Improving the Covid Inquiry Terms of Reference  – Recovery’s submission

RECOVERY has called since its launch in October 2020 for a balanced and comprehensive Inquiry as one of the ‘Five Reasonable Demands for Good Government During Covid-19’ which were the basis of our campaign. We therefore welcome this Inquiry but are anxious to ensure that it addresses the full range of issues in a balanced way.

The draft terms of reference (see foot of page) are broad and do not exclude the consideration of subjects that are not explicitly mentioned in the 32 specific areas of focus which are set out in bullet points. However, the fact that so many specific areas are specified in the draft terms of reference suggests that key areas which currently do not appear will either be overlooked or given more limited attention. 

This would be a grave error as some of the areas about which the public is most concerned are currently missing. We can say this with authority as Recovery has commissioned robust independent research into public views in these areas and found high and widespread concern. 

In particular, there is an implication in the draft terms that the Inquiry will consider the problems associated with restrictions solely in economic terms. This would be to overlook the extensive issues they have caused in other areas, such as health and mental well-being, and also the extent to which measures called into question some of the key shared values which underpin our society in areas such as freedom of speech and action.  These are huge issues which cannot be ignored: they should be referenced both in the factual narrative and in drawing the lessons of the pandemic. 

We therefore believe that to be generally seen as credible and robust, the Inquiry should add explicit mention of these important topics to the current bullet-points in the draft. The areas of greatest public concern which do not appear in the draft terms include:  

  • The impact of the pandemic and the associated restrictions on children (two out of three UK adults in our survey said the impact on children and education should be specifically included in the terms of reference);  
  • The use of behavioural psychology or ‘nudge’ techniques to alter people’s behaviour without their awareness (42% of those surveyed wanted this included, with concerns rising sharply amongst the young and in Northern Ireland, where 58% said they wanted ‘nudge’ addressed).
  • The role of the media and the restrictions placed by Ofcom and others on freedom of speech (backed by 40% of adults surveyed, with concern rising sharply amongst 25–34-year-olds and in the North East, where 55% wanted the role of the media examined); 
  • The impact on mental health. Polling by Recovery in November 2020 revealed that a massive 57% of adults were concerned about the mental health of someone close to them, 17% of whom were seriously concerned. Concerns have been repeatedly raised by the leading mental health charities over the past two years and the evidence suggests that the restrictions led to sharp rise in mental health problems, which must be considered in any assessment of the costs and benefits of lockdowns in particular. Recovery was strongly supported by mental health professionals and the testimony below is typical, given to us by a practitioner in the NHS on condition of anonymity, as she feared disciplinary action for speaking out. We include it here as though it dates back before the end of restrictions and the setting up of the Inquiry, the last sentence reveals a worrying lack of trust that these issues will be addressed properly:   

“I work in mental health in England. Last year was the worst by far of my entire career. This was not because of Covid itself but because of the obsessional focus on Covid related risks at the expense of all else. 

“I strongly believe the public health interventions we have had to implement have caused severe, avoidable, harm, and that we have enacted by diktat a serious moral failure of state, impacting the most vulnerable people. 

“There has been no strategy to mitigate these harms and no voice for those who seek balance. 

For people with severe mental health problems, the pandemic has exacted an unjustifiable toll in terms of missed contact with clinicians, the inability to undertake accurate assessment and meaningful intervention over video, impaired access to justice via the tribunal system operating remotely and, most egregiously of all, impaired access to primary care, when we know that this population has significantly reduced lifespan and higher physical morbidity. 

“The willingness of mental health and primary care clinicians to ‘down tools’ with full permission of management has led me to question the fundamental moral grounding of healthcare. 

“I have no faith that the harms suffered by people with severe mental illness will be given due witness in a public inquiry.”

One notable feature of our survey is the strength of public feeling that the Inquiry should pay specific attention to the personal stories of difficulties associated with lockdowns as well as those of Covid-19 victims. As I know from my ow personal experience, these are often difficult to relate and were rarely the subject of mainstream media attention. Recovery and others talked to a range of people, some of whom shared their stories, who were seriously affected by lockdown and other measures. In particular, we were aware of many anecdotal reports of suicide amongst specific groups where the impact of lockdowns was greatest. The sensitivities around suicide, issues with reporting, and the understandable disinclination of coroners to record suicide if an alternative term can be found mean that it is not easy to establish the true picture. However, disturbing numbers were reported by mental health practitioners working with those who lost income during the pandemic but were unable to access the furlough scheme. Similarly, we have anecdotal evidence from care home owners and relatives over some elderly people who were cut off from friends and loved ones. A close relative of my own died in this way during the first lockdown, refusing food and drink, but it’s not a story I can tell due publicly to the enormous pain it causes to family members. In this case, as reportedly in others, the cause of death was wrongly given as Covid-19, though she showed no symptoms and did not test positive. While evidence like this is anecdotal, it is important to a full picture of the pandemic. 

