Our response: UK COVID-19 Inquiry draft terms of reference

On 11 March 2022, the COVID-19 Inquiry team chaired by Baroness Hallett published its draft terms of reference for consultation, which sets out the aims and scope of the independent public inquiry into the COVID-19 pandemic in the United Kingdom.

We responded to the consultation, emphasising just how important it is for the Inquiry to focus on listening carefully to the voices and experiences of the public who were directly and indirectly affected by the Government’s preparation and response to the COVID-19 pandemic.

We will be looking forward to the opportunity to provide written and/or oral evidence to further support the work of the Inquiry and its secretariat as the process commences.

Our response

Do the Inquiry’s draft Terms of Reference cover all the areas that you think should be covered by the Inquiry? Please explain why you think the draft Terms of Reference do not cover all the areas that the Inquiry should address.

Healthwatch England are of the view that the draft Terms of Reference do a reasonably good job of covering most of the issues that people/the public want the Inquiry to cover. In order for people to have trust and confidence in the Inquiry and its processes, it is imperative that they do not feel that the Terms of Reference have been influenced and/or manipulated by/for anyone who might be under investigation. It is also important for the purposes of public confidence that the Inquiry is not seen to be excluding any aspects of an investigation which would provide resolution or clarity for the public and we welcome the consultation on the Terms of Reference itself.

Whilst it is imperative that families of the bereaved must be listened to very carefully and with empathy, it is also important that sufficient focus should be placed on those people (and their loved ones) who have been affected by the pandemic but have survived. Their views and experiences are of equal value.

Although much of the focus will understandably be placed on the known harm that is endured, there is also a consideration which needs to made regarding unknown harm and the issues people are facing that are yet to surface. Healthwatch England acknowledges the fact that it is significantly more challenging to investigate the ‘unknown’ but the scope of the Inquiry should also be seen to include developments/findings arising at a later stage. This will help to ensure that once the Inquiry concludes, that nobody is left feeling like answers/explanations for the issue(s) they experienced weren’t provided purely because it wasn’t technically included within the original scope of the Inquiry.

Which issues or topics do you think the Inquiry should look at first?

If the main purpose of the Inquiry is to provide the public with answers and to “produce a factual narrative account”, chronological order would seem to be the most practical way of going about looking into these issues. This would provide the public with an easy, logical way of understanding how the issues at hand are being investigated.

From a Healthwatch perspective, in the early stages of the pandemic we reacted to what people were telling us were issues for them and produced reports/insights for the NHS/Government accordingly in roughly this order:

• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR)
• Communications - Shielding, Government advice for staying home/lockdown and guidance for both the public and the system
• Hospital discharge
• Visitation (care homes and maternity wards)
• Wider changes to services - GP access, remote and digital care and other services
• Vaccination roll out
• Elective backlog
• Emergency dentistry
• Long Covid

Do you think the Inquiry should set a planned end-date for its public hearings, so as to help ensure timely findings and recommendations?

Given that a significant part of the Inquiry’s purpose is to “identify lessons to be learned” from the pandemic and “inform the UK’s preparations for future pandemics”, there is a strong case for timeliness to ensure that lessons are learned (and subsequently implemented) as quickly as possible as we can’t possibly know how soon we could be dealing with another pandemic.

However, this importance of timely findings and recommendations should not come at the expense of people’s experiences being heard and the public feeling like they’ve been adequately listened to. This could lead to a loss of public confidence in the Inquiry and its processes, thus undermining any recommendations that are made.

A healthy balance between these two options could be to set out an expected, sensible and realistic timeframe (e.g. by end of 2023) but with a clear caveat that this could be extended should there be an overwhelming influx of people’s views which require further time and consideration.

Not only would this give the public an approximate timeframe to know when they can expect findings and recommendations by, but it also provides the secretariat with a realistic deadline to work towards whilst allowing flexibility to extend the duration of the Inquiry if need be, and simultaneously reinforcing the Inquiry’s commitment to hearing and listening to people’s views.

How should the Inquiry be designed and run to ensure that bereaved people or those who have suffered serious harm or hardship as a result of the pandemic have their voices heard?

The Inquiry could make use of existing structures that are already in place and specifically created for the purposes of listening to people from all communities all over the country. It is important that the Inquiry works with organisations that already have reach into communities, particularly with those who are seldom heard. The Healthwatch network could be a part of this process.

Healthwatch have a proven track record in amplifying local, individual public voices up to a national level and have experience in supporting statutory bodies in large scale national engagement:

• In September 2020 the House of Lords Public Services Committee held an oral evidence session as part of their Inquiry on ‘Public Services: Lessons from Coronavirus’. We assisted this parliamentary select committee by putting real people who had contacted Healthwatch about their real-life experiences (of using services impacted by the pandemic) on the witness panel for their oral evidence session. Here they were able to share their experiences publicly and directly inform the recommendations of this particular Inquiry. 
• When the NHS Long Term Plan was published in January 2019, Healthwatch were asked by NHS England to engage people across the country about how people wanted the priorities to be implemented locally. Between March and June 2019, the Healthwatch network carried out over 500 focus groups, attended over 1,000 events and engaged tens of thousands of people online to find out what people want from the next ten years of the NHS. We were able to feed in over 80,000 (plus an additional 40,000) people’s views to help shape the NHS Long Term Plan.

People trust Healthwatch and feel comfortable in sharing views with us and we have the expertise and knowledge of how to effectively engage with people. Healthwatch could assist the secretariat in conducting the large scale engagement that will be required across the country and/or advise on how best to reach out to people from all walks of life in different communities including those who are seldom heard.