Identification of vulnerable groups

¶10.109. Vulnerable groups were particularly susceptible not only to the virus itself, but also to the decisions made by the UK government and devolved administrations to reduce transmission. Decision-makers were required to be alert not only to the direct harms caused by the virus, but also to the indirect harms caused by decisions such as 'stay at home' orders and the closure of schools.

¶10.110. Yet, in large part due to a lack of pandemic planning (as set out in the Inquiry's Module 1 Report²²⁴²²⁴ Module 1: The resilience and preparedness of the United Kingdom, UK Covid-19 Inquiry, July 2024, Executive summary (https://covid19.public-inquiry.uk/documents/module-1-full-report)), limited consideration had been given before the pandemic to the indirect consequences arising from the response to it. Decision-makers had limited understanding of the need to plan to mitigate the worst impacts of, for example, a lockdown – and it does not appear as if any of the governments entered into a systematic consideration of how the decisions that they took to combat the virus would affect vulnerable sectors of the population.²²⁵²²⁵ Mark Sedwill 8 November 2023 34/20-35/5; Arlene Foster 15 May 2024 131/19-132/3; Michelle O'Neill 14 May 2024 144/4-20; Robin Swann 13 May 2024 159/21-160/23; Naomi Long 9 May 2024 28/6-14; INQ000411509_0061 para 278; INQ000438173_0073 para 340; Karen Pearson 3 May 2024 93/14-22, 94/4-22; INQ000273956_0025, 0028 paras 117, 131; Mark Drakeford 13 March 2024 50/14-25; Eluned Morgan 12 March 2024 8/12-17; INQ000389184_0096 para 338Show full note As Mr Cummings recognised, vulnerable people and those in need of protection were "almost entirely appallingly neglected by the entire planning system".²²⁶²²⁶ Dominic Cummings 31 October 2023 142/3-143/10

¶10.111. Ms MacNamara warned at the time that leaders had insufficient time to identify those who would be most at risk during a lockdown and to develop strategies to protect them. There was also a lack of understanding in the UK government about the lives of those who would be most adversely affected by the pandemic and the foreseeable risk they faced.²²⁷²²⁷ lNQ000308302_0001; INQ000273841_0051, 0054 paras 101, 107 Ms MacNamara noted:

" [ W]hile there was undoubtedly sympathy for the differential impacts on women, poorer people and how Covid was disproportionately harming Black and Asian communities, when it was raised it was treated as if these were naturally occurring phenomena rather than the consequences of deliberate choices (albeit often historic). I do not think impacts on women and children were properly appreciated even much later in the process."²²⁸²²⁸ INQ000273841_0053 para 106

¶This manifested itself in the fact that policy discussions within the UK government did not always recognise the reality of home life for many – for example, of those who lived in multi-generational housing and could not self-isolate, those who lived in tower blocks and had no garden, those who could not afford to provide laptops for their children, and those who had to work from home and look after their children in confined spaces. As Ms MacNamara commented: "[P]eople who were living like that were not working in Downing Street or 70 Whitehall."²²⁹²²⁹ INQ000273841_0081 para 165

¶10.112. Lee Cain, Director of Communications at 10 Downing Street from July 2019 to November 2020, explained:

" One of the challenges you face when you work on policy is the dynamic of the room, which in this case was white and middle aged. They were doing their best, but without diversity, some policy decisions slipped through the cracks."²³⁰²³⁰ Lee Cain 31 October 2023 56/24-57/3

¶Mr Cain described asking 20 people in the Cabinet Room: "[H]ow many people had received free school meals[?] Nobody had – resulting in a policy and political blindspot."²³¹²³¹ INQ000252711_0027 para 121c The UK government's approach to free school meals and, in particular, the delayed introduction of free school meals to support children during holidays (following footballer Marcus Rashford's campaign in favour of free meals during holidays) was, in Mr Cain's view, a "huge blunder".²³²²³² Lee Cain 31 October 2023 57/16-58/25

