Examination of Witnesses (Questions 360-381)
Q360 Chair: Good
morning. Lord Adonis and Mr Burnham, you were both senior Ministers
in the previous Government, at the heart of Government, and both
had the unfortunate responsibility of dealing with two different
but difficult circumstances. We want to press you about that in
the context of our inquiry. As you know, we are also looking horizontally
across the way that science advice is used in emergencies and
looking forward at events that might happen in the future as well.
In your experience, were you content with the Government's process
of risk assessment and contingency planning? Perhaps you could
separately answer that. Who is going to start?
Lord Adonis: Would
you like me to start in respect of the ash cloud? The response
of the regulator in the scientific community, once the ash cloud
crisis had started on 14 April, was, I thought, exemplary. All
of the agencies involved—the Civil Aviation Authority, NATS,
the Met Office, the Department's own advisers and the European
regulatory authorities—were immediately galvanised into
action on addressing this fundamental question, which is, what
is a safe regime for flying through concentrations of ash, given
that the previous regulatory rule was that any concentrations
of ash were not safe for planes to fly through? Or, rather, the
rule was, in those words which are engraved on my mind, "Avoid,
avoid, avoid". Regulatory authorities in European Member
States should not allow planes to take off if there are any notable
concentrations of ash.
The issue, which is one that the regulatory authorities
have been reflecting on and need to reflect on more, is why this
rule was in place in the first place. Of course, it clearly isn't
the case that it's not safe to fly through concentrations of ash,
as you have just heard Professor Beddington say. It is possible,
and indeed it proved possible within the course of six days, to
put in place a regulatory regime which made it possible to fly
through concentrations of ash. The problem was that the International
Civil Aviation Organisation, which had set the standards to which
individual European regulators were operating, had a rule which
essentially prohibited flying through concentrations of ash and
did not go to the next stage of looking at a safe regime for flying
through ash were ash present in the atmosphere.
My own view, as I look back on it, is that ICAO—the
International Civil Aviation Organisation—should have done
this work beforehand because, although volcanic eruptions in northern
Europe are rare, they are not unprecedented. The Icelandic volcano
which erupted in April causing this huge disruption has erupted
before. From memory, it was previously in the 1820s, and it is
next door to another volcano that has erupted more frequently.
The question which needed to be asked, and involves a searching
process of self-examination on the part of the International Civil
Aviation Organisation and the European regulators, is why, before
April 2010, they had not conducted the scientific work that was
necessary to put in place a safe regime for flying through concentrations
of ash. They are doing that and a new regulatory structure has
been put in place, but, if there are any other safety issues of
a similar kind which could come from their field, it would be
very helpful if they had done the work on this before rather than
what actually happened, which is that the work on it had to be
done after the volcanic eruption had taken place.
Andy Burnham: Chair,
I had the misfortune of arriving at the Department of Health three
days after the World Health Organisation declared H1N1 swine flu
to be a global pandemic. If nothing else, it confirmed that the
political timing of the right hon. Member for Kingston upon Hull
West & Hessle is immaculate, as in all things. So it was a
very difficult situation to arrive in.
There was, I think, a difference between the situation
that Lord Adonis has just described, in that the world health
community had anticipated this situation for some time and, indeed,
plans had been based on a more severe virus—H5N1 or bird
flu—so we were in some senses well prepared because of that.
Indeed, I remember as a junior Health Minister going to many meetings
on pandemic preparedness and, perhaps, at times thinking, "Why
am I sitting here doing this? Isn't there something more important
I could be doing?" However, in terms of your question on
contingency planning, we were extremely well served as Ministers
by the depth, the quality and the range of planning that had been
conducted over many years across the Government in this country.
That placed us in an extremely strong position when it came to
the crunch.
I remember the immediate question that was on everyone's
mind was the vaccine. I know you might want to get on to talk
about the contracts that we had for vaccine, but I was immediately
clear that we were at the head of the queue for vaccine. I can
only say to you that, sitting where I was at that time, to be
in that position was a position of immense reassurance because
it was a new virus, there was emerging evidence about it from
around the world but we didn't know. It turned out to be a mild
virus but severe in some cases, and that was in many ways the
challenge of swine flu because it wasn't mild in everybody. We
mustn't forget that 450 or more people died from swine flu. So
that was the challenge. In terms of contingency planning, I would
say it was excellent, although clearly there are lessons that
we can learn.
