Standing Committee of Tynwald on Public Accounts

PP 2020/0118

STANDING COMMITTEE OF TYNWALD ON PUBLIC ACCOUNTS

EMERGENCY SCRUTINY

FOURTH REPORT FOR THE SESSION 2019-20

DECISION MAKING, RISK, AND EXITING THE EMERGENCY

STANDING COMMITTEE OF TYNWALD ON PUBLIC ACCOUNTS EMERGENCY SCRUTINY FOURTH REPORT FOR THE SESSION 2019-20 DECISION MAKING, RISK, AND EXITING THE EMERGENCY

3.1 There shall be a Standing Committee of the Court on Public Accounts.

3.2 Subject to paragraph 3.6, the Committee shall have –

(a) a Chairman elected by Tynwald,

(b) a Vice-Chairman elected by Tynwald,

(c) four other Members, who shall be Chairman of each of the Policy Review Committees (ex officio) and the Chairman of the Committee on Constitutional and Legal Affairs and Justice;

and a quorum of three.

3.3 Members of Tynwald shall not be eligible for membership of the Committee, if, for the time being, they hold any of the following offices: President of Tynwald, member of the Council of Ministers, member of the Treasury Department referred to in section 1(2)(b) of the Government Departments Act 1987.

3.4 The Committee shall –

(a) (i) consider any papers on public expenditure and estimates presented to Tynwald as may seem fit to the Committee;

(ii) examine the form of any papers on public expenditure and estimates presented to Tynwald as may seem fit to the Committee;

(iii) consider any financial matter relating to a Government Department or statutory body as may seem fit to the Committee;

(iv) consider such matters as the Committee may think fit in order to scrutinise the efficiency and effectiveness of the implementation of Government policy; and

(v) lay an Annual Report before Tynwald at each October sitting and any other reports as the Committee may think fit.

(b) be authorised to require the attendance of Ministers for the purpose of assisting the Committee in the consideration of its terms of reference.

(c) be empowered to issue directions under Standing Order 5.6(3), provided that any direction so issued shall be reported to Tynwald within a year. (d) be the Accounts Committee referred to in section 3 of the Tynwald Auditor General Act 2011, with the relevant powers and responsibilities in relation to the Tynwald Auditor General; and

(e) be the Tynwald Public Accounts Committee referred to in section 3 of the Tynwald Commissioner for Administration Act 2011, with the relevant powers and responsibilities in relation to the Tynwald Commissioner for Administration.

3.5 The Chairman, Vice-Chairman and any member of the Committee shall not sit when the accounts of any body of which that person is a member are being considered.

3.6 Should the need arise in relation to a particular matter, such as a conflict of interest, Tynwald may elect an alternate member for the purpose and duration of the Committee’s consideration of that matter. Subject to paragraph 3.5, a conflicted member so replaced shall continue to serve as a member of the Committee for all other purposes.

The powers, privileges and immunities relating to the work of a committee of Tynwald are those conferred by sections 3 and 4 of the Tynwald Proceedings Act 1876, sections 1 to 4 of the Privileges of Tynwald (Publications) Act 1973 and sections 2 to 4 of the Tynwald Proceedings Act 1984. Committee Membership

The Hon J P Watterson SHK (Rushen) (Chairman) Mr L L Hooper MHK (Ramsey) (Vice-Chairman) Mr R E Callister MHK (Onchan) Ms J M Edge MHK (Onchan) Mrs J Poole-Wilson MLC Mr C R Robertshaw MHK (Douglas East) Copies of this Report may be obtained from the Tynwald Library, Legislative Buildings, Finch Road, Douglas, IM1 3PW (Tel: 01624 685520) or may be consulted at www.tynwald.org.im

All correspondence with regard to this Report should be addressed to the Clerk of Tynwald, Legislative Buildings, Finch Road, Douglas, Isle of Man, IM1 3PW. Table of Contents

