Scotland “ironically” stalled on long-running plans to improve PPE distribution just as Covid reached the UK because staff had been diverted to deal with other aspects of the emerging pandemic, the country’s former chief medical officer (CMO) has admitted.

Giving evidence to the UK’s Covid inquiry, Dr Catherine Calderwood said not all recommendations produced by a pandemic planning exercise in 2018 had been carried out by the time Covid made landfall two years later.

When asked which of the 13 recommendations that came out of Exercise Iris, a 2018 trial by the Scottish government’s Health Protection Division, were not implemented, Calderwood said “the most important” related to sending information to Scottish health boards about PPE, including its distribution and the fitting of FFP-3 masks for health workers that were needed to safely treat patients.

The recommendations involved encouraging health boards to ensure staff had not only supplies of PPE, but that they had also done FFP-3 mask fitting, she said.

“Several recommendations [from Exercise Iris] were implemented, meaning there were several that were not,” Calderwood told the inquiry, chaired by Heather Hallett. “Perhaps ironically, some of those were, in fact, not continued with because staff were taken away from that implementation process in order to move into Covid-19 pandemic work.”

Last week, openDemocracy reported that Scottish NHS boards had been written to in July 2019 to remind them of their responsibilities to ensure staff were prepared for PPE, including ensuring workers were “fit-tested” for the FFP-3 masks. Calderwood’s evidence suggested this work had not been fully implemented by the time Covid struck.

Calderwood served as Scotland’s CMO from March 2015 to April 2020. She resigned from her post after making two trips to her second home, which breached lockdown rules at the time.

When asked how the health system and healthcare specialists could remain well prepared for another pandemic, Calderwood said it was “extremely difficult”: “Our NHS is working at or beyond full capacity at all times. We haven’t got the luxury of sending staff for mask-fitting exercises, for example.

“Drills happen frequently but it’s very difficult without increased capacity within the NHS… to run exercises because they are unable to leave work that is prescient, and the emergencies that are sitting facing them that day, when it’s for something that’s unknown and the timing is unknown.”

Early communication problems

Speaking in general terms, Calderwood said relations and communications among CMOs in Scotland, England, Wales and Northern Ireland, and with directors of public health across Scotland’s regional health boards, had been good during her tenure.

However, when asked about phone calls with the government’s Scientific Advisory Group for Emergencies (SAGE) in the early stages of the pandemic, she agreed that logistical and technical issues had made communication with the London-based group “more difficult”.

“There were a large number of people dialled into meetings, of course – our infrastructure for remote working was nothing like it is now,” she said. “I or my deputy would attend frequently… but very often the quality of the line was poor.

“It dropped out very frequently and there was often not nearly a fully fluent read-out from some of those very important meetings in the early days of the pandemic.”

The challenge of communicating with central government in the early stages of the pandemic was also raised by the second witness of the day, Jim McManus, a professor and president of the Association of Directors of Public Health (ADPH).

Directors of public health set objectives and oversee public health in local areas, or in a specific area of public health.

In the early stages of the pandemic, McManus said UK central government took a “top-down approach” to communications: “Sometimes we had no response or communication. We found out at the same time as the rest of the population on the 5pm bulletin about the new [Covid] guidance.”

It was often apparent that central government departments “had not read their own guidance about the role of [local public health directors and their departments] and were not clear about what we could and should do”.

There was a general lack of understanding of the role of public health directors and of local authorities’ capabilities, he said. This poor communication contributed to parallel systems being established, such as for contact tracing, rather than making use of existing local capabilities, he added.

“For the first few months of the pandemic, some parts of central government didn’t have a mailing list to reach out to directors of public health,” he said. “They frequently couldn’t contact us.”

Calderwood said the UK’s response to Covid had been “late and slow”, drawing particular attention to a lack of communication with countries that had dealt with SARS and MERS outbreaks.

“There wasn’t a co-ordinated or formal way in which to communicate with other countries where we could have learned more rapidly,” she said.

Data issues

How UK health and population data is gathered, accessed and shared was a theme throughout the evidence given in today’s session.

“We do not have information and data governance right from an emergency, in any part of the United Kingdom, in the way it needs to be to save lives,” said McManus.

Calderwood was asked whether Mark Woolhouse, a professor and epidemiologist who sits on the Scottish Government Covid-19 Advisory Group, and gave live evidence in the afternoon session, had raised issues of data access in Scotland with her prior to 2020.

The former CMO said she could not recall receiving an email in 2018 in which Woolhouse described the system for accessing health data in Scotland as “terminally dysfunctional”.

The email, referenced at the hearing by Allison Munroe KC, representative for Covid Bereaved Families for Justice, stated: “This is a hugely disappointing state of affairs, and one that urgently needs attention. I dread to think of the consequences if we were ever to find ourselves facing a health emergency such as a pandemic influenza.”

She said Woolhouse had emailed and visited her in February 2020 to discuss modelling of the coronavirus and the effects it might have on the community.

No data on race and ethnicity in the health workforce

Munroe also quoted from a written statement submitted to the inquiry by Ade Adeyemi from the UK’s Federation of Ethnic Minority Healthcare Organisations (FEHMO): “FEHMO believes that planning, forecasting and preparatory work for a high-consequence infectious disease such as Covid-19 did not properly consider the context of a multicultural UK having a global diverse health and care workforce.

“UK laboratory field modelling and case studies prior to Covid-19 did not include references to race and/or ethnicity.

“The absence of a national system of data capture regarding race and ethnicity may well be one of the biggest system failures in emergency planning from the Covid-19 pandemic.”

Giving in-person evidence, Kevin Fenton, a public health expert who has held multiple roles for public health bodies in the UK, said he agreed that this was a failing. Earlier in the session, he said that an equality impact assessment, appended to the government’s 2011 flu pandemic strategy, was not detailed enough in terms of how pandemics “express themselves in terms of inequalities”.

He agreed, when asked, that this analysis did not discuss “potential inequalities in mortality or morbidity” that could be caused by a pandemic.

The inquiry continues.