Chapter 4: Realisation and lockdown (13 to 23 March 2020)

Chapter 4: Realisation and lockdown (13 to 23 March 2020)

Introduction

¶4.1. The decision to announce a mandatory lockdown across the UK on 23 March 2020 was one of the gravest decisions that any government in the UK has had to make. Such intensive and widespread measures had not been adopted in Western Europe for more than a century.¹¹ INQ000273553_0058 para 9.6 Similar decisions had already been taken across the world, including in Wuhan, China on 23 January 2020, in Italy on 9 March following regional measures across Lombardy and 14 northern provinces on 8 March, in France on 17 March and in large swathes of other parts of Europe.²² 'Coronavirus: Italy extends emergency measures nationwide', BBC News, 10 March 2020 (https://www.bbc.co.uk/news/world-europe-51810673; INQ000573840) More than 100 countries had instituted a full or partial lockdown by the end of March.³³ 'Coronavirus: The world in lockdown in maps and charts', BBC News, 7 April 2020 (https://www.bbc.co.uk/news/world-52103747; INQ000573841)

¶4.2. Prior to mid-March 2020, it was considered "inconceivable" that such a step would be taken in the UK.⁴⁴ Helen MacNamara 1 November 2023 40/4-19 This chapter examines the events that led to the UK government and devolved administrations finding themselves with no option but to contemplate the previously inconceivable.

Public health data and NHS capacity at 13 March 2020

¶4.3. By 13 March 2020, the UK government and the devolved administrations had moved to the 'delay' phase of their responses. They had stopped community testing and implemented the first restriction – the advice to self-isolate – with the objective of flattening the peak of infections to reduce the pressure on their healthcare systems. Time was quickly running out to prevent NHS capacity in England being overwhelmed. This would become apparent to decision-makers and their advisers in the following days. Professor Neil Ferguson, Mathematical Epidemiologist at Imperial College London, described 13 March 2020 as "pivotal in determining policy over the next 10 days".⁵⁵ INQ000249526_0066 para 211

¶4.4. As noted in Chapter 3: The first 12 days of March 2020, in this volume, papers provided to COBR on 4 and 12 March made clear that, in the reasonable worst-case scenario, the NHS would be overwhelmed before the peak of the virus was reached.⁶⁶ INQ000056209_0006; INQ000056158_0001 para 3. The reasonable worst-case scenario for Covid-19 estimated infection of "80% of the UK population, and up to 1% of this group will die as a direct result of the infection"; this was "up to 520,000 people" dying (INQ000146569_0001-0002).

¶4.5. Boris Johnson MP (Prime Minister from July 2019 to September 2022) and Matt Hancock MP (Secretary of State for Health and Social Care from July 2018 to June 2021) had also been told by NHS England on 12 March 2020 that, in the reasonable worst-case scenario and if no restrictions were put in place, it would "need 800,000 beds". This considerably exceeded the "total capacity of 100,000 and the ability to free up 30,000".⁷⁷ INQ000215035_0014 para 56 Even if restrictions were introduced, 200,000 beds would be required and there would be a demand of 100,000 beds at peak.⁸⁸ INQ000215035_0014 para 56 The same applied to the devolved administrations, with demand vastly outstripping the number of beds available.⁹⁹ INQ000383739_0002-0003; INQ000425604; INQ000485979_0094 para 357

¶4.6. NHS England had been placed on a Level 4 Major Incident emergency footing (on 30 January 2020) and discussions were taking place about discharge of patients and cancellation of elective treatments to increase NHS capacity. On 13 March 2020, Sir Simon Stevens (later Lord Stevens of Birmingham), Chief Executive of NHS England from April 2014 to July 2021, telephoned Mr Hancock. He proposed postponing all non-urgent operations from 15 April 2020 to free up 30,000 beds and that:

¶" frail, elderly patients who did not need urgent treatment would need to be discharged, either to their home or care homes".¹⁰¹⁰ INQ000232194_0064 para 270

¶4.7. However, up-to-date data on NHS England capacity were still not readily available to decision-makers in mid-March 2020. Mr Johnson told the Inquiry that he:

¶" could not believe that in the first few weeks the NHS did not even know how many beds there were in the whole organisation".¹¹¹¹ INQ000255836_0060 para 239; see also INQ000089005_0004

¶4.8. Dominic Cummings, Adviser to the Prime Minister from July 2019 to November 2020, described the data system for NHS updates to Mr Johnson as "me dragging the whiteboard in and scribbling tables" as Sir Simon Stevens spoke. Mr Cummings said that there were not "any real time data".¹²¹² INQ000273872_0053 para 232

¶4.9. According to Lord Stevens, statistics on bed availability were published from 2000.¹³¹³ INQ000280647_0009 para 27 However, NHS England bed availability was recorded as statistics on a weekly basis, rather than as real-time data.¹⁴¹⁴ INQ000283193 Lord Stevens recognised that, before the second half of March 2020, "it was not possible automatically to 'pipe' real time information on patient case mix and capacity" due to the nature of records and systems available. He attributed this to NHS England proposals to invest in more modern systems being "repeatedly rejected or scaled back" and noted that the lack of immediate access to data therefore "should not have come as a surprise to ministers".¹⁵¹⁵ INQ000280647_0009 para 27, footnote 5 Data from the new NHS Covid Situation Report (SitRep) system became available on 16 March.¹⁶¹⁶ INQ000249526_0082-0083 para 254 Professor Ferguson described this as a system "for monitoring COVID-19 related healthcare demand".¹⁷¹⁷ INQ000249526_0081-0082 para 251 From this point, NHS England began to provide data on bed occupancy and availability, the number of ventilated beds available and occupied, hospital capacity, staffing numbers and deaths.¹⁸¹⁸ INQ000144792_0036 para 85; see also INQ000252722_0007 para 16

