Communication from central government was so poor during parts of the Covid pandemic that directors of public health relied on TV and newspapers to find out about key decisions, the UK Covid public inquiry has heard.
Government departments did not even have contact details for some of the 150 senior public health officials based in councils, said Prof Jim McManus, president of the Association of Directors of Public Health, who told the inquiry: “They physically couldn’t contact us.”
Directors of public health have expertise in contact tracing and tackling inequalities and a key role in managing infection control in settings such as care homes. But McManus said that when communication routes failed “we didn’t know what was going on, we found out by looking at the television or reading the papers.
“Sometimes, we had no response or communication, and we found out at the same time as the rest of the population on the 5pm [televised press conference] bulletin about the new guidance.”
McManus gave evidence in the fourth week of the inquiry’s module examining national preparedness for the pandemic that claimed more than 220,000 lives. Matt Hancock, the serving health secretary for most of the pandemic, has already told the inquiry he is “profoundly sorry” the UK was not properly prepared for Covid.
McManus described how some government officials did not understand what directors of public health did, despite them having expertise in contact tracing, dealing with sexual disease and food poisoning outbreaks and local knowledge about inequalities.
For example, they could have avoided “putting a vaccine centre in a golf club … a mile and a half from a deprived area with no public transport”, he said.
McManus said problems with sharing data remained. This became an urgent issue in the pandemic, when local health leaders struggled to get addresses for infected people that would have enabled them to use their local knowledge to trace contacts and suppress the virus’s spread.
“We do not have information and data governance rights for an emergency in any part of the UK in the way it needs to be to save lives,” he said.
The inquiry also heard from Catherine Calderwood, the chief medical officer for Scotland until April 2020, when she resigned over lockdown breaking. She offered “sincere condolences to the bereaved families”.
The inquiry heard that Calderwood was warned in 2018 of the need for “urgent” action because “the system for assessing accessing health data in Scotland is terminally dysfunctional”.
But Calderwood said she did not recall an email from Prof Mark Woolhouse, a senior Edinburgh University epidemiologist, who told her: “I dread to think of the consequences if we were ever to find ourselves facing a health emergency, such as a pandemic influenza.”
She said NHS capacity issues made running exercises for a pandemic “extremely difficult” partly because NHS rotas lacked the slack to spare people.
She also revealed communication problems in the early weeks of the pandemic and said the “line kept dropping out” and was “very poor” on group calls from Edinburgh to the UK government’s scientific advisory group on emergencies (Sage).
Meanwhile, Prof Kevin Fenton, an infectious disease epidemiologist, president of the UK Faculty of Public Health and an expert in tackling health inequalities, challenged evidence to the inquiry that there is a limit on how much planning can be done to mitigate a pandemic’s disproportionate impact on society’s most vulnerable people until details of the diseases are known. This was broadly the position of Chris Wormald, permanent secretary at the Department of Health and Social Care and Mark Drakeford, first minister of Wales, the inquiry heard.
“There is a lot that can be done,” said Fenton. He said plans could be tested against the perspectives of vulnerable communities and data systems could be designed in advance to understand a pandemic’s impact on vulnerable populations.
He agreed the absence of a national system of data capture regarding race and ethnicity, could well be “one of the biggest system failures” of the pandemic. But he demurred when asked if the problems amounted to structural and institutional racism.
The inquiry continues.