Your second question was on risk assessment.
The issues I would flag up there, as they relate to SAGE and the
scientific advice we were getting, is how best to assess the reasonable
worst case scenario in an emerging situation as epidemiological
evidence about the virus is emerging from around the world. How
possible is it to gather that information and then produce reasonable
worst case scenarios in an evolving situation, recognising that
the figures are, possibly, going to change as more is known about
the virus?
The second point would be how to communicate those
figures when it is a moving situation and when, perhaps, the media
doesn't understand or doesn't give people space to explain why
figures have changed. I noticed Professor Sir Liam Donaldson spoke
about that issue to you, and I think that is a very real learning
point that we must all face up to as part of it: how to assess
those reasonable worst cases in a proportionate way as evidence
emerges in an evolving situation, and then how to communicate
it. For me they are crucial things and I wouldn't say that we
have got the right answers although I can give you the best of
my experience.
Q361 Chair: In
the two cases—the "reasonable worst case scenario"
is a phrase which keeps coming back in our evidence sessions—Mr
Burnham, you were assessing that against pressures from the Treasury,
the costs that were being incurred in preparing for what could
have been a much more serious pandemic, and in Lord Adonis's case,
there were huge pressures coming from the commercial world outside
that were asking for a different measure to be used. So "reasonable
worst case scenario" is an important tool, but do you perceive
any alternative way of dealing with these things?
Andy Burnham: I
don't actually, no. The Department of Health had a phrase that
they used when I arrived, and I find it reassuring on one level
but not on another. They used to say, "Hope for the best,
plan for the worst." I was never quite happy with the first
part of that phrase. The fact that we did take the precautionary
principle has got to be the right thing to do. I'll give you an
example. There was a big debate in the summer of 2009 about the
use of antivirals and should they be given to all symptomatic
patients or just given to those, perhaps, most at risk or those
with the most severe symptoms. I think it was the one occasion
where there was a difference of view within SAGE.
If I take your question, you are perhaps leading
me to say to what extent cost was then driving those decisions.
It was not, actually. At the time, as always, you have an eye
on the cost, but I was receiving advice and the Chief Medical
Officer was saying to me that he felt, on the basis of the opinion
within SAGE and his opinion, it was right to adopt a treat-all
strategy, given that we were dealing with a new virus. As I have
just said, it was a new virus that was proving to be severe in
a small number of cases, attacking the respiratory system of young
children with disabilities, for instance.
In those circumstances, when we were just finding
out, of course I felt I had no choice but to say that we go with
the treat-all strategy. I wouldn't say the cost was not a consideration
but, at that point, public safety absolutely takes precedence
over cost.
Q362 Graham Stringer:
Did he make it clear to you, as he made it clear to this Committee,
that there was no evidence base for the use of antivirals in an
epidemic?
Andy Burnham: What
was made clear, Graham, was that there was a difference of view
about the—
Q363 Graham Stringer:
You have said that before, but he came to this Committee and said,
"There is no evidence base for the use of antivirals during
an epidemic", in those words. Did he make that clear to you?
Andy Burnham: Yes,
that was made clear, absolutely, because—obviously—it
was an unprecedented situation. There was talk of side effects.
The Chief Medical Officer said to me that even among GPs there's
a difference of view. It seemed to me that the right thing to
do in that situation was to take the precautionary approach because,
in many ways, the lack of an evidence base further reinforced
the need to go down the precautionary route.
Lord Adonis: I
think there is a fundamental difference in these two cases. In
the case that Mr Burnham has just been talking about, the reasonable
worst case scenario was, thank goodness, not remotely realised.
In the case of the ash cloud, a situation far worse than any worst
case scenario that had ever been prepared for literally arrived
overnight with the ash cloud and the whole of northern European
airspace being closed for successive days leaving millions of
passengers stranded.
On the part of the regulatory authorities, work had
not taken place on the estimation of what a worst case scenario
might be in the case of a volcanic eruption, which is the reason
why we had to put in place a new regulatory regime, literally,
over the course of a long weekend. It would have been a good thing
if it had taken place on the part of the regulatory authorities
but it hadn't. My answer to your question is that I think it is
a very good idea to make assessments of reasonable worst case
scenarios.
