August to October 2021

¶8.68. On 1 August 2021, The Executive Office published Building Resilience Together: NI Civil Contingencies Framework, which set out the Northern Ireland arrangements for emergency management and replaced a number of former protocols and guidance documents.¹⁷⁵¹⁷⁵ Building Resilience Together: NI Civil Contingencies Framework, The Executive Office, 10 August 2021 (https://www.executiveoffice-ni.gov.uk/publications/northern-ireland-civil-contingencies-framework; INQ000086922); INQ000438174_0176-0177 para 671 Northern Ireland's civil contingencies arrangements had, prior to this, not been reviewed in over 20 years.¹⁷⁶¹⁷⁶ INQ000205712_0001 This had been acknowledged within The Executive Office in February 2020, when a strategic review of the civil contingencies arrangements within Northern Ireland had been proposed.¹⁷⁷¹⁷⁷ INQ000205712_0001 The development of an up-to-date and consolidated civil contingencies framework for Northern Ireland was an appropriate step, albeit one which was far too late by August 2021.

¶8.69. Cases began to rise in August 2021 across the four nations. Deaths still remained low compared with previous waves but, by September, hospitals across the UK were under significant pressure, with Northern Ireland and Scotland facing acute pressures.

¶Figure 32: Estimated percentage of the population testing positive for Covid-19 from 1 August to 31 October 2021 across the UK

02 1 02 1 02 1 02 1 02 1 02 1 — 02
1 — 1
02 21 — 1
02 — 02

t2 t2 t2 t2 t2 r2 r2 r2 r2 r2 r2 20 r2 r2 us us us us us be be be be be be er be be Au Au Au Au m em em em ct o ct o Oct ct o ct o ug g g g g te pt pt pt O O ob O O

8 15 22 29 Se p Se Se Se 3 10 17 24 — 31
5 12 19 — 26

¶Source: Coronavirus Infection Survey from 1 August to 31 October 2021 (Modelled estimates, 95% confidence intervals not shown). For raw data, see the Coronavirus (COVID-19) Infection Survey: England, dataset, Office for National Statistics, 10 March 2023 (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/ coronaviruscovid19infectionsurveydata/2023)

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¶8.70. On 11 August 2021, only eight intensive care unit beds were available in Northern Ireland, with Covid-19 accounting for nearly half of all intensive care admissions and ventilated patients.¹⁷⁸¹⁷⁸ INQ000286302_0001 At its meeting on 12 August, the Executive Committee was advised that adult vaccination remained lower in Northern Ireland than elsewhere and that, in the circumstances, it was not recommended that relaxations proceed at the same rate as the rest of the Common Travel Area.¹⁷⁹¹⁷⁹ INQ000065675_0001 The Executive Committee agreed to a number of relaxations (including removing the ban on large, outdoor house parties, removing the rule of six in hospitality settings and removing 'bubble' provisions) but retained several restrictions. It was agreed that the Executive Committee would consider the remaining restrictions at its next meeting.¹⁸⁰¹⁸⁰ INQ000065675; INQ000048540

¶8.71. On 1 September 2021, the hospital system in Northern Ireland was operating at 106% bed capacity with a waitlist.¹⁸¹¹⁸¹ INQ000421321_0041-0042, 0053 paras 82, 110 While the number of new positive cases had begun to decline, Northern Ireland had the highest prevalence of Covid-19 in the UK, with 1 in 40 people infected.¹⁸²¹⁸² INQ000375741 Professors McBride and Young advised that hospital pressures would remain considerable when prevalence was high, particularly given increasing evidence of waning immunity after natural infection or vaccination. Adult vaccination coverage also remained lower in Northern Ireland.¹⁸³¹⁸³ INQ000065672 Despite this and advice to the contrary, on 6 September the Executive Committee agreed to relax a number of restrictions, including increasing the maximum number of people who could meet indoors in a domestic setting to 15 from up to 4 households.¹⁸⁴¹⁸⁴ INQ000207223_0004 para 10

