development of mers special instructional video on ppe level and use. numberfour, to develop instructional video on ppe level and use. number four, to develop a mers serology— use. number four, to develop a mers serology procedure, that's blood tests _ serology procedure, that's blood tests searching for antibodies, to include _ tests searching for antibodies, to include a — tests searching for antibodies, to include a plan for a process to scale — include a plan for a process to scale up — include a plan for a process to scale up capacity. number seven, to produce _ scale up capacity. number seven, to produce an _ scale up capacity. number seven, to produce an options plan using extant evidence _ produce an options plan using extant evidence and cost benefits for quarantine versus self isolation for a range _ quarantine versus self isolation for a range of— quarantine versus self isolation for a range of contact types, including symptomatic, asymptomatic and high risk groups. and just going back up the page to number— and just going back up the page to number five, to produce a paper on the south _ number five, to produce a paper on the south korean outbreak with details — the south korean outbreak with details on the cases in response and consider— details on the cases in response and consider a _ details on the cases in response and consider a direct application to the uk, including port of entry screening. you may be aware that professor — screening. you may be aware that professor heyman gave evidence to the inquiry— professor heyman gave evidence to

the inquiry last thursday, and he told the — the inquiry last thursday, and he told the inquiry that he thought that recommendation five was an extremely— that recommendation five was an extremely good idea to learn from the experiences of south korea is in terms _ the experiences of south korea is in terms of— the experiences of south korea is in terms of their response to mers and to see _ terms of their response to mers and to see how— terms of their response to mers and to see how those matters could be possibly— to see how those matters could be possibly adapted to the united kingdom in the event of a similar pandemic — kingdom in the event of a similar pandemic. do you agree that was a useful— pandemic. do you agree that was a useful and — pandemic. do you agree that was a useful and important recommendation? yes, useful and important recommendation? yes. i_ useful and important recommendation? yes. i do _ useful and important recommendation? yes, ido. ministers useful and important recommendation? yes, i do. ministers won't involved but there's a sentence in alice which is access to sufficient levels of ppe was also considered and pandemic stockpiles were suggested. that is a sentence in alice but doesn't make it into the recommendation. so if you're asking does it look like they were a failure to follow through from theirs, i think the answer to that is yes. fist

theirs, i think the answer to that is es. �* theirs, i think the answer to that is es. ~ . , is yes. at the same time, there was another exercise _ is yes. at the same time, there was another exercise it _ is yes. at the same time, there was another exercise it being _ is yes. at the same time, there was another exercise it being planned, l another exercise it being planned, and although this was not delivered by public health england until you had left office, in fact it took place over two days between the 18th and 20th of october 2016, planning for this exercise began in 2014 it but was postponed due to the ebola response. where you aware at the time that this was being planned? i'm afraid ijust don't recall. i haven't anything from i know from an official saying this is going on. i have notes for me tojeremy hunt saying let's do an exercise in ebola and i do remember that but i don't remember — that doesn't me and i did not quite get a note on it but i haven't been able to find out and i don't think

you have either? irate able to find out and i don't think you have either?— able to find out and i don't think you have either? we have not. this was an organisation _ you have either? we have not. this was an organisation to _ you have either? we have not. this was an organisation to assess - was an organisation to assess preparation to pandemic, the inquiry is heard _ preparation to pandemic, the inquiry is heard about it and were continue to do— is heard about it and were continue to do so, _ is heard about it and were continue to do so, trut— is heard about it and were continue to do so, but to do so, but at about 950 representatives from the devolved administrations, the department of health, 12 government departments, nhs england, public heatth— departments, nhs england, public health england and eight local resilience forums and six persons took— resilience forums and six persons took part— resilience forums and six persons took part in— resilience forums and six persons took part in the exercise, huge in terms _ took part in the exercise, huge in terms of— took part in the exercise, huge in terms of the organisation. i'd like to look— terms of the organisation. i'd like to look briefly at some of the recommendations from this exercise, white _ recommendations from this exercise, while acknowledging using again that you had _ while acknowledging using again that you had left office at the time this report— you had left office at the time this report was— you had left office at the time this report was produced. could we go to pa-e report was produced. could we go to page 30? _ report was produced. could we go to page 30? we can see that here we have the _ page 30? we can see that here we have the table of lessons identified. i'm going to move through— identified. i'm going to move through these quite swiftly because

