Do you think the inquiry will be looking at local authority public health functions, and how decisions were made there and the impact on the NHS?
One of our legal partners offered the view that the inquiry will look across how central government and local authorities responded to the pandemic, including looking at how local authorities and the NHS worked together. While the inquiry may not have capacity to look at all decisions made across the country, they would expect that it will examine some decisions in greater detail. For example, it may decide to look at an area which had a higher than expected number of deaths or hospital admissions, when compared with statistics from across the rest of the country.
We might expect the inquiry to look at the response and decision making of the relevant local authorities and NHS bodies, as well as any intervention by central government and what lessons can be learnt from the approaches by the relevant bodies. As a result, we would expect the inquiry to look at how some local authorities exercised their public health functions and the impact that had on the NHS because understanding how those bodies could work better, will help in dealing with any future public health issues and also the greater integration of health and social care.
Do you think it's likely the inquiry will take a "separate streams" approach?
It would seem a sensible option for the inquiry to explore in determining the methodology and process to examine the issues which are set out in the terms of reference, when they are published. Given the vast range of issues that it is possible the terms of reference could cover, then creating a systematic approach to how the inquiry will investigate those matters will mean consideration needs to be given to how they can be sorted. In other public inquiries we have seen, this is done through chapters looking at specific events on a chronological or organisational basis, or through streams looking at specific topics. Generally, we would expect the inquiry to separate out specific issues for it to look at in a systematic way.
Are we likely to be asked about specific incidents at our trust, or our experiences given certain characteristics, e.g., nosocomial outbreaks or large Black, Asian and minority ethnic communities? Would this mean we might be asked to be core participants?
It may be that the inquiry will look at some specific incidents and seek to understand how NHS organisations approached them. That could relate to any number of issues, including whether people became infected in hospital, specific risks for Black, Asian and minority ethnic communities, the impact of the Nightingale hospitals and how the health and social care workforce was supported, to name but a few. In doing that, the inquiry will seek information and evidence from a wide variety of sources including NHS organisations, but that does not mean you would automatically need to be a core participant. A core participant is normally an organisation or person which/who:
- played a direct role in the subject of the inquiry;
- has a significant interest in an important aspect of the inquiry;
- may be subject to explicit or significant criticism during the inquiry or in the report.
Generally, it would seem that not many NHS trusts or foundation trusts will be core participants in this inquiry, but that is subject to the above analysis. It is also possible that core participant status can be given for specific parts of the inquiry due to the matters being considered at that time. However, it seems likely that many NHS trusts and foundation trusts will be requested to provide evidence for the inquiry to consider without being designated core participants.
How far might the inquiry focus on the impact of those who have suffered disproportionately during the pandemic, such as Black, Asian and minority ethnic groups and those with learning disabilities?
The inquiry could decide that it's going to have a chapter looking at the impact across different populations, for example across ethnic, religious and age groups. It might look there in terms of what happened, how people were cared for, whether there were outliers across the country. It might look at whether certain parts of the country may not have had the resource or the capacity to deal with the issues they were facing because they may have had, for example, a larger population, or a larger ethnic population that was more susceptible to COVID-19. There may also be some focus on discharge to assess and how well it worked given that the law changed in order to enable this policy to be taken forward properly.
The inquiry may go through issues like this because those are the type of things which are about understanding how do you deal with a pandemic if it ever happens again – in the event of another pandemic, how do we protect those groups that are more susceptible?
Is the inquiry likely to draw in all trusts (acute, ambulance, community and mental health) equally, or might there be some variation according to sector?
It seems likely that there is going to be a broad reflection of the sector, rather than just looking at acute trusts, because there has been an impact on our colleagues and patients across ambulance, mental health and community services. Because of this breadth, there may be a role here for the regional hubs in helping to manage input.