¶8.72. In Scotland, by 30 August 2021, Covid-19 cases had virtually doubled each week since the lifting of restrictions on 9 August, leading to an increase in hospitalisations and the cancellation of non-urgent procedures.¹⁸⁵¹⁸⁵ INQ000249453_0011 It was reported that, according to World Health Organization figures, Lanarkshire's and Glasgow's health board areas had Europe's highest case rates.¹⁸⁶¹⁸⁶ 'Covid in Scotland: Cases doubling weekly after restrictions eased', BBC News, 30 August 2021 (https://www.bbc.co.uk/news/uk-scotland-58383606; INQ000360053) At this point, Scotland had moved beyond Level 0 to a set of ongoing baseline measures and the use of temporary, targeted responses.¹⁸⁷¹⁸⁷ This phase follows the 'Route Map' approach in place during mid-2020; and the 'Levels' approach implemented from November 2020 to August 2021 (INQ000273978_0096 para 385; INQ000078476). These baseline measures were legal requirements and included the wearing of face coverings in most indoor public settings and on public transport (unless exempt), the gathering of contact details in hospitality settings so that Test and Protect (Scotland's testing programme) could continue to contact-trace positive cases, and the setting of capacity limits on live events.¹⁸⁸¹⁸⁸ INQ000339033_0140 para 400; 'Coronavirus (COVID-19) update: First Minister's statement – 3 August 2021', Scottish Government, 3 August 2021 (https://www.gov.scot/publications/coronavirus-covid-19-update-first-ministers-statement-3- august-2021-1; INQ000353731) Ms Sturgeon publicly stated that the Scottish Government was not considering the introduction of a 'circuit breaker' lockdown.¹⁸⁹¹⁸⁹ 'Coronavirus (COVID-19) update: First Minister's statement – 27 August 2021', Scottish Government, 27 August 2021 (https://www.gov.scot/publications/coronavirus-covid-19-update-first-ministers-statement-27-august-2021; INQ000353708)

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¶The Scottish Cabinet met on 31 August and considered two scenarios: one in which cases would peak within a fortnight without further intervention, and a second in which cases continued to rise and required the reintroduction of restrictions.¹⁹⁰¹⁹⁰ INQ000214565_0045; INQ000078614 It agreed not to impose further restrictions but to continue to monitor the situation.¹⁹¹¹⁹¹ INQ000214641_0008; see also INQ000214563_0003 para 13(a)

¶8.73. By 14 September 2021, the Scottish Cabinet noted that pressures on the NHS were at an "extremely high level" and that there might yet be a need to reimpose more stringent restrictions in due course.¹⁹²¹⁹² INQ000214735_0003-0004 paras 12, 17, 18 On 16 September, Ms Sturgeon described the situation to the Scottish Parliament as being the most challenging set of circumstances in NHS Scotland's history.¹⁹³¹⁹³ Official Report: Meeting of the Parliament (Hybrid), The Scottish Parliament, 16 September 2021, Session 6, (https://www.parliament.scot/api/sitecore/CustomMedia/OfficialReport?meetingId=13300; INQ000548024) Scotland had the highest Covid-19 daily infection rate in the UK in the week ending 11 September and daily deaths were at comparable levels to February 2021, with 135 deaths involving Covid-19 recorded in the week ending 19 September.¹⁹⁴¹⁹⁴ Coronavirus (COVID-19) Infection Survey, UK: 17 September 2021, Office for National Statistics, 17 September 2021 (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/ coronaviruscovid19infectionsurveypilot/17september2021; INQ000548012); 'Coronavirus (COVID-19): State of the epidemic', Scottish Government, 24 September 2021 (https://www.gov.scot/publications/coronavirus-covid-19-state-epidemic-24-september-2021; INQ000626477)Show full note

¶8.74. The number of deaths and hospital admissions in England was described through this period as remaining "relatively stable although the rates were high".¹⁹⁵¹⁹⁵ INQ000092120_0004 Mr Javid reported in September 2021 that the NHS was "currently coping, and coping well, but there would be higher pressures to come".¹⁹⁶¹⁹⁶ INQ000092120_0006

