Modules 2, 2A, 2B, 2C – Core decision-making and political governance – Volume II

“providing scientific advice to the Prime Minister and members of the Cabinet, advising the government on aspects of science for policy and improving the quality and use of scientific evidence and advice in government”.²

“During the pandemic it was not entirely clear how the Scottish Government wanted to use its Chief Scientific Adviser and CSH [Chief Scientist (Health)]. Certainly, there were times where I was uncertain where I fitted into the structures which provided advice to Scottish Government.”¹¹

Professor Crossman’s limited early involvement in the pandemic response and his evidence that he did not know if he “would have had much traction” had he attempted to be more vocal in raising his concerns demonstrated a lack of engagement by Dr Calderwood with a senior scientific adviser to the Scottish Government at the beginning of the pandemic.¹²

“did an excellent job of presenting the science in a way that was most useful to political decision-makers”.²⁷

“for all aspects of public health, so that would have included health protection, health improvement. I also had policy responsibility for quality and safety and policy, so as that pertained to, for instance, serious adverse incidences, investigation processes and policy, complaints policy. I also had policy responsibility for research within health and social care … I also had a number of other roles within that, including sponsorship responsibilities on behalf of the department which I exercised in relation to the Public Health Agency.”³⁸

During the pandemic, Professor McBride’s role also extended to the operational aspects of the response.³⁹ He accepted that he was not functionally independent of the Department of Health (Northern Ireland). He told the Inquiry that he was “conscious it almost seems like I’m trying to wear two hats, you know, both at the same time”.⁴⁰ While he accepted that he was “not independent in terms of policy responsibility”, he emphasised that he was independent in his “professional advisory role”.⁴¹

“[I]t narrowed down to a more sensible system, and that then improved quite a lot over time in terms of them being able to ask better questions as well and frame them more appropriately.”⁶⁰

“[T]here needs to be a system that swings into action immediately … a structure which will stay constant … properly populated with people who can both look at the operational needs that come out of that, so they can co-ordinate that across Whitehall, and have enough scientific understanding and data analysis understanding to be able to absorb the evidence and understand the implications.”⁶¹

“a good case to be made for representatives of Devolved Administrations being invited to SAGE discussions that concern their countries from the first meeting”.⁸⁵

“[It] was a reliable and effective source of advice, and it worked well – both in terms of the advice it provided directly and through its sub-groups, either on its own initiative or commissioned, and in its reciprocity with SAGE, which enabled advice from the latter to be interpreted for the Scottish context.”⁹⁰

A principle of reciprocity was agreed between SAGE and the Scottish Government Covid-19 Advisory Group to ensure that the two groups were given access to each other’s papers.⁹¹

“in order to engage with that expertise properly or appropriately, it would have been necessary for the CMO [Chief Medical Officer] to have attended the meetings and listened to the views and expert opinions of that wide variety of experts”.⁹⁵

“Ideally, the rapid assembly of the C19AG [Scottish Government Covid-19 Advisory Group] would have been part of mature and pre-existing advisory structures, with deep integration across the four nations.”⁹⁷

“collate, create and mobilise knowledge related to the pandemic, including Welsh specific information, to support decision making within the Welsh Government by Welsh Ministers”.¹⁰⁰

“The decisions taken over a number of years to reduce the science budget of PHE [Public Health England] must have had an effect on its ability to perform at scale during the pandemic. The outsourcing of research to universities left PHE with restricted internal science and operational capability … it is important to view public health science funding as a resource that is required for the future, much in the same way as the army is required to be ready for action even when there is no war.”¹¹⁸

“people … interpreting what they heard and … trying to then re-interpret that in the context of what they were being asked”.¹²²

“I cannot rule out the possibility that, had the Public Health Wales view been more directly communicated to ministers, that that would have made a difference to the actions that we took, but the system that we had … is that the Public Health Wales does not speak directly to ministers by routine, they speak to Welsh ministers via the Chief Medical Officer.”¹²⁷

“much more command and control-type approach as opposed to the normal relationship between sponsor department and arm’s length body where there’s quite a remove between the two organisations”.¹⁴¹

“The first three SAGE meetings were attended by a number of experts chosen because of their expertise in the fields most directly relevant to the questions SAGE had to address, as well as some officials from DHSC [the Department of Health and Social Care], PHE and some CSAs [Chief Scientific Advisers].”¹⁴⁹

In a medical crisis, the Chief Medical Officer will also usually “suggest medical and public health experts”.¹⁵⁰ The initial list of invitees was determined by Professors Vallance and Whitty, in consultation with the SAGE Secretariat, and included:

“people who had experience of epidemic modelling and other sciences in the context of previous emergencies such as Ebola”.¹⁵¹

“led to advice being less robust than it could have been if a broader group of experts was empowered to provide analysis and advice from the outset”.¹⁵⁴

“There was no time or resource available in the early stages of the pandemic to undertake a systematic search for a wide, representative group or to engage in formal processes for selecting and inviting members … only people with the capacity to free up substantial time for SPI-B from their day jobs and home commitments could make a significant input.”¹⁵⁵

“[A]n early central clearinghouse for policy requests to SAGE and its subgroups with senior scientists and policymakers triaging the requests would have improved prioritisation.”¹⁷⁹

“where a particular topic was seen as a priority at that stage in the pandemic and the [Scottish Government Covid-19 Advisory Group] judged it important to provide further information on this”.¹⁸²

The Scottish Government Covid-19 Advisory Group provided advice without commission on eight occasions, on topics ranging from testing to risk communication.¹⁸³ Professor Morris noted:

“This was a strength of an independent group as it had the flexibility to do more than just answer the questions that were posed.”¹⁸⁴

“slow to model the implication of lockdown policies in detail … It was not clear to me that such radical measures were politically acceptable and so we did not spend as much time on them in early March as we should have.”¹⁹²

“[I] asked the question on my first meeting about what the strategy was, and essentially it was to reduce harm or harms, and I was never convinced that it was any clearer than that.”¹⁹³

• clear commissioning channels are established and followed;
• commissions are refined, prioritised and screened to ensure clarity as to what advice is being sought and to identify any requests outside a group’s remit;
• there is clear tracking of requests and responses to prevent duplication and reduce administrative delays; and
• scientific advisory groups are provided with a better understanding of the governments’ strategies and objectives so that the purpose and context of the commissioned advice can be better appreciated and advice made more pertinent.