We welcome the fact that the Inquiry appears open to hearing this testimony but believe these contributions should be invited explicitly, since it is often hard for those affected to talk about their loss and few of these stories have attracted media attention. Our polling reveals that people around the UK want these stories to be heard, with feelings stronger in Wales (57%) and Scotland (50%) than England (45%), perhaps because the restrictions there were harsher and more prolonged.

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Jon Dobinson is a co-founder of Recovery and a former Secretary-General of the International Society for Human Rights (UK). Now CEO of Other Creative Ltd, the London-based creative business, his companies have raised millions for charities and causes including Freedom FromTorture, Amnesty International, Greenpeace and 38 Degrees.

UK COVID-19 INQUIRY
DRAFT 
TERMS OF REFERENCE – MARCH 2022

The inquiry will examine, consider and report on preparations and the response to the pandemic in England, Wales, Scotland and Northern Ireland, up to and including the inquiry’s formal setting-up date. In doing so, it will consider reserved and devolved matters across the United Kingdom, as necessary, but will seek to minimise duplication of investigation, evidence gathering and reporting with any other public inquiry established by the devolved administrations.

The aims of the inquiry are to:

1. Examine the COVID-19 response and the impact of the pandemic in England, Wales, Scotland and Northern Ireland, and produce a factual narrative account. Including:

  •  In relation to central, devolved and local public health decision-making and its consequences:
    • preparedness and resilience;
    • how decisions were made, communicated and implemented;
    • intergovernmental decision-making;
    • the availability and use of data and evidence;
    • legislative and regulatory control;
    • shielding and the protection of the clinically vulnerable;
    • the use of lockdowns and other ‘non-pharmaceutical’ interventions such as socialdistancing and the use of face coverings;
    • testing and contact tracing, and isolation;
    • restrictions on attendance at places of education;
    • the closure and reopening of the hospitality, retail, sport and leisure sectors, andcultural institutions;
    • housing and homelessness;
    • prisons and other places of detention;
    • the justice system;
    • immigration and asylum;
    • travel and borders; and
    • the safeguarding of public funds and management of financial risk.
  • The response of the health and care sector across the UK, including:
    • preparedness, initial capacity and the ability to increase capacity, and resilience;
    • the management of the pandemic in hospitals, including infection prevention andcontrol, triage, critical care capacity, the discharge of patients, the use of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions, the approach to palliative care, workforce testing, changes to inspections, and the impact on staff and staffing levels;
    • the management of the pandemic in care homes and other care settings, including infection prevention and control, the transfer of residents to or from homes, treatment and care of residents, restrictions on visiting, and changes to inspections;
    • the procurement and distribution of key equipment and supplies, including PPE and ventilators;
    • the development and delivery of therapeutics and vaccines;
    • the consequences of the pandemic on provision for non-COVID related conditionsand needs; and
    • provision for those experiencing long-COVID.
  • The economic response to the pandemic and its impact, including government interventions by way of:
    • support for businesses and jobs, including the Coronavirus Job Retention Scheme, the Self-Employment Income Support Scheme, loans schemes, business rates relief and grants;
    • additional funding for relevant public services; and
    • benefits and sick pay, and support for vulnerable people.

2. Identify the lessons to be learned from the above, thereby to inform the UK’s preparations for future pandemics.

  • In meeting these aims, the inquiry will:
    • listen to the experiences of bereaved families and others who have suffered hardship or lossas a result of the pandemic. Although the inquiry will not investigate individual cases of harm or death in detail, listening to these accounts will inform its understanding of the impact of the pandemic and the response, and of the lessons to be learned;
    • highlight where lessons identified from preparedness and the response to the pandemic may be applicable to other civil emergencies;
    • consider the experiences of and impact on health and care sector workers, and other key workers, during the pandemic;
    • consider any disparities evident in the impact of the pandemic and the state’s response, including those relating to protected characteristics under the Equality Act 2010 and equality categories under the Northern Ireland Act 1998, as applicable;
    • have reasonable regard to relevant international comparisons; and
    • produce its reports (including interim reports) and any recommendations in a timely manner.