father, Olufemi Akinnola, contracted Covid-19 and died on 26 April, 2020 aged 60. He was a black man who exercised regularly and had no known underlying health conditions. He was a key worker, working for the charity Mencap, assisting people with learning difficulties. The family had been concerned about the Government response to the pandemic and had resolved to take precautions as much as possible, because many of them worked in public facing roles.

• Lobby’s father became ill in early April. Over the next 2 weeks, he deteriorated and very sadly died. During that period Lobby’s father called the 111 service several times and also spoke to his GP on what he should do and whether he needed to go to hospital. He was advised to stay at home. It was thought he might have a lung infection and was prescribed antibiotics but he died at home shortly after receiving them, without ever seeing a doctor.

 

Lobby Akinnola told the Inquiry that:

• It is his belief that the pandemic has further highlighted socio-economic inequalities and that the black community has been especially affected. There is a higher rate of death in the black community and other communities of colour.

• He was concerned about how able medical services are to diagnose and treat some conditions in black bodies due to unconscious biases in the care of people of colour and lack of knowledge in some areas. For example, his mother had been asked whether her lips were blue (a sign of hypoxia) in a phone call to 111. But she had been unable to identify that in herself as a symptom, nor were others in the household. Yet this question was one of the thresholds for testing.

• He had been upset to hear Boris Johnson joking about ‘operation last gasp’ when Lobby’s family ‘had to sit and watch my dad die for two weeks’.

 

• When asked what he would see as justice for the families, Lobby Akinola said he wanted a public inquiry, for people to be held to account, to take responsibility for their actions, and that there should be consequences such as resignations.

• He told the Inquiry that to rebuild trust with communities of colour, he believed that you need to show people that they are being heard, and then that their concerns are being addressed and acted on.
   

 

Witness 3: Jan Shortt, General Secretary, National Pensioners Convention (NPC)

Read witness statement
 

Jan Shortt expressed a number of deep concerns to the Inquiry about how older people were categorised and treated during the pandemic, the causes of the high number of deaths in care homes, and how the pandemic had exposed the already poor state of the social care system.

 

• The NPC had been concerned because all people over the age of 70 were told to stay at home. She told the Inquiry that using ‘frail’ and ‘vulnerable’ as a reason for locking all people over 70 away in their homes was completely unacceptable.

• In 2016, the NHS, residential care and care at home services were already in crisis having suffered decades of privatisation, underfunding and cuts to budgets, leading to fragmented services, bankruptcies, home closures, homes being sold off.

• The Government has continued to ignore all academic, professional and public outcries to fully fund health and social care which meant the UK would never be properly prepared for a pandemic.

• There is no required notice to close a care home (unlike schools) yet for those who live there, it is their home.

• The decision to discharge people from hospital into care homes without a negative test is the biggest reason for the devastating and tragic deaths of staff and residents. The lack of respect and value for older people’s lives is shown starkly in this one act of arrogance. Wider health needs of residents were not met due to the contagion in care homes. 

• Many staff in care homes fell sick; many homes used agency staff who moved between care homes, so infection rapidly spread. There was a lack of PPE:  staff were using bin bags as aprons, sharing masks. Care staff do a hugely important job, and this was not their fault.

• The blanket imposition of Do Not Resuscitate Orders without consultation and without due diligence was a direct violation of the right to life. While the complexities of resuscitating those with complex health issues are understood, the process for such orders has to take into account the human rights of the individual and their family.

• Jan told the Inquiry that Boris Johnson’s ‘ring of steel’ round care homes had meant nothing. The devastation that care homes suffered and are still suffering is unacceptable and that it should not and need not have happened, and should never happen again. Over 30% of Covid deaths have been residents of care homes.

• The NPC have published their own National Care Service policy, which calls for a national care service, alongside the NHS, free at the point of need, funded by taxation, publicly owned and delivered, and publicly accountable.

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Witness 4: Dr. Helen Salisbury, Oxford GP and columnist

Read witness statement

 

Helen Salisbury drew on her experience as a GP in Oxford to tell the Inquiry her concerns at the beginning of the pandemic when: patients were told not to contact their GPs, and instead to go through the 111 service; lack of access to testing, contact tracing; and missed opportunities to use the GP and public health systems.

 

• GPs were sidelined for the first part of the pandemic. Patients were told to stay at home and only contact their doctor in an emergency and mostly they complied. Patients were directed to contact NHS 111 rather than their own GP if they had symptoms of coronavirus. It was unknown at the time how overwhelmed primary care might become, so the rationale for creating more triage capacity is understandable.

• However, NHS 111 itself lacked capacity to respond to calls, not only in an appropriate timeframe but also with the necessary expertise (see Helen’s statement). Some of the clinical features of Covid-19 were unexpected and differed significantly from other respiratory infections: in particular, the lack of subjective breathlessness experienced by patients at rest, even with dangerously low oxygen levels, was entirely new. Subtle assessments of fatigue and exercise tolerance were needed to form accurate judgements of disease severity over the phone. Although this was an evolving area of knowledge, it is fair to assume that fewer lives would have been lost in that initial wave if there had been more direct contact been patients and their GPs.

• Much later GPs started to receive test results and were then able to create a system. If patients were over 60, Dr Salisbury’s practice would ring them every day. They held special clinics for Covid patients.

• On testing: if GPs had been given some resources to build their capacity, and worked with Public Health partners, they could have built on the expertise and systems they already had. But testing went somewhere else to people who have no idea what they were doing. For some time, GPs did not know if their patients were ill. Still now, they cannot organise a Covid test for a patient which would be normal procedure. ‘We would have needed a lot of help, but we would have started at least a few steps ahead of the whole privatised system that happened.’

• On Government messaging and messages. The first messages seemed to be based around a ‘herd immunity’ policy. But it was soon realised that at a 1% mortality, if everybody got it, that's 660,000 deaths, which would be unacceptable. The Government kept changing its mind which caused loss of trust, for example disastrous policies over Christmas and the return of schools. There was a huge spike of completely unavoidable deaths that happened in January 2021 because of the failure to listen to what all the scientists were saying,

• Many non-Covid services have been disrupted. Helen Salisbury told the Inquiry that some of it was unavoidable, in some cases she didn’t know why some services hadn’t been restored, but there are patients who have suffered harm, and that these harms as usual, fall unequally.

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