“a central view of scientific understanding at that point in time, and where necessary indicates the spread of opinion or uncertainty around that central view”.¹⁹⁷

“We should have from the beginning had the discipline more thoroughly of saying high confidence and low confidence. I think that was a sensible way to do it.”²⁰⁰

“SAGE and its subgroups put too much emphasis on consensus and too little on minority views. The most likely outcome – intended or otherwise – of only expressing a single view is that it presents policy makers with an overly limited set of options and so will channel policy decisions along a particular route.”²⁰¹

“[R]eporting what was effectively the majority view might have given an impression of groupthink … minority views were not always communicated to officials and ministers.”²⁰²

“If the CMO and the GCSA [Government Chief Scientific Adviser] were to give non-scientists (such as the Prime Minister) a range of different opinions, I think it is inevitable that they would simply ask them which one they ought to listen to; the result being that the Prime Minister would be making decisions on the basis of one person’s view rather than a broad range that have been discussed and tested before being assimilated into an agreed central opinion.”²¹¹

“could have been better at feeding back to the sub-groups how their work had been used by SAGE and how it had been communicated to policy-makers”.²¹⁸

“Feedback loops, particularly on the use of data or responses, would have helped but in most cases did not occur.”²²⁰

“unsure, even now, of the extent to which the CMO and CSA were providing briefings to the Executive Committee based on their interpretation of the information coming from SAGE or whether they were providing advice based upon the views of their UK counterparts”.²²³

“a reticence within DoH [Department of Health (Northern Ireland)] to give Ministers access to the raw material, i.e. before it had been synthesised by the DoH and/or the CMO and CSA”.²²⁴

However, she reflected that:

“the elected representatives tasked with the decision-making should be entitled to greater transparency in terms of access to minutes, and an understanding of the basis for dissenting views”.²²⁵

“did struggle with some of the concepts … I do not think that there was necessarily a unique inability to grasp some of these concepts with the Prime Minister at the time, but it was hard work sometimes to try to make sure that he had understood what a particular graph or piece of data was saying.”²²⁹

• 4 May 2020: “Late afternoon meeting with PM [Prime Minister] on schools. My God this is complicated … PM is clearly bamboozled.”²³¹
• 14 May 2020: “PM still confused on different types of test (he holds it in his head for a session and then it goes).”²³²
• 11 June 2020: “Watching PM get his head round stats is awful. He finds relative and absolute risk almost impossible to understand.”²³³
• 22 July 2020: “PM struggled with the whole concept of doubling times … just couldn’t get it.”²³⁴

“generally lagged behind NI local modelling which used the most up-to-date data … to inform advice to the Minister of Health and NI Executive”.²⁴⁷

“[Politicians] were often asking questions that were way beyond the scope of any model, while for modellers it was often difficult to clearly communicate many of the subtleties and uncertainties to policy makers.”²⁵³

“heavily criticised in the press and by some politicians when reality did not match these ‘predictions’, with the resulting reputational damage that this entailed”.²⁵⁸

“From the very early stages of the pandemic, the concept of following the science became central to the decision-making of the Executive i.e. the advice of the CMO and CSA was critical to our decision making process, and, while not dictating the decision, was often the central plank of our decision-making process, allied with the provision of information that was channelled through them such as by SAGE or the PHA [Public Health Agency].“²⁶⁶

This was also recognised by Baroness Foster, who told the Inquiry that, at the outset of the pandemic, the approach of following the science became “the principal and foremost consideration”.²⁶⁷ She described it as:

“something of a comfort blanket for society in general – a way of ensuring that we were acting rationally and doing what was best, on the basis of the best available evidence”.²⁶⁸

“I do not consider that the practise [sic] of ‘following the science’ risked that scientists bore too much responsibility for decisions. Scientific information was offered as advice which politicians then considered and then took a decision.”²⁶⁹

“I considered the concept that the Government was ‘following the science’ to be a misunderstanding, and potentially a misleading one … the decisions political leaders and other core decision-makers were taking were informed by the scientific and medical evidence available at the point in time the decision was taken. They were however also rightly informed by economic, social, political, diplomatic, operational, political and other issues.”²⁷⁵

Professor McLean suggested that this misconception was exacerbated by “having science advisers alongside decision-makers at press conferences, and no representatives of the sources of other evidence”.²⁷⁶ Professor Vallance explained that, while he understood the likely intent of the phrase was to show that the UK government was listening to the evidence and the advice that scientific advisers were providing:

“Looking back, I think that ‘following the science’ was not a good choice of words as it elided the advice with the policy.”²⁷⁷

“From that moment on I could see that there were limits to the mantra that we were ‘following the science’. Science could guide us and help us but many of the decisions would involve such complex moral and political dilemmas that only elected politicians could take them.”²⁷⁸

That notwithstanding, Mr Johnson’s realisation was not reflected subsequently in the UK government’s communications approach.

“there was a bit of dependency, that this was a scientific problem and people would listen slavishly to this and wanted to sort of slightly hide behind this at times”.²⁸¹

“I am seeking today really, to start a grown up conversation with you, the public. The decisions that lie ahead of us, of all of us, are really complex. We will – as we have done all along – seek to inform those decisions with the best scientific advice possible. But the science will never be exact, so we will also require to make very careful judgments.”²⁸³

“With particular reference to the phrase, ‘following the science’, I do think it blurred the boundary between scientific advice and policy decisions for the public and raised issues of accountability. This boundary was more clearly communicated in Wales.”²⁸⁷

“Secrecy leads to speculation which can easily lead to distrust in the process of policy formulation and mistrust in the aims and intentions of the Government.”²⁸⁸

“If by making names public individual scientists or their families are targeted, or the best available scientists feel unable to take the risk of advising Government, the benefits of transparency may be outweighed by the risks to personal safety (to the scientists involved and their families) and proper advice (to Government and wider society).”³⁰⁵

“provide the Prime Minister and Chancellor with the latest picture of the UK economy, reflecting on the impact of the pandemic itself and the measures taken to manage its impact, plus – on occasion – deep dives into specific issues as relevant”.³⁰⁷

“HMT’s [the Treasury’s] analytical capabilities were poor. Although senior HMT officials pushed back repeatedly over policy they never had their own serious alternative based on quantitative analysis. At no point when I was there did HMT produce models of the economy in different scenarios … Many have said there was never a full cost-benefit analysis done on lockdowns including the economic effects. This is true but the Treasury could not and would not produce such analysis, either pre-first wave or later in 2020.”³¹⁷