In the case of the ash cloud, I think that would
have required international regulators—because, of course,
aviation is, by its nature, an international business—to
have put in place a safe flying regime in respect of concentrations
of ash. It is very telling that in the guidance from the International
Civil Aviation Organisation, which is the guidance which led to
the closure of European airspace, the opening sentence of that
guidance in respect of ash concentration is as follows: "Unfortunately,
at present there are no agreed values of ash concentration which
constitute a hazard to jet aircraft engines." Those are the
opening words. It would have been a jolly good thing if there
had been some agreed values and if the regulatory authorities
had sought to establish them. So I am fully behind the process
of setting worst case scenarios. In the case of the ash cloud
crisis, it means that regulators have to look at areas which may
be very remote contingencies, like swine flu epidemics, but ones
that could well occur and in respect of which they have to have
regulatory regimes in place.
Andy Burnham: Could
I just make an additional point, Chairman? I agree with Lord Adonis.
It is right to make these judgments, particularly in a fast moving
and an evolving situation. You have to because the public services
need to understand what might be coming. The purpose here is partly
about public confidence but it is about preparedness on a much
wider field than just in the health service because, obviously,
we were looking at local government and schools. There was a very
big potential impact.
The question for me that arises is how to do this,
in a freedom of information world, in a way that doesn't alarm
the public and lead to headlines which, quite frankly, mean that
you might lose some kind of control over the situation.
Q364 Chair: But
that happened?
Andy Burnham: No,
I wouldn't say it happened. But I would say that, in the summer
of 2009, as cases of swine flu were climbing on a spike that was
just unbelievable to watch— and the west midlands was the
first place to feel the pressure—it was quite a frightening
moment. When you are putting new figures into that situation as
people are experiencing a very real change on the ground, the
question for me is to what extent a scientific committee can
think about public presentation. But that is crucial because that
does affect the ability of services to deal with the situation
before them because the more there is a sense of concern, the
more that public services will be overwhelmed in a disproportionate
way.
The one moment I would just pick out for you is when
I made a statement to the Commons. I am trying to remember the
exact date, but it would have been July 2009. It was at the point
when things were getting quite worrying. We had a long debate
in the Department of Health about whether or not I would give
a figure for a reasonable worst case scenario in terms of number
of new cases per day. I had a SAGE range that was just massive.
It went from a very small number to an incredibly large number.
After prolonged debate I used the phrase, "We could be looking
at around 100,000 cases per day."
At the time that changed people's view of the situation,
but it was very much in the middle of the range that SAGE had
given me, from memory. It wasn't at the far end of the reasonable
worst case scenario. Towards the end of July, we got up towards
100,000 or more cases per week, so we got well up into the big
numbers but we didn't get close to that figure.
Given that I had been given those figures in
a Cabinet Committee, I wanted, and I think Alan Johnson did too,
to put figures into the public domain. I think the Committee should
ponder this question so that you can give further help to Ministers
in the future. You are making judgments on the spot because you
don't want a newspaper to say, "They are withholding figures
that say there could be this x thousand number of cases",
because then it would be sensationalised and it would be a secret
paper given to a Committee. Equally, you don't want to alarm the
public.
In the end, Liam Donaldson and I agreed that the
publication of that figure probably actually helped to snap public
services more on to the front foot in terms of getting ready,
and it probably helped get everybody into the right place to deal
with what was before them. This is an absolutely crucial question,
I think.
Q365 Chair: I
agree with you. It is a crucial question. So you were aware that
there are limitations on the use of "reasonable worst case
scenario" in the context of the way it might be interpreted
outside?
Andy Burnham: In
a freedom of information age you have to think about that, don't
you?
Q366 Chair: Yes.
Did you take any advice either through SAGE or other sources,
from behavioural scientists, about how best to handle that?
Andy Burnham: We
debated it pretty endlessly in the CCC committee. The four UK
Health Ministers debated it in a telephone conference. In the
end, Chairman, it became a matter of political judgment, I have
to say. I made a decision about the figure I put into the public
domain. There were no guidelines for me to say what I should and
shouldn't say. I come back to the point that SAGE can have a discussion,
but when they are actually putting it down in black and white
on a paper that is going to a Cabinet Committee in an FOI age,
you've got to think about what you do with that information. I
took the view in this situation that we had to be as open and
transparent with the public as we possibly could be so that we
didn't lead to any sense that there was information being withheld.
