18 November 2022: Van-Tam - C

And for the final time, there were questions from core participants;

On people not being constrained to speak up in the example of his experience; he said it represented his own situation of being very senior and being the expert on the topic. He did not feel constraints related to worrying about his job if he upset things, but obviously others would not have that luxury.

On the expert committees having the Government as the customer, would that mean the public too; he said yes absolutely.

On expert committees recording dissent, for example in minutes or advice; he said he couldn’t answer whether or not the minutes or advice was so recorded, but from his own experience he would want minutes to record dissenting voices, but he could not think of any examples of when specific objections by someone later being raised with Ministers. During Covid, the JCVI did include different views on issues, like vaccines. Where a committee was split, that should be reported to a Minister he said.

On the potential impact of incidents related to specific groups among the public; he said a lot of the preparedness had not been framed through inequalities factors, but they were implicit.

On making the advice from CMOs to Ministers public; he said he could see no reason why not.

The Chair referenced the various Inquiries into NHS incidents where it was stated that the culture needed to change. Specifically, the Chair asked about how “quality” operates when it came to candour and openness. He noted how the witnesses’ own candid behaviour was known, but as a leader how does that culture become embedded. The witness said it was a difficult question that bothered him every day. It boiled down to a set of personal values. It also means insisting on other leaders and those who report to him on themselves seeking to establish a sense of responsibility and accountability. From top to bottom there should be an insistence on quality. It could not be achieved by a mission statement or posters around the office, but about lived relationships, including the expectation leaders have of their people; a “built-in” ownership and accountability. That would extend both below and above the particular individual. He also mentioned a system of incentives based not only on the achievements of the person, but also on the person above then, knitting the thinking together.

The Chair wondered how such a model would apply in the NHS. The witness declined to answer, considering that it would involve maybe five hours of thought and explanation. The Chair invited the witness to take that time after his oral evidence and send his thoughts to the Inquiry.

The witness read a prepared closing statement. He thanked the Inquiry for being asked to appear. He then spoke to the core participant victim-survivors. He recognised he was giving evidence about his experience of being involved in the healthcare system at a certain high level. He recognised the length of time core participants had been involved in these issues. He could only scratch the surface of the deep anguish, suffering, and loss related to “this incident” (interesting choice of word). He knows the Inquiry cannot give back what was lost, and he was sorry for that. He hoped people felt heard, and to have been able to ask their questions. He hoped the Inquiry would bring some degree of closure, and a different ending had there not been an Inquiry.

The Chair thanked the witness for the considered nature of what he had to say. The witness was invited to leave if he wanted to while other matters were presented. He did leave.