Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

18/06/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Angela Burns AS
Dai Lloyd AS Cadeirydd y Pwyllgor
Committee Chair
David Rees AS
Jayne Bryant AS
Lynne Neagle AS
Rhun ap Iorwerth AS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Syr David King Grŵp Cynghori Gwyddonol ar Argyfyngau Annibynnol
The Independent Scientific Advisory Group for Emergencies
Yr Athro Deenan Pillay Grŵp Cynghori Gwyddonol ar Argyfyngau Annibynnol
The Independent Scientific Advisory Group for Emergencies

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Claire Morris Ail Glerc
Second Clerk
Dr Paul Worthington Ymchwilydd
Researcher
Lowri Jones Dirprwy Glerc
Deputy Clerk
Lucy Morgan Ymchwilydd
Researcher
Sarah Beasley Clerc
Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Cyfarfu'r pwyllgor drwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:30.

The committee met by video-conference.

The meeting began at 09:30. 

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Bore da i bawb a chroeso i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon, yma drwy gyfrwng rhithwir, drwy gyfrwng fideo gynadledda Zoom. O dan eitem 1—cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau—allaf i groesawu fy nghyd-Aelodau o bedwar ban Cymru i'r cyfarfod yma? Ac, wrth gwrs, yn naturiol, dwi'n nodi taw cyfarfod rhithwir ydy hwn o achos amgylchiadau y pandemig rydym ni yn gorfod i gyd fyw oddi tanynt, a mwy am hynny yn nes ymlaen. 

Good morning, everyone, and welcome to this latest meeting of the Health, Social Care and Sport Committee, here in a virtual capacity via video-conferencing on Zoom. Under item 1—introductions, apologies, substitutions and declarations of interest—may I welcome my fellow Members from all parts of Wales to this meeting? And, of course, I note that this is a virtual meeting as a result of the COVID-19 pandemic that we're all facing, and more on that later on.

2. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd ar gyfer eitemau 3 a 4
2. Motion under Standing Order 17.42(ix) to resolve to exclude the public from items 3 and 4

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd ar gyfer eitemau 3 a 4 y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from items 3 and 4 of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

Fe wnawn ni symud yn syth i eitem 2 a chynnig o ran Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd yn ystod eitemau 3 a 4 y bore yma, cyn dod nôl yn gyhoeddus wedyn erbyn 11:00. Ydy pawb yn gytûn? Pawb yn gytûn, felly dyna ddiwedd yr adran yma o'r cyfarfod cyhoeddus. Fe awn ni mewn i sesiwn breifat rŵan am yr awr nesaf. Diolch yn fawr. 

We'll go straight to item 2 and a motion under Standing Order 17.42(ix) to resolve to exclude the public from items 3 and 4 this morning, before we return in public session by 11 o'clock. Is everyone content? Everyone is content, so that's the end of this section of the public meeting. We'll go into private session for the next hour. Thank you very much.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 09:31.

Motion agreed.

The public part of the meeting ended at 09:31.

11:00

Ailymgynullodd y pwyllgor yn gyhoeddus am 11:00.

The committee reconvened in public at 11:00.

5. Covid-19: Sesiwn dystiolaeth gyda chynrychiolwyr y Grwp Cynghori Gwyddonol Annibynnol ar Argyfyngau (SAGE Annibynnol)
5. Covid-19: Evidence session with representatives of Independent SAGE

Croeso nôl i'n cynulleidfa fyd-eang i’r eitem ddiweddaraf yn y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon, yma drwy fideo gynadledda Zoom rhithwir. Dwi’n gweld fy nghyd-Aelodau o’r Senedd o bedwar ban Cymru yma.

Rydym ni wedi cyrraedd eitem 5 ar yr agenda rŵan, a pharhad efo’n hymchwiliad mewn i COVID-19. Dyma sesiwn dystiolaeth gyda chynrychiolwyr y Grŵp Cynghori Gwyddonol Annibynnol ar Argyfyngau, sef SAGE Annyibynnol. Felly, fel rhagarweiniad, gaf i groesawu nôl fy nghyd-Aelodau a nodi, yn amlwg, taw cyfarfod rhithwir ydy hwn? Allaf bellach esbonio, yn naturiol, fod y cyfarfod yma yn ddwyieithog, gyda chyfieithu ar y pryd o’r Gymraeg i’r Saesneg? Efallai bod yna rywfaint o oedi ichi ddisgwyl wedi i rywun fod yn siarad Cymraeg. Wrth gwrs, mae’r cyfieithu yn dilyn, felly, mae yna ryw bum eiliad o oedi cyn ichi siarad. Mi fyddwch chi wedi derbyn, bawb, yr hyfforddiant ynglŷn ag ymdrin â meicroffonau a sut i ddiffodd y sŵn neu ailgodi’r sŵn. Bydd yna gyfarwyddyd ar y sgrin os bydd angen ichi ddiffodd y sŵn. Wrth gwrs, rydym ni yn gyfan gwbl ddibynnol ar y rhyngrwyd, felly os digwyddiff rhywbeth i’m system ryngrwyd i, cyn rŵan rydym ni wedi ethol Rhun ap Iorwerth fel dirprwy Gadeirydd i’r pwyllgor yma os bydd fy sgrin innau yn diflannu.

Felly, gyda chymaint â hynny o ragymadrodd, dwi’n falch iawn—hynod falch, mae’n rhaid imi ddweud—o groesawu i’r cyfarfod o’r pwyllgor iechyd Syr David King, cadeirydd SAGE Annibynnol, a hefyd yr Athro Deenan Pillay, aelod o SAGE Annibynnol. Rydym ni i gyd wedi darllen eich adroddiad cychwynnol bendigedig, adroddiadau eraill bendigedig o bob peth rydych chi wedi bod yn ei ddweud dros y misoedd diwethaf. Rydym ni’n eich llongyfarch chi’n fawr ar y gwaith. Mae yna nifer helaeth o gwestiynau gydag Aelodau, felly heb oedi rhagor, awn ni’n syth mewn i gwestiynau, ac mae Jayne Bryant yn mynd i ddechrau.

Welcome back to our global audience to this latest item of the Health, Social Care and Sport Committee meeting, here via video-conference on Zoom, in a virtual capacity. I see my fellow Members of the Senedd from all parts of Wales have rejoined us.

