Marita Moloney
Live reporter

We're going to pause our live coverage of today's session at the Covid Inquiry, thanks for joining us.

We heard from the health security chief Dame Jenny Harries, as well as Emma Reed from the Department of Health and the RCN's Rosemary Gallagher, about their assessment of how prepared the UK was before the pandemic hit.

Former Health Secretary Matt Hancock will be giving evidence at the inquiry tomorrow morning, and we'll be back to report, analyse and fact check what he says.

Today's page was brought to you by Heather Sharp, Jim Reed, Michael Sheils McNamee, Emily Atkinson, Malu Cursino, and myself.

Want to read more? This piece explains everything you need to know about the Covid Inquiry. And here's a quick guide to Matt Hancock ahead of his appearance tomorrow.

Dame Jenny Harries and her 'wicked' issuespublished at 17:37 British Summer Time 26 June 2023

17:37 BST 26 June 2023

Jim Reed
Health reporter

Dame Jenny Harries was seen by ministers as a safe pair of hands during the pandemic and was never likely to be the most outspoken of witnesses in this inquiry.

Today she kept coming back to what she described as "wicked" issues - those questions that are particularly hard to grapple with and no obvious right answer.

Whether to put in place mandatory quarantine for travellers arriving in the country or voluntary self-isolation was, she said, a "very difficult" decision where the "evidence base is often in the opposite direction to political will."

Unlike other witnesses, she said basing pandemic planning on an outbreak of a new flu virus was "a pretty good" strategy.

She did though suggest a better idea would be to have a plan which could "flex" and adapt quickly to the specific attributes of a future virus if and when it emerges.

Harries said she would agree with the overall conclusions of a report finding that Covid hit the most vulnerable in society the hardest.

But she was very careful not to criticise the economic policies of the government since 2010, saying there was "no evidence" of a direct link between austerity and the impact of the pandemic.

Finally she appeared to support calls for a new senior minister to be appointed to be in charge of resilience and emergency planning in the future (another of her "wicked" issues).

Dame Jenny Harries finishes up her evidence by discussing the possibility of recommending the appointment of a resilience minister.

She says the country would benefit from an individual dedicated to assessing key infrastructure, maintaining high containment level laboratories, and the social care agenda.

Dame Jenny says one of the difficulties in the past was that all these key concerns "cannot be tackled even by a very willing - and I might add Department of Health have worked very hard with us - individual, it needs somebody and you see it happening in incident response".

"I've had four different ministers in the Department of Health, and you can start to see the difference in people who understand the problems," she says.

Adding that the resilience minister would have to "stay with it for the whole of the parliamentary session for it to maintain infrastructure".

Dame Jenny continues to be questioned about pandemic planning, and on a potential influenza-type virus spreading.

"My view is that the flu plan is actually a pretty good one," she says.

She explains that if she had to consider again "what other example of a respiratory virus with pandemic potential" she would use to plan for the pandemic, she says she "would still use flu because that is the history to date."

Dame Jenny adds that an improvement would be considering the characteristics of other types of viruses.

Dame Jenny was also asked by Kate Blackwell KC about Public Health England's (PHE) emergency planning documents - the National Incident Emergency Response Plan (NIERP) in particular.

Blackwell focuses on the minutes of a board meeting from July 2019 - which stated that some PHE structures had "changed significantly since the last PHE pandemic flu plan was published" - and the lawyer asks Dame Jenny if the pandemic influenza response plan had been updated since 2014.

"I think it wasn't," she responds, adding that the Department of Health was due to update their plan, which would then lead PHE to update their own.

But she says the operational response would still have happened without an updated plan and the NIERP works as the backbone of emergency response, not in isolation.

Asked to confirm that there had been no update between 2014 and 2020, Dame Jenny replied: "Yes."

Dame Jenny is questioned further on some of the issues which came up in Exercise Alice, a pandemic preparedness exercise.

She is asked about Public Health England taking on some of the actions as part of the exercise, even though they may not have been part of its remit.

"They will always try and do the right thing, and that is often not recognised," says Dame Jenny, of the organisation's staff.

"So this is a great opportunity to do so. I tell staff to run towards things if it’s important for health protection."

She says Exercise Alice raised issues about port health and community sampling, which had to be examined.

Jim Reed
Health reporter

Dame Jenny Harries is being asked about Exercise Alice - a subject which has come up repeatedly in the last two weeks.