Looking back, I would say that it was quite a precarious judgment
to make.
Q367 Chair: Lord
Adonis, clearly, you have said to us that international agencies
were ill prepared, and that opening sentence you read out illustrates
it extremely well. But we, as a nation state, are part of the
international community. We can't cop out. Why were we so unprepared?
Lord Adonis: That
is a question which needs to be asked of the Civil Aviation Authority
because they are the regulatory agency. I never did get to the
bottom of the answer. I haven't seen your list of witnesses and
I don't know whether you have called the chief executive or the
chair of the Civil Aviation Authority, but the key question is:
Why the threat of volcanic ash over north European airspace? The
point that the chief scientific adviser made previous to this
hearing is a very important one. It is because of the concentration
of flight paths in northern Europe that the ash concentration
is such a big issue because you can't go around ash clouds, as
in the United States or in Asia. It is why the potential risk
to flights of ash concentrations hadn't been taken into account
as a risk factor to safe flying in Europe.
The answer, which was always given at the time,
and one that I think is worth probing, is that volcanic eruptions
don't take place. "This is an act of God." Of course,
on one level it was an act of God, and there haven't been any
recent volcanic eruptions. The issue for those whose job it is
to reflect on these events and plan for the future is to explore
whether in fact there should have been a higher level of readiness
given that volcanic eruptions are not unprecedented in Northern
Europe. As I said earlier, they have taken place. The particular
volcano that erupted and which caused the ash crisis has a pattern
of eruptions over the last 600 years.
Q368 Chair: We've
heard from Sir John about the science advice, but you never had
any advice from your civil service that said, "Minister,
it's your job to predict this"?
Lord Adonis: It
manifestly wasn't my job to predict it. It was the job of the
regulatory agencies to have in place a safe flying regulatory
regime in respect of this hazard, concentrations of ash, in the
way they do for many other hazards. For example, a big issue that
they are constantly dealing with is bird strike. There are rules
in place for how one deals with a bird strike, what are acceptable
levels, and a whole lot of others. For fog and almost every conceivable
weather eventuality there is guidance and rules in place. There
wasn't in respect of concentrations of ash.
As I say, the reason that was given at the time is,
"Volcanoes don't erupt in Northern Europe", which, as
a general rule, is true, but in fact there is a pattern of volcanic
eruptions from these volcanoes in Iceland. If one could rewind
the clock, that should have led the regulatory authorities, in
my view, to have worked with ICAO to prepare in advance for what
were agreed values of ash concentration constituting a hazard
to jet aircraft engines so that we weren't faced with the wholesale
closure of airspace. It wasn't a particularly productive use of
my time to start asking those questions in these six days, though,
because that was a historical question. We were dealing with a
crisis in real time. The issue which I had to confront as Transport
Secretary was working with the regulatory authorities, with the
aircraft manufacturers—and with my European colleagues,
because this was a Europe-wide issue—to put in place a regulatory
regime that would establish, in the judgment of the scientific
advisers to those regulatory authorities, safe concentrations
of ash which would permit flying to resume.
Q369 Stephen Mosley:
Mr Burnham, you have answered pretty much everything I was going
to ask because I was going to ask about risk and communication
with the public. I have one question, though. I know that Dr Peter
Holden from the BMA has expressed a concern that there was, maybe,
too much information out there and that sometimes it could get
confusing for people if there were multiple sources of information.
I know that in the US the Government set up a flu.gov website
that was a single source of information for both the public and
for medical professionals. Do you think something like that in
the UK would be a sensible way forward as a way of getting a single
source of information?
Andy Burnham: We
could certainly look at that as a model. We tried something similar
in that we instituted, as the situation developed, a weekly press
briefing with the chief medical officer. We built an expectation
that that was the place where the most dependable figures would
be given and the context for those figures would be provided.
I think that is important, too. It is not just about figures.
It is also about the wider context in which those figures are
given.
