18 November 2022: Van-Tam - B

The restart began with a clarification by Counsel about communication issues between the four nations involving Ministerial levels rather than between CMOs. The Ministerial coordination meeting usually involved the Chancellor of the Duchy of Lancaster. The witness was usually the advising DCMO for these inter-ministerial meetings. There was a very large number of these meetings during Covid.

The issue of the turnover of staff, particularly senior staff and Ministerial “churn” was another matter raised by the Expert Group. The witness could not say if it was any more of a turnover these days compared to the past, but it is an issue. Among civil servants there seems to be a value in moving between Departments of Whitehall, including to move up the grades. There are some benefits to change, of course. For doctors, they move around but usually within health settings.

The matter of inadequacies in monitoring and reporting was next but the witness did not have anything to contribute. The matter of listening to the patient voice was also raised. He could only use personal experiences to answer. His experience is that there are genuine reasons why people raise concerns. He has noted defensiveness on this issue in some respects. Again, it is best to respond by avoiding platitudes but engage in straight talking. At the national level, there were meetings with civil society arising from the pandemic, for example with faith groups. He admitted that these were at the request of the faith groups, not the other way round. During the pandemic the workload on staff was tremendous, so the option of taking time to speak to certain groups would be difficult to fit in.

Another matter was the apparent difficulty in challenging and testing existing policy decisions, and the possibility of there being “silos”. The witness always saw it as part of his role to “speak his mind”. He was probably seen as challenging to some in the policy teams. He could freely walk into the CMO office if he had something to say. Equally, he was fine about having a direct conversation with a permanent secretary. He agreed that there is an issue for less senior staff to ask questions. The culture in a department will influence the capacity people feel to express themselves.

There was the issue of Ministers  not having expertise and how their backgrounds affect the way they lead their departments. The witness saw it as the role of the civil servants to support their Minister in areas where they may lack competence. On medical matters, the expert advisers have a role in ensuring Ministers can make their own decisions with all the information they need.

Poor corporate memory was raised next. JVT agreed with the criticism. He was one of the few scientists who came to the SAGE table during the pandemic who has prior experience of SARS. It makes it important for good records to be kept so as to inform the future people and help them not have to start from an empty page. The next topic was linked, that of a lack of long-term planning and preparedness, particularly related to risks. The witness said there was preparation and the records about these are available.

The issue of resource constraints came up next. Prof Van-Tam recognised the past decade of cuts overall to the public health budgets. Obviously that changed during Covid. He understood how public health could be an easier target since the outcomes cover a longer trajectory than direct patient care and treatment.

Finally, the witness was asked to comment on the overall strengths, weaknesses, and improvement options in the public health landscape. He saw strength in the ability to deal with incidents (some might say, “he would say that, wouldn’t he”). He was concerned about the Expert Group assertions of the breakdown of medical and non-medical local public health staff. On learning from mistakes as being an issue, he did not have specific thoughts, but considered the embedding of quality from top to bottom of an organisation helps with getting things right. On there being a blame culture, he could not say much since he was so long away from frontline working in the service. He also could not comment on the ability of Government Departments to learn from mistakes. He did mention “wash-up” exercises to identify lessons learned. And on the Duty of Candour developments, he was happy to restate his own tendency to be very direct in how he had communicated with the public. He supports that kind of approach.