We've reached item 5 on the agenda, and the continuation of our inquiry into COVID-19. This is an evidence session with representatives of the Independent Scientific Advisory Group for Emergencies, or Independent SAGE. So, as a few words of introduction, may I welcome back my fellow Members and note that this is a virtual meeting? May I further explain that this meeting is bilingual, and interpretation from Welsh to English is available? There may be some delay after a contribution has been made in Welsh. The interpretation will then follow, and there's a five-second delay, also, before we ask you to start speaking. You will have all received the training with regard to dealing with the microphones and how to unmute them or mute the sound. There will be instructions on the screen if you need to accept the unmuting of the sound. We are entirely dependent on the internet, so if something should happen to my internet system, we have already decided that Rhun ap Iorwerth should step into the breach as temporary Chair if my screen should disappear.

So, with those few words of introduction, I'm very pleased—very, very pleased—to welcome to this meeting of the health committee Sir David King, chair of Independent SAGE, and also Professor Deenan Pillay, member of Independent SAGE. We have all received your initial report, the excellent reports that you have produced, on everything that you have been discussing over the past few months. We congratulate you very warmly on the work that you have done. We have a whole host of questions to ask you, so without further delay, we'll go straight into those questions, and Jayne Bryant is going to begin.

Thank you, Chair, and good morning. Firstly, can I ask you what the purpose was of creating Independent SAGE?

Well, I'm very happy to answer that. We only formed ourselves after we had gone into lockdown, and the reason that we were formed is, principally, because there was no knowledge of what the science advice was going into Government. At the time that we were formed, there was not even a knowledge, a public knowledge, of the membership of SAGE, as set up by the chief scientific adviser and the chief medical officer of the Government.

When I was chief scientific adviser, I had explained, before I took the job, to Tony Blair and subsequently to Gordon Brown, that whatever advice I put into Government, I would put into the public domain as well. And the reason for this is, in order to keep the trust of both the Cabinet and the public, this process is, I think, vitally necessary.

Unfortunately, in 2010, this was altered. I went back into Government to work in the Foreign Office, and at that time, as the special representative on climate change to the foreign Secretary, the foreign Secretary welcomed me because he said, 'You've got a public voice and you can tell the country what we're doing on climate change.' The answer's a bit lengthy, but let me just say, I was never allowed on television and radio. The communications were all controlled through No. 10 and it wasn't felt it was a good idea to let me simply tell the public what we were doing.

One target was to demonstrate what an independent voice in Government ought to look like, and the second thing was that we decided, also, to hold our meetings open to public scrutiny. And this was an interesting exercise because we all know that scientists argue with each other, and what emerges from the argument is a coherent way forward, and so we were keen to allow the public to see that. I think that's the simple answer to your question.

11:05

Brilliant. Thank you very much, that's very helpful. What do you feel that you're offering in terms of differing advice throughout this process, or since you've been established?

I think the first thing I would say is while we were holding our first meeting in the public domain, the Government began to publish SAGE minutes. Now, these minutes were redacted, and several minutes have not yet appeared, but, nevertheless, we feel this was already a good response.

In our meetings, and I think this is where I'm going to ask Deenan to come in, we have covered the whole range of Government advice, but what we were very keen on was to take the situation as we found it then when we had our first meeting and advise what actions were required to get the country as quickly as possible out of this pandemic and with the least number of further fatalities. That was our objective in setting out our advice.

Yes, if I can just add—and thank you for inviting us to this committee to give evidence—as Sir David has said, this was a response to a relative paucity of scientific information coming out in the way that we normally would expect that as scientists. We've all witnessed the sanitisation, in a way, of the way in which that information comes out. I should also add that our response to our public inquiries and consultations has been very vibrant, and that, in a way, demonstrates to us the hunger, we feel, amongst the population of all sorts of—. This lockdown and COVID affect us all and, therefore, everyone has a legitimate voice in this. We feel and we've witnessed ourselves a great excitement and engagement with what we're doing, which was why we were so encouraged to continue.

Excellent. I have a couple of rapid-fire supplementaries. Jayne, I'll come back to you. Angela.

Thank you for that. I just want to ask: do you feel that your voice added clarity to the public debate, given that the Governments of all four nations were running at great speed, there's an awful lot of people who've got an opinion, and a lot of people with strong opinions, because they have strong experiences and are used to being listened to, some who weren't involved, others who were? Did it actually add clarity? Because, of course, if you were to stop and listen to absolutely every single person, you could argue that Government would be paralysed and not able to move forward. I think you can look back with hindsight, which is always perfect 20:20 vision, isn't it, and say, 'This was wrong,' or 'That was wrong', but at the time, in the moment of the crisis—what's your view on that? Because, I guess, like politicians, if you have 100 of us in a room, you've got 100 different views. I suspect that's not entirely dissimilar with the scientific community, because everybody looks at things in slightly different ways.

I think you're making a very, very good point. Of course, I was responsible for containing the foot-and-mouth disease epidemic in 2001, and during that period, I was on television and radio almost every single day for about five weeks, and the reason was because the Prime Minister said to me, 'Right, you are taking control of this and you have to explain what you're doing to the public.' Now, I personally think that was a very good model. It meant that the public was hearing what the scientific group that I set up was advising at the same time as the Government was being told. I was meeting COBRA virtually every morning for about three weeks in that period. So, I think, for me, that was the ideal way to run it.

We, on our Independent SAGE, have been rather overwhelmed with the amount of requests that have come in from the media, and the reason is quite simple: the media cannot get the science advisers, or even the Ministers, to come on their programmes. So, it's all, once again, command and control, rather than explaining everything. I have to say—and I know this sounds a bit critical, but we have every reason to be critical—it really looks like we're in an electioneering mode rather than an explanatory mode in the way things are put across to the public. I think what is so shameful about the way this has been handled is the number of fatalities and the length of time that we're in lockdown, both of which could have been avoided by much quicker action. If we had just gone into lockdown one week earlier, because the epidemic was then growing at something like doubling every three to four days, one week is two doubling periods, and the death rate is equal to a fraction of the number of infected people, it means that instead of 40,000 people dying, we might have looked at 10,000 people dying. That was the critical factor in these delays in taking any real action.

We have just put out our report on the test and trace system. Every other country in Europe and in the world has got a good operative test and trace system; we haven't. It's all come about extremely late.

11:10

No, I'm not using hindsight.