One of the things, in terms of this question
of communication, is that I went to the first couple of those
with Liam Donaldson but, in the end, I decided to remove myself
from them because the presence of a Minister or politician just
upped the ante. I could see it. It immediately became a thing
of, "Oh, well, let's get them on the back foot on something
or other", whereas when Liam did them it tended to attract
the scientific correspondents rather than the political correspondents
and it led to a much more balanced coverage. It was a deliberate
decision. In the first two weeks in my job I went to them. I felt
I had to be taking a grip, blah-blah, and all of that. But, actually,
I realised that the more sensible thing was for Liam to do it
in a non-political, not super-charged environment where the figures
could be given in context. Whether we could build on that approach
and have a single portal approach is a very good question.
Communication is very important in a transport situation,
of course, in terms of whether people add to the problem by doing
something that you don't want them to do, but in a health situation
it is utterly crucial because alarmist reporting can lead to more
people going to GPs, more people ringing NHS Direct and more people
ringing the national pandemic flu service. Keeping that balanced
tone in reporting was fundamental to the ability of the NHS to
cope with what was before it, and understanding that balance is
a very complicated business.
Q370 Stephen Mosley:
Moving on to the ash cloud, one of the things that we saw in Committee
was that there was a big gulf between British Airways and the
CAA in terms of what they thought the appropriate response would
be. What levels of communication were there between those organisations
and Ministers at the time?
Lord Adonis: There
was constant communication. Once the airspace was closed, there
was constant communication between the airlines, the Civil Aviation
Authority, NATS and the Department for Transport. Indeed, it was
a very productive relationship, although, of course, British Airways
and the other airlines were making very clear in public their
view that it was safe to fly. Let's be more precise. What they
said was that they believed it was possible to identify safe flying
paths through the ash cloud by identifying areas of lower ash
concentration and paths which didn't involve long flight paths
through those areas of low concentration. They believed it was
possible to do that and they were making that view very loud and
clear in public.
They were also working very hard behind the scenes
on establishing what was a safe flying regime. For example, very
rapidly after the closure of airspace British Airways got test
flights in the air, as did KLM. Indeed, KLM got their test flights
up before British Airways. Other European airlines did the same.
There was Met Office monitoring equipment on Met Office planes
and on the commercial planes as well. All of the data that came
from those test flights by the airlines and the test plane sent
up by the Met Office fed into the scientific evaluation that then
led to the revised advice which was adopted by all of the European
safety regulators in a co-ordinated manner, which differentiated
between different levels of ash concentration, that significantly
narrowed the no-fly zone and made it possible to re-open the good
parts of northern Europe airspace.
So, although, as you rightly say, British Airways
was very vocal, as were the other European airlines, about the
need to revise the safety regime so that flights could resume
over a good part of northern Europe, they worked closely and productively
with the safety regulators to make available the data and information
that were crucial to revising the safety regime.
Andy Burnham: Could
I just make a supplementary point? It does refer back to the single
portal question that Mr Mosley asked. The closest we had to that
was the Health Protection Agency, which, in the early stages of
the pandemic, provided a surveillance function across the country
in terms of how the virus was spreading and also drew in information
from its counterpart bodies around the world. That was very helpful
in those early stages and helped us to begin to map how quickly
this virus was developing.
It is important, if the Committee is taking evidence
from the Government, that you ask which body would do this function
in the future, given that, I believe, the Health Protection Agency
is no more. It was something that I relied on heavily in the early
days. I went to visit the Health Protection Agency in the West
Midlands who were co-ordinating a cross-agency response to an
incredibly difficult situation that grew out of nowhere. They
were, obviously, responsible for the containment phase of the
response. It is really important that questions are asked as to
how the Government would plan to operate that early containment
surveillance function in a further pandemic, given that the Health
Protection Agency has ceased to be. As shadow Health Secretary,
I was beginning to ask that question. I don't believe it has been
adequately answered yet, but for me it is a crucial question on
which the Government needs to provide clarity. I think a pandemic
is as likely today or tomorrow as it was then. We have had swine
flu and people think, "Oh well, that's the pandemic for the
next 20 years." Obviously, it is as likely there'll be a
new one and at any time.
Chair: We have taken a
little longer than we intended, but there are a few more short,
sharp questions we want to ask you.