¶8.75. Deaths in Wales continued to "remain very low compared with previous waves".¹⁹⁷¹⁹⁷ INQ000056330_0002 Public Health Wales had advised that the focus of the Welsh Government should "shift to the impacts of Covid rather than case numbers".¹⁹⁸¹⁹⁸ INQ000056330_0004 The Welsh Cabinet agreed that Alert Level 0 should be retained.¹⁹⁹¹⁹⁹ INQ000022547_0003 para 2.7 By 17 September 2021, there had been a rise in hospital numbers, deaths and pressures on the NHS.²⁰⁰²⁰⁰ INQ000090707_0001. Mr Drakeford announced the compulsory Covid-19 pass for a number of venues and reinforced the importance of working from home and face coverings (see INQ000090708).

¶8.76. It was in this context that autumn and winter planning commenced. The scientific advice was that the pandemic was "entering a period of uncertainty".²⁰¹²⁰¹ INQ000061603_0002 para 4 SAGE and SPI-M-O advised that hospital occupancy and deaths were lower than expected.²⁰²²⁰² INQ000061603_0003 para 12; INQ000253920_0002 para 10 Behavioural change following Step 4 had been slower than anticipated and it was increasingly unlikely that the peak of the January 2021 wave would be reached.²⁰³²⁰³ INQ000061603_0003 para 12 There was, however, evidence of waning vaccine effectiveness. They advised that it was likely that there would be a delay in the timing of peaks later in October to

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¶December 2021, with possibly "broader, longer peaks" and the potential for another large wave of hospitalisations.²⁰⁴²⁰⁴ INQ000253920_0001 para 2; INQ000061603_0003 paras 12-18 While vaccination had changed the relationship between infection and hospitalisation, rising infections would remain "the earliest warning sign that hospital admissions are likely to rise".²⁰⁵²⁰⁵ INQ000061603_0002 para 2 Advice was reiterated regarding early interventions to curb growth and prevalence, noting that a relatively light set of measures could be sufficient if enacted early.²⁰⁶²⁰⁶ INQ000253920_0001 para 6

¶8.77. Planning work for the autumn and winter response had been due to commence at the end of June 2021 but in fact began after the announcement of a move to Step 4 of the COVID-19 Response – Spring 2021 roadmap and "in earnest" in August 2021.²⁰⁷²⁰⁷ INQ000252914_0070 paras 304-305 It is unclear why this planning was delayed – it would have been better for the planning to run alongside the roadmap. The aim was to shift from "crisis to active management", with departmental plans in place to respond to any surge in Covid-19 alongside managing recovery.²⁰⁸²⁰⁸ INQ000198208_0001 para 4 The Covid-19 Taskforce advised that the COVID-19 Response – Spring 2021 roadmap should not be reversed – the aim was to live with Covid-19 without the need for increased interventions.²⁰⁹²⁰⁹ INQ000198208_0001 para 4

¶8.78. The UK government subsequently published COVID-19 Response: Autumn and Winter Plan 2021 on 14 September 2021, following its approval at Covid-O and the UK Cabinet.²¹⁰²¹⁰ INQ000092113; COVID-19 Response: Autumn and Winter Plan 2021, HM Government, September 2021 (https://www.gov.uk/ government/publications/covid-19-response-autumn-and-winter-plan-2021/covid-19-response-autumn-and-winter-plan-2021; INQ000137270); INQ000198217 The plan explained that the country was learning to live with Covid-19. The main line of defence was "vaccination rather than lockdown".²¹¹²¹¹ COVID-19 Response: Autumn and Winter Plan 2021, HM Government, September 2021 (https://www.gov.uk/government/ publications/covid-19-response-autumn-and-winter-plan-2021/covid-19-response-autumn-and-winter-plan-2021; INQ000137270) It provided for 'Plan A' and a more pessimistic, contingency 'Plan B' to be used only if it was needed to protect the NHS from coming under unsustainable pressure. Plan A was described as a comprehensive approach. Interventions were minimal, with an emphasis on:

vaccination and other pharmaceutical interventions;
the NHS Test and Trace programme;
supporting the NHS;
advising people how to protect themselves;
pursuing an international approach to help "vaccinate the world"; and
management of "risks at the border".²¹²²¹² COVID-19 Response: Autumn and Winter Plan 2021, HM Government, September 2021, p6, para 7 (https://www.gov.uk/ government/publications/covid-19-response-autumn-and-winter-plan-2021/covid-19-response-autumn-and-winter-plan-2021; INQ000137270)