the common theme of the recommendations that i'm going to highlight— recommendations that i'm going to highlight is capability, capacity in health— highlight is capability, capacity in health and social care. we can see, an effective — health and social care. we can see, an effective response to pandemic influenza — an effective response to pandemic influenza requires the capability and capacity to surge resources into key areas. — and capacity to surge resources into key areas, which in some areas is currently— key areas, which in some areas is currently lacking. further down the page. _ currently lacking. further down the page, further work is required... where _ page, further work is required... where have _ page, further work is required... where have we got now? further up the page. _ where have we got now? further up the page, please. thank you. further work is _ the page, please. thank you. further work is required to inform consideration of the issues related to the _ consideration of the issues related to the possible use of population—based triage during a reasonable worst—case influenza pandemic. next, please. thank you. expectations of the mit's capacity to assist— expectations of the mit's capacity to assist men a worst—case scenario influenza _ to assist men a worst—case scenario influenza pandemic should be considered as part of a cross

government review of pandemic ptenning~ — government review of pandemic planning. next, please. the process and timelines for providing and best presenting data on which responders will make _ presenting data on which responders will make strategic decisions during an influenza pandemic should be clarified — an influenza pandemic should be clarified. next, please. a methodology for assessing social capacity — methodology for assessing social capacity and surge capacity during a pandemic— capacity and surge capacity during a pandemic should be developed, this should _ pandemic should be developed, this should be _ pandemic should be developed, this should be conducted with directors of adult _ should be conducted with directors of adult social services and colleagues within the default administrations. and finally, department of health nhs england, this ecs— department of health nhs england, this ecs and the voluntary sector and relevant authorities in the devotved _ and relevant authorities in the devolved administrations should work together— devolved administrations should work together to propose a method for mapping — together to propose a method for mapping the capacity of an providing strategic— mapping the capacity of an providing strategic national direction to voluntary resources during a pandemic. given the exercise of the exercise. _ pandemic. given the exercise of the exercise. its— pandemic. given the exercise of the exercise, it's reminded this work draws— exercise, it's reminded this work draws on— exercise, it's reminded this work draws on the expertise of non—health

departments and other organisations at national— departments and other organisations at national and local level. starting _ at national and local level. starting pack for a moment, and mr cameron, _ starting pack for a moment, and mr cameron, and considering that these recommendations were made in october 2016, recommendations were made in october 2016. which— recommendations were made in october 2016, which you have expected the government to have implemented the lessons _ government to have implemented the lessons learned from exercise cygnus tryjanuary_ lessons learned from exercise cygnus by january 2020?— by january 2020? security... i don't really want — by january 2020? security... i don't really want to _ by january 2020? security... i don't really want to comment _ by january 2020? security... i don't really want to comment on - by january 2020? security... i don't really want to comment on my - really want to comment on my successors, but you would hope so. i thought a lot about this because, having been the fact through all the paperwork, i haven't found any moments when i was answering some of the treasury was asked to approve surge capacity for ppe supplies are anything like that. i think that's because there wasn't enough attention on the sort of pandemic we ultimately experienced, but i don't

recall any recommendations like that. but these are quite clear and i think that the treasury, money was tight and we made it decisions about public spending, though when we did need to spend money on important priorities, when we had to spend money on ebola, we did and we would. before we come to deal with austerity and the effects of that on health _ austerity and the effects of that on health and public health, i clockwatch like to draw together the lessons _ clockwatch like to draw together the lessons that we have just seen identified in these exercises. in exercise — identified in these exercises. in exercise alice, we saw recommendations of a need to plan for scaling — recommendations of a need to plan for scaling up testing capacity for isolation — for scaling up testing capacity for isolation and self—isolation options. _ isolation and self—isolation options, for asymptomatic transmission and decisions for the provision — transmission and decisions for the provision of — transmission and decisions for the provision of ppe. do you know what of those _ provision of ppe. do you know what of those matters were addressed during _ of those matters were addressed during your time of those matters were addressed during yourtime in