“[T]he biggest absence throughout the pandemic was the lack of economic modelling in decision making. HMT, who is responsible for economic modelling, has a strong set of policy officials, but when it came to my interactions for all aspects of my work in Government, I found that HMT was severely limited when it came to specialists in science, advanced analytics, technology or data.”³²¹

“Given their inability to spot egregious errors in other things they were sent I do not have any confidence in their ability to hack a simple, sensible model.”³²⁴

This was a reference to another Treasury model, which Professor McLean had identified as having “very substantial flaws”.³²⁵

“Teams within [the Scottish Government] did not always appear to be hearing each other, particularly on the interaction between economic and Covid harms, and economic teams did not seem equipped or prepared to explain to stakeholders why certain restrictions were in place and why decisions were taken not to lift them.”³³⁴

“people who were very eminent in business and the economy in Northern Ireland, so I had my economic advisory panel … they were very significant people – within the economy … I am content that within my department that we had significant recourse to very, very expert advice in terms of the economy.”³⁴²

“[M]y role as CSA within the Department is a part time one, with no deputy or any supporting infrastructure in the Department. This was addressed in a flexible way as part of the pandemic response, but I believe that more investment in scientific expertise and advice is required both in the Department and in other NI government departments.”³⁴³

“The nature of the role meant that there was very little respite from work or pressure for many months on end, indeed for more than two years … Everyone was working under enormous stress and felt the intense strain of our responsibilities.”³⁵¹

“search, critically evaluate and summarise the huge emerging relevant national and international datasets (e.g. from polling), policy and strategy documents and rapid research studies which were the key sources of data available to inform SPI-B advice”.³⁵⁴

As Professor Keeling told the Inquiry, many participants would not have been able to provide the scientific input they did without support from UK Research and Innovation (a non-departmental public body sponsored by the Department for Science, Innovation and Technology) and host institutions.³⁵⁵

“only lasted for a maximum of 18 months … the epidemic lasted for longer than two years, yet extensions to the scheme were not available”.³⁵⁶

“At times the lines between external participants on SAGE and what would be expected if I was a civil servant felt like they were blurred, in terms of the time input and number of requests … it felt like some in government forgot that external participants of SAGE had day jobs in a university alongside the advice they were giving around the pandemic response.”³⁶⁰

“[It was] horrendous for all of us at the beginning, it certainly was in the kind of 16 hours a day mark, and it certainly was seven days a week, it was very, very intense.”³⁶³

Professor Vallance stated:

“The process of getting help and scaling up resources should have been simpler and there should be mechanisms in place to allow this to happen in the event of an emergency.”³⁶⁴

“Due to limited resources it was not possible to offer media training to all SAGE participants in the early stages of the pandemic. We relied then, and are likely to rely in the future, on individual academic institutions seeking to help their faculty members with media support and training.”³⁷¹

Some media coverage went beyond reasonable interest, becoming intrusive and personal. Professor Vallance referred to cases in which newspaper photographers were “stationed outside houses” and details were published that “allowed identification of a home address”.³⁷²

“I did not expect my family to be threatened with having their throats cut. I did not expect the police to have to say … in the middle of the night … ‘Will you move out for a few days while we look at this and potentially make some arrests’ … it was a very stressful time indeed. And, you know, my family didn’t sign up for that.”³⁷⁵

“Infectious disease epidemics and pandemics usually expose and exacerbate existing disparities in society, such as those associated with deprivation, ethnicity, sex, age and sexuality.”²

“[T]he burden of disease and mortality from COVID-19 is not evenly spread in the population.“³

Those at greater risk of direct harm were largely those who were most at risk clinically. People in later life experience a greater prevalence of chronic illness, reduced immunity and, more generally, frailty.⁴ People with underlying health conditions were at greater risk of suffering severe illness requiring hospital admission and of dying from Covid-19.⁵

“could have been small enough to accommodate, even with the limited number of tests [the Welsh Government] had“.²⁴

“[T]he safest thing we could do was to remove people who didn’t need to be in hospital out of hospital, given the impact that the disease was about to have on those hospital services.“²⁶

Nicola Sturgeon MSP (First Minister of Scotland from November 2014 to March 2023) said that, in hindsight, discharge from hospitals into care homes without testing was a “mistake”.²⁷ Michelle O’Neill MLA (deputy First Minister of Northern Ireland from January 2020 to February 2022) told the Inquiry that the lack of testing “did not serve those residents of care homes well”.²⁸

“an individual at higher risk from COVID-19, albeit not with the same predictability or to the same extent as the clinically extremely vulnerable cohort“.³⁸

“deeply disappointed in the responses … Several departments have not responded to the commission; other returns lack ambition.“⁸⁰

Collection of data about disabled people did not improve markedly across the pandemic – and on 30 March 2021, the Disability Unit remained concerned about a lack of disability data in general and sub-categories of impairment.⁸¹

“[E]thnicity is often poorly or confusingly captured, or not captured at all … NHS data on ethnicity is often patchy and does not always rely on self-identified ethnicity, although this is arguably improving.“⁹⁹

“[D]isaggregating data robustly to identify population variation is critical in ascertaining where to provide appropriate intervention for improved outcomes.“¹⁰⁶

That lesson can also be applied in relation to disabled people.

“At that time (March 2020) it was not apparent that ethnic minority people were disproportionately impacted.“¹²⁶

However, Mr Bell told the Inquiry:

“Once emerging data was clear about the disproportionate impact of the pandemic on ethnic minority people I returned.“¹²⁷

Mr Bell accepted that the redeployment of staff from the Race Disparity Unit:

“could have had a negative impact on our ability to respond, although it is difficult to quantify“.¹²⁸

“[S]ome of the highest incidence of Covid was in areas of relative deprivation, where there were higher rates of people who were not in continuous employment and therefore covered by ordinary sick leave.“¹⁴³

“Treasury were generally not convinced by these arguments in favour of payments for working people who were self-isolating and who were not otherwise paid for that time.“¹⁴⁵

Rishi Sunak MP, Chancellor of the Exchequer from February 2020 to July 2022, confirmed to the Inquiry that he was:

“sceptical that [financial provision] would make a significant difference to the levels of people self-isolating“.¹⁴⁶

“[M]otivation to self-isolate is high in all groups; ability to self-isolate is lowest among the poorest sections of the population.”¹⁴⁸

Many of those in low-paid professions had no option but to go out to work, and they faced additional risks of becoming infected by Covid-19.¹⁴⁹ They then faced financial hardship if they self-isolated.