I. EXECUTIVE SUMMARY...... 1

Where we are now...... 3

II. COMMITTEE MEMBERSHIP...... 3

III. EMERGENCY SCRUTINY...... 4

IV. DECISION MAKING, RISK, AND EXITING THE EMERGENCY...... 4

SCOPE AND APPROACH 4

DECISION MAKING 5

PROFESSIONAL ADVICE ON RISK 8

RELAXATION OF LOCKDOWN 9

EMERGENCY POWERS 14

THE WAY FORWARD 17

Social distancing ...... 17

Masks...... 17

Immunity and testing...... 18

Borders...... 19

COMMUNICATION 21

ANNEX 1: PAC EMERGENCY SCRUTINY – BRIEFING PAPER...... 23

ANNEX 2 CASES COMPARISON - UNITED KINGDOM AND THE REPUBLIC OF IRELAND 33

APPENDIX 1 LETTER FROM HM ATTORNEY GENERAL 27 MAY 2020 35

APPENDIX 2 EMAIL FROM DR HENRIETTA EWART DIRECTOR OF PUBLIC HEALTH 14 MAY 2020 43

APPENDIX 3 EMAIL FROM PETER BOXER EXECUTIVE DIRECTOR CROWN AND EXTERNAL RELATIONS DIRECTORATE 29 MAY 2020 47

APPENDIX 4 ISLE OF MAN INTERIM STRATEGIC PANDEMIC INFLUENZA PLAN 2020 51

APPENDIX 5 ISLE OF MAN GOVERNMENT PANDEMIC FLU A STRATEGIC PLAN FOR PREPARING AND RECOVERING FROM AN INFLUENZA PANDEMIC IN THE ISLE OF MAN 2009 73

APPENDIX 6 LETTER FROM HON CHRIS THOMAS MHK 20 MAY 2020 125

To: The Hon Stephen C Rodan OBE MLC, President of Tynwald, and the Hon Council and Keys in Tynwald assembled

STANDING COMMITTEE OF TYNWALD ON PUBLIC ACCOUNTS EMERGENCY SCRUTINY FOURTH REPORT FOR THE SESSION 2019-20 DECISION MAKING, RISK, AND EXITING THE EMERGENCY

I. EXECUTIVE SUMMARY

1. As one of the early jurisdictions to successfully ‘flatten the curve’, we also became one of the first to start grappling with the complexities of emerging from lockdown towards a ‘new normal’1.

2. Our thoughts now turn to how close to normality we can get, without undermining that success. Whilst our closest neighbour has the third highest mortality rate per million populous2, there is rightly little appetite to open our

1 WHO Situation Report 132 - 31/5/20 https://www.who.int/docs/default- source/coronaviruse/situation-reports/20200531-covid-19-sitrep-132.pdf?sfvrsn=d9c2eaef_2 accessed 31 May 2020 - Only four jurisdictions have had over 300 cases and 9 days or more since the last confirmed case: New Zealand, Tanzania, Montenegro, and the Isle of Man. 2 569 deaths per million population puts the UK third behind Belgium (822) and Spain (580) and ahead of Italy (548). https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per- million-inhabitants/ accessed 31 May 2020

1 borders3. However, domestically, with the reduced health risks there is pressure to allow businesses to open and for greater personal freedoms.

3. We have seized on Government’s repeated assertion that they are open to suggestions, and offer a number in this document.

4. The Committee believe that the first key is to transition out of Emergency Powers. As the Chief Minister said, ’Now that we are taking another step out of people’s lives, we will need to entrust even more decision making to the public. I have faith that they will respond and rise to this challenge.’4 There can be no clearer demonstration of that trust on Government’s part than reducing legislation and regulation as far as possible, and replacing it with advice and best practice. This will also reduce inconsistency in legislation, and ensure achievable and consistent enforcement. We set out our thoughts about how this can be achieved in more detail starting at paragraph 45.

5. Amongst the more immediate actions to be considered will be modifications to the Public Health Act 1990, to include provisions for custody and fixed penalties if still considered justified in light of recent experience, as well as power to amend the secondary legislation made under that Act. We also welcome Government’s commitment to review the Emergency Powers Act before the end of this administration.5

6. Government committed to an 8-14 day cycle of reviews before making policy announcements. This appears to have been subverted as economic pressure has triumphed over declining case numbers. It did so based on a decision framework, but has not routinely published the assessment of that framework. We welcome the fact that this will be done going forward.6 We remain concerned that there remains no objective test as to Manx, UK or Irish conditions for reopening the borders (or different ‘corridors’ for off-island travel) and under what circumstances. We believe this is essential to allow people to plan going forward and understand what Government’s level of acceptable risk is in phasing the reopening of the border.