of those matters were addressed during your time in office? what i know is there _ during your time in office? what i know is there was _ during your time in office? what i know is there was capacity - during your time in office? what i know is there was capacity for - know is there was capacity for isolation, when we had the ebola outbreak in africa and there were some cases in the uk, but i would say the problem with alice was that it was a mers outbreak with a very high degree of mortality, at 35% mortality, but a very low caseload. again, that wasn't anywhere close to the sort of pandemic we then experienced. br; the sort of pandemic we then experienced.— the sort of pandemic we then experienced. the sort of pandemic we then exerienced. �* , , ., experienced. by the time you left office, to accept, _ experienced. by the time you left office, to accept, and _ experienced. by the time you left office, to accept, and mr- experienced. by the time you left i office, to accept, and mr cameron, that had _ office, to accept, and mr cameron, that had not— office, to accept, and mr cameron, that had not been any planning specifically of the effects of a pandemic. about that, i mean this, that had _ pandemic. about that, i mean this, that had been no planning for incense — that had been no planning for incense by the department for education about the impact of school ctosures. _ education about the impact of school closures, had there? i education about the impact of school closures, had there?— closures, had there? i don't know the answer _

closures, had there? i don't know the answer to _ closures, had there? i don't know the answer to the _ closures, had there? i don't know the answer to the bundle, - closures, had there? i don't know the answer to the bundle, there l closures, had there? i don't know| the answer to the bundle, there is mention of school closures in relation to, is it signet? it mention of school closures in relation to, is it signet? it was raised. during _ relation to, is it signet? it was raised. during my— relation to, is it signet? it was raised. during my time - relation to, is it signet? it was raised. during my time in - relation to, is it signet? it was l raised. during my time in office, there were _ raised. during my time in office, there were investigations - raised. during my time in office, there were investigations into i there were investigations into psalms virus and mers and other types of pandemic, including ebola, but there wasn't one into a highly transmissible coronavirus—style pandemic like we had, it so these questions weren't asked. eaten pandemic like we had, it so these questions weren't asked.- questions weren't asked. even in relation to _ questions weren't asked. even in relation to an — questions weren't asked. even in relation to an influenza - questions weren't asked. even in l relation to an influenza pandemic, which _ relation to an influenza pandemic, which has — relation to an influenza pandemic, which has been a tier1 risk the whole — which has been a tier1 risk the whole time in office, here we have the exercise reporting just after you left — the exercise reporting just after you left office that there should be ptans _ you left office that there should be plans and — you left office that there should be plans and research into the effect of school — plans and research into the effect of school closures in the event of a

pandemic — of school closures in the event of a pandemic. that have been done, it was being — pandemic. that have been done, it was being raised on a recommendation in sickness _ was being raised on a recommendation in sickness because that planning had what — in sickness because that planning had what was being done in? as far as i can had what was being done in? as far as i can see. _ had what was being done in? as far as i can see, that _ had what was being done in? as far as i can see, that was _ had what was being done in? as far as i can see, that was the - had what was being done in? as far as i can see, that was the first - had what was being done in? as far as i can see, that was the first of i as i can see, that was the first of its rights, after i left office. yes, which means that type of planning — yes, which means that type of planning was absent during your time in office _ planning was absent during your time in office |_ planning was absent during your time in office. . �* , ,., in office. i haven't seen report while i in office. i haven't seen report while i was — in office. i haven't seen report while i was in _ in office. i haven't seen report while i was in office _ in office. i haven't seen report while i was in office saying - in office. i haven't seen report| while i was in office saying that sort of planning should be done, because the pandemic preparedness plan, which had been worked out by previous government and then i meant and improved and enhanced during my time in office, there were lots of recommendations made in all there were lots of recommendations made and also things are bad stockpiles of tamiflu and all the rest of it, but denmark were going to things like school closures. had but denmark were going to things like school closures.— but denmark were going to things like school closures. had been any ”lannin like school closures. had been any planning of — like school closures. had been any planning of the — like school closures. had been any planning of the political, _ like school closures. had been any planning of the political, social- planning of the political, social and economic consequences of restrictions in the event of a pandemic? thompson took the answer to that _ pandemic? thompson took the answer to that is, _ pandemic? thompson took the answer to that is, first of all, our whole