“[T]he lesson for the future is that self-isolation payments, rapidly delivered, are a necessity when self-isolation or indeed mandatory isolation is required.“¹⁵³

The Inquiry agrees: governments must ensure that planning is in place for adequate financial provision to ensure that people have the economic ability to self-isolate, along with mechanisms for payments.

“[N]o option came with only good outcomes; even when restricted to health outcomes the choice was usually between two bad outcomes with one being worse.“¹⁵⁴

“Older people in residential care described losing the will to carry on; people living with dementia lost their remaining memories and recognition of people in their lives; and thousands of people would go on to die without ever seeing their loved ones again.“¹⁵⁸

“For many disabled people the clock was turned back. They lost their independence, some their human rights, and others their lives.”¹⁶²

“[W]e should make a list of all of the things that have happened because of lack of gender diversity in decision makers. It isn’t enough that we keep observing this phenomenon: and it doesn’t matter if the political team haven’t asked or don’t seem interested. As Civil Servants we have a responsibility to find a way of building this input in so that the country gets the best outcome.”¹⁷⁷

She noted that “it is very difficult to draw any conclusion other than women have died as a result“.¹⁷⁸

“We considered such things as the ‘hidden harms’ like increased domestic abuse and child abuse and wanted to ensure it was essential that services supporting women and children remained available and steps were taken to tackle these crimes.”¹⁷⁹

“The science is clear that children and young people are typically at very low risk from COVID. The disease is much less severe for children, even if they do catch coronavirus.“¹⁸²

The decisions to close schools and early years provision to most children and to implement a lockdown were steps taken to protect the adult population. They brought ordinary childhood to a halt.

“[C]hildren experienced an extraordinary period, losing many of the activities that all of us would have taken for granted in our own childhood, of course: attending school, socialising with friends, visiting grandparents, et cetera. And we need to remember that these are not just nice to haves for children, but they’re an important part of their development and their ability to thrive.“¹⁸⁶

Anne Longfield (later Baroness Longfield), Children’s Commissioner for England from March 2015 to February 2021, observed:

“Whilst the pandemic, and our country’s response to it was a major challenge for most children, it was a disaster for many disadvantaged children who were already living with risks and vulnerabilities.“¹⁸⁷

Professor David Taylor-Robinson, expert witness on child health inequalities (see Appendix 1: The background to this module and the Inquiry’s methodology, in this volume), believed that the unequal impact of the pandemic on children could have been anticipated and mitigated with a comprehensive strategy that addressed the needs of children and young people.¹⁸⁸

“[L]ocal authorities were encouraged to ensure that appropriate provision of education was put in place to support children and young people at that time.”¹⁹⁵

“Specific and detailed modelling (of the type which UK Government was best placed to source during this period) as to the potential short and long-term negative impacts ought to have been carried out in order to inform decision-making on mitigating such consequences.”¹⁹⁸

However, this does not explain the lack of planning and consideration afforded to vulnerable groups in Northern Ireland. Devolved administrations are best placed to understand the potential impact of such measures upon their own populations.

“[W]hen making decisions of a strategic nature about how to exercise its functions, have due regard to the desirability of exercising them in a way that is designed to reduce the inequalities of outcome which result from socio-economic disadvantage.“²⁰⁷

This section has not yet been brought into force in England, nor is there any analogous provision in Northern Ireland.

“If we were ever to face a similar challenge again in future, I would want us to establish an earlier pattern of formal impact assessments (both equality and children’s rights impact assessments, as well as socio-economic impact assessments under the new socio-economic duty).”²²³

The Inquiry understands that, in the early days of the pandemic, faced with a desperate crisis, many decision-makers might have felt there was insufficient time to conduct formal impact assessments. However, decision-makers could and should have commissioned assessments at an earlier stage or at least as soon as circumstances permitted. They would have enabled an assessment of impact and helped in the evaluation of the mitigating actions which had been taken.

“[W]hile there was undoubtedly sympathy for the differential impacts on women, poorer people and how Covid was disproportionately harming Black and Asian communities, when it was raised it was treated as if these were naturally occurring phenomena rather than the consequences of deliberate choices (albeit often historic). I do not think impacts on women and children were properly appreciated even much later in the process.“²²⁸

This manifested itself in the fact that policy discussions within the UK government did not always recognise the reality of home life for many – for example, of those who lived in multi-generational housing and could not self-isolate, those who lived in tower blocks and had no garden, those who could not afford to provide laptops for their children, and those who had to work from home and look after their children in confined spaces. As Ms MacNamara commented: “[P]eople who were living like that were not working in Downing Street or 70 Whitehall.“²²⁹

“One of the challenges you face when you work on policy is the dynamic of the room, which in this case was white and middle aged. They were doing their best, but without diversity, some policy decisions slipped through the cracks.”²³⁰

Mr Cain described asking 20 people in the Cabinet Room: “[H]ow many people had received free school meals[?] Nobody had – resulting in a policy and political blindspot.”²³¹ The UK government’s approach to free school meals and, in particular, the delayed introduction of free school meals to support children during holidays (following footballer Marcus Rashford’s campaign in favour of free meals during holidays) was, in Mr Cain’s view, a “huge blunder”.²³²

“with ensuring that decisions on future interventions fully factor in the likely impacts on disproportionately impacted groups (including due consideration of Equalities Impact Assessments)”.²³⁸

As late as November 2020, Mr Case – by this time Cabinet Secretary and Head of the Civil Service – asked the Covid-19 Taskforce to commission SAGE to produce estimates and modelling in relation to the non-Covid-19 health and societal impacts of the second lockdown. He also asked that, in future, SAGE produce assessments of these consequences of their advice.²³⁹ The Covid-19 Taskforce sought to “ensure that the different components of the COVID-19 response balanced the health, economic and social impacts”.²⁴⁰ From about January 2021, it produced ‘consensus packs’ that considered the health, economic and social impacts of potential policy decisions.²⁴¹

“The extent of the impact of NPIs [non-pharmaceutical interventions] on different groups within society was not assessed in any systematic way during my tenure.“²⁴⁷

She considered that the Executive Covid-19 Taskforce (Northern Ireland), instituted in December 2020, should have had a specific equality workstream.²⁴⁸

“explicitly recognised the important impact of inequality on the harm experienced by people in Wales. There have been slightly different definitions given for the four/five harms over time and in different places.“²⁵⁰

“a (reasonably high level) document setting out the principles that will guide our decisions on an exit strategy“.²⁵⁵

It served as a useful aid to take account of “multiple inter-related, non-linear impacts of decisions and interventions”.²⁵⁶ However, its purpose was not to identify the specific risks faced by vulnerable groups or mitigation. There was still a need for the proper consideration of vulnerable and at-risk groups within the decision-making process.