I just wonder, at the moment, when it all first kicked off—I was just interested in your view then. Because I don't know, if I was presented with multiple choices, I'd have to say, 'Right, I'm going to go with this one.' It could be wrong, and I absolutely accept that, but I'm more interested in that very first little bit when you actually say, 'Okay, which group do I go with, or which scientist do I listen to, and which modelling'—and they went with the Imperial College modelling—'do I concentrate on?' So, just your view there on how that decision at that point was made as to—

Let me very quickly say, no, this isn't hindsight. Remember, this happened in China, it happened in Italy, it was happening in Spain. We could have learned so much from what they were doing. Why did Greece go into lockdown so quickly? Greece has emerged from the epidemic with 174 deaths—174 deaths—because they went into lockdown very early. No, this isn't hindsight at all. They were following World Health Organization advice given early in February.

Very quickly, just to add to Sir David's comments, our control of the pandemic, which is unique in our lifetime—these control measures require trust, and we are advised, as is SAGE and Government, by behavioural scientists, who've underlined the importance of trust, and that trust is based on transparency, on people seeing how advice is generated, and how policies are developed. In that sense, we feel that we want to redress that balance of increasing the trust in the scientific basis of decision making. It is for politicians to make that decision, but I think we've seen, and all the polls have demonstrated, that, at the moment, and certainly over the last three weeks, there's been a loss of trust in Government, and of course that compromises our response to the pandemic.

Thanks, Chair. I don't think it was hindsight, either. We could see the carnage that was unfolding in the rest of the world, especially in mainland Europe. Why do you think that the Government didn't look to what was happening in Italy and Spain and take action more quickly, then?

Thank you for pointing the finger at me with that one. [Laughter.] I couldn't claim to be able to get into the minds of the Government and the advisers at that point in time. What I have to say is it seemed very, very strange to me. Of course, lockdown looks like a dramatic thing to do, and nobody wants to go into lockdown and lose economic growth for any period of time. So, if there's an alternative, I think you might pause and try and go for an alternative. I have a feeling that the alternative that they were really thinking about was the herd immunity.

We'll come more into that in a second. I need to go back to Jayne. There'll be plenty of opportunities, Professor Pillay. Jayne.

Thank you, Chair. Just finally from me, Independent SAGE have already produced a number of detailed reports. How receptive have others been to your recommendation and those reports?

11:15

How receptive have others been to the recommendation and to your reports more generally?

Well, I think I'm going to let Deenan try this one, and then I'll follow.

I think as key indicators of the impact of Independent SAGE, as Sir David started with saying, actually, simultaneously to our first public consultation, with the press as well included, SAGE released the names of their membership and documentation as well from reports. And as a direct consequence of our second report, which was around the school-opening issue, then, again, simultaneously as we produced that report, the scientific advice around schools was released by SAGE. So, that's a surrogate, if you will, of an impact of what we're doing, but, in a way, that's all good. I mean, we all respect the scientists who sit on SAGE, the independent scientists—they're all fine individuals and, in some cases, our own Independent SAGE scientific membership is made up of individuals who sit on SAGE as well.

I think the impact we've had is to loosen some of these more politically constrained discussions that were at the beginning, and that is our purpose, to open up discussion to all.

Thank you, Chair. Can I just ask about the behavioural advice that the UK Government was given? One of the reasons we've been told in Wales that we didn't go into lockdown earlier was that the public wouldn't tolerate it for a longer period of time. Now, I personally felt that that was not the case, based on my constituents' attitude to the lockdown. Do you think that the public attitude to lockdown was something that should have prevented us going earlier?

If I can just very quickly come in and say absolutely not. The earlier we would have gone into lockdown, the more quickly we would come out of lockdown, because you would have had far fewer cases, you would have had far fewer fatalities. And the point I'm going to make now is that there was no conflict in handling the pandemic between the economic outcome and the fatality outcome. Both of them point to going into lockdown early.

Thank you. I've got some specific questions. I think it's a really fascinating report, so thank you for it. The first thing I wanted to ask about was the point that you've made about the need for there to be public buy-in, and taking the public with you on these issues. You've said that the UK Government had a very top-down approach. Actually, I think probably all the Governments in the UK have had a pretty-down approach in terms of handling this. Are there any lessons for Wales, do you think, in terms of trying to take people with us now as we go forward, especially given the fact that we could be in and out of lockdowns now for quite some time? 

I'll have a go at that. Well, I think what we've learnt, and, as you've said, there was a belief—I don't think it was a scientific belief, but there was a belief that the population would not tolerate a lockdown. I think we've now learnt that, with appropriate information, the population are very compliant, in fact, with that. And behavioural scientists also deny themselves that they had suggested that the lockdown couldn't go on for a longer period of time, as has been said by some UK Government Ministers as a reason for bringing the lockdown to an end. It is all about the messaging and understanding, and I think at the time of lockdown why it was so impactful was precisely because there was an understanding, but also I think, importantly, a common feeling of the population that, in a way, the virus was something to be defeated, and an understanding that it needed everyone to go along with that, which is why the unfortunate and highly publicised incident of one of Boris Johnson's advisers appearing to break that had a far bigger influence than, actually, you would imagine from just one individual doing something. So, I think trust is important.

The other thing I think that has impacted on the delay, and maybe the poor policy decisions in the early days, was just thinking about the politics of the UK at this time, at the beginning of the year. Remember, we've been through a pretty difficult three years with Brexit discussions and negotiations, and I'm less familiar with the precise nature of this within Wales, but, clearly, the nature of politics has clearly changed. The nature of civil service advice, the functioning of Government was clearly atypical at that time. So, I would also argue that good politics, in terms of democratic politics, good understanding, explanation, is going to be critical to a future lockdown, if need be.

11:20

Thank you. I wanted to ask about mental health: you've picked it up in the report, and you've talked about the damage caused, and you've described it as, effectively, 'solitary confinement' in the report. One of the things I've been concerned about, really, is how we balance damage to people's mental health with the wider public health issues. You didn't make a recommendation in this report in relation to mental health. So, I'd just like to ask: do you feel that the impact—? We know that people with dementia have died of dementia, because they've been on their own. Do you feel that sufficient account has been taken of the huge physical and mental impacts of loneliness and isolation?

I think you're asking a very, very important question, and we are not finished with our work, by any means, and there will be more reports. And so, for example, just to add to the list that you've put forward, we're very concerned about schools and children, and the fact that the closure is for so long. And the real concern is with those living in the more deprived conditions, where home learning isn't quite so easy, where may be they haven't got laptops and so on. But the point that you're raising—absolutely critical. We all know that the indirect damage of COVID-19 in the population is really pretty strong, and we would like, therefore, to have seen, for example, the test and trace system—absolutely critical. We cannot emerge from this without a functioning system. We need to emerge as quickly as possible. Everything needs to be fully up and running.