¶10.113. Given the lack of diversity among decision-makers, it was all the more important for there to be proper, centralised oversight within the UK government of the impact that the pandemic was having across society. Initially there was none. Work to address these impacts was fragmented. In April 2020, Simon Case (later Lord Case), Director General in the Cabinet Office from April to May 2020, with responsibility for coordinating the UK government's efforts to support non-shielded, vulnerable people, told Ms MacNamara that the UK government's work on non-shielded vulnerable people was "chaos", lacking in direction, strategy and authority.²³³²³³ INQ000303253_0005-0006; see also INQ000207294_0002 para 1.3.2

¶10.114. Responsibility for oversight of the impact of the pandemic on vulnerable groups was initially carried out under the authority of the General Public Sector Ministerial Implementation Group and its chair, Mr Gove.²³⁴²³⁴ INQ000137209 From May 2020, work on vulnerable groups within society was subsumed into the general work of Covid-O.²³⁵²³⁵ INQ000198850_ 0027 paras 63-65; INQ000248852_0016 para 3.3.6 Mr Gove told the Inquiry that Covid-O was more concerned with operational matters and the effectiveness of delivery because the big policy questions, and what was required, had already been identified. This underestimated the work that needed to be done, both to identify and to mitigate the impacts of the pandemic on vulnerable groups. The position was such that it became one of Mr Case's "key inspirations behind the Covid Taskforce".²³⁶²³⁶ Simon Case 23 May 2024 40/14-15

¶10.115. The Covid-19 Taskforce had a workstream for disproportionately impacted groups, which came into existence following Public Health England's June 2020 report, Disparities in the Risk and Outcomes of COVID-19.²³⁷²³⁷ INQ000252914_0079 para 348 In September 2020, Covid-O tasked the taskforce:

" with ensuring that decisions on future interventions fully factor in the likely impacts on disproportionately impacted groups (including due consideration of Equalities Impact Assessments)".²³⁸²³⁸ INQ000207294_0010

¶As late as November 2020, Mr Case – by this time Cabinet Secretary and Head of the Civil Service – asked the Covid-19 Taskforce to commission SAGE to produce estimates and modelling in relation to the non-Covid-19 health and societal impacts of the second lockdown. He also asked that, in future, SAGE produce assessments of these consequences of their advice.²³⁹²³⁹ INQ000267718_0022-0023 The Covid-19 Taskforce sought to "ensure that the different components of the COVID-19 response balanced the health, economic and social impacts".²⁴⁰²⁴⁰ INQ000248852_0010 para 2.21 From about January 2021, it produced 'consensus packs' that considered the health, economic and social impacts of potential policy decisions.²⁴¹²⁴¹ INQ000252914_0088-0090 paras 386-394

¶10.116. A briefing paper from the First Minister and deputy First Minister of Northern Ireland to the Northern Ireland Executive Committee, dated 19 March 2020 and titled 'COVID 19 – Planning framework', contained no clear identification of inequalities caused by, or exacerbated by, the pandemic, or of the response to it.²⁴²²⁴² INQ000086884 The lack of consideration remained in the final version of the Covid-19 Executive Strategy and Plan.²⁴³²⁴³ INQ000023187 Given that the plan was intended to identify to ministers the most important issues that they needed to address, it reflected a collective lack of consideration of inequalities.²⁴⁴²⁴⁴ Karen Pearson 3 May 2024 46/20-23

¶10.117. Under the Northern Ireland Civil Contingencies Framework, The Executive Office looked to the Department for Communities (Northern Ireland) to respond operationally to "contingencies involving vulnerable people or groups" rather than leading on the issue itself, which the Department for Communities (Northern Ireland) accepted in its Covid-19 action plan.²⁴⁵²⁴⁵ INQ000187620_0033 para 130; INQ000251519_0017 paras 2.10.1-2.10.2; INQ000101386_0006 This effectively resulted in the department being seen as the default lead in respect of contingencies involving vulnerable and/or protected groups during the pandemic – notwithstanding the limitations of its actual role in that regard. The Department for Communities (Northern Ireland) did not seek systematically to gather information or data specifically relating to the impact of measures on vulnerable or at-risk groups of people.²⁴⁶²⁴⁶ INQ000251519_0036 para 10.1.1; Carál Ní Chuilín 8 May 2024 204/20-205/2