Q371 Pamela Nash:
Lord Adonis, you have already touched on the Civil Aviation Authority's
lack of previous information on what could happen in a volcanic
ash emergency. You have also spoken about British Airways and
how quick they were to put up test flights. Do you think that
airline operators should have more of a role in deciding when
it is safe to fly if they have more up-to-date information?
Lord Adonis: They
play a key role. The regulatory regime, which is an interactive
process between the airlines and the safety authorities, is constantly
undertaking risk assessments in respect of the whole range of
potential risks to flights, so they do play that role—and
they did play that role in this case. The key issue here was that
the contingency planning hadn't taken place because none of the
safety authorities or, indeed, the airlines themselves regarded
it as a contingency that there would be a volcanic eruption that
would lead to an ash cloud that would therefore mean, adopting
ICAO's guidelines, that European airspace had to be closed. The
problem in this case was not that the structures were not in place.
As soon as the ash cloud struck, the airlines, the aircraft manufacturers—who
also played a key role—the safety authorities and the scientific
advisers to my Department all worked 24 hours a day to put in
place a regime that would enable flights to resume. The issue
in this case is simply that this hadn't been regarded as a contingency
before the Icelandic volcano erupted.
Q372 Pamela Nash:
I would like to ask you a couple of questions on Government co-ordination.
There have been criticisms of the Department for Transport that
they did not take a lead as soon as they should have on the volcanic
ash issue. How would you respond?
Lord Adonis: I
don't think that is a fair criticism at all. From the moment that
the Department was advised that airspace was likely to have to
close because of this eruption, all of the relevant agencies and
authorities and all of my then advisers in the Department swung
into action. I don't believe that more could have been done more
quickly. Indeed, you can see that by looking at what happened
in other European countries too. We all worked in parallel on
this crisis and almost all north European countries re-opened
their airspace on the same day. There was a bit of a debate about
whether we should have opened on the morning or the afternoon
of the day when the new regulations were put in place. Because
of the need for the Civil Aviation Authority's board to meet—because
it was that board which had to put in place the new regime under
which NATS had to operate—it took a few hours for that process
to take place, but that was a proper decision-making process.
Indeed, quite a number of countries didn't open their airspace
until after the United Kingdom did. So I don't think the criticism
of the authorities is fair from the point when the crisis struck.
As I say, the issue that the ash cloud raises
is whether adequate risk assessments had been done by the international
safety agencies before the ash crisis.
Q373 Pamela Nash:
Just quickly, Mr Burnham, you spoke a little bit about trying
to get an approach across the UK in response to swine flu. Does
the fact that health is a devolved issue prove an obstacle both
in planning for this and for the response?
Andy Burnham: No,
I certainly wouldn't say it was an obstacle. It presented a challenge
in terms of the different natures of the health systems across
the UK. It was clear to me that much depended upon the personal
relationship that we began to develop between the four of us,
and we did. Edwina Hart, Nicola Sturgeon, Michael McGimpsey and
I—the four of us—began to develop quite a good relationship.
I think that was crucial because we were dealing with some very
difficult stuff in a very urgent situation. That carried us through.
If I could make a suggestion to the Committee,
it would be this. We had the CCC, which had old Uncle Tom Cobleigh
and everybody in the debate, which has its function, but the crucial
engine of this thing was the four UK Health Ministers. We were
doing our thing by telephone call whereas CCC had all of the paraphernalia
of Government behind it. In fact, it would have made more sense
for us all to meet face to face somehow every week, the four Health
Ministers, because we were the ones doing the day-to-day operational
stuff. That relationship was crucial to the proper handling of
the crisis. We managed it, we found a way, we got through it and
we made it work.
If I could, I would just like to make a couple
of very quick comments. I want to pay tribute to the Department
of Health—in fact, the Cabinet Office, the Secretariat and
everybody. We were tremendously well served, not just during the
crisis but by the planning that had been done before it. I attended
a meeting of 12 Health Ministers in Washington in October or November
2009, where all of the other Health Ministers were saying that
they had absolute pandemonium back home in terms of the clamour
for vaccine. On the TV screens in America at the time there were
queues round blocks of people fighting for the swine flu vaccine.
It was just chaos. However, because of the orderly way in which
we handled it, with SAGE giving advice about priority groups and
a queuing system, it really worked well. We had a grip on the
situation and we handled it without causing any public alarm.