And I entirely concur with the remarks that you've made on schools, and I hope that we can do that differently in Wales and address those issues.

Finally, from me, then, on workplaces: you've made a clear recommendation about workplaces. You've linked it to inequalities, which is really welcome. In Wales we have put the 2m in workplaces in; it's kind of in law, it's guidance—if employers can do it. Do you think that's sufficiently strong? And going forward, say we have a really nasty second peak in the autumn—just thinking of the kind of behaviour I've seen in the supermarkets and what staff there are having to put up with—is there anything more we can do to actually protect people in the workplace? 

Shall I take this? Well, again, this is a really important issue and, in fact, something that we're working on at the moment for a short report around particularly the 2m versus 1m issue. And just something on that advice around 2m to 1m, before the broader questions, it may seem just semantics in some way—a 2m versus 1m—but what our report, that we're writing at the moment—. It focuses on the fact that, actually, moving to 1m in effect is saying 'ending lockdown', because what people perceive as that, the change of behaviour of 1m, and, of course, in terms of normal human interaction—. When you're asked to keep at 2m, that's very clear that you've got to stay away from people. But when it's 1m, actually, that doesn't stop the breathing out and increasing the risk to others. So, I really think that we need to consider that, recognising at the same time that we need to open up the economy. Of course, we recognise that keeping lockdown continuing, as you previously said, is a stress and is a contributor to other illness and morbidity.

So, it is a balance, but we feel that workplaces can actually adapt. Of course, there are going to compromises and of course it's going to be difficult. Masks is a debatable issue, but, clearly, in restaurants and pubs, masks are not relevant when you're going there to eat and drink. So, that's not an option there. And where industries are having to suffer in this respect, then we would urge the Government to maintain support, to allow the virus really to be defeated.

11:25

I just wanted to make a comment about face masks and their use. I haven't seen proper information being given to people about how you should properly wear a face mask and what sort of face mask is safe to use. My advice to people is go for Chinese face masks. The Chinese have a culture of wearing face masks, and these face masks have a metal strip at the top. People ask me, 'Does the metal strip go at the bottom or on the top?' There's a lot of lack of information here. Putting on a face mask, you need to bend that metal around the bridge of your nose, and you need to make sure, when you take it off, that you take it off carefully and throw it away without touching any aspect of it. I would like to see much more information given out on how to safely wear a face mask.

Excellent. I'm sure our worldwide audience has picked up some useful tips there.

Angela, you've got a brief question before we move on.

It was just on the 2m  distance, because I'm very cautious about us changing that. But I just wondered if you'd had a look at what—. As we note, many European countries have either got a 1m or 1.5m, and Welsh Government produced a report that came out earlier this week where they'd looked at how the R factor and how lockdown was changing in other European countries. And, in fact, they also looked at New Zealand. I just wondered what your view was, because, of course, those countries do have a smaller distance, and they still seem to be able to control their R value.  

Yes, shall I take this? Thank you, Angela. We've got to recognise that distancing and this physical distancing is just one component of the array of techniques that we have to limit the spread. There are some other key issues that determine the spread. First of all is the overall prevalence of infection within the population, and secondly is the ability to identify people who've got the infection very early, and to clamp down on that virus through contact tracing and isolation.

And all the countries that have reduced to 1m are in situations with far lower prevalence of infection within the population, and also having a far more active test and trace programme than we have. So, I would just place it in that context, and I'd agree with you that that is a reason why we as a group within Independent SAGE feel strongly that it is too soon to start to release that 2m rule.

Good morning. Before I go on to my questions, I just want to ask a question on behavioural issues, because I think that Professor Pillay highlighted that the reduction to 1m, for example, most people would see that as end of lockdown. This is back to behavioural patterns. In the various actions taken, we've seen behaviour—and I will highlight it, mainly in England more, because we saw on the beaches an example of people gathering. Do you believe that the behavioural aspects have been given full consideration when deciding on some of the lockdown easing? And have you seen the evidence for that?

Well, briefly, we're lucky in Independent SAGE to have members of the behavioural sub-committee, SPI-B—the scientific pandemic influenza group on behaviours—which is one of the sub-committees feeding into SAGE on behaviour. We're very fortunate to have a number of them that are also supporting ourselves, and it's clear that the advice that they have been providing is very much in line with what we're saying: that we need to have techniques that ensure that the behaviour does fulfil the needs of the lockdown, and that requires trust, it requires engagement, it requires understanding, and it's clear that some of those recommendations through SAGE have not made it through to policy. So, we're aware of that. Now, of course, SAGE is only there to advise and it's for politicians to make that decision, so we accept that that is the decision taken, but we're very well aware that that advice has not always been taken by Government. 

11:30

Thank you for that, because the question I wanted to ask, then, is, you had 19 recommendations, and Jayne asked earlier how did people respond—well, respond in one sense, or how were they behaving to that. Have you got, actually, Government responses to those 19 recommendations or even perhaps SAGE responses to those 19 recommendations?

I'm not following whether you're saying—. Are you asking about the Independent SAGE recommendations?

We've not had formal response from SAGE and we wouldn't expect from SAGE, remembering that some of our advisers are actually on SAGE, so these discussions would have been there, and we've not had a response back on these issues from Government as far as I know, but Sir David may be able to—

Yes. Well, all I've had is a response from Sir Patrick. Every time I send him a minute of our latest report, he responds by saying, 'Thank you', and, 'I have sent the report around the membership of SAGE'.

Thank you. You also added in your report that there's a window of opportunity between peaks. Now, I'm assuming, clearly, we're talking about opportunity to prepare for the next peak, but when do you see the window opening? At what point do you think the window could open because we are on a decline, but at what point do you think it's open? And when do you think it needs to be done—at what point do you see the window closing again?

Well, let me jump in quickly. Deenan is the right person to answer this, though. I think there's a real problem because of the behavioural issue. We, and the Government as well, may set rules, but it's a question of whether the rules are being followed. So, we've already discussed the state of the moral authority of Government; that is really required to get people to follow the rules.

So, for example, we talk about people on beaches: now, I'm not too worried about the distance apart from most of the photographs I've seen, but what I'm worried about is I had a conversation with a train driver on radio and he said to me, 'I was taking people to the beaches around Liverpool in my train', he said, 'The trains were crowded. The trains were crowded'. I said, 'Were they all wearing face masks?', he said, 'No, nobody was'. They were all going down to the beach and then separating out in the open air. So, this is a behavioural issue. Until we know how people are responding to all of this crisis, it's impossible to predict when the next wave will come, I think, but Deenan is in a better place to respond, I think.