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¶8.79. Plan B provided for the reintroduction of face coverings, public health communications focused on risk and behaviours and potential mandatory vaccine certification for nightclubs and mass events. Consideration would also be given to asking people to work from home if necessary.²¹³²¹³ COVID-19 Response: Autumn and Winter Plan 2021, HM Government, September 2021, pp25-28, paras 85-88 (https://www.gov.uk/government/publications/covid-19-response-autumn-and-winter-plan-2021/covid-19-response-autumn-and- winter-plan-2021; INQ000137270) The UK government stated that it remained:

" committed to taking whatever action is necessary to protect the NHS from being overwhelmed but more harmful economic and social restrictions would only be considered as a last resort".²¹⁴²¹⁴ COVID-19 Response: Autumn and Winter Plan 2021, HM Government, September 2021 (https://www.gov.uk/government/ publications/covid-19-response-autumn-and-winter-plan-2021/covid-19-response-autumn-and-winter-plan-2021; INQ000137270)

¶The UK government should have understood, by this time and given previous experience, that the modest measures outlined in Plan B were unlikely to deal adequately with a more transmissible or lethal variant evading natural or vaccineinduced immunity.

¶8.80. The document noted the SPI-M-O and SAGE advice, in that they considered the most pessimistic modelling to be unlikely except in the case of a new variant of concern or "significant waning immunity", but it warned that "scenarios which place the NHS under extreme and unsustainable pressure remain plausible".²¹⁵²¹⁵ COVID-19 Response: Autumn and Winter Plan 2021, HM Government, September 2021, p23, para 73 (https://www.gov.uk/ government/publications/covid-19-response-autumn-and-winter-plan-2021/covid-19-response-autumn-and-winter-plan-2021; INQ000137270)

¶8.81. On 17 September 2021, following a request from Mr Javid, the Joint Committee on Vaccination and Immunisation announced the rollout of the booster vaccine programme for the winter of 2021 for the most vulnerable groups.²¹⁶²¹⁶ 'JCVI statement regarding a COVID-19 booster vaccine programme for winter 2021 to 2022', Joint Committee on Vaccination and Immunisation, 14 September 2021 (https://www.gov.uk/government/publications/jcvi-statement-september-2021-covid-19-booster- vaccine-programme-for-winter-2021-to-2022/jcvi-statement-regarding-a-covid-19-booster-vaccine-programme-for-winter-2021- to-2022; INQ000257044)

¶8.82. On 8 October 2021, the Welsh Government published the Coronavirus Control Plan: Autumn and Winter 2021 Update.²¹⁷²¹⁷ Coronavirus Control Plan: Autumn and Winter 2021 Update, Welsh Government, October 2021 (https://www.gov.wales/sites/ default/files/publications/2021-10/coronavirus-control-plan-autumn-and-winter-2021-update.pdf; INQ000082368) It outlined two scenarios: 'Covid Stable' would not require the reimposition of significant restrictions; however, 'Covid Urgent' may be caused by unexpected pressures such as a new and highly transmissible variant, which would necessitate more "significant action".²¹⁸²¹⁸ Coronavirus Control Plan: Autumn and Winter 2021 Update, Welsh Government, October 2021, p6 (https://www.gov.wales/sites/ default/files/publications/2021-10/coronavirus-control-plan-autumn-and-winter-2021-update.pdf; INQ000082368) This reflected a recommendation from the Technical Advisory Group.²¹⁹²¹⁹ INQ000390618_0061-0062 para 185; INQ000350502_0002 While it stated that "our response to these challenges will not be to simply return to lockdown measures or to impose new restrictions", the plan for a Covid Urgent scenario was predicated on the basis of retaining:

