People’s Covid Inquiry: what must happen now?

“It’s really quite hard not to feel outright anger at the evidence that we’ve heard over the last few months.” – Tony O’Sullivan

This was the final session of the inquiry and Tony O’Sullivan, co chair of Keep Our NHS Public, began by reminding people of some stark facts that had emerged during the previous sessions. One third of all covid deaths – 47,000 – had been of residents in care homes. Disabled people accounted for 6 out of every 10 deaths. Black men were 4 times more likely to die than their white counterparts. And still the government continued to reject basic public health measures, including a refusal to support those self-isolating as they might “game the system” for their £500.

Michael Mansfield QC promised that the inquiry would be publishing the “manifestly obvious” findings as soon as possible, along with urgent recommendations to the government. He reminded people that the object of the inquiry had always been to learn lessons and save lives.

The first witness was Deepti Gurdasani, senior lecturer in machine learning at Queen Mary University London. Her research involves understanding the impact of different interventions on covid, pandemic growth, and how to synthesise evidence into policy

Asked what she thought of government strategy in response to the pandemic, Gurdasani said it had amounted to negligent manslaughter, and perhaps not even negligent as the government had been fully informed of the risk to public health, of suffering and mass deaths, but went ahead anyway. Government policy from the beginning had been essentially herd immunity or “living with the virus,” accepting that deaths were inevitable. As a result, over 150,000 had died in the UK, and a million were living with long covid, including “unforgivably,” 30,000 children.

Our government doesn’t care about ‘acceptable’ deaths, because they’re in vulnerable individuals. They’re in ethnic minority groups, key workers, frontline workers, they’re in people who live in deprived areas, and people who’ve been left behind, they’re in the disabled and the homeless. As a society we can’t accept that.”

The public had been told that these deaths were inevitable, but many countries, including densely populated ones, had managed to avoid such a massive impact on their societies.

“The values that have been inherent in our government’s response have been a lack of value for life, lack of compassion, and a lack of consideration for people’s suffering.”

Gurdasani said that government strategy had been grounded from the beginning in “exceptionalism.” They had rejected the public health measures that other countries were taking, for example abandoning quarantine and the test, trace, and isolate system (TTIS) in March, saying these measures were “only appropriate for low and middle income countries.” As a result, lockdowns became necessary, which other countries, for example in South East Asia, largely managed to avoid. 

Other poor decisions involved putting TTIS in the hands of a private service “that hasn’t delivered,” asking companies who had no relevant experience, to manufacture ventilators, and ignoring established local companies who offered to make personal protective equipment (PPE) while awarding contracts to those with no experience. Operation Moonshot was a recent example of a very expensive exercise that not only hadn’t helped our exit from the pandemic, but whose tests have been recalled over safety concerns. 

In brief, the government had put their faith in technology rather than basic public health measures, but had not consulted the experts in those technologies. They had also failed to consult the NHS, public health, and local authorities. As a result the UK still hadn’t sorted out aerosol transmission, with no appropriate ventilation in schools and work places, no functioning Test, Trace, Isolate and Support (TTIS), and no coherent mask policy. The government had persuaded the public that lockdowns were the only way to control the virus whereas, as other countries had shown, they represent a failure of response. The answer was always to get on top of the virus through basic public health measures.

Gurdasani felt that it was never too late to return to classic public health measures, which included a functioning TTIS and practical and financial support for those self-isolating. She said the government’s excuse that the public are “really tired of restrictions” was nonsense. The public had always been “ahead of the government,” and it was the government themselves who hadn’t wanted to put restrictions in place.

She then turned to the fact that government strategy essentially relied completely on vaccines.

“We’ve chosen a very risky strategy by putting all our eggs in the vaccine basket, which we didn’t need to do.”

The risk lay in the fact that the government weren’t protecting the vaccines against variants, which would require comprehensive restrictions at borders and elimination of the virus in the community. Other countries such as Australia and New Zealand had managed this, whereas as we had imported highly contagious variants.

Looking ahead Gurdasani wanted the government to adopt a policy of elimination for the virus by fixing TTIS, putting it in the hands of local authorities, and to prevent new variants coming into the country through a comprehensive border policy. “That is completely achievable.” She wanted a focus on stopping aerosol transmission including an investment in better ventilation for schools and workplaces. Finally she wanted the government to help the roll out of vaccines around the world, instead of practising vaccine nationalism and at the same time cutting foreign aid.