Just to answer that, there's no doubt, I agree, that coming out of lockdown makes it much more difficult to go back into lockdown, and that's one of the reasons why we're quite clear that we've been premature to stop the lockdown. And we're all part of this; no-one is divorced from the lockdown, and psychologically, I can speak for myself, I'm dying to go out and see people I've not been able to see and so forth. So, it's a natural thing to do, but I'm well aware that once I am psychologically in that space, it's very difficult to go back into my box, into the lockdown box. So, that's important to recognise.

But the second is what is going to be the nature of a second wave, and our modelling tells us—and other modelling as well—suggests that the future waves will come in much more locality-based outbreaks; whether it is healthcare settings such as hospitals or care homes, or schools or other places. That is where the next indication of infection will come. And what we need to do as well is prepare in this meantime for that to happen by developing local response networks, making sure that test and trace and isolate and supporting those isolations is really in place to be able to then—. And local governance of that so that as soon as there's a local outbreak, we can really deal with that without it then spreading and coming into sort of a next, a second wave of pandemic, as we've witnessed so far with the excess 40,000 or more deaths.

11:35

On that particular point—[Inaudible]—dynamic causal modelling, and I was just wondering, because it is highlighted in your recommendation that it could be a far more local or devolved aspect. Is dynamic causal modelling used by SAGE in any form, or is that just simply an alternative that you think should be used?

I'm certainly not a modeller, and we're fortunate to work with Professor Karl Friston in our group on this, and he has proposed this approach to modelling, which then allows us to be a little bit more fine-tuned in terms of predicting what's going to happen.

But I think the critical aspect about modelling is to recognise that models are used because there is no data, and Sir David will be very well aware of this from his time as chief scientific adviser. We've now got data; we're getting data all the time, so we're able to then plug those data in to the models and make them far more robust and far more realistic. So, that is what our proposal is, but again, there are many different approaches to modelling. There's been a fair bit of argument in the media about this, and people using different assumptions, and so I'm of the view that we should have a sceptical suspicion of models, and ultimately, it's going to be the data that's now emerging that is going to guide us.

Angela's got a—. Angela's into modelling. You've got an itsy-bitsy short question, Angela.

I have. Last week we had Public Health Wales in, and we specifically asked them about this whole issue of modelling, and also lockdown in small parts of Wales, and they put up a very robust defence of why they didn't believe it would work in Wales, to do with the way people move and so on and so forth. I just wondered if you had a view on whether or not you actually think Wales, when you look at our geography and our size—. From a layman's view, I don't think it's too small to do small patches of lockdown, but I just wondered if you had a view on that.

I'll be very brief and then Sir David will come in. I think what has been an error within the UK response, which I think the model has fed into, is to assume that there's a homogeneity around the pandemic. It's easy to do, because there are so many infections, but we now know that there are certain areas of high risk and certain areas of low risk, and the danger with having a universal approach to this is we're not able to fine-tune according to different risks. I'm minded, for instance, of the French system, where, from early on, they categorised risk to different départements, and going from green, amber and red, and that's changed—. And that has been the way in which French policy has been guided, and I think that, again, is a better way of explaining to the population. So, without being sucked into whether Wales is specific in one way or the other, I do agree with having a much more local regional approach to this.

My only comment to add is much the same. We need local involvement, local ownership, using our existing public health systems, using GPs, engaging people locally, and that has been missing in the Government's centralised approach.

That actually takes us on to the next question, in the sense of co-ordination between the nations. And in your report, again, one of the recommendations was that there should be good co-ordination between the nations. Are you seeing that co-ordination? Because we are seeing a slightly different approach to easing of lockdown, so are you seeing co-ordination between them? Could it have been better? And, perhaps, do you have any comments as to perhaps how this change is actually having an impact?

11:40

So, let me jump in quickly and say what we were hoping to see was much more engagement with local authorities. If we just look at England—I go back to the point I was just making; it's locally where the knowledge is known. If we just take schools, the school is an essential part of a local community. So, if I can extrapolate from that comment to engagement between London, in containing this, and Wales, for example, I would have hoped that there'd have been an extensive discussion going on between No. 10 and you guys in Wales, and, if that hasn't happened, then I think we would be very, very critical.

Okay. Rhun is going to dwell on the vexed issues of contact tracing and testing and stuff, because he's a big expert on this. 

Rhun, drosodd i ti.

Rhun, over to you.

I don't think so. [Laughter.] Thank you very much, Chair. Yes, you've made it abundantly clear how important you consider a robust test and trace regime to be in order to allow us to meaningfully relax restrictions. Given that, have you found it odd that it was in June, sort of three months into the pandemic, that a test and trace programme was launched in Wales, and indeed across the UK, given that testing and tracing was meant to be at the core of the battle against coronavirus, wasn't it? 

[Inaudible.]—one word about that: it was a disastrous process, a disastrous process. Because everyone surely knows that—especially once you've gone into lockdown, but even before you go into lockdown—you need to know where the disease is, you need to be tracing, testing and isolating people. To come into it in the late period of the close-down just seemed to us to be irresponsible.

But there's another aspect to it. We believe—and our report that was just published this morning, and I'm sure you haven't had time to see it, but please do—we're saying we need a system that is more sophisticated. We need to find every new case of the disease, and that person then needs to be tested if they're showing the symptoms. And the only way we're going to see that happening is if there's very clear advertising: these are the symptoms, if you have them dial 111, get hold of—don't go to your GP, phone—your GP, whatever; you need to be tested as soon as possible. So, test, trace, isolate and then support.

So, I come back to the point, when I say 'support', that if we are isolating people—. It's easy to say, 'You've got to isolate yourself.' What about if you're living in a large family in a small tenement block? Don't you need to see what other countries have done, which is to take over hotels, to requisition hotels, isolate people under supervision, make sure they're fed and make sure they've got the medical supplies they need? I think that what we're saying is that the whole system really has got to be quite sophisticated, but it's also got to be run—again, I stress this point—through the local areas. We've got to engage with GPs. GPs aren't the ones doing the testing, they're being left out of this, so we have it all, again, centralised.

So, we have come to test and trace too late. We have a system that has been created de novo—in other words, they've ignored the local authorities, they've ignored the health system and created a new private sector to manage this from scratch. And to do that in the middle of an epidemic just seems to me foolhardy. 