404

" the coronavirus restrictions regulations, which set out the alert levels and enable us to move up and down the levels, depending on the specific risk to public health that is identified".²²⁰²²⁰ Coronavirus Control Plan: Autumn and Winter 2021 Update, Welsh Government, October 2021, p6 (https://www.gov.wales/sites/ default/files/publications/2021-10/coronavirus-control-plan-autumn-and-winter-2021-update.pdf; INQ000082368)

¶Annex A to the plan contained a list of key indicators that would be monitored.²²¹²²¹ Coronavirus Control Plan: Autumn and Winter 2021 Update, Welsh Government, October 2021, pp34-35 (https://www.gov.wales/ sites/default/files/publications/2021-10/coronavirus-control-plan-autumn-and-winter-2021-update.pdf; INQ000082368)

¶It would have been of even greater benefit if these indicators had clearer thresholds for the Welsh Government to consider further action.

¶8.83. In Northern Ireland, on 7 October 2021, the Executive Committee endorsed an autumn and winter contingency plan.²²²²²² INQ000065667 Its premise was that the pandemic could change course rapidly and unexpectedly. It therefore set out measures that could be deployed "to contain the virus or to respond to surges or pressures that may emerge" while minimising economic and social impacts.²²³²²³ NI Executive Autumn/Winter COVID-19 Contingency Plan, Northern Ireland Executive, October 2021 (https://www.executiveoffice-ni.gov.uk/sites/default/files/publications/execoffice/autumn-winter-covid-19-contingency-plan-2021.PDF; INQ000104468_0003) The document recognised that the early introduction of 'low-cost' interventions would help to avoid unacceptable hospital pressures and more disruptive interventions at a later stage.²²⁴²²⁴ INQ000438174_0164 para 605

¶8.84. In contrast, the Scottish Government continued to operate in terms of Scotland's Strategic Framework Update, published on 22 June 2021.²²⁵²²⁵ COVID-19: Scotland's Strategic Framework Update, Scottish Government, June 2021 (https://www.gov.scot/publications/ coronavirus-covid-19-scotlands-strategic-framework-update-june-2021; INQ000235137) This document set out plans for the easing of restrictions to beyond Level 0, when all levels' restrictions and physical distancing regulations would be lifted in Scotland, with the indicative date of 9 August 2021. The strategic framework did not contain plans for the autumn and winter of 2021 and was not updated again until 16 November, over a month after the other three governments had updated their pandemic response plans for the autumn and winter. The Scottish Government appears to have delayed devising its autumn and winter strategic plans.²²⁶²²⁶ The Scottish Government published specific plans for winter preparedness for the health and social care sector in October 2021: Health and Social Care Winter Overview 2021-2022, Scottish Government, 22 October 2021 (https://www.gov.scot/publications/ scottish-government-health-social-care-winter-overview-2021-22/documents; INQ000492663); Adult Social Care Winter Preparedness Plan 2021-22, Scottish Government, 22 October 2021 (https://www.gov.scot/publications/adult-social-care-winter- preparedness-plan-2021-22; INQ000280634).Show full note

¶8.85. Instead, on 5 October 2021, the Scottish Government published its Covid Recovery Strategy, which noted that the success of the vaccination programme and the summer 2021 "lifting of restrictions has provided the platform for recovery".²²⁷²²⁷ Covid Recovery Strategy: For a Fairer Future, Scottish Government, 5 October 2021, p3 (https://www.gov.scot/publications/covid-recovery-strategy-fairer-future; INQ000131075) The Scottish Government's focus was now shifting to "the next 18 months" and the need to seize the "opportunity to drive a more positive change".²²⁸²²⁸ Covid Recovery Strategy: For a Fairer Future, Scottish Government, 5 October 2021, p4 (https://www.gov.scot/publications/covid-recovery-strategy-fairer-future; INQ000131075) The document set out actions to address inequalities made worse by Covid-19, to make progress towards a "wellbeing economy" and to accelerate inclusive, person-centred services.²²⁹²²⁹ Covid Recovery Strategy: For a Fairer Future, Scottish Government, 5 October 2021, p4 (https://www.gov.scot/publications/covid-recovery-strategy-fairer-future; INQ000131075) John

