Jim Reed
Health reporter

As we've been reporting, the inquiry has just been talking about one of the most divisive policies of the pandemic: face masks.

Harries says there was little evidence on the effectiveness of homemade face coverings and she was concerned that recommending them could encourage people to socialise more and lead to a "false sense of security".

"If people just thought they could get a bit of t-shirt, put it around their face, and that would solve all our problems and we could go back to normal [then] that was not going to be a good public health intervention," she said.

But, more than three years later, she says the evidence on face coverings is still "uncertain", partly because it's so difficult to design a study to accurately test their effectiveness in real world conditions.

Inquiry Chair Baroness Hallett asks Harries to list the lessons she's learned from the Covid pandemic.

Harries says they are around data, science, and social care.

On social care, Harries says there can't be a health and social wellbeing sector if the values and the workers aren't recognised.

Looking forward at future pandemics, she said there should be "much better" planning for "frail individuals in residential settings" each time there's an infectious disease incident.

On data, Harries says there should be a transparency of data. "The problem with ethnicity is people aren't looking to collect it but we need to enable them to feel they trust us to share that data."

And on science, she says scientists at UKHSA "are just not recognised" and every test is validated by UKHSA, and no vaccine programme can run without its colleagues.

The chair Baroness Hallett intervenes - is there any harm in encouraging the public to use homemade face masks, she asks.

Harries says that at the time we had a "very low evidence base" and understanding the scientific effects of this was quite tricky.

She highlights that there is a difference between the government mandating, recommending and encouraging something - and that it is "quite difficult" to encourage something when the evidence is not strong.

Harries recalls this discussion was around the same time as the distancing guidance was coming out about how far you should distance, or stand away, from another person.

So she didn't want there to be a false sense of security.

"There was a risk that if you encouraged this people would stop doing the "really important" thing. That was distancing."

Lawyer Andrew O'Connor KC continues pressing on the guidance regarding homemade face coverings and presents a draft from May 2020 that suggested putting two squares of fabric together to make a Covid mask.

Harries wrote at the time: "I think they are both [one square and two squares of fabric] ineffective but someone might want to come up with an answer for the Q& As", referencing the government press conferences.

Harries tells the inquiry "I didn't draft this guidance but I was querying the logic".

She said the public would be confused over the need for one or two layers and "the only evidence at the time we had was (to use) three layers".

The lawyer says then why didn't you say that we should be telling people to use three layers?

Harries says this guidance came to her from somewhere else, saying that "this is what someone decided to do with policy, now make it the best you can".

Harries is asked if there was any convincing evidence that homemade face coverings worked.

She responds that if you had one or two layers of cloth and if you didn't wear the mask properly, it wouldn't have worked.

She adds this depends on what face covering you wore, noting that this does not include PPE masks but masks worn in "community settings" such as homemade cloth masks.

The inquiry's lawyer points to another issue related to care homes during the pandemic - the ability of healthcare workers and social workers to spread the infection.

Harries explains that because of the often precarious nature of the work, workers missing shifts can have negative economic consequences and this "very understandably" discourages people from taking sick leave or isolating when ill.

The lawyer asks whether this was sufficiently understood and sufficiently accommodated for in 2020.

Harries says she thinks it was understood and was dealt with, by giving "strong" guidance to workers, and later putting in place strong testing procedures and payment support to sick workers.

But, she argues, "You can't just exclude everybody because you [would] lose the capacity to continue.

"The precarious state of the workforce was a problem throughout the pandemic."

Care homes were 'very concerned', emails revealpublished at 10:42 Greenwich Mean Time 29 November 2023

10:42 GMT 29 November 2023

Hugh Pym
Health editor

In a significant exchange, the public inquiry has been shown emails between health officials in March 2020 about the need to discharge some patients with Covid symptoms from hospital to care homes.

On 16 March, an official says it was assumed that “we would have to allow discharge to happen and have very strict infection control” because the NHS might get “clogged up”. The email notes that care homes were “very concerned” and there were questions from family members.

In response, Jenny Harries, as deputy chief medical officer for England, says it was “what none of us would wish to plan for” but some patients with Covid would need to be discharged to residential care.

Harries told the inquiry that this was not a policy but a reflection of the state of the pandemic and managing an exponential rise in cases.

The issue of discharging patients from hospitals to care homes was one of the most controversial during the Covid crisis.

Jim Reed
Health reporter

The first wave of the pandemic saw an extraordinary number of excess deaths among care home residents.

Research from the University of Stirling, external found that by August 2020 17,127 Covid deaths had occurred in care homes - or 31% - of the total number of deaths attributed to the virus.

Professor Dame Jenny Harries is being asked about the discharge of elderly and frail patients from hospitals into residential care.

The inquiry was shown an email she sent to a colleague in the Department of Health on 16 March 2020 saying, "The reality will be that we will need to discharge Covid-19 positive patients into residential care settings."

The message said it would be "entirely clinically appropriate because the NHS will triage those to retain in acute settings who can benefit from NHS care."

Asked to respond, she agreed the email "sounds awful" but says it was "taking a very, very high level view".

She said she was trying to explain the poor position the country was in that weekend.

"This is not a policy," she added. "It is a statement of, if you have a pandemic in a country, how are you going to manage that exponential rise in cases."