On testing, specifically, there was a target early on in Wales, back in the end of March, of eventually building up to 9,000 tests before the end of April, but to 5,000 tests within a matter of weeks, which would be a UK equivalent of around a 100,000 tests a day. Now, things happened—we don't need to go into that; we've done that in this committee. Things happened that meant that that wasn't delivered. Do you think it was problematic that the building up of capacity for testing itself was so slow, and what does that tell us for subsequent peaks, for example—and future pandemics, in fact?

11:45

If I take the best behaved country in Europe—this was Greece—the Greeks, in February, were setting out to bring in all the equipment from other countries where they had the equipment their hospitals needed. They were getting all of the ability to do the testing, setting that up in February. They were able to start the process of going into lockdown early in March—4 March. So, what were we doing over all of that period of time? Sorry, Deenan, I should let you come in.

No, no, but if I can just add to that what went wrong. So, first of all, a focus on numbers of tests is a sort of irrelevancy, is a political target. What matters is what are the protocols and procedures for who we find to test, surely. If we say on the one hand we're only going to be testing those individuals who are sick enough to come into hospital, which, of course, was the case, then we're only going test people who are sick enough to come into hospital; we're not going to be testing people in the community. So, that is what determines the number of tests that are done, rather than just a target of tests, which always seemed a disconnect.

Secondly, of course, something about the trust—certainly, in England, the way in which test numbers were made into a political football, I think lost the trust of people.

But the third issue—and I speak as someone who is a clinical virologist and has worked in laboratories, both public health and NHS laboratories—is I think what was lacking right at the beginning was any oversight of saying, 'We need all the labs. There are 44 laboratories within the UK, including Wales, that have the capacity to do these sorts of tests for COVID-19'—very good quality labs in Wales—'Why don't we get all of those together? Let's work out how to do it.' Rather than it was a Public Health England—in England, certainly—versus NHS.

And so we had something like two months where actually very little was done before the recognition of, 'We need to get in Deloitte to develop these new testing centres', which is good capacity but we now know are not integrated. NHS numbers are not necessarily included with samples, so it's difficult to know who's been tested and so forth. So, I think we should have recognised that. 

Yes. And given that we're trying to learn lessons for the future here, not just look back and lay the blame, could that kind of work be done outside the period of a pandemic, so that you have labs on standby for such a point as a pandemic does rear its ugly head again?

Well, indeed there has been. From the days post 1945, when there was a public health laboratory service, including very strong laboratories in Wales, through to, now, the fragmentation of this response—. In fact, there's a letter actually written by some senior individuals of the old public health laboratory service, including in Wales, in today's Guardian, which expressed this very, very well. 

I think, now, that we have the opportunity to consider what is going to be the future of testing for the next wave. The lighthouse laboratories that have been developed are themselves dependent on volunteers staffing them who've come because their universities—they're no longer able to do the research they were doing in universities because of the lockdown. Equally, machines that have been used have been taken from universities to put into these lighthouse laboratories. That is all going to come to an end because we're going back, releasing lockdown. So, now, we have to take a plan, we have to develop a plan, for what is going to be an integrated, more local, embedded diagnostic service and testing service, utilising all the systems we've got in place. And that needs to be done now.

Okay. And quoting from your report—the fourth one, I think—

'There is an urgent need to plan for migration of testing back from the emergency Lighthouse laboratories into a more integrated future "normalisation" of such increased capacity across our existing PHE/NHS laboratories'.

Right.

That's exactly what I'm saying, yes.

Considering that, what do you make of this, from Welsh Government:

'Officials are in discussions with UK Government and LHBs about switching Carmarthen, Cardiff, Newport and Llandudno to lighthouse lab capacity.'

i.e. not moving away from dependency on lighthouse, but seemingly—

11:50

—moving more testing to lighthouse? I've asked my team to write to the Minister on this this morning, as it happens. I mean, it says:

'This could produce greater flexibility in the Welsh system to develop regular testing priorities and enable LHBs to develop greater access opportunities for testing.'

I don't know what that means, but what's your response to that?

Yes. There's a strong history of really high-quality diagnostic services supporting the NHS within the UK as a whole. We're one of the—. And whereas many countries around the world have systems, even if it's a sort of semi-national health service, laboratories are privatised and so on, and that's the norm, whereas, in the UK, we have a network. Now, that network has been damaged somewhat by mergers of laboratories that came following a Carter report—Lord Carter, in 2005—but, nevertheless, the skill base, the fact that these laboratories are clinically run, they're clinical pathologists—I'm a virologist, but, equally, they're haematologists and chemical pathologists, who are leading this very professionally—there's a really strong underpinning of training and leadership of these laboratories.

And it is, I must say, shameful if this is going to be ditched in order to develop something that may look flashy, it may look like a new building, it may bring in many different consultancies and private companies into that, but, I would argue, if we are to bring in extra capacity in whatever way, then it should still be embedded as much as possible within the network. And just one reason why that is so important: at the moment, the way in which data are accumulating and presented demonstrates how woeful it is. There's very poor quality data. In fact, the head of the office of statistics within the UK has actually rebuked a Minister of health in England for that, and one of the reasons is that these samples that have been tested cannot be linked back to an NHS number, which we're uniquely placed in the UK to have, which means there's immediate integration.

And we've had all sorts of examples that, again, I've written to the Minister about, of people who haven't been tested, being sent their test results back—one couple in my constituency receiving a negative test by text and a positive one by e-mail, and so on; clearly not acceptable.

Another element, perhaps, we suffered—. I'm a representative of a constituency in the north of Wales, where we experienced much longer turnaround times for test results throughout this pandemic, actually, and one of the things that helped was the opening of a test processing laboratory here in the north. It doesn't have enough capacity, but it's a help. Does the idea of moving testing, the actual processing of tests, away from the locality, bring with it the risk of adding to the turnaround time for test results?

Well, I think the last point is the only one I wanted to comment on; Professor Pillay is the one who is closer to these things. But the turnaround time after testing is critically important. If you get the test result five days after the test is made, and that person is still wandering around in their community, imagine the number of people infected during that period. It's critically important that the timeline between the test being drawn and completed, and the information going through, is as short as possible.

Shall we try a couple of one-word answers? Because I know the Chair's running out of patience with me. Does it seem odd to you that, whilst we have capacity for, say, 10,000 tests, we're only testing 3,000 to 4,000 a day? Should we just be looking at ways of maximising that testing capacity, or is that not particularly relevant?