economic— to that is, first of all, our whole economic strategy was about safeguarding the economy and the nation's finances so we could cope with whatever crisis hit us next month but i think that's incredibly important because there's no resilience without economic, financial and fiscal resilience. so that was absolutely by one of our plan for dealing with any unexpected crises. also, ithink plan for dealing with any unexpected crises. also, i think i'm plan for dealing with any unexpected crises. also, ithink i'm right plan for dealing with any unexpected crises. also, i think i'm right in saying that in the national risk registers emo 2014 and subsequently, there was quite a lot of examination of how to respond to different, catastrophic economic problems that these sort of pandemics would bring about. there was a national business resilience planning going through a area by area, looking at what you might have to do. but i think all of those, a plan is only as good as the

financial and economic capacity of the country to deliver it, and that was the most important thing of all. utilita inquiry that as soon as she came into office in 2010 and you made significant improvements to the architecture of planning and resilience that one of your major intentions was that resilience that one of your ma'or intentions wa— resilience that one of your ma'or intentions was that that would lead to a whole system _ intentions was that that would lead to a whole system of— intentions was that that would lead to a whole system of level - intentions was that that would lead to a whole system of level of - to a whole system of level of preparedness. do you accept that you faited _ preparedness. do you accept that you failed in _ preparedness. do you accept that you failed in that desire by the time you left— failed in that desire by the time you left government in 2016, their wasn't _ you left government in 2016, their wasn't wholesale preparation and resilience? | wasn't wholesale preparation and resilience? ., �* wasn't wholesale preparation and resilience? , . resilience? i don't accept that because we — resilience? i don't accept that because we set _ resilience? i don't accept that because we set up _ resilience? i don't accept that because we set up a - resilience? i don't accept that because we set up a much - resilience? i don't accept that - because we set up a much superior architecture for looking at risks and judging risks and planning for risks. and that's what they national risks. and that's what they national risk register, the national security

secretariats, at the national security council did and think there was more attention onto those sorts of risks than there had been previously. but as i said, the problem was that when pandemics were looked at, there was too much emphasis on pandemic flu, and when other pandemics were looked at, including ebola, including mers, they tend to be high for charity but low infection. the regrets you see in oliver letwin's evidence and in george osborne's evidence is that more questions weren't as about the pandemic we faced. but i think many other countries are in the same boat, of not knowing what was coming. but i think we did more than many to scan the horizon and to try and plan. we did work on ebola, which it exercises, we try to change that national dynamic on these things and we planned and prepared

in accordance with that. the evidence — in accordance with that. the evidence of _ in accordance with that. the evidence of professor alexander, received — evidence of professor alexander, received by the inquiry last thursday, it included them posing this question — who— this question — who is in charge of keeping the country— who is in charge of keeping the country save? what is your answer to that question? a country save? what is your answer to that question?— that question? a prime minister is alwa s in that question? a prime minister is always in charge — that question? a prime minister is always in charge of _ that question? a prime minister is always in charge of keeping - that question? a prime minister is always in charge of keeping the i always in charge of keeping the country safe and onto my reforms, the prime minister was more actively involved because he was chairing the national security council, the national security adviser was appointed by him, reported to him, and in my specific case, i set up an inquiry which looked exactly at this area with a highly capable minister in. i'm sure there are further improvements we could make which seem sensible to me, with the proviso i made, but at the pinnacle of it must be the prime minister, because all my period of chairing of it must be the prime minister, because all my period of chairing cobra, whether it was terrace cobra, whether it was terrace

problems, her problems, her consumer, disasters, a bowler or anything else, the system works extremely well but the system works extremely well but the system works better when the prime minister is in the chair, asking questions, are driving changes in making sure changes are made. some answer the prime minister. we have dealt with your concerns around _ we have dealt with your concerns around the — we have dealt with your concerns around the world health organization and how— around the world health organization and how you sought to deal with those _ and how you sought to deal with those and — and how you sought to deal with those and i'm now going to move on to the _ those and i'm now going to move on to the final— those and i'm now going to move on to the final area of questioning, the impact of austerity on the health— the impact of austerity on the health and social care service and underlying — health and social care service and underlying health inequalities. i would _ underlying health inequalities. i would like to