¶10.118. The situation did not improve over time. Dr Jenny Pyper, Interim Head of the Northern Ireland Civil Service from December 2020 to August 2021, stated:

" The extent of the impact of NPIs [non-pharmaceutical interventions] on different groups within society was not assessed in any systematic way during my tenure."²⁴⁷²⁴⁷ INQ000411509_0060 para 273

¶She considered that the Executive Covid-19 Taskforce (Northern Ireland), instituted in December 2020, should have had a specific equality workstream.²⁴⁸²⁴⁸ Jenny Pyper 2 May 2024 202/16-203/15

¶10.119. The Welsh Government published Leading Wales out of the Coronavirus Pandemic: A Framework for Recovery (the framework) on 24 April 2020, which set out the principles that the Welsh Government would apply when considering whether to lift restrictions. These principles included whether each measure had a "high positive equality impact" and a "high impact on social and psychological well-being".²⁴⁹²⁴⁹ Leading Wales out of the Coronavirus Pandemic: A Framework for Recovery, Welsh Government, April 2020, p7 (https://www.gov.wales/sites/default/files/publications/2020-04/leading-wales-out-of-the-coronavirus-pandemic.pdf; INQ000349353) As explained in Chapter 5: Exit from lockdown, in Volume I, the framework identified four ways in which Covid-19 could harm people in Wales. A fifth harm was added on the advice of the Technical Advisory Group, in July 2021, which expressly recognised the "harms arising from the way Covid-19 has exacerbated existing, or introduced new, inequalities in our society". The Technical Advisory Group explained that this:

" explicitly recognised the important impact of inequality on the harm experienced by people in Wales. There have been slightly different definitions given for the four/five harms over time and in different places."²⁵⁰²⁵⁰ INQ000066315_0003

¶10.121. The Scottish Government adopted a four-harms framework approach to decision-making from April 2020, which is discussed further in Chapter 5: Exit from lockdown, in Volume I.²⁵²²⁵² Covid-19 – A Framework for Decision Making, Scottish Government, 23 April 2020 (https://www.gov.scot/publications/ coronavirus-covid-19-framework-decision-making; INQ000369689) Unlike the approach taken by the Welsh Government, the four-harms process did not include a 'harm' that specifically considered equalities issues.²⁵³²⁵³ INQ000340113_0002 para 7 Instead, inequalities were regarded as a factor within each of the four harms.²⁵⁴²⁵⁴ INQ000340113_0002 para 7

¶10.122. The four harms framework was an important decision-making tool to guide the Scottish Government's decision-making during the pandemic, as is discussed further in Chapter 11: Government decision-making, in this volume. It was intended to be:

" a (reasonably high level) document setting out the principles that will guide our decisions on an exit strategy".²⁵⁵²⁵⁵ INQ000343888_0018-0021 para 73

¶It served as a useful aid to take account of "multiple inter-related, non-linear impacts of decisions and interventions".²⁵⁶²⁵⁶ INQ000343888_0018-0021 para 83 However, its purpose was not to identify the specific risks faced by vulnerable groups or mitigation. There was still a need for the proper consideration of vulnerable and at-risk groups within the decision-making process.