405

¶Swinney MSP (Deputy First Minister of Scotland from November 2014 to March 2023) had been appointed as Cabinet Secretary for Covid Recovery after the Scottish

¶Parliament elections in May 2021. He explained that his appointment was:

" a recognition by the First Minister that we needed to ever more turn our attention to recovering from Covid and to make sure there was a whole-government response in a co-ordinated and cohesive way to that effort".²³⁰²³⁰ John Swinney 30 January 2024 99/8-13

¶Although it was proper for the Scottish Government to focus on recovery from the pandemic, the prevailing attitude was to focus too much on recovery to the exclusion of the still present threat and the timely development of autumn and winter plans.

¶8.86. On 14 October 2021, SAGE warned that "there should be no complacency around the risk posed by further viral evolution".²³¹²³¹ INQ000061604 It was a "real possibility" that a further variant would become dominant globally.²³²²³² INQ000061604_0002 As had been seen with Alpha and Delta, variants were emerging with increased transmissibility, but there were also concerns that, for some variants, the vaccines would be less effective or would cause more severe disease. SAGE reviewed Plan B and advised that policy work on the reintroduction of restrictions "should be undertaken now so that it can be ready for rapid deployment if required".²³³²³³ INQ000061604_0002 para 4 It noted that other "measures beyond those proposed as part of Plan B are available to mitigate the need for further measures over winter".²³⁴²³⁴ INQ000061604_0005 para 31 This endorsed SPI-M-O's advice that "action beyond Plan B may be required to control growth".²³⁵²³⁵ INQ000128600_0001 para 1

¶8.87. SAGE's advice about efficacy, early deployment of measures and the use of triggers was repeated. This was less than a month after Plan A had been announced. As Professor Vallance observed: "[T]hese were common and repeated themes of SAGE advice which had been reinforced by the experience of previous waves."²³⁶²³⁶ INQ000238826_0147 para 446

¶8.88. On 25 October 2021, this advice was reinforced by Professors Whitty and Vallance to Simon Ridley (Head of the Cabinet Office Covid-19 Taskforce from July 2021 to March 2022). The "main ministerial objective" was understood to be preventing NHS 'overwhelm'.²³⁷²³⁷ INQ000064175 They advised that pressures on the NHS would inevitably worsen over the winter period. They considered that the measures in Plan B, combined with good immunity from ongoing vaccination, would:

406

" likely be enough to take the edge off things and allow numbers of infections to decrease. The earlier action is taken the less severe the measures need to be."²³⁸²³⁸ INQ000064175

¶Despite this – and Mr Johnson having already acknowledged privately as early as

¶9 October that Plan A was "clearly not working and time for plan b" – as addressed below, the decision to move to Plan B in England was not taken for a further two months.²³⁹²³⁹ INQ000236362_0001

¶8.89. Throughout October 2021, Wales had the highest infection rates of the four nations. Higher case rates had begun to translate into increased hospital occupancy; however, this remained significantly lower than in previous waves.²⁴⁰²⁴⁰ INQ000022553; see also INQ000350062 The Welsh Cabinet discussed ways to avoid moving to its Covid Urgent scenario and agreed that messaging should encourage people to take precautions and explain that there may be a need to tighten restrictions in the future. On 29 October, more stringent rules on self-isolation were announced.²⁴¹²⁴¹ 'Written Statement: Review of the Health Protection (Coronavirus Restriction) (No. 5) (Wales) Regulations 2020', Mark Drakeford, First Minister, Welsh Government, 29 October 2021 (https://www.gov.wales/written-statement-review-health-protection-coronavirus- restriction-no5-wales-regulations-2020-15; INQ000023302_0002) This was a sensible precaution.