This training exercise day in 2016 modelled what would happen if a group of people arrived in UK cities from the Middle East and started spreading Mers - a disease caused by a different coronavirus.

Harries, who was not involved personally in the exercise, was asked in particular about one of the recommendations which said an "options plan" should be drawn up spelling out the evidence, costs and benefits of telling people to self-isolate on entry to the UK versus mandatory quarantine.

She called this a "wicked issue" and not something that Public Health England could resolve independently without the involvement of other institutions such the Department of Transport and Border Force.

"These are very difficult decisions for individuals to make. The law needs to support them and costs are involved," she says.

"The evidence base is often in the completely opposite direction to political will."

It appears this recommendation went no further, although four years later, as Covid hit, ministers and health officials were having to grapple with exactly that question.

Image source, PA Media

UKHSA chief executive Dame Jenny Harries has been asked by Kate Blackwell KC about concerns over "groupthink" in advisory groups, particularly among Public Health England experts.

Speaking to the inquiry last week, former health secretary - and current Chancellor - Jeremy Hunt said the UK had not learned lessons from East Asia over the Sars and Mers outbreaks and he wished he had done more to challenge "groupthink".

Dame Jenny says she doesn't "hold with the groupthink agenda," and "people spoke very freely" during meetings.

However, she adds, scientists may not have had the same opinions but "at the end of a meeting you have to come to a consensus statement, and position, to support progressing whatever the topic in charge is".

"On the whole, scientists are quite outspoken," she says, but there is a "practical limit" to the number of experiences and viewpoints included in key decision making - like the pandemic response.

Dame Jenny has also been asked about structural reforms and changes to people's roles at Public Health England.

"This started with the Health Protection Agency problems," Harries begins, mentioning the body which was superseded by Public Health England (PHE) in 2013.

The administration of PHE was split into four regions - London, the South of England and Midlands, the North of England, and the East of England - which ultimately led to staff numbers reducing, she says.

Dame Jenny was then asked if these structural reforms had an effect on preparedness for the pandemic.

"It's very difficult to look back...as there was definitely uncertainty in 2013 when PHE started," she replied, referencing people's changing roles and their responses to those changes.

"My feeling is the overall issue is to do with capacity rather than roles and responsibilities," she adds.

Some questions now for Dame Jenny Harries about the funding of Public Health England.

Kate Blackwell KC notes evidence which Dame Jenny submitted to the inquiry in which she said the organisation had undergone a 40% real-terms funding cut over its lifetime - something it had to account for in its budgeting.

"Not only was the grant in aid dropping, but the costs were going up," says Dame Jenny, citing maintenance of "very expensive laboratories" which had to be retained.

She says the organisation became very dependent on “its earned income”, and it was trying to “pedal fast” to keep up with income “and often using its scientists to do that” - something which came at the cost of the focus on the wider public health system.

Dame Jenny notes that at the time “almost all” public sector bodies faced cuts, and the “combined effect” was the “overall impact was quite significant”.

Jim Reed
Health reporter

Dame Jenny Harries was appointed as deputy chief medical officer for England in June 2019, reporting to Chief Medical Officer Sir Chris Whitty.

In that advisory role she appeared at many of the daily Covid news conferences held by the government at Downing Street, answering questions from the press and members of the public alongside ministers and other experts.

In April 2021 she was appointed as the first chief executive of the UK Health Security Agency - an organisation which replaced Public Health England and was also responsible for the test and trace system which was run by a separate body up to that point.

Her background is in public health administration - before 2019 she worked as Public Health England's regional director for the South of England.

She has long experience of how the complex health system works across England - and is currently answering questions about who was responsible for pandemic planning before 2020.

Here's a quick reminder of some of the key things to know about the UK's Covid Inquiry.

• It is being chaired by Baroness Hallett - a former Court of Appeal judge who previously led the inquests into the 7 July London bombings in 2005
• Witnesses will be announced each week, but we expect to hear from key politicians, scientists, unions, health and care organisations, Covid bereavement groups and more
• Members of the public are being encouraged to share their stories with the inquiry by filling in this form online, external
• No-one will be found guilty or innocent during this inquiry
• This is about going through what happened and learning lessons
• Any recommendations made by the inquiry at the end of this process do not have to be adopted by governments

Harries defends going to the 'dark side'published at 15:18 British Summer Time 26 June 2023

15:18 BST 26 June 2023

Jim Reed
Health reporter

There's now a brief pause in the hearing after the first part of Dame Jenny Harries' questioning, during which she was asked to explain her role as a government adviser and public health expert.

