Thread by @danielgoyal

Monday was another damning day for the government at the Covid Inquiry.

It is becoming clearer what the recommendations from the Inquiry are likely to be…

But there is also a bigger question raised about criminality…
1/n

TUC union, the BMA, the Health Foundation, and The British Red Cross gave evidence.

Many of the govt defence positions were weakened.

The TUC Union provided evidence that public service spending was cut by 24% per capita in the decade leading up to the pandemic.

Evidence was provided to show that demands for healthcare increased 2% per year but bed capacity fell and the number of nurses only grew by 0.2%. The Inquiry seems to be engaging the govt’s meaningless statement that “highest number of doctors and nurses”

The Union highlighted that NHS staff burnout had doubled from 2010 to 2019 due to a failure to increase resources to meet demands.

In 2016 the Union along with other bodies produced a report to govt “NHS Safety - Warnings From All Sides”. The report was entered into evidence.

The KC reiterates the consequences of austerity on NHS waiting lists by 2018: “Not enough capacity to respond to the demands of emergency and planned care….waiting lists at 4.2m in 2018”

Next BMA President - Prof James Banfield, a serving frontline doctor. Makes a great point - not sure Inquiry picked up on it enough - that Local Public Health Resilience Groups were fully prepared for a pandemic “it’s their bread and butter”.

The point (and one we on the frontline were screaming about) is that we had the expertise and capability to manage the pandemic locally BUT the government took central control of it and took that power away. Can’t emphasise how crucial this is.

This is where big questions need to be asked in relation to why power was taken away from local areas. It was not the recommended approach nor was it typical internationally.

The BMA hit home this crucial point by highlighting how testing was far too slow to come online. Instead of the 44 NHS Labs coming online with such tests, they were outsourced to the private sector, said Dr Banfield.

It is a massive point and potentially one with criminal connotations. Firstly, ordering a diagnostic test without a responsible doctor is dubious and at times criminal - a form of assault - especially when the patient themselves derides no benefit from such a test.

This was the case in the pandemic. Tests were being ordered via private labs with no clinical oversight. This meant positive cases had no clinical input at all. THIS IS WHY THE PUBLIC FELT ABANDONED. And yes, this was most unusual!

Imagine the reverse situation whereby a GP is triaging the patient, suspects Covid, conducts the test, gives the patient advice, and then when a positive result returns follows-up that patient, especially if vulnerable. This was WHO guidelines and normal medical practice.

But here we have a government that circumvented the usual system - patients were NOT allowed to consult GPs about Covid symptoms. Instead, patients were directed onto ‘111’ and typically were directed to a testing station and tests sent to private labs with no clinical contact.

So, the big question: have we reached the threshold (or will we soon) of evidence required to establish that govt Ministers in charge of the pandemic response were acting to generate profit and by doing so neglected their primary duty of responding to the pandemic?

If this is so, this seems likely to be acting out-with ministerial duties and as such ministerial privilege (whereby they cannot be prosecuted for the consequences of the actions they took as a minister) would not apply. For example, MPs have previously been prosecuted for fraud.

This would be a much more serious breach. If Ministers frustrated the pandemic response in order to generate profit (for themselves or others) and this led to death and disability (as well as the economic costs) then it seems a serious level of Misconduct in Public Office.

Bear in mind that this is only Module 1 - Preparedness, and the next module will drill down into these decisions. The Inquiry will have the evidence (if Johnson ever hands over the WhatsApps) and one expects the narrative of 'profit before people' to be quite discoverable.

This may explain why some MPs have such reluctance to cooperate openly and fully with the Inquiry. The Inquiry may well unveil evidence that could lead to a criminal case against specific MPs and government officials.

Next was the CEO of The Health Foundation. The health foundation is a politically neutral, independent research body that provides data and analysis on the state of the UK's health and health systems.

It seems they were called to provide objective evidence of the state of the health system prior to the pandemic. And the evidence provided does not bode well for this govt and specifically Osborne, Cameron, Hunt, Sunak and Johnson.

The evidence was of an underfunded public sector, specifically the NHS with only “half the growth” than average. And when asked directly by the KC Was the NHS given the resources it needed to meet demands, “No, the NHS was not given enough resources to meet demands.”

Blistering stats by the health foundation CEO, that despite (as commented on by the KC) the govt rhetoric and evidence in the Inquiry of record number of doctors and nurses (Osborne, Cameron, Hunt,,..) there was in fact only a 1% growth in number of FTE staff per year since 2010.

And here is the testimony of the CEO about NHS funding…

In the decade preceding the pandemic:

£40bn per year less than France

£70bn per year less than Germany

Summary
It is likely that one of the major findings of this Inquiry will relate to the underinvestment in public services and infrastructure. The policies imposed by the Conservative Govt from 2010 onwards are likely to be heavily blamed for the carnage of the pandemic response.

But the major issue still to be traversed is the question around response and why the govt failed to engage with local govt and local providers and instead control Covid pathways centrally. Many of us raised this in April 2020 - why cut out GPs and restrict access to hospitals?