Welsh Government criticised strongly again at Covid Inquiry

The Welsh Government’s “Test, Trace and Protect” programme during the pandemic was chaotic, with policies ill-thought-out, ineffective and delivered late, the UK Covid-19 Inquiry has been told.

Naomi Parsons, a barrister representing the group Covid Bereaved Families for Justice Cymru, told how residents of care homes had caught the virus and died after patients were discharged from hospitals into care homes without being tested.

She said the group was keen to understand why policies between Wales and elsewhere in the UK diverged as they did, and why they were implemented late.

Ms Parsons said: “Within the programme in Wales, a key concern relates to testing. From very early on, Wales went down its own path. First, its value was denied or overlooked. Then when accepted, implementation was delayed.

“Concerns were raised in a letter from MPs on April 30 2020 to the then First Minister Mark Drakeford. They wrote this: ‘We write with alarm in respect to the disparity that now exists in Covid-19 testing availability between England and Wales.’ The letter then went on to outline the headline disparities.

“In Wales, availability of testing was limited to symptomatic key workers and their family members. By contrast, in England testing was much more widely available. A crucial difference was that testing was available to all key workers and all care home residents whether symptomatic or not.

“In addition, the symptoms required to get a test were also restricted. There was evidence as early as April 2020 that Covid-19 involved a broader range of symptoms than the cardinal three, fever, cough, and loss of smell. But the failure to expand the range of symptoms for testing in Wales, even when the wider symptoms were widely known, is unexplained and likely resulted in the further transmission of the virus.”

Routine testing

Ms Parsons said a key issue for the group was the failure of the Welsh Government to provide routine testing in care homes: “Mr Drakeford’s comments on this issue are concerning. On April 29 2020, he told the Senedd that routine tests were not offered in care homes because the clinical evidence tells us there is no value in doing so. His own head of science, Robert Hoyle, wondered what the rationale, evidence and advice was behind Mr Drakeford’s comment.

“Again, on June 5 2020, Mr Drakeford told the Senedd he had not seen any clinical evidence that led him to believe that testing of non symptomatic residents and staff in care homes where there was no coronavirus in circulation had any clinical value.

“On May 16 2020, the Welsh Government finally changed its position, almost three weeks after England, and introduced some routine testing in care homes. It was confined to large care homes for reasons not at all clear to those working in care homes and only expanded to all care homes in mid June 2020. In the context of this most vulnerable population, these delays are significant as explained by care homeowners in Wales.”

Ms Parsons said the owner of one care home in Newport had reported how she first observed symptoms on March 20 2020. She requested tests from Public Health Wales, but none were available. Three days later, the care home had its first death. Within a few weeks, 14 residents had died. Public Health Wales had visited the care home in that period just once, testing just three residents.

Asymptomatic transmission

Similarly, the owner of a care home in North Wales had reported how she had campaigned extensively for routine testing because of the risks of asymptomatic transmission. She knew that her residents were falling ill and dying within 48 hours of becoming symptomatic. No testing had been made available by Public Health Wales, not even for those with symptoms. Delays in testing, in particular routine testing, were unexplained.

Ms Parsons said: “Testing in hospitals in Wales followed a similar pattern with delays in the introduction of routine testing, insufficient levels of testing, and patchy implementation. This was the case both for health care workers and for patients. As to health care workers, the British Medical Association has described the wait to introduce routine health care testing in Wales as inordinate. It was not until December 14 2020 that Wales commenced a policy of routine testing twice weekly for health care workers – that same policy having been introduced in England a month earlier.

“However, most health boards in Wales did not implement routine testing of health care workers until March 2021, and in one case, as late as July 2021. Furthermore, whilst the policy mandated testing twice weekly, in practice it only took place every five days. As to patients, whilst the Welsh Government announced routine testing on admission in June 2020, in practice routine testing was not done until much later on, and even then, not consistently. It was not until January 28 2021 that the Welsh Government introduced repeat testing every five days for asymptomatic patients. However, many patients waited many more days for repeat testing in what felt like a testing lottery.

“One member recalls how in December 2020, her loved one was admitted to hospital with a non-Covidrelated issue, and his health rapidly deteriorated. However, he was not tested until his fourth day following admission. Instead, he underwent a series of intrusive and invasive tests during that period. When eventually tested for Covid, it was positive. He was discharged without a further test and later died from Covid.”

Hospital acquired

Ms Parsons said that 39% of cases of Covid-19 in January 2021 in Wales were hospital acquired, adding: “Given the availability of testing and given the knowledge by then that testing would reduce transmission within hospitals, why was routine testing subject to such an inordinate delay? Why was testing not implemented consistently in accordance with the levels required by policy?”

Andrew Kinnier KC, representing the Welsh Government, told the Inquiry: “The Welsh Government recognises it should have acted more swiftly in respect of testing of patients being discharged from hospital to care home settings. In short, there ought not to have been a delay between April 15 2020, when the risk came to the fore, the announcement of the new approach in joint letters of April 22 and 24 2020, and the ultimate publication of guidance on April 29.

“The Welsh Government is sorry for that delay, and most particularly to those affected by it.”

“However the Welsh Government does not believe it unreasonably delayed the introduction of asymptomatic testing.”

Anna-Loise Marsh-Rees, the lead campaigner for the Welsh bereaved group, told the Inquiry: “We are very pleased to hear just now that the Welsh Government has finally apologised for the delay in discharging those from hospitals to care homes. It was a massive impact, but what we’d like an apology for and an explanation for is why there was no testing of anyone in care homes, neither staff nor residents.”

She added: “It is almost preposterous for a government to say they did not know Covid was asymptomatic.

“And to hear Mark Drakeford throughout that time saying there was no value to asymptomatic testing – what was that? We will look forward to finding out where he got his clinical advice from, because it seemed that everyone else differed from that clinical judgement.”