¶4.10. The devolved administrations also faced problems with real-time NHS data. Professor Sir Patrick Vallance (later Lord Vallance of Balham), Government Chief Scientific Adviser from April 2018 to March 2023, considered that there was generally a better understanding of hospital capacity in Scotland than in England, due to Scotland's well-developed electronic health data system.¹⁹¹⁹ INQ000147810_0029-0030 para 90 However, Professor Andrew Morris (Professor of Medicine at the University of Edinburgh and Chair of the Scottish Government Covid-19 Advisory Group) noted that, at the start of the pandemic, Scotland was still "in the foothills" of being able to use healthcare data in a sufficiently agile and real-time way for rapid analysis generation of insights to inform decision-making, including difficulties with access to primary care data.²⁰²⁰ Andrew Morris 23 January 2024 182/20-23; INQ000346264_0011 para 41

¶4.11. On 5 March 2020, Dr Andrew Goodall (Director General of Health and Social Services in the Welsh Government and Chief Executive of NHS Wales from June 2014 to November 2021) wrote to all Chief Executives of local health boards in Wales. He asked hospitals to review their critical care and high dependency capacity and consider how this could be increased.²¹²¹ INQ000226148_0004 On 13 March, Vaughan Gething MS, Minister for Health and Social Services in the Welsh Government from May 2016 to May 2021, announced a "framework of actions, within which local health and social care providers can make decisions".²²²² INQ000226942_0001; see also Mark Drakeford 13 March 2024 90/4-5; INQ000147283_0001 The framework "switched off" large parts of the health service in Wales, including allowing the suspension of non-urgent work.²³²³ Vaughan Gething 11 March 2024 56/16-20 In an update to the Permanent Secretary to the Welsh Government on 13 May, Dr Goodall confirmed that, as a result of modelling for NHS Wales by mid-March, which projected a necessity for 900 critical care and an additional 10,000 system-wide beds at the point of peak demand (which was anticipated to be over the next three to four weeks), "critical care beds were more than doubled from a normal level of 156 beds to over 400".²⁴²⁴ INQ000182427_0007 By 3 April 2020, there were 353 critical care beds.²⁵²⁵ 'Written Statement: Critical care capacity and ventilation', Vaughan Gething, Minister for Health and Social Services, Welsh Government, 5 April 2020 (https://www.gov.wales/written-statement-critical-care-capacity-and-ventilation; INQ000182395) However, by 20 March, the Technical Advisory Cell (which coordinated scientific and technical advice to the Welsh Government) confirmed:

" [T]here has not been a complete set of accurate data from all Health Boards that describes both ICU [intensive care unit] or Hospitalisations from COVID-19."²⁶²⁶ INQ000083241_0004

¶This meant that:

" TAC [the Technical Advisory Cell] is currently not being provided with the data it needs to effectively provide timely and accurate advice."²⁷²⁷ INQ000313127_0001

¶When these data were initially collated, it was "done by phone using an Excel Spreadsheet".²⁸²⁸ INQ000356177_0022 para 77

¶4.12. Professor Sir Michael McBride, Chief Medical Officer for Northern Ireland from September 2006, observed that, at the outset of the pandemic, there was:

" more limited ICU capacity in NI [Northern Ireland] than in some other parts of the UK and Europe per head of the population. On 1 March 2020 there were 88 critical care beds in NI."²⁹²⁹ INQ000421704_0019-0020 para 45

¶4.13. The Department of Health (Northern Ireland) announced on 13 March 2020 that health service activity would have to be significantly curtailed as resources needed to be diverted to care for Covid-19 patients. Affected services included non-urgent outpatient appointments, day cases and inpatient and diagnostic work.³⁰³⁰ INQ000421704_0150-0152 para 326 The process of scaling back provision was phased in over days and weeks.³¹³¹ INQ000421704_0150-0152 para 326 As this announcement was made prior to the Northern Ireland Executive Committee's meeting on 16 March, there can have been no advance scrutiny or examination of the decision to curtail health services by it. It was not until the end of April 2020 that reliable data on hospital admissions in Northern Ireland became available.³²³² Ian Young 7 May 2024 153/18-22; INQ000437430_0090 para 282; Joanne McClean 2 May 2024 120/17-121/22 The delay in these data becoming available was the result of Northern Ireland "relying largely on [a] paper-based records system".³³³³ See Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, recommendation 5 (https://covid19.public-inquiry.uk/documents/module-1-full-report); Covid-19 Inquiry: Resilience and preparedness (Module 1) Report. Executive response, The Executive Office, 16 January 2025, p14 (https://www.executiveoffice-ni.gov.uk/publications/executive- response-covid-19-module-1-report-jan-2025)Show full note

¶4.14. During a pandemic, real-time and accurate knowledge of data relating to NHS bed capacity and patient case mix (the mix of adult, paediatric and neonatal general and acute beds), bed occupancy and admissions is vital to understanding whether interventions may be required to prevent hospitals being overrun. Each of the four governments faced its own lack of real-time health data in mid-March 2020, which reflected a lack of planning by the UK government, Scottish Government, Welsh Government and the Department of Health (Northern Ireland).