“discussed extensively, and reviewed available data on, issues including vulnerabilities, at risk groups, inequalities, ethnicity and non-Covid health care. However, those discussions were mainly about the effects of these considerations on health outcomes rather than wider harms.“²⁵⁸

“From my observations of topics covered in the SAGE, SCSAG [the Scottish Government Covid-19 Advisory Group] and Four-Harms meetings the impact of NPIs on ‘at risk’ and other vulnerable groups in light of existing inequalities had limited deliberation.”²⁵⁹

“where an emergency has occurred or is likely to occur with a LEVEL 1 impact. The CCG [Civil Contingencies Group] will generally be convened for rising tide incidents such as pandemic flu.”¹⁹

The main purpose of the Civil Contingencies Group (Wales) is to “provide strategic leadership to the response to emergencies falling fully within devolved competence”.²⁰ It is “chaired by a senior Welsh Government official and comprise[s] largely of representatives from Welsh Government Departments”.²¹ It was convened in response to Covid-19 on 4 February 2020.²² The Pan-Wales Response Plan also provides for activation of the Emergency Coordination Centre (Wales), the primary function of which is to gather, coordinate and disseminate information.²³ As outlined in Chapter 2: The emergence of Covid-19, in Volume I, there was a lack of clarity about the extent of the operations of the Emergency Coordination Centre (Wales) in February 2020.²⁴

“for future pandemics there needs to be a – more clarity about which are the debating – the discussion meetings and which are the decision-making meetings”.³³

“[C]oncerns included the wrong people being in the room and so the Prime Minister was not being given sufficiently expert policy advice; concerns about an over-mighty No 10 operating without Ministers, and the sense that too many groups of people were whirring around having similar conversations – duplicating efforts and creating confused lines.”³⁵

There was, therefore, a need to put in place decision-making structures suitable for a prolonged crisis. There were no established structures available to which the UK government could transition at that time, and so steps were taken to develop them.

“an attempt to delegate some decision making to ministers, but so many decisions were proving so difficult and so sensitive that in the end they had to come to me”.⁴²

“[I]t quite rapidly became clear that there were overlapping remits, that the co-ordination between these four MIG [Ministerial Implementation Group] structures was not working well, they were trespassing on each others’ policy and operational functions, and that decision-making through those MIGs was proving difficult.”⁴⁵

“[I]n general, a Cabinet committee or similar group works better if it is chaired by a senior minister who is able to hold departments to account from outside the department rather than inside.”⁵⁰

• Covid-S was established to drive the strategic response to Covid-19.⁶⁴ It first met on 4 June 2020, chaired by Mr Johnson.⁶⁵ It was also attended by Mr Sunak, Mr Raab, Mr Gove, Mr Hancock, Priti Patel MP (later Dame Priti Patel), Secretary of State for the Home Department from July 2019 to September 2022, and Alok Sharma MP (Secretary of State for Business, Energy and Industrial Strategy from February 2020 to January 2021).⁶⁶
• Covid-O was established to drive the delivery of the policy and operational aspects of the response.⁶⁷ It first met on 29 May 2020 and was typically chaired by Mr Gove.⁶⁸ It was also attended by Mr Sunak and Mr Hancock, with other Cabinet ministers invited according to the agenda.⁶⁹

“The downside of going smaller (both in the taskforce and the smaller make up of Covid S or 0) was the loss of the richness of the balancing arguments that would come from civil servants and ministers from wider departments. One of the challenges of responding to Covid was that it is highly unusual in Whitehall to have one group of people advising on decisions that affect every aspect of government policy or of people’s lives.”⁷⁵

• The decision to impose the first UK-wide lockdown was made by COBR – the Cabinet did not discuss the decision until after it had been publicly announced.⁷⁹
• The approach to easing the first lockdown in England was agreed at Quad meetings. The Cabinet was asked to approve Our Plan to Rebuild: The UK Government’s COVID-19 Recovery Strategy only the day before it was publicly announced, which meant that there was no real opportunity for the Cabinet to influence the content of the plan.⁸⁰
• The decision to impose the second lockdown in England was made by Covid-O. The Cabinet was informed just a few hours before the decision was made public and only after Covid-O’s decision had been discussed in the media.⁸¹

“Cabinet took numerous key decisions in response to Covid-19. I was clear that any major decisions on the Covid response would be discussed and agreed at full Cabinet.”⁸²

Similarly, Mr Sunak stated: “Cabinet meetings were the forum in which key decisions were made.”⁸³

“an in-principle decision, and if it was highly significant, a Cabinet meeting would be called to ensure the Cabinet were informed and any dissenting views could be taken into consideration before the Prime Minister made a formal decision in Cabinet”.⁸⁵

“had to shut down a proposal to apply different conditions to school re-opening and not tell people why in order to experiment with the impact of different measures – the idea of systematically trialling what worked was not as much of a problem as not being transparent about it”.⁹³

“[T]he overwhelming majority of ministers and advisers managing the response were men. This was particularly true at senior levels.“⁹⁶

“[O]ne of the challenges you face when you work on policy is the dynamic of the room, which in this case was white and middle aged … without diversity, some policy decisions slipped through the cracks.”¹⁰⁰

“[I]t was really, really obvious that not only were there hardly any women there, but when they were there … they had to turn their screens off … on the Zoom meeting or they were sitting in the back row or – there just weren’t any women talking.”¹⁰²

“Strategic decisions would be made by Cabinet and more operational ones by SGORR [Scottish Government Resilience Room]. These decisions would often be informed by discussions in ‘Gold’ meetings or Deep Dive sessions.”¹¹⁰

However, the evidence suggests that important decisions were, in practice, made outside the formal structures of the Scottish Cabinet and the Scottish Government Resilience Room.

“when a decision made by the former First Minister or discussed within Gold Command was not cascaded to the rest of Cabinet or all Ministers due to the fast nature of decision-making during the pandemic”.¹¹⁵

“The advantages and drawbacks of closing schools and other educational establishments should be considered further over coming days in light of emerging evidence across the UK.”¹²²

Mr Swinney explained that the Scottish Government needed to come to a “definitive conclusion about whether schools should remain open”.¹²³ He and Ms Sturgeon discussed school closures informally following the Cabinet meeting on 17 March. He said:

“We took a decision that she should say on 18 March the likelihood was that schools would close on Friday 20 March and I confirmed this closure would take place in a statement to Parliament on 19 March.”¹²⁴

This important decision was therefore taken by Ms Sturgeon and Mr Swinney outside the Cabinet decision-making process and in circumstances in which the Cabinet had agreed to keep the proposed measure under consideration. Although the situation was rapidly deteriorating, the Cabinet should have been sufficiently agile and engaged to play its central role in decision-making and not be sidelined in this way.