“People who think that our pandemic strategy has been a success must look at the number of deaths, the number of people suffering with long covid, but also the impact on our economy and the fact that we’ve had restrictions for 16 months, three lockdowns, four months of children being out of education. How is this even remotely a success?”

“The media never actually discusses the response in other countries…so people aren’t aware that life could be so different had we adopted the elimination strategy last year, or even learned much later and adopted it more recently. It’s very, very clear that countries that valued life, that treated deaths as preventable are the same countries that have done best economically.”

The next witness was Stephen Cowan, leader of Hammersmith & Fulham Council. He was asked what the role of local government had been during the pandemic. He noted that we have ‘a very centralised system’ in the UK, which means that everyone in local government ‘looks to Westminster to tell them what to do’. Unfortunately, in the early days of the pandemic it seemed that the government’s focus was elsewhere, with little direction coming out of central government. This was at odds with similar countries, who were much quicker to take action.

“The government wasn’t on top of this in January/February. The prime minister wasn’t talking about it. And he’s a very strong leader of his party, and therefore the government. And if he wasn’t engaged, I suspected the government wasn’t engaged. Or it had a different agenda.”

In February, Cowan could see what was going on internationally, for example in Italy, and stopped looking to the UK central government for advice. He told his chief executive to move the borough onto a civic emergency footing as the pandemic was sure to arrive in London. They were the first council to do this.

“We decided to act on the side of caution and to do everything we could to protect people.”

He locked down local parks and at the same time organised a letter from all London Councils to the prime minister demanding a lockdown. This was sent on 22 March 2020, and on 23 March Boris Johnson announced a national lockdown.

Overall Cowan was very critical of Boris Johnson, whose attention appeared to be “elsewhere.”

“He’d gone to a rugby game and had been boasting about shaking hands with people in a hospital. And all these were indications that his head wasn’t in the place we needed it to be. Maybe they were going for herd immunity.”

Because of the lack of central direction, local councils found themselves in the front line. For example in early April, Cowan heard about deaths in Italian care homes because Italians had allowed people with covid back in to the homes. He arranged for PPE in care homes in his borough, introduced testing for staff and patients and also training for staff, most of whom have very little relevant training.

He also promoted mask wearing from May 2020, whereas the government dithered and made that decision later in the year. He felt that local government had really risen to the occasion, with a ‘wartime operation’ aimed at protecting people, but then central government would knock them back and tell them not to act.

“The public sector ethos came into its own at a ground level. And the lesson is that if you empower people, then they will rise to the challenge. I think people were at their best in the public sector at that time…it’s about trusting people on the ground.”

Going forward Cowan wanted the government to empower people on the ground and to give real powers to local government

The next witness was Matt Western, Labour MP for Warwick and Leamington, who submitted evidence via a written statement. Western’s evidence concerned the Leamington Lighthouse laboratory project, one of two “megalabs” to be set up for large scale covid testing. He was notified of this in November 2020, after a public announcement. There had been no prior discussion with himself nor with local authorities.

The government said the project would create up to 2,000 jobs and would open early in 2021. However at the time that he submitted his evidence (16/6/21), there was still no start date available. Meanwhile he was hearing from constituents who had left jobs after being recruited to work in the new lab and were consequently now unemployed.

A report compiled by a local campaign group had highlighted a number of concerns. It questioned why the government had chosen to set up a brand new laboratory rather than expanding existing local NHS pathology services. It raised concerns regarding lack of regulation, accreditation, and quality standards of the facility and its employees, which fell far short of the requirements within NHS based laboratories. A contract to run the lab had been awarded without being put out to tender and private companies had been involved in recruiting staff. Some staff and suppliers were the subject of non-disclosure agreements. It had been impossible to find out how much the project was costing the tax payer.

Finally, earlier in the year there had been an outbreak of covid among the staff who were getting the site up and running. He felt it was “an embarrassment” that the government couldn’t even protect staff working on a large scale covid testing site.

“There is a clear lack of transparency, waste and cronyism surrounding this Government’s contracting process throughout this pandemic, which equally applies to this project.”

In summary his concerns were the total lack of transparency around the project, the unnecessary privatisation of NHS services, and the delay of the project. He wanted transparency and accountability from those in government who were responsible. 

“There have been too many failures and too much taxpayers’ money squandered by this Government for us to allow ministers to avoid accountability in the way they are at the moment.”