A former director of director of public health in Norfolk, she moved in 2013 to work for Public Health England - an executive agency of the Department of Health.

At the inquiry she describes this move as "being accused of going to the dark side" and says there was a "very clear perception" that government was trying to "stop everything being published" which she claims was "entirely incorrect".

Public Health England was disbanded in 2021 in the middle of the pandemic and Harries was appointed to lead its replacement - the UK Health Security Agency, although some parts of its work were split off into other parts of the health system.

Why does any of this matter? Well the questioning is teasing out criticisms - by some - about the independence of these organisations.

That raises questions about the planning for Covid and whether the structure of the health system meant that officials could adequately challenge ministers and other officials in government.

Dame Jenny has been questioned about the impact of austerity on public health.

She is presented with figures about budget cuts to local authorities, with one figure showing a real terms cut in public health funding from more than £3.5bn in 2015/16 to just over £3bn in 2020/21.

"I know that directors of public health were under significant pressure," she says.

"Local authorities were actually often much more efficient at commissioning services. So they could almost generate savings from that, and get just the same public health outcomes.

"Nevertheless, they were significantly under pressure."

Kate Blackwell KC starts off by establishing some details about Dame Jenny’s credentials and biography, and the status of Public Health England (PHE), the body she served as a regional director.

The questions focus on details about the responsibilities of PHE, how it interacted with the Department of Health, and its role in responding to the pandemic.

As a reminder, this inquiry is focused on examining how prepared the UK was for the pandemic. We'll be bringing you updates on the key lines from Dame Jenny as she gives evidence.

Image source, PA Media

You might recognise Dame Jenny Harries from the daily Covid briefings held in No 10 during the pandemic.

From 2019 to 2021, she was deputy chief medical officer for England, a senior public health leader that supports and assists the chief medical officer (CMO).

She is now chief executive of the UK Health Security Agency (UKHSA), a body responsible for public health protection and infectious disease capability.

The UKHSA was brought in to replace Public Health England, which was disbanded in 2021.

Jim Reed
Health reporter

The inquiry is now hearing about Dame Jenny Harries' various roles in the healthcare sector.

While this is going on, we can bring you an overview of the evidence given this afternoon by Rose Gallagher, a specialist in infection control at the Royal College of Nursing.

She agreed with previous witnesses that there was a “longstanding bias” in the planning system which prioritised the threat of pandemic flu above a new type of disease such as Covid.

She said there was “inadequate consideration” given to the use of Respiratory Protective Equipment (RPE) - tight fitting masks designed to protect healthcare workers from the airborne transmission of Covid.

Gallagher also raised concerns about the resilience of the NHS workforce, saying that the health service in England entered the pandemic around “50,000 nurses short” which “immediately put us at risk when we needed to surge capacity”.

We're now hearing from Dame Jenny Harries, who is chief executive of the UK Health Security Agency.

Press play above to watch her evidence, and we'll also have text updates here.

Although established and funded by government, the Covid inquiry is being led by an independent chair, Baroness Heather Hallett.

She’s a retired judge and crossbench peer in the House of Lords.

Baroness Hallett previously led the inquests into the 7 July bombings in 2005.

Listen to a 15-minute profile on her here.

Jim Reed
Health reporter

Image source, COVID INQUIRY

This morning we heard evidence from Emma Reed, a civil servant who was appointed director of emergency response and health protection at the Department of Health and Social Care in England from 2018.

She was asked in detail about the government’s 2011 pandemic influenza strategy – the only document setting out how to deal with a widespread disease outbreak before Covid emerged.

That document said that – during any future pandemic - there were no plans to close borders, stop mass gatherings or impose controls on public transport, the inquiry heard.

Reed also said that she could recall no discussion or debate about the possibility of mandatory quarantine or mass testing in the department before 2020.

After a major training exercise for pandemic flu - Exercise Cygnus - was conducted in October 2016, a series of recommendations were made to update parts of the 2011 strategy.

Reed agreed that preparing for a possible no-deal Brexit then took precedence “for a short period of time” and that some areas of pandemic planning, such as the impact on adult social care, had been “deprioritised” as a result.