I'll just say the answer is 'yes', according to a clear strategy.

Well, I'll use a bit of a Chair's prerogative here, just to flesh something out as regards the contact tracing element. Some of us have been a GP in Swansea for the last 35 years, and my GP colleagues over the last few months have been diagnosing COVID, in the absence of tests, clinically, symptom based. What do you think about basing a contact tracing system on symptoms, not test results, bearing in mind we have a false negative of 30 per cent on tests? Can we just isolate on symptoms?

11:55

Can I start with this, David? So, one of the real problems is that even at the height of the pandemic, we estimated that probably, maybe, only 20 per cent to 30 per cent of those individuals with these sort of flu-like symptoms, which is, of course, as you know, broad—only about 30 per cent of them—even at the peak, would be due to COVID, because there are other viruses and other infections circulating. So, the danger there is then the contact tracing and quarantine is actually in excess of what's needed. So, there have been proposals to base contact tracing on symptoms. I think we need to make sure that testing is there—that even if we start isolation based on symptoms, we need to get results of tests back very quickly, as Sir David has said, in order to not mean unnecessary quarantining of contacts, which could become a huge number.

Good. I'm conscious of time, and with everybody's allowance, we're going to extend by about five to 10 minutes, because I'm conscious that Angela has got some very interesting questions to ask you both. So, thank you, both, in advance. Angela.

Thank you. Actually, Deenan, can I just pick up on that comment you made when you were talking there about quarantine? I see in your report that you talk about extending the quarantine process to 14 days, rather than the seven days, and I was just really interested to understand the science behind that. Where's that—?

So, there are two sets of issues. One is quarantine for those who've been diagnosed with infection and quarantine for those who are contacts, and I think it's important to distinguish between that. Secondly, when we wrote this report—I'm trying to think back when that first report was actually published; maybe about a month or more ago—we were guided by the data that was there. I think now that if you or I were infected today, with symptoms, we would very likely have cleared the virus from our respiratory tracts within seven days. But there are cases that are coming out of maybe 10 days of shedding of virus. There's a debate about whether, in the virology literature, what is shed—whether that's just bits of the virus, or whether that's virus that can actually infect somebody. But if we're going to be clamping down on this virus and investing in this contact tracing and so on, we've just got to be mindful and we've got to make sure that we're really robust about that.

I'm now a bit more flexible on that seven to 14 days for people who are actually infected. We need to be driven by the data. But I would say, certainly, seven days alone may very well miss a few people who remain infectious.

And do you think that, if we miss those few people, it's actually critical to the overall reduction of the—? One of my fears about this whole issue is that we need to learn to accept that there is always going to be an element of risk, and I worry that we are striving for the perfect, where there's no risk, nobody has any harm, and that we're losing out on some of the things along the way. So, I just want to be really clear about whether we should be seven or 14 days in your view.

So, I fully agree with you, and we mustn't let the perfect be the enemy of the good. In medicine, you never say 'never'. There will always be the odd case, and, of course, those are being reported. So, I'm not going to stick my neck out now, but I think, particularly as prevalence of infection comes down and new data are coming out, we may want to flex that. It may be 10 days, for instance, rather than 14 days.

Can I just come in with a very quick anecdotal example? I'm sure you've all read about the two Brits who went out to New Zealand. They were isolated—they were meant to be isolated for 14 days, and they were let out after seven days to visit their relative, who was very ill. They were then found to have the disease. So, this was after the seventh day, and they'd already travelled over in a plane. The result is that more than 35 people have been put into isolation. These are their contacts over that period of time. I fear we need to err on the cautious side. I do agree we can't go for the perfect 100 per cent, but we need to get an 80 per cent response in terms of the total testing, tracing, isolation—80 per cent successful would go a very long way.

12:00

My questions are all really random, as I've gone through, so they don't hang together on a theme. Sir David, I wanted to ask you about the Imperial modelling model, which obviously SAGE and lots of people have put an awful lot of stock by, especially given your experiences during foot and mouth—because my understanding is that Imperial did the modelling for the foot-and-mouth pandemic as well. Do you think that we are right to have such faith in that model? Because, of course, I've read an awful lot of articles that say that the data in there is really old; the modelling system hasn't been uprated for 13, 15 years; that, during the foot-and-mouth pandemic, actually it produced some really ineffective results that didn't come true. So, are we right to continue to hold that up as the bible, or should we be looking at other modelling structures elsewhere, going forward?

The way you've phrased your question would imply that modelling has little use, and I really have to tell you that during—

Sorry—I just want to be very clear. I am a fan of modelling. The committee will tell you I bang on about this subject with any witness that we have, because I think it is the only way—if we have a set of assumptions, we can make educated guesses. Without modelling, without that set of assumptions, we can't make educated guesses. My concern is that the assumptions we've been using, i.e. the Imperial model—has it given us a reasonable set of assumptions, or are we actually now focusing on a set of assumptions that are so far off base that we need to recalibrate?

The key factors we needed to know in handling this epidemic I believe were essentially published on 23 January by the Chinese scientists in The Lancet. By that time, we knew roughly what the doubling period was of this disease. We were working on a smaller number of people infected on average per infected person, but, nevertheless, the main point is the doubling period was short— whether it was two to three days or five days, the doubling period was short. That is the essential piece of information you need in order to try to manage to keep the epidemic as small as possible and to get it over with as quickly as possible.

So, when we look at the modelling, I think that Neil Ferguson's data was key in saying, effectively, if we don't go into a lockdown, the number of fatalities is going to be over 200,000. Not a very difficult calculation; if you know, roughly speaking, the number who've been discovered to have the disease—nobody knows how many actually had it, but the number who are discovered—and, of that number, how many died, you can calculate what the death rate would be. This is not sophisticated modelling. The modelling that they do is really much more sophisticated than that, but I don't think it's essential that we know the details; I think we get a bit hung up on that. As it happens, the doubling rate was three to four days, and that is a critical number, and I think Neil Ferguson was at the time working with five days. So, it does make a difference, but I just don't think we can hang the blame on the modellers, except that the modellers are perfectionists and they take time. They need data, they take time to get their models up and running. 

