NI less prepared for pandemic in 2020 than it was a decade earlier, UK covid inquiry told

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A three-year political impasse and ongoing budget uncertainty left the health system in Northern Ireland less well equipped to deal with a pandemic than it had been a decade earlier, the region’s chief medical officer (CMO) has said.

Professor Sir Michael McBride told the Covid-19 Inquiry that services were existing on a “hand-to-mouth” basis in the years leading up to the outbreak of the coronavirus pandemic at the outset of 2020.

Giving evidence in Belfast to the inquiry module assessing Northern Ireland’s handling of the Covid emergency, Dr McBride was asked to assess the impact of the three-year powersharing vacuum at Stormont, which only ended weeks before the onset of the pandemic when elected ministers returned after a political deal restored the devolved institutions.

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“I think that it is absolutely preferable to have a government in Northern Ireland, to have ministers in place,” he told inquiry chair Baroness Hallett.

Professor Sir Michael McBride arrives at the Clayton Hotel in Belfast City Centre to take questions at the UK Covid-19 Inquiry which is sitting in the city for three weeksProfessor Sir Michael McBride arrives at the Clayton Hotel in Belfast City Centre to take questions at the UK Covid-19 Inquiry which is sitting in the city for three weeks
Professor Sir Michael McBride arrives at the Clayton Hotel in Belfast City Centre to take questions at the UK Covid-19 Inquiry which is sitting in the city for three weeks

“I think we were fortunate during the pandemic that we did have ministers in place and a government in place.”

He added: “I think that that period between 2017 for three years until three weeks before the pandemic started was a difficult period certainly from a departmental perspective, and from my role as chief medical officer – we were not able to advance significant policy decisions or take forward legislation underpinning those policy decisions. That was problematic.”

Dr McBride said by 2020 the health system was “long overdue” for structural change and reform. But he said implementation of such measures stalled between 2017 and 2020 as there were no ministers in place to sanction them.

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“Major restructuring requires ministers to agree to those major changes, and we didn’t have ministers to agree to those major changes,” he said.

“We could not make decisions about the end point and final decisions around what that new structure would look like and how those services would be redesigned.”

He said that was only one half of the problem facing the health system. The CMO said the other issue was the financial uncertainty created by operating on a “hand-to-mouth existence” on one-year budget cycles, rather than having longer-term spending plans.

“We had that, if I may say, a double hit of not being able to implement the change and actually not having budgetary certainly either,” he added.

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“Which meant that many decisions were short-term decisions, as opposed to longer-term strategic decisions, which only ministers can make.”

Dr McBride said the result of these issues meant the system was less well prepared to deal with the pandemic than it had been in 2009, when there was the outbreak of the H1N1 virus.

“We headed into this pandemic with a less resilient health and social care system, budgetary uncertainty, significant workforce challenges and vacancies, (and) a system that was long overdue for change,” he said.

“My assessment would be that we were not in as good a place as we were in 2009.”

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McBride denies overreaching into department headed by Stormont leaders

Meanwhile, Dr McBride today denied overreaching on his responsibilities by asking to “clear” briefing papers sent to Stormont leaders during the coronavirus pandemic.

Giving evidence to the UK Covid-19 Inquiry in Belfast, Dr McBride was asked to comment on an email he sent to an official in The Executive Office in early 2020 about a paper that was being prepared for the then First Minister Arlene Foster and deputy First Minister Michelle O’Neill providing an update on the developing health emergency.

The paper’s purpose was to inform the ministers about the discussions at the latest UK-wide Cobra meeting on the situation.

Dr McBride, who works within the Department of Health (DoH), not The Executive Office (TEO), wrote in the email to the TEO official that “given the professional and technical nature of these papers, as CMO I will wish to clear all future Executive papers while DOH remains the lead government department”.

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Lead counsel for the inquiry Clair Dobbin KC questioned the CMO over the intervention.

“That might be thought or might appear to the outside eye to be a clear example of overreach into the Executive Office on your part,” she said.

Dr McBride insisted he was only asking to give clearance on the “professional and technical” advice within the paper.

However, he conceded his email was “not well worded” and could lead to the interpretation drawn by Ms Dobbin.

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“I don’t think it’s a question of interpretation,” replied the inquiry’s counsel.

“I mean, I think it’s a question of you as CMO inserting yourself into the processes of The Executive Office, so that the officials couldn’t provide an update without, as you saying, wishing to clear, and it’s not just this, (it’s) clearing all future Executive papers whilst the Department of Health remains the lead government department.”

Dr McBride again insisted he had only been referring to the professional and technical advice.

“I think it was entirely appropriate that I was assured of the completeness of professional and technical advice to the First Minister and deputy First Minister,” he said.

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The CMO made clear he had “no role” in clearing the entirety of Executive papers.

“I think it would have been a dereliction of my responsibilities as chief medical officer were I not to assure myself of the accuracy of the information that was being provided on the professional and technical aspects of that,” Dr McBride added.

“I have no role in clearing Executive papers, none, and never have had, and did not have throughout the pandemic and that would have been understood, I understood that and officials in TEO would have understood that.”

Ms Dobbin also questioned Dr McBride on an email he wrote to all Stormont departments at the start of February about Covid-19.

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In the letter, he said the Department of Health was “closely monitoring” the situation. He asked public bodies to make sure staff were across their contingency plans for dealing with infectious diseases but said no further action was required at that point.

The inquiry’s counsel suggested the letter lacked urgency.

“It might be thought that that’s hardly sounding alarm bells for either Northern Ireland government departments or to all of the public authorities that they sponsored,” she said.

Dr McBride said the email was only a “scene setter” ahead of a planned meeting with departments to outline the potential risks.

“This letter was not meant or intended to explain or set out the level of risk or the level of concern, it was an enabler to facilitate a meeting which had been suggested… (at) which there would be an update provided.”

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