15 November 2022: Hopkins - B

Questions from core participants included:

On loss of corporate memory and the option to publish the organisation’s documents for the public record; she said she agreed it was helpful and important. It was a reason why the organisation had more recently moved to publish its documents in a timely fashion.

On learning from Monkeypox and the potential impact on the UK blood supply; she said the UKHSA had close working relationships with the NHSBT with close liaison throughout the time Monkeypox was considered to be an issue. That included risk assessment and the best use of screening questions for donors.

On the briefing notes; she said they were not updated to any regular schedule, but as and when needed. There is a regular Public Protection Report which includes updates. The briefing notes can be quite technical. Dissemination is important, but they had to be careful of overloading people with alert updates, so they had to prioritise and target their alerts. Doing presentations at meetings and linking to the professional bodies are other ways of sharing new information.

On cascading information to key bodies; she said there is a system and that does rely on the organisations using their own processes to cascade. Where alerts are urgent and important, there are systems to make sure these are not missed. The situation for hospital doctors and GPs needed particular attention. She uses her own situation as a clinician to know if the system is working at her hospital. For GPs there was a need to ensure practices were registered and that the person who receives the updates does actually disseminate them as required. The witness agreed that it would be useful to audit the process for dissemination.

On the Duty of Candour being legally based in health settings; she said she thought that helped.

On protected characteristics and inequalities related to socioeconomic factors; she said they look at the Index of Multiple Deprivation and at other tables.

On funding or underfunding related to public health; she said the UKHSA had experienced cuts in the past, but that changed when Covid happened.

On the numbers of public health personnel; she said they needed a multi-disciplinary workforce to support public health, including non-clinicians. They do support making the case for funding of bodies nationally and locally that link to the UKHSA work.

On ProMED; she said she did not know why it was initiated (she was still a medical student then). It does receive some funding from bodies and individual subscribers, but it does not receive major amounts from anywhere.

On reports sometimes needing to go to the DH; she said there were good relationships with colleagues in the DH. She regularly speaks with the Chief Medical Officer (CMO). The Secretary of State receives certain updates as considered necessary. There are weekly updates on identified threats they are dealing with.

On the preference for there being a public notification exercise if such was being considered; she said she thought it was part of the organisational culture to think that way.

On not directly working with patients or their groups; she said that in the local or regional teams there were more direct links to patient groups. She gave the example of vaccine and particular ethnic or religious groups as a reason to work together.

On the suggestion that infectious diseases threats being less emphasised in the overall healthcare realm; she said that had probably gone down as a result of Covid. She recognised how there would be a natural focus on direct healthcare matters such as people having specific conditions needing to be treated as opposed to emerging theoretical risks not yet, if ever, at the stage of impacting on people.

The Chair asked about the funding for UKHSA being a matter for Government after a request is made and the possibility that it might not be enough for what is needed, and also he extended that to include the local situation for funding. He wondered what the witness thought were the priorities for improving the services of UKHSA. She said that during the Covid pandemic there was a large increase in resources and activity, but detecting infections better would be a hope for future funding decisions, including diagnostic tests. Another is to have best data available so as to achieve the best lead-time to investigate and respond. A third hope is for the agency being better at delivering interventions, even beyond the automatically exclusive partnering with the NHS to deliver these.

The Chair continued on the theme of how any funding would be used to pursue these ends. She said that currently they provide the science and the evidence base but rely on the resources of the NHS to deliver what is recommended.

The Chair asked about the witnesses’ hopes for public health improvements more generally if the funding was available. She spoke about the personal element of relationships and trust as important ways for systems to work best. She also would like to see more excellent training and enough training places so that clinicians have a more holistic view of public health. Having well-trained experts who are continually updated on their knowledge and giving them the time and opportunity to reflect of their work so as to deliver services more effectively, and if required to challenge the status quo.

The Chair picked up on a career structure for public health, including the option to move around. She agreed that moving between jobs broadens experience and keeps people more fresh in their work.

The witness thanked the Inquiry for the invitation to attend. She expressed her sympathies for those infected and affected for what they have endured over the last 40 years and expressed her apologies for the system failings that have happened.

The Chair thanked the witness for her help and for making it a very interesting morning.