Department of Health and Social Care permanent secretary Sir Chris Wormald has admitted that elements of the government’s pandemic planning were impacted by a “philosophy” that placed too much focus on flu preparedness – and that no-deal Brexit work was a diversion for staff.
In a two-hour evidence session at the UK Covid-19 Inquiry yesterday, Wormald was questioned over multiple aspects of DHSC and its predecessor department’s work to plan for a potential pandemic.
Wormald acknowledged that DHSC’s “ready for flu, ready for anything” approach “may have been incorrect thinking”. He told the inquiry the philosophy had been based on the idea that approaches for dealing with flu could be adapted to deal with other diseases.
During the session, he was also quizzed about concerns expressed by members of the health department’s board about a “continuing lack of engagement” on the part of then-health secretary Jeremy Hunt. The fears were expressed at a meeting looking into 2016’s Exercise Cygnus, which sought to estimate the impact of a theoretical H2N2 influenza pandemic on the UK.
Inquiry lead counsel Hugo Keith KC asked Wormald what steps he had taken to ensure the secretary of state attended board meetings addressing matters of the highest importance, such as pandemic planning.
“I don’t recall having a specific conversation with the secretary of state on that point, and I don’t have a record of doing so,” the perm sec replied. “The secretary of state would have been aware of the meeting and would also have been shown the minutes of the meeting, I assume.”
Exercise Cygnus found that the UK’s systems, plans, policies and capability were insufficient to deal with a severe pandemic. But Monday’s session heard that DHSC’s preparations for a potential no-deal Brexit in 2018 and 2019 had led to some workstreams that sprang out of the exercise being paused.
Wormald told the inquiry that around 70 DHSC staff had been redirected to no-deal preparation workstreams. He said ensuring the supply of pharmaceuticals was the “biggest worry” for the department at the time.
He said decisions to pause work on the 22 recommendations from the report that followed Exercise Cygnus “were not taken lightly”.
“Our intention all along was, once we had come out of the period when we had to plan for EU exit, that those things would continue,” Wormald said. “That was our expectation.”
He told the inquiry that although a “whole load of work” on enhancing the flu plan was stopped, the no-deal preparations were helpful to DHSC staff for the health crisis that was to come months later.
“We added a whole series of generic capabilities that we then used in the Covid response, and my reflection on that is that the capabilities that we built up as a by-product of our no-deal Brexit work were extremely valuable to us in the pandemic,” he said.
Elsewhere in his evidence, Wormald said the nation had never run out of PPE – but he admitted that supplies had been “very short” and that there had been “significant logistical issues”.
Inquiry chair Baroness Heather Hallett, who is a former Court of Appeal judge, said the perm sec’s suggestion would come as a surprise to medical professionals.
“I chose my words very carefully,” Wormald said. “There were huge pressures on PPE and we had significant challenges getting PPE to the right place.”
He said there were places that suffered shortages of PPE, and situations in which professionals had to use PPE that was not correct. But he said the situation was “different from it having run out nationally”.
At the end of his evidence session, Wormald set out five “hindsight” lessons DHSC has drawn from the Covid-19 pandemic. He said the “two biggest ones” were the need for a focus on capabilities and underlying resilience, rather than plans and systems.
“Third is what's become known as the pathogen-agnostic approach to planning, which is moving away from the ‘ready for flu, ready for anything’ philosophy,” he said. Wormald said the approach looked at the roots of transmission.
His final lessons were the need for a focus on surge capacity and better testing capacity.
“That's obviously not an exhaustive list, and it's not a complete list [but] it is those five areas that we think would make the biggest differences in our approach to planning,” he said.
Earlier in the day yesterday, former prime minster David Cameron gave evidence to the inquiry.
He was asked directly whether the austerity overseen by the coalition government he led from 2010 to 2015, and the Conservative-only administration that took office afterwards, had left the National Health Service in a poorer position to provide the public with adequate services.
Cameron rejected the suggestion and said stabilising the nation’s economy and “having a reasonable debt-to-GDP ratio” could not be separated from funding the NHS or other public services.
“If you lose control of your debt and you lose control of your deficit and you lose control of your economy, you end up cutting the health service,” he said.
“That's what happened in Greece, that's what happened in countries that did lose control of their finances. So I don't think you can separate the two.
“We made the important decision to say that the health service was different, its budget would be protected, and so there were real-terms increases every year. For instance, there were 10,000 more doctors working in the NHS at the end of the time I was prime minister than there were at the beginning.”
Cameron said he believed at the time – and still believed – that it was “absolutely essential” to get the British economy and public finances back to health, to enable the country to cope with any future crises.