“some sort of emergency ability to step in and change that structure, at least temporarily for the period of a pandemic or another unpredicted circumstance”.¹⁴⁴

“Even the head of the Civil Service, because of the unique circumstance, can’t direct other permanent secretaries to do certain things. So that makes, I think, the response to a pandemic or some other circumstances quite difficult in terms of our own system of governance.”¹⁴⁵

For example, when Northern Ireland moved to set up a hub as part of its civil contingency response to the pandemic, only 2 of 85 civil servants who had been trained volunteered to staff the hub. Even the Head of the Civil Service could not insist that people move to work in this area. This was a “fault line”.¹⁴⁶

“[I]t was the reality that in those early days Health were the only people that had the expertise and the advice, they were receiving the information from SAGE.”¹⁵⁰

“As DoH [Department of Health (Northern Ireland)] was leading the pandemic response, NICCMA was to be activated when DoH asked for it to be activated.”¹⁵²

Yet the First Minister and deputy First Minister were both empowered to activate the protocol for NICCMA (which was not, in the event, activated until 18 March 2020).¹⁵³

• “Silo mentality from DOH and others, more co-ordinated approach required.
• FM [First Minister] & dFM [deputy First Minister] ‘don’t know what’s happening’; are responsible for Civil Contingencies.”¹⁵⁸

“we were taking decisions which would have a huge impact upon people’s lives, and yet were not part of the wider conversation”.¹⁶²

It is understood that, given the system of mandatory coalition, prior collaboration between the two main parties in Northern Ireland happens routinely. A desire by the two main parties to narrow issues in advance of Executive Committee meetings in the hope of achieving consensus was understandable. However, given that each minister on the Executive Committee bore part of the overall responsibility for those matters they were asked to decide on, no ministers should have felt that they were excluded or deprived of their ability to properly scrutinise the decisions being made.

“more conducive to collective conversation, and the cross-cutting nature of ministerial responsibilities means that there are fewer issues that could be deemed the sole responsibility of one”.¹⁶⁴

• Harm 1: Direct harm to health as a result of Covid-19.
• Harm 2: The wider impact on health and social care services – including how people used the services – and the postponement of other care and treatment in mobilising health and social care services in response to Covid-19.
• Harm 3: Societal harm and harm to the broader way of living.
• Harm 4: Economic harm.¹⁶⁹

“[I]t was recognized that if Covid-19 was effectively managed through, for example, lockdowns then economic activity could restart more quickly. Failing to effectively manage Covid-19 could mean that economic activity was constrained and suppressed for longer.”¹⁷⁹

“We often provided funding to mitigate the impact of NPIs [non-pharmaceutical interventions] rather than avoid the harms of NPIs. For example, if we had invested in better technology up front for Test and Protect or in Education so that children’s education wasn’t disrupted, the harms might have been less pronounced.”¹⁸¹

• the evidence by which the Welsh Government would judge the current infection level and transmission rates;
• the seven principles that would “form the basis for our approach to easing the current restrictions” – including whether a measure was of “relatively high positive economic benefit” and “high positive equality impact“; and
• how the Welsh Government would enhance its public health surveillance and response system to enable it to track the virus.

Mr Drakeford said that “this framework formed the basis for the 21-day reviews that were carried out by Cabinet from 7 May onwards”.¹⁸³

WhatsApp can be used for things like:

• Confirming who is in the office,
• Confirm a time for a meeting
• Confirm receipt of a document …

WhatsApp chat should NOT:

• Include any discussion about detailed policy or policy development …

If you find a chat is unexpectedly developing into a more sensitive conversation, you should move the chat onto the No10 [10 Downing Street] IT system and continue it there.”²³⁷

• It provided clarity within the UK government as to which team within the Cabinet Office was responsible for supporting decision-making, and for ensuring that there was a single, consistent voice on strategy and policy across government.²⁵⁰ The Covid-19 Taskforce worked closely with UK government departments – in particular, the Department of Health and Social Care and the Treasury – and with Professors Whitty and Vallance to develop its advice.²⁵¹ In doing so, it played a critical role in coordinating the UK government response across Whitehall and in improving the relationship between the Cabinet Office and the Treasury.²⁵²
• It ensured that Mr Johnson received unified and consistent advice from 10 Downing Street and the Cabinet Office.²⁵³ The Covid-19 Taskforce was the principal body responsible for briefing and advising Mr Johnson on all aspects of the pandemic.²⁵⁴
• It fulfilled the need for a single team at the centre to synthesise evidence across government to advise decision-makers on the development of strategy and the probable health, economic and social trade-offs of any potential decision.²⁵⁵ Prior to the creation of the Covid-19 Taskforce, no team in the UK government was responsible for doing this.²⁵⁶ Mr Thomas told the Inquiry that, up until May 2020, there were issues in the Cabinet Office with: “talented individuals working extremely hard, extremely long hours, but not in a decision-making structure that was good either at responding quickly and authoritatively to rapidly developing external events or synthesising complex material that was coming in from scientists, economic advisers, other departments“.²⁵⁷

“opening up the economy (arguably under-appreciating that a thriving economy was reliant on successfully controlling the virus)”.²⁶¹

Mr Thomas stated that this period of decision-making was therefore:

“confused … because the objectives of different parts of government were not aligned, and the centre was not clear or strong enough to impose coherence”.²⁶²

“[T]he strategy that the [UK] government in fact adopted post lockdown was to keep R [reproduction number] below 1, without taking a view about how many infections were tolerable … Without a commitment to a target level of infections, the aim of keeping below 1 [was] only half a strategy.”²⁸⁸

“changes strategic direction every day (Monday we were all about fear of virus returning as per Europe, March etc – today we were in ‘let it rip’ mode cos [because] the UK is pathetic, needs a cold shower etc). He cannot lead and we cannot support him in leading with this approach. The team captain cannot change the call on the big plays every day. The team can’t deliver anything under these circs [circumstances] … IT HAS TO STOP! Decide and set direction – deliver – explain. Gov’t [government] isn’t actually that hard, but this guy is really making it impossible.”²⁹⁶