We were the only country, it seemed, that had that benefit.
As a very final thought, the structure of the NHS
is crucial to the manner in which we responded. The chief executive
at the time used to say, with a glint in his eye, that we had
gone into what he called, "command and control mode".
He quite liked the idea of being in command and control mode,
which perhaps shows the top-down instincts of the NHS.
I would also ask a question. Sometimes the NHS can
respond better than other health systems elsewhere because of
the ability to put a message out quickly that is then followed
up. In the new NHS that is being created, would it be as efficient
if it is a much more atomised, localised system? Localism is everything,
we are told. Actually, I don't agree with that, personally. I
think the strength of the NHS is the ability at times for it to
do exactly what is needed to be done. In this case, again, I was
hugely well served by that.
Q374 Stephen Metcalfe:
Recognising that we are short of time, I want to turn to the role
of SAGE. But just before I do that, Lord Adonis, you very much
tried to put the responsibility for having identified the volcanic
ash cloud on to the Civil Aviation Authority and the international
authorities. Do you not think that Government has a role in identifying
risk and making sure that those risks are on the register?
Lord Adonis: For
the purposes of this discussion, I take the Civil Aviation Authority
to be part of Government. They are the regulatory authority established
by Government for the purpose of ensuring that we have a safe
flying regime.
Q375 Stephen Metcalfe: Did
you ever query with them whether they had identified risk?
Lord Adonis: I,
myself, did not question whether they had a safe flying regime
in place in respect of ash concentrations for a volcanic eruption,
no.
Q376 Stephen Metcalfe:
No. I accept that.
Lord Adonis: That
is the answer, I am afraid, to that. I wish I had. If I had had
better predictive powers, I would have had them into my office
immediately after my appointment and said, "Can you tell
me, if there is a volcanic eruption, what your plans are?"
Unfortunately, I didn't have that foresight.
Q377 Stephen Metcalfe:
But were you identifying them? Was the idea that there were risks
within the Department that might come up? Was that a topic that
was discussed with you and your advisers, "What are the risks
to our Department?", and was that something that was being
looked at?
Lord Adonis: At
the official level these discussions do take place, but I am not
aware of them having taken place in respect of ash, which is the
key issue. The big issue, to come back to it again, is that it
simply hadn't been identified as a contingency, so it was completely
different from swine flu. What we were faced with was a crisis
caused by an eventuality which, beforehand, had not been regarded
as a contingency.
Q378 Stephen Metcalfe:
Our investigation goes slightly wider than just swine flu and
volcanic ash. What we are looking at is how the Government use
scientific advice in an emergency and what preparation they have
made for that, such as, "Was there a general risk assessment?"
But could you give me examples of where SAGE has advised you in
either role, either specifically within the two areas that we
are talking about or perhaps at other times, and whether that
advice was useful? Did you ever reject any SAGE advice that was
given to you?
Lord Adonis: No,
is the answer to the second question. In respect of the first,
if I can answer it more generally, in dealing with eventualities
in respect of terrorist attacks, my advisers were constantly making
risk assessments—constantly—and had to do so in what
were very difficult circumstances. In my time as Transport Secretary,
you will remember we had the serious attempted bombing of the
plane from the Netherlands, and that was a constant preoccupation
of advisers to the Department.
Andy Burnham: I
wouldn't overplay the role of SAGE, necessarily, because in our
context, the JCVI probably were more important in terms of specific
advice on treatment options. SAGE were often providing a broad
context and information in which to make the decisions. They were
providing specific advice, although, as I mentioned, there was
a split opinion around antivirals. You must remember that in the
health context the JCVI has a crucial role in advising on vaccination
and vaccination priority. I would encourage you to look at those
two together. But no, we didn't. I think David Harper said, when
he gave evidence to you, that Ministers always based decisions
on the scientific advice. Perhaps that wasn't the perception of
Ministers but, believe me, at all times, all four UK Health Ministers
said, "We will be guided by the science. We cannot go outside
the science or the scientific advice." We stuck to that as
an absolute 24-carat principle throughout swine flu.
Lord Adonis: If
I could echo Mr Burnham's point, it wasn't SAGE which I dealt
with in respect of terrorist threats. It was TRANSEC, the transport
safety organisation, which, of course, has very high level scientific
and other advisers in guiding its work.