3 Although in light of our previous report, we welcome the increased emphasis and capacity on getting Manx residents home in a more dignified manner. 4 Hansard, Tynwald 19/5/20 lines 956-958 5 Tynwald Hansard 21 Apr 2020 ll654-656 6 Appendix 3

2 7. Our reflections as public representatives are that confidence is markedly different across different sections of our community. The more vulnerable are most sensitive to a hasty ‘return to normal’, whilst others have flocked to pack out Port Erin beach over the hot late May weekend. It is at this point that scientific evidence and good communications are key. We have identified a need for public health to take a more prominent role in communications which, alongside the publication of the evidence and risk assessments used for decision making, should add to public confidence. Prominent publication on the website of key data and our current status, as seen in New Zealand’s model7 will also aid public understanding of the current situation. We would also welcome publication of the Government’s communication strategy.

Where we are now

8. In terms of the Medium Term Plan, it has been over a month since we exited ‘Stage One: Stay at Home’. We are now working through the 6 ‘phases’ of the Economic response,8 and currently find ourselves set to enter phase 4 – lifestyle and tourism. In many areas we are on the brink of level 3, the ‘new normal’, with schools reopening and a greater ability to gather in groups.

9. In terms of the decision making framework, we have no reason to believe that we have deviated from a ‘green’ status of health readiness.9 However, due to an absence of published data, we cannot ascertain whether we remain at ‘amber’ status regarding social pressures, and ‘red’ status regarding economic pressures.

10. Government said the medium term framework was based around the principles of ‘Consistency, Clarity, Openness, Balance and Listening’. It would be good to look at a number of decisions through this lens.

II. COMMITTEE MEMBERSHIP

11. Following his recent appointment as a Member for the Cabinet Office, Mr Hooper did not take part in this inquiry.

7 https://covid19.govt.nz/alert-system/ accessed 31 May 2020 8 Stay Safe Isle of Man Government medium-term response to COVID-19 GD 2020/0013 https://covid19.gov.im/media/1198/stay-safe-iom-government-medium-term-response-to-covid-19- cdim.pdf accessed 30 May 2020 p19 9 Stay Safe Isle of Man Government medium-term response to COVID-19 GD 2020/0013 p12

3 III. EMERGENCY SCRUTINY

12. Our approach to scrutiny during the current emergency was set out in detail in our first report.10 Our objectives are:

 to promote a timely conduit for effective scrutiny;  act as a critical friend, adding value as opposed to detailed retrospective analysis; and  assist the Government in getting its message across.

IV. DECISION MAKING, RISK, AND EXITING THE EMERGENCY

Scope and Approach

13. We held two evidence sessions focused on this topic as, following the publication of the Isle of Man Government’s Stay Safe Medium Term Response to COVID-1911 on 4 May 2020, we wanted to discuss the plans for moving out of the state of emergency and felt that such a far reaching topic would need more than one hour.

14. On 22 May we met with the Chief Minister, Hon Howard Quayle MHK; Chief Secretary, Will Greenhow; Director of Public Health, Dr Henrietta Ewart; Interim Chief Executive, Department of Health and Social Care, Kathryn Magson; and Medical Director, Dr Rosalind Ranson, with a further meeting on 29 May with the Chief Minister, Chief Secretary and the Director of Public Health.

15. A briefing paper prepared by the Chamber and Information Service provided a point-in-time look at work underway in a range of other jurisdictions, along with a selection of guidance published by worldwide organisations; this is available in Annex 1. After the first meeting, we wrote to the Attorney General to ask ‘what regulations have been made under the emergency powers that could not have been achieved using the Public Health Act 1990?’. His full response can be found in Appendix 1.

10 PP 2020/0094 paras 8-16 11 Stay Safe Isle of Man Government medium-term response to COVID-19 GD 2020/0013 https://covid19.gov.im/media/1198/stay-safe-iom-government-medium-term-response-to-covid-19- cdim.pdf accessed 30 May 2020

4 16. In his opening statement on 22 May the Chief Minister set out Government’s four key objectives during the pandemic: ‘(1) preservation of life; (2) maintain critical national infrastructure; (3) maintain public safety and confidence; and (4) support a controlled return to normality.’12 He explained that the initial priority was preservation of life13 but that moving forward an incremental change and review approach would consider the impact on ‘infection rates, to our healthcare system, to our economy, and on our society,’14 as each change was made.