“tendency to say different things to different people, reverse settled decisions and be heavily influenced by pressure from different parts of the media made it difficult for civil servants and special advisers to understand the policy direction the Prime Minister wanted, whatever structure was in place”.³⁰¹

“Dom is the most senior [adviser] and the most blatant in keeping things from the PM and driving a different agenda. It’s that I object to – making the elected PM a puppet.”³²⁷

“thought it was better on the whole for the country to have a disputatious culture in Number 10 than one that was quietly acquiescent to whatever I or the scientists said”.³⁴⁸

“that Boris Johnson engendered a chaotic No. 10, with competing power sources and unclear lines of responsibility”.³⁵⁰

Mr Cummings told the Inquiry that Mr Johnson had explained to him in July 2020 that “chaos isn’t that bad. Chaos means that everyone has to look to me to see who is in charge.”³⁵¹

“team effort … with a clear understanding of respected roles and relationships in terms of expertise and authority”.³⁵⁴

Many of those responsible for working on the pandemic response had already known each other and worked together positively for a number of years.³⁵⁵ The evidence presented to the Inquiry suggests that those positive relationships continued throughout the duration of the pandemic response.

“Due to its scale, the UK government does not operate as cohesively as the DAs [devolved administrations] … agreement reached with an individual UK department can break down when it gets to the Cabinet Office or Number 10, and vice versa.”³⁵⁶

“it’s not fair for me and the government to try to offload those onto other people, be it local authorities or health boards”.³⁶⁰

“[A]t no stage did I or the CSA [Chief Scientific Adviser] advise that one community was adhering to public health advice more than another and further we had no evidence to support such a conclusion.“³⁷¹

This was an undisguised attempt to blame one section of society for rising rates by reference to the political views they held.

• the support of a majority of the members, a majority of the designated nationalists and a majority of the designated unionists voting; or
• the support of 60% of the members, 40% of the designated nationalists and 40% of the designated unionists voting.

If cross-community support is not demonstrated in this manner, the vote fails.

“Disgraceful they should all hang their heads in shame. How will history tell this story to the wife and two boys of a 49 year old who said goodbye to their father on Facebook on Friday as he lay in ICU [intensive care unit]. For the sake of two more weeks of effort.”³⁸³

“had a habit of saying things which he didn’t have a basis for, and he would say them too enthusiastically too early, without the evidence to back them up, and then have to backtrack from them days later”.³⁹⁶

Ms MacNamara described Mr Hancock’s “nuclear levels of confidence” as a problem.³⁹⁷ Mr Johnson identified a “chronic optimism bias” at the Department of Health and Social Care.³⁹⁸

“increasing questions about the performance of DHSC [Department of Health and Social Care] and the Health Secretary where the issue was a lack of confidence that what he said was happening was actually happening”.⁴⁰⁰

She told the Inquiry that there was “a pattern of being reassured that something was absolutely fine and then discovering it was very very far from fine”.⁴⁰¹ Thereafter, the Cabinet Office and 10 Downing Street lacked trust and confidence in Mr Hancock and the Department of Health and Social Care.⁴⁰²

“a very small number of people who were not Mr Hancock’s friends saying this, as opposed to a widespread thing around government”.⁴¹¹

In fact, the concerns were more widespread and justified.

“I urge you at this moment of national emergency to stay at home, protect our NHS and save lives.“¹³

“could lead some members of the public to delay seeking needed medical care for other urgent non-COVID related health problems such as cancer or cardiovascular disease“.²⁵

“During a crisis, the most important outcomes from official messages are behavioural. Saving lives often depends on telling people what they should be doing … Behavioural science can help by explaining what features of a message make it more likely that people will listen to it, understand it, and engage with the behaviour.“³¹

“[T]here was little involvement of people with direct expertise in human behaviour when it came to interactions with those in government who made the decisions.“³²

“Aside from our involvement as individuals, I do not think the group itself had any particular involvement with specific campaigns.“³³

“provokes fear and anxiety, but with no clear call to action, while at the same time implying that the rules of the game have just changed. Behaviourally, it is literally the worst possible combination.“³⁶

“[G]iven the critical point we are at, it would be catastrophic for me to drop the ‘stay at home’ message, which is why I am not prepared to do it … particularly in favour of a message that is vague and imprecise.“⁴⁸

“[T]here is room for improvement in future pandemic messaging … FACTS was, perhaps, a clever acronym in search of a coherent message.“⁵²

“[T]he messaging worked better in the early stages of the pandemic as it was clear and precise … The changes to the message in May 2020 – ‘Stay alert, Control the virus, Save lives’ – made the messaging less clear and more abstract.“⁵⁴

The Stay Home campaign was placed on all government channels in Northern Ireland from March 2020 and ran with the core message ‘We all must do it to get through it’, alongside the key actions people needed to take to protect themselves and others from the virus. In the initial stage, this was ‘Stay at home, Keep your distance, Wash your hands’.⁵⁵ By 28 May 2020, the campaign was estimated to have reached approximately 98% of the population in Northern Ireland at least once, with the average adult exposed to it 86 times.⁵⁶ Throughout June and July 2020, this appears to have been supplemented with the ‘two Ws and three Cs’ campaign for social media, which encouraged people to:

• Avoid crowded places.
• Avoid closed spaces with poor ventilation.
• Wash hands regularly for at least 20 seconds.
• Wear a face covering in indoor spaces.
• Avoid close contact settings, such as face-to-face conversations.⁵⁷

“Our trial and survey evidence was strongly suggesting that people did not understand, or were not aware of, the relatively large reduction in risk of transmission when meeting outside, or from opening windows inside. I tried and lost the argument to update the phrase ‘hands face space’ to include ‘air’.“⁶⁰

The Welsh Government’s Coronavirus Control Plan for Wales, published in August 2020, alerted the public to the importance of ventilation:

“to support prevention efforts and to support the management of new cases and clusters: … Ensure indoor spaces are well ventilated, with good passage of air.”⁶⁶

Likewise, the Coronavirus Control Plan: Alert Levels in Wales – A Guide to Restrictions, published in December 2020, referred to behaviours that the Welsh Government was asking the public to adopt, which included “keeping your home well ventilated”.67 While this was a helpful step in alerting the public to the importance of ventilation, the Inquiry has not seen evidence of any specific campaigns referring to the importance of ventilation in Wales until both the Hands, Face, Space, Air and Stop COVID-19 Hanging Around campaigns were launched in Wales in March 2021 and November 2021 respectively.⁶⁸