¶10.123. Although the four harms framework was applied by the Scottish Cabinet from April 2020, the Four Harms Group – convened as a forum to discuss the various harms and potential responses to inform advice for decision-making – did not hold its first meeting until 24 October 2020. This was too late. The Scottish Government Covid-19 Advisory Group remained predominantly bio-medical in expertise and focused on the epidemiological harm posed by the virus.²⁵⁷²⁵⁷ INQ000369765_0005 paras 25-26 Professor Mark Woolhouse, Professor of Infectious Disease Epidemiology at the University of Edinburgh and a member of the Scottish Government Covid-19 Advisory Group, noted that it:

" discussed extensively, and reviewed available data on, issues including vulnerabilities, at risk groups, inequalities, ethnicity and non-Covid health care. However, those discussions were mainly about the effects of these considerations on health outcomes rather than wider harms."²⁵⁸²⁵⁸ INQ000369765_0005 para 27

¶10.124. Dr Jim McMenamin, Head of Infections Service and Strategic Incident Director for Covid-19 at Public Health Scotland, noted:

" From my observations of topics covered in the SAGE, SCSAG [the Scottish Government Covid-19 Advisory Group] and Four-Harms meetings the impact of NPIs on 'at risk' and other vulnerable groups in light of existing inequalities had limited deliberation."²⁵⁹²⁵⁹ INQ000360968_0074 para 26.4

¶10.125. However, the fast pace of the pandemic meant that the Scottish Government's aspirations to embed consideration of equalities in its decision-making did not always transform into a proper consideration of vulnerable and at-risk groups within the decision-making process.²⁶⁰²⁶⁰ INQ000274052_0002; INQ000099698_0005; INQ000099678_0003; INQ000219085_0009; INQ000099687_0007; INQ000104082_0002 The Scottish Government set up a sub-group – the Expert Reference Group on COVID-19 and Ethnicity – within its Covid-19 Advisory Group, to consider and inform its approach to the impacts of Covid-19 on ethnic minority communities.²⁶¹²⁶¹ INQ000340113_0010 para 34 The group first met on 10 June 2020 but was stood down by November 2020.²⁶²²⁶² INQ000340113_0010 para 36 There is little evidence that the group played a significant role in informing the Scottish Government's consideration of the impact of the pandemic and interventions on ethnic minority groups.²⁶³²⁶³ INQ000326291_0004; INQ000274052_0002 In its October 2020 Rights at Risk, Inclusion Scotland expressed the view that, in relation to disabled people, there was an "abyss between the rhetoric of national policies and what happens on the ground".²⁶⁴²⁶⁴ Rights at Risk: Covid-19, Disabled People and Emergency Planning in Scotland, Inclusion Scotland, October 2020, p1 (https://inclusionscotland.org/wp-content/uploads/2021/05/Rights-At-Risk-Main-Report.pdf; INQ000142277)

¶10.126. At an early stage of any future pandemic, the UK government and devolved administrations should establish proper structures with ministerial oversight to identify and mitigate, where possible, indirect harms caused by the decisions they take.

¶10.127. A framework to identify those most at risk – not only from the disease itself but from the decisions taken to respond to it – would assist the ministers charged with the oversight and the decision-making itself, to understand the needs of the most vulnerable, the risks to which they are exposed and how those risks can be mitigated.

¶10.128. This framework ought to be prepared as part of the development of future pandemic preparedness strategies (see the Inquiry's Module 1 Report, Recommendation 4).

¶In short, the framework should identify who in society is most at risk in a national emergency, what is being done to reduce the risk to which they are subject and what is being done to help them. This strategy should be subject to continuous review.

¶Effective planning should enable governments to adapt existing plans to the specific circumstances of the emergency being faced.

Recommendation 8: A framework for considering those at risk in an emergency

¶The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should each agree a framework that identifies people who would be most at risk of becoming infected by and dying from a disease and those who are most likely to be negatively impacted by any steps taken to respond to a future pandemic. The framework should set out the specific steps that could be taken to mitigate the risks to these people. Equality impact assessments should form part of this framework. Where they cannot be undertaken in a national crisis, they should be reinstated as soon as possible. Each government should agree and publish in its response to this Report how it will ensure that this framework is embedded into emergency decision-making and who will be responsible for ensuring these issues remain under consideration throughout a national crisis.