Chair: A final question,
Graham.
Q379 Graham Stringer:
Andy, you said that you and the Health Ministers from the other
countries in the UK were guided by the scientific advice. There
was a dispute, wasn't there, in terms of order of vaccination?
Some of the other Health Ministers wanted to vaccinate children
first rather than the most at risk. How did you deal with that?
Andy Burnham: There
was a difference of opinion both on use of antivirals and—I
wouldn't say it was huge—different perspectives on what
we should do vis-à-vis vaccination. We often took that
and then put it back to the JCVI and said, "We have a different
perspective." We asked the JCVI for clarification a couple
of times, asking them to take into specific account feelings that
Ministers had. If I can say this, you and I spoke at that time
around children and whether or not there should be a schools'
vaccination policy.
Graham Stringer: We did.
Andy Burnham: It
was clear that schools were the engine of spread, weren't they?
The schools broke up for the summer. In Scotland, of course, because
the schools broke up a little earlier, immediately the cases flattened
in mid-July. For us, it was at the end of July. So the role that
schools were playing was clear.
We, as Ministers, all of us, based on the discussions
we were having in Parliament—not everybody felt as strongly
about that—asked and pushed JCVI a couple of times again
to advise us whether this was the right thing to do. The very
clear advice that came back was, "No, don't vaccinate otherwise
healthy children. That is not a proportionate response to the
situation we are in. We are dealing with a mild virus. Yes, it's
severe in some, but get the vaccination quickly to those at most
risk of developing serious illness or at most risk, even, of death."
As I said before, there were kids with severe disabilities who
had complications with their respiratory system. They were clearly
at more risk, as were pregnant women. Bear in mind, we did not
have an unlimited supply of vaccine. What we had had to go first
to where the risk was. I think we were, in the end, advised very
well. The tendency was—all of us reading the newspapers—"Oh,
look at schools. Why don't we vaccinate schools?" It was
a natural politician's response, if you like. This was an area,
I think, where the scientists had it absolutely right. They saw
that there was a limited supply of vaccine. In the conditions
of swine flu, where it was a mild virus for most people, some
wouldn't even notice they had had it, some would have a very mild
cold, but in some cases it was dangerous. That was the challenge
of swine flu, if you like: mild in most but severe in some.
In those circumstances, it was clearly right to have
a priority group system where the available vaccine went to those
groups in order. I think it was a classic example of where the
scientists absolutely had it right and potentially some of the
political response had it wrong.
Q380 Graham Stringer:
Andrew, there was a general election going on when you had your
crisis. How did that affect it?
Lord Adonis: Not
at all. I'm sorry, I mean that I didn't do any campaigning while
this was going on. I had more important things to attend to.
Andy Burnham: It
took me off the campaign trail as well.
Lord Adonis: I,
personally, as Minister, was on this every waking hour from the
moment I was phoned on a campaign visit to be told that we had
this ash cloud. It was explained to me what this meant and that
it would lead to airspace having to be closed. At the moment that
was said to me, I realised that we faced a national emergency
and I came straight back to London. In my waking hours I didn't
leave my office until we got the airspace re-opened.
So far as the Government was concerned, we behaved
in full operational mode with no impact whatsoever caused by the
election. I don't believe, if the crisis had struck at any other
time, that we would have reacted any differently. Indeed, it continued
after because, although the immediate crisis was over after six
days, I was still spending a good deal of my time dealing with
the after-effects, in particular, some of the consequential decisions
that needed to be taken in terms of European regulation right
up until the moment when the Government changed hands. Two days
before the general election, I spent the day in Brussels at the
European Council with European counterparts when we put in place
a whole set of arrangements for handling the regulation of ash
concentrations and how a new regulatory regime, which was then
temporary, would be made permanent. That process, as I say, continued
until the change of Government and it was, as far as I could see,
entirely seamless.
Andy Burnham: Now
I know why you cancelled that visit to my constituency.
Lord Adonis: I
am glad to say that Mr Burnham got re-elected without my help.
He may have needed help, but I wasn't there.
Q381 Chair: Can
I thank you very much for your attendance this morning? It has
been an extremely useful session. Thank you.
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