As far as I can see, though, this is not an issue, surely, about blame. Because I believe that, in the heat of battle, you make the decisions you make, and second-guessing is the easiest of easy. I'm much more interested in understanding what modelling systems or assumptions we should use as Wales, going forward, especially if, as Professor Pillay has suggested, and in your report, that we might want to look at localised lockdown areas—you know, responses to local infections—because we've got to go out and explain that really easily to people and I want to ensure that we are using the correct set of assumptions. So, if you can say to me, 'Do you know what, Imperial was fine for then, but this is what the better systems are now?' That's what we need to know. 

12:05

Just to quickly add to Sir David's comment, I also do support modelling in the absence of data; it's very useful. I think it's also what assumptions and what interventions are modelled that are also important. It's a bit of an anecdote but, nevertheless, it's important. And I've certainly asked all the modelling groups why they did not model early on what the projected impact of a full test and trace strategy would be. The answer was they were told at the time that that was not feasible. It's an interesting way in which political constraints at the time impact directly into models. And so, all I'd ask, then, is that we really do include all the things that we can imagine a locality can do to clamp down on infection in terms of future modelling, which I think the teams are starting to do.  

Well, that's a bit of a hint, isn't it? [Laughter.] I just wanted to—. All right. The last question, I guess, I'd like to try to check out with you is the reporting of death, and if you think that there is any significant analysis to be done in terms of understanding those who died of COVID to those who've died with COVID, and whether the assumption is that if you had COVID anyway and even if you died of a terminal cancer, that the COVID would have played a significant part. The reason why I'm asking this, again, is that it is all about the data, and your report is quite clear, actually, that the data—. And I can tell you, Wales is no better either—some of our data collection is pretty poor and our data analysis, therefore, is not great. So, I just wanted to understand from you just your opinion on this issue about dying of COVID and with COVID, and the differences that would make in interpretation of the numbers, which, in turn, would lead to difference in, perhaps, assumptions going forward. 

Can I just come in very quickly? If we take the average 80-year-old male in this country, in the UK, what is their anticipated lifespan? Regardless of precondition, it's about 89. If you then take somebody with preconditions that may be quite serious, it's still around 85. So, if we're trying to say that somebody who has died with COVID-19 but had other conditions and has therefore died earlier, we've just got to be very careful about the exact number of months or years that that person has lost. And I think this is where the mistake is being made in the statement that was made yesterday.

I agree; it is a complex issue. It needs to be dealt with properly, but we should not forget—and it's not something that's come up—the excess non-COVID deaths that are happening at the moment as well. And it is very worrying for me, because we're all told that the NHS has coped with the pandemic, and I would argue that it has not coped with the pandemic in terms of the non-COVID activity—people dying at home from myocardial infarctions and strokes, and so forth, which would have been preventable. So, I would also suggest that that also becomes part of the assessment of excess mortality as a result of COVID. 

It's an issue that's been raised by the society of pathologists, and you're absolutely correct: it's one of the things that taxes us, in terms of the non-COVID harms, whether it's to the economy or to somebody's health. If you had a set of scales, the non-COVID harms may well be weighing far more than the harms we could have had from COVID. Now, of course, that is entirely different to saying, 'Well, perhaps we should have just let it all happen', because nobody thinks that. But, at some point we have to make a—[Interruption.]

12:10

Yes. I am afraid I'm going to have to withdraw—

I'm just wondering perhaps if Professor Pillay could just answer that. Do we think that—? When do you think we're going to be brave enough to accept politically, scientifically, nationally that at some point we have to know when we've got to the tipping, where we have to say, 'Actually, we now have to stop all of this, because we must address this and rebalance'?

Yes, it's a really difficult issue. The other component of this is the timing, because, I think, as someone else asked earlier on, issues such as mental health issues will be longstanding. Loss of diabetes control will lead to longstanding morbidity, late diagnosis of cancer will mean that people are at a further stage of cancer by the time they come to treatment.

So, the consequences of this will be over a much longer time period, and, therefore, the response of the NHS to that needs to be modified. It's not an answer, but in terms of what we do now in terms of planning, I think what I've seen, both in terms of my own hospital, where I work, as well as another hospital where I'm a non-executive director, is that they estimate it's going to take some years before, actually, we've all caught up with that. And by that time, of course, there will be excess mortality. So, all I would suggest, and it's no different for any of us—Wales, England—is that the planning now for coming out of the lockdown, coming out of COVID, does really address seriously this longstanding backlog there is within the health service and other social care provision. 

It's on the list of things to do. Of course, there are many other issues. The next report—just if I can take this time for a plug—we're planning is on how disadvantage has really impacted on the impact, both for individuals as well as communities. But, there's no doubt, the longer term, we will have to address this issue. 

Great. We're well out of time. I'm grateful for everybody's patience. Cracking session, I have to say. Thank you very much indeed.

Diolch yn fawr iawn i Syr David King, cadeirydd SAGE Annibynnol, a hefyd i'r Athro Deenan Pillay, aelod o SAGE Annibynnol. Sesiwn fendigedig. Rydym ni'n wirioneddol yn gwerthfawrogi eich presenoldeb a hefyd yr holl waith sydd yn mynd ymlaen yn y cefndir. Gallaf bellach gadarnhau y byddwch chi'n derbyn trawsgrifiad o'r trafodaethau yma er mwyn ichi allu gwirio eu bod nhw'n ffeithiol gywir. Ond gyda chymaint â hynny o ragymadrodd, diolch yn fawr iawn am eich presenoldeb, a dyna ddiwedd yr eitem yna. Diolch yn fawr iawn i chi.

Thank you very much to Sir David King, chair of Independent SAGE, and also to Professor Deenan Pillay, member of Independent SAGE. An excellent session. We very much appreciate your presence and all of the work that's going on behind the scenes. May I confirm also that you'll be receiving a transcript of today's discussions, so that you can check them for factual accuracy? But with those few words, thank you very much for your attendance this morning, and that brings us to the end of that item. Thank you.

6. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
6. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

Ymlaen i'm cyd-Aelodau, rydym ni'n symud ymlaen i eitem 6 a chynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o weddill cyfarfod heddiw. Ydy pawb yn cytuno? Pawb yn gytûn. Felly, dyna ddiwedd y cyfarfod cyhoeddus, ac fe awn ni fewn i gyfarfod preifat nawr. Diolch yn fawr. 

And for my fellow Members, we move on to item 6 on the agenda, and a motion under Standing Order 17.42(ix) to resolve to exclude the public for the remainder of today's meeting. Is everyone content? Everyone is content. So, that brings us to the end of the public meeting. We'll go into private session now. Thank you very much. 

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 12:14.

Motion agreed.

The public part of the meeting ended at 12:14.