We now move onto the guidance for care homes at the time of the pandemic.

In evidence shown to the inquiry it states: “Care homes are not expected to have dedicated isolation facilities for people living in the home but they should implement isolation precautions when someone in the home displays symptoms in the same way as if that individual had influenza.

"If isolation was needed, a residents own room could be used be used.”

Harries stated that it is guidance that she did not sign off on.

She says first case of Covid in a care home was on 10th March 2020.

Guidance published for care home residents with Covid symptoms said care homes were not expected to have dedicated isolation facilities.

The lawyer asks Harries if she thought that was appropriate when her email said "care homes could have received large numbers of Covid patients"?

"You should not take my email to suggest NHS will suddenly discharge lots of Covid positive patients and that's absolutely fine.

"It was painting a picture to those making policy decisions," she says.

She says this advice was sitting on top of relatively well known systems of infection prevention control in care homes.

The lawyer continues to ask Harries about decisions to discharge patients with Covid-19 back into care homes.

Harries says that these people needed to be moved as they were "safe in terms of their physical welfare" to go back to care homes. Otherwise there wouldn't be hospital spaces for other infected people, she says.

The inquiry lawyer presses on this issue. We are talking about "discharging symptomatic, possibly infectious patients", he says.

She disagrees, saying the people in question were "positive, not symptomatic".

The inquiry is shown an evidence document from DHSC asking Harries for advice on discharging people who've tested positive for Covid into care homes.

In the email, Harries replied: "I believe the reality will be we will need to discharge Covid positive patients into a residential setting."

She wrote that the "numbers of people with disease will rise sharply", but corrects the inquiry to say she meant the population more generally, not in care homes.

She explains that hospitals would do their best and some patients who'd had symptoms and were still positive would no longer need acute care and hospitals would have to manage them being discharged - either to care homes or other homes.

The lawyer replies that the email was about people who were symptomatic, not asymptomatic, but Harries corrects him that the email was about Covid positive patients.

Harries says that “there would be children at home and invisible to the system” after Andrew O’Connor KC questioned her about raising concerns about welfare during the pandemic but not enough being done to follow up.

Andrew O’Connor KC asks if enough was being done at the time.

Harries replies: "Not that I couldn’t see. Yes, agree”.

O'Connor brings up other evidence that has been heard in the inquiry suggesting that the issue of safeguarding and domestic violence was raised but maybe not carried through.

He asks Harries whether she was conscious of her concerns being taken forward.

Since she sat in the health department, she says, and many of these issues were taken up in other departments she can't say for sure.

But, she says, she didn't see relevant responses consistently and even when colleagues were writing things into guidance, "they were being taken out in the next version," she adds.

Harries adds that, as infections started to rise, calls to domestic violence charities "shot up" because public understanding that there might be a lockdown rose.

"I didn't see that coming through in guidance at that time. It was corrected later but personally don't think it was given significant attention."

Inquiry counsel Andrew O'Connor KC begins by referencing an email from March 2020 where Harries raised concerns about the prospect of imposing more severe Covid restrictions too early.

Harries drew attention to the risk to safeguarding of adults and children and domestic violence. The lawyer asks why she was concerned and what happened as a result of the email?

Harries says while she wasn't always in key meetings, she always put her old director of public health hat on, and "these things will be normal things to think about if you're public health trained".

She says her concern was she couldn't see these issues coming through consistently in Covid planning documents.

"I was commenting, I wasn't in control of the policy, it was my job to advise," she says.

She says the issues weren't easy to control but these emails shows "the issues were definitely being raised".

The inquiry is starting now that Dame Jenny Harries has arrived to take her seat.

Andrew O'Connor KC is asking the questions.

Stay with us and we'll bring you more.

You can watch every moment of today’s public hearing by pressing Play at the top of this page.

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Image source, .

This public inquiry was launched by Boris Johnson in May 2021 and covers decision-making in Westminster and the devolved administrations in Wales, Scotland and Northern Ireland.

You might be wondering what the overall aim of a public inquiry is? Well, in this case, it aims to respond to "public concern" about events.

Any inquiry has the power to make people appear as witnesses and provide evidence. Inquiries are expected to publish conclusions and may make recommendations – which governments do not have to follow.

Image source, PA Media

Prof Dame Jenny Harries is the chief executive of the UK Health Security Agency (UKHSA) - a body responsible for public health protection and infectious disease capability.

Harries appeared before many of 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).

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

She also appeared before the inquiry in June, and Harries - unlike other witnesses - said basing pandemic planning on an outbreak of a new flu virus was "a pretty good" strategy.

Image source, Reuters

We're into the seventh week of the second phase of public hearings for the Covid inquiry.

This module is looking at UK decision making and political governance during the coronavirus pandemic, and several key government figures during the pandemic are up this week.

As we've mentioned, this morning will start with Professor Dame Jenny Harries, former deputy chief medical officer, followed by Sajid Javid, who was health secretary from June 2021 to July 2022, and in the afternoon we'll have Dominic Raab, former deputy PM and foreign secretary.

And later this week, we’ll hear from Matt Hancock, health secretary during the pandemic.

Today's session kicks of at 10:00 GMT so stay with us for live updates, and you can watch live by clicking Play at the top of this page.