In Scotland, at a meeting of the Scottish Government Covid-19 Advisory Group on 5 October 2020, a member of the group suggested that ventilation needed to be added to the list of key behaviours in the FACTS campaign.⁶⁹ Advice was also provided to Ms Sturgeon in May 2021, which included a consideration of options for potential changes to restrictions that month. This advice recognised that ventilation was an essential behaviour and that it was not, at that stage, included in the FACTS campaign.70 Although it was recognised that the UK government’s Hands, Face, Space, Fresh Air campaign was also being run in Scotland, the FACTS campaign remained unchanged. It was not until the summer of 2021 that the Scottish Government’s own public health communications began to emphasise the importance of fresh air and good ventilation.⁷¹

In November 2020, the Northern Ireland Executive launched the ‘Don’t Pass It On’ campaign with the slogan ‘Don’t Spread Coronavirus: Limit Your Contact With Others’.⁷² A television advertisement, made mostly in black and white, contained visuals showing blue Covid-19 vapours being expelled as people engaged in conversation.⁷³ A voiceover stated:

“You’re in a room with friends. One of them has coronavirus. But which one? You can’t see it. They might not have symptoms. But the virus is in the air. So now you could have it. You’ll bring it home without knowing … So please, limit your contact with others. We all must do it to get through it.”⁷⁴

While this visual campaign highlighted the potential for respiratory droplet transmission, it failed sufficiently to emphasise the importance of ventilation in reducing the transmission of Covid-19, despite that issue having been recognised and highlighted in earlier messaging in June and July 2020.⁷⁵ Moreover, the Northern Ireland Executive’s core ‘We all must do it to get through it’ message (which consistently featured across all its campaigns) continued, at that time, to depict only three key actions: keeping a distance, wearing a face covering, washing hands.⁷⁶

Handwashing was an important mitigation against transmission of Covid-19 and it was right that governments sought to promote it. However, government messaging in all four nations focused for too long on handwashing and failed adequately to communicate the risks associated with airborne transmission. As Mr Cummings told the Inquiry:

“Even in 2021, a year after the start, the government was over-stressing handwashing and under-stressing airborne transmission and the value of ventilation.”⁷⁷

Even if the exact extent of transmission by different routes was not clear, the risk of people mixing in poorly ventilated indoor environments was well understood by the time of the endorsement of the importance of good ventilation by SAGE, on 23 July 2020.⁷⁸ Ventilation should have been incorporated prominently into government messaging in all four nations from this point. This was an important, missed opportunity in each nation to communicate clearly and prominently the importance of ventilation and the relatively lower risk of people meeting outside, at a time when restrictions on social contact had been eased across the UK.

“The public were very confused. The rules were getting more complicated. They were struggling to remember what they were. They might not know which tier they’re in, and so we would test this. We were testing it periodically and many of the public didn’t really understand the rules, and this in some ways got worse and worse.“⁷⁹

“In a pandemic, work is undertaken at a far more rapid pace, necessitated by the need for a rapid response. While it is better to communicate uncertainty in the evolving scientific position, because it avoids later claims of engaging in ‘U-turns,’ I can understand why politicians may want to communicate certainties in order to make people feel safe.“⁸⁶

Professor John explained that perceptions of U-turns are significant because they can possibly lead to reduced adherence to any measures adopted. Providing explanations that are fully reasoned would avoid changes in response being viewed as U-turns.⁸⁷

“asked the public to consider not just what they can and can’t do, but to ask themselves what they should be doing”.⁹⁰

• the risks that exist;
• the strategy for addressing those risks; and
• the behavioural changes that are required to pursue that strategy.

“I really think people now need to be told that with our new found freedoms these (attached) are still the main risk factors. I think we should unashamedly copy the Japanese who have done very well.“⁹³

“I was at a hospital the other night where I think there were actually a few coronavirus patients and I shook hands with everybody.“⁹⁵

This undermined the handwashing campaign that was launched by the UK government the following day.

“It is my strong and sincere hope that we will be able to review the outstanding restrictions and allow a more significant return to normality from November at the earliest – possibly in time for Christmas.”⁹⁹

“Any over confidence that we had ‘defeated’ covid or would be ‘returning to normal’ would be treated, at best, sceptically and, with the likelihood of a second lockdown in the winter, I felt it could significantly erode public trust in the government if we moved too quickly.“¹⁰⁰

“[T]he lifting of restrictions by the UK Government on July 4th … encouraged an unrealistic sense that the pandemic was finished, people were safe and that they could revert to old ways.“¹⁰¹

“[T]hat is fine if you are intent on never having to do suppression measures again, but from all of the evidence we were receiving, from all of the advice that we were receiving, it was incredibly clear we were certainly going to have to do suppression next again.“¹⁰⁷

“Whilst the spread of the virus has slowed, it remains a serious threat in Northern Ireland … I cannot stress enough the dangers that remain.“¹¹⁴

In February 2021, Mr Swann was still sounding a note of caution, urging the public in Northern Ireland: “Never ever underestimate Covid-19 and the damage it can do.”¹¹⁵

“created confusion, because it wasn’t always clear within the devolved populations, that the messaging was exclusively directed at England“.¹¹⁹

“for England alone but that the devolved administrations would offer their own guidance in due course“.¹³¹

“[T]he decision of BBC Wales to televise those really, I think, made a huge difference, because they were – we were able to reach, then, people who may have been digitally excluded.“¹⁴²

“Personally I felt very upset about it all, and I didn’t feel there was any credibility in going back to press conferences at that time. The press conferences began again in September. I think at that stage Michelle [O’Neill] had acknowledged the hurt that had been caused, I think was the phrase that was used at that time, and in particular the damage to messaging, and given where we were then going, I felt it was important that we started to give those public messages again.“¹⁴⁵

Ms O’Neill accepted that her attendance at the funeral damaged relations in the Northern Ireland Executive and led to the cessation of joint press conferences.¹⁴⁶

“worked best and were strongest when they included the First Minister/deputy First Minister/Health Minister, on a united platform, as everyone had someone to listen to and identify with“.¹⁴⁸

“were more trusted than politicians because they were not political, becoming doctors to the nation at a time of national crisis“.¹⁵⁰

“[T]he Prime Minister and wider Government accepted that the main benefit of me giving advice and opinions in public was that I was obviously free to say what I thought was technically correct. The public could therefore trust that the advice was a professional opinion rather than the Government line.“¹⁵¹