17. Our objective for the session was, ‘To understand the journey from present position to new normal, and how decisions are made.’ We had identified six specific areas for questions:

 Decision making  Professional advice on risk  Relaxation of lockdown  Emergency powers  The way forward  Communication

Decision making

18. We asked how the Council of Ministers made decisions, how closely clinical recommendations were being followed. The Chief Minister explained that clinical advice would be part of the consideration and, like other advice received, sometimes there would be a recommendation and on other occasions a range of options would be presented. He confirmed that the Council of Ministers would not often deviate from clinical advice but that they do make the final decision.15

19. We have not sought, through this inquiry, to attempt to look closely at the decisions that were made and on what evidence base. This would require analysis of all of the evidence, and was not achievable within the tight timescale of this inquiry. As such, we have looked generally and contemporaneously at the decision making environment as a foundation for further research.

12 Hansard 22 May 2020 ll32-33 13 Ibid l34 14 Ibid ll59-60 15 Ibid ll74-100

5 20. A series of committees have been established under Council of Ministers to present options and recommendations to Council of Ministers for ultimate decision. We feel it appropriate to set out this structure as to date; whilst aspects of it have been frequently referred to, we are not aware that it has been laid out succinctly in a public forum.

Council of Ministers (CoMin) •Chief Minister (chair), all Ministers, Chief Secretary, Chief Financial Officer, Attorney General National Strategy Group (NSG) •Chief Minister (chair), Treasury Minister, Minister for Enterprise, Minister for Health & Social Care, other Ministers depending on agenda, Attorney General, Chief Secretary, Chief Financial Officer, CEO DfE, CEO DHA, CEO DHSC, Executive Director of Crown and External Relations, Head of Silver Command. Chief Officers Group (COG) •Chief Secretary (chair), Chief Executive Officers of all Departments Gold Command (Strategic) •Chief Secretary (chair), Chief Officers Group (as above), Chief Constable, Director of Public Health, Emergency Planning Officer, Attorney General, Head of Silver Command, Director of Change and Reform, Executive Directors of Crown and External Relations, Executive Director of the Office of Human Resources and Executive Director of Government Technology Services. Silver Group (Tactical) •Director of Public Health (chair), Medical Director, Director of Nursing, Infection Prevention & Control Lead Nurse, Chief Pharmacist, Senior managers in acute patient areas, Consultant Respiratory Physician, Emergency Department Consultant, Dentistry representative, GP representative, Emergency Planning Officer, Communications Manager, Head of Health Intelligence (Public Health), Hospital Director (Acute Services), Consultant Microbiologist, Health Protection Lead (Public Health), Legal representative, Finance representative, Environmental Health representative, Head Biomedical Scientist Bronze Group (Operational) •Medical Director (Chair), Director of Public Health, Head of Community Health Operations, Emergency Department representative, Infection Prevention and Control representative, Pharmacy representative, Pathology Services representative, GP and Dentistry representative, HR and Occupational Health senior advisor, DESC representative, Senior Manager (Acute Services), School Nurse & Health Visitor representative, Ambulance and Rescue representative, Environmental Health representative, Health Protection Representative (Public Health), Funeral Director representative. Sources16

21. The manual for Government decision making in an emergency is the Emergency Planning Manual,17 which sets out the functions of each of the above groups, as

16 NSG/Gold -Tynwald Hansard 31 Mar 2020 ll47-54; Silver/Bronze – Appendix 4 Interim Strategic Pandemic Influenza Plan 2020

6 well as the command, control and co-ordination framework. Inevitably, the ‘lead Department’ for the current pandemic is the Department of Health and Social Care (DHSC).

22. There is also the Interim Strategic Pandemic Influenza Plan 202018 based on the earlier 2009/10 plan19 and Public Health England’s Pandemic Influenza Response Plan 201420. The 2020 Plan sets out the strategic approach, WHO alerts levels, planning assumptions, roles and responsibilities of Public Health Directorate, Co- ordination and Response. It was interesting to note that the planning assumptions in this document varied somewhat from the actual experience in that:

Assumption21 COVID-19 Experience

Stopping the spread into the Island Border controls have been effective at is unlikely to be a feasible option preventing uncontrollable growth of cases on the Island

About 50% of the population may Around 3% of the population appear to be affected have been infected

Up to 50% of staff may be affected Unknown, but probably similar to general population exposure

No