The next witness was Professor Jonathan Portes, who had been a government economist for 25 years and is now professor of economics and public policy at King’s College London. He said there was a clear consensus across a broad spectrum of economists that during the pandemic the right thing to do from a health point of view was also the right thing to do from an economic point of view.

“It was better to take whatever measures were necessary to address the health crisis, even at the cost of economic output in the short term, because the alternative of not dealing effectively with the health crisis would actually lead to greater and longer-term economic losses.”

In response to a question about public expenditure during the pandemic, he felt that money spent on business support schemes was “money fairly well spent” and appropriate from a social and economic perspective. On the other hand, that spent on the procurement of PPE was clearly “hugely wasteful and occasionally corrupt,” and that the expenditure on test and trace was badly spent and mismanaged, and had led to adverse outcomes. He felt that in general the Government had erred on the side of spending too little and he was very critical of “the frankly ludicrous levels of sick pay that we pay in this country.” He said that with regards to sick pay the UK is “not only lower than, I believe, anywhere else in the OECD, but lower by quite a long way than almost all of our obvious major comparators.!

“The biggest obvious policy error has been the failure to raise sick pay or to put in place an effective system of sick pay that incentivises people …to take time off work to self-isolate. That has been a real false economy, which has undoubtedly inhibited the effectiveness of test and trace, and therefore probably led to more people getting sick than needed to be, prolonging the pandemic unnecessarily.”

Portes then addressed the effects of the government’s “austerity” and deficit reduction policies in the decade prior to the pandemic. These had resulted in a slowing down and in some cases a reversal of the social progress made in the previous decade, and this had particularly been the case for lower income groups. He felt the policies had left us more vulnerable to the crisis and that this was reflected in the structural inequalities which had emerged.

“There was a very, very high differential mortality gradient where the most disadvantaged groups have clearly been most vulnerable both to contracting covid and to getting seriously ill and dying from it. And again, I think there’s a clear relationship between those two – between what happened in the run up to 2020 and what happened during the pandemic itself.”

Portes said more austerity would be the wrong response to the pandemic. He gave as an example the funding needed to address the damage done to children’s education during the pandemic. It had been estimated by the Institute for Fiscal Studies that this could represent a cost to the country of £350 billion over the next 40 years, but when the Education Policy Institute proposed an initial catch-up programme of £15 billion the government’s response had been to offer 10% of that, i.e. £1.5 billion. Given the economic and social case for funding catch up, especially for the most disadvantaged, he found it ‘almost impossible’ to see what the justification for that decision was.

“I really find that the Government’s decision on this almost incomprehensible from almost any perspective.”

Going forward he said government debt certainly wasn’t “the first, second, or even fifth most important economic problem the country faces at the moment.” What the Government needed to do was whatever was necessary to definitively suppress the pandemic and spend whatever it takes to do that. And after that, to reopen in a safe and controlled way and to get back to normal as quickly as possible.

“What we have learned is that we shouldn’t be worried about spending money in the short term.”

The next witness was Jean Adamson, representing Covid-19 Bereaved Families for Justice, and also an independent consultant to the Care Quality Commission.

Adamson’s elderly father had died in a care home after contracting covid during the first wave. Following his death, she had made a formal complaint to the home, including questions about the use of PPE, hospital discharges to the home, and the number of covid related deaths in the home. She noted a “lack of transparency and honesty” in the replies she got, including a refusal to allow her to see his unredacted care records. She had then sought support in the Bereaved Families for Justice group.

“We all share the one thing in common, we were looking for answers. I needed to understand, and our members need to understand why our loved ones died in a place where we expected them to be safe.”

Adamson said the group had not been able to get those answers and in particular felt very let down by the Care Quality Commission (CQC), who had refused to release the number of covid related deaths in individual care homes. She felt they had sought to protect the interests of the commercial sector at the expense of the interests of the public and in choosing to hide behind Freedom of Information exemptions their position had become “untenable.”

“We feel very let down by the Care Quality Commission. As the health and social care regulator for England, we thought they would be supportive of relatives, you know, bereaved families.”

As a result of pressure from Bereaved Families for Justice the CQC had since agreed to provide more data. She believed their original refusal to release the care home data was a political one taken to protect the commercial care sector and her experiences had led her to question the motives of the CQC, and their supposed arm’s length status. 

“It just beggars belief actually, where is the commitment to us, the public? The reason the CQC was set up, the very reason they exist, is to protect the public, and to have our interests at heart.”

Going forward her group wanted a public inquiry “now,” and failing that a rapid review in order to learn lessons and make recommendations. The government had not responded to their requests.

“How many more people need to die, how many more lives need to be lost to this virus before we start to learn lessons and prevent further deaths, further tragedies. We have a tragedy on a national scale, unprecedented in our times, and still the Government is dragging their feet.”

The final witness was Michael Bimmler, a barrister specialising in public and human rights law who discussed the legal aspects of the government’s response to the pandemic. Bimmler explained the “no harm” principle which exists in international law, which says that states have a duty to take all appropriate measures to prevent and reduce what is called significant trans boundary harm. This applies to natural disasters, during which states have to take appropriate steps to prevent harms. The greater the risk of the harm at hand, the more efforts are required from the state.

With regard to the pandemic, all states were subject to this duty, so they had a duty to stop further spread of the pandemic, or at least to take such steps as they could to stop the further spread, and to prevent or reduce further outbreaks.

He then discussed International Health Regulations (IHRs), dating from 2005, and adopted by more than 190 states in the World Health Assembly, which place a number of mandatory obligations on states. These include, for example, a duty to develop and maintain the capacity to respond promptly and effectively to public health risks including pandemics, and a duty to base that response on scientific principles and evidence.

These laws raised a number of questions as to whether the UK’s response actually complied with IHRs, including adequate pandemic planning, and a capacity to respond promptly and efficiently. Bimmler mentioned as examples the availability of PPE and ventilators, discharge of patients into care homes without testing, protection of patients in hospitals and care homes, and reaction to the second wave.

He discussed the European Convention on Human Rights (ECHR), in particular the right to life, the right not to be subjected to inhumane treatment, and the right to respect for private and family life. He explained that the government has to take proactive steps to promote these rights by putting appropriate safeguards in place, and that they are systemic duties owed to the public at large, in particular to exposed people. This would include front line workers in the NHS, and the vulnerable such as the elderly and those with pre-existing medical conditions.

“It is quite clear from the case law that acts and omissions in areas such as health care policy, health care provision, health care regulation, are covered by this article to the right to life.”

Bimmler pointed out the “duty to investigate” when a state’s breach of those duties under the ECHR had cost someone’s life. This could range from a coroner’s inquest to a public inquiry if national level policy decisions were involved.

He also mentioned the duty of employers to ensure the health and safety of their employees at work by providing a safe work place with necessary training and equipment (such as PPE), and that a breach of those regulations could be a criminal offence.  

Finally he said that claims against breaches of ECHR could be brought in UK domestic courts but that it was more difficult to challenge breaches of international law. In response to a question about prosecuting those felt to be responsible for failings during the pandemic, he said that individuals can’t be charged with corporate manslaughter, but an organisation, such as the Department of Health and Social Care, could. 

In this last session the inquiry heard a series of damning testimonies. The government’s “austerity” policies had slowed and even reversed social and health progress in the decade before the pandemic, resulting in a widening of social inequalities and a very high differential mortality rate during the pandemic. The government’s attention had been ‘elsewhere’ when the pandemic broke out, and others such as local authorities had had to step in. When the government did respond it was very late and partial, possibly as a result of initially planning to adopt herd immunity.

Witnesses were again critical of the fact that the government by-passed the NHS in favour of the private sector, and condemned the lack of transparency, waste, and cronyism around the contracts involved. They also criticised the fact that there was no effective sick pay system which was thought to have prolonged the pandemic.

Finally the government was accused of manslaughter. There had been no need for the very high number of avoidable deaths in the UK, as other countries had shown. There was a possibility of holding the government to account via legal routes for some of these deaths.

Tony O’Sullivan, co-chair of Keep Our NHS Public, ended the final evidence session of the People’s Covid Inquiry by thanking all those who had participated, including the 41 witnesses, and by joining the Bereaved Families for Justice in calling for a public inquiry now. He said the final report of the inquiry would be out later in the year.

“We are really proud … of what the inquiry has achieved. It set out to look for urgent lessons to be learned now from this coronavirus pandemic and to recommend action that would save lives…”

Jacky Davis, consultant radiologist, founder member of Keep our NHS Public, panel member of the People’s Covid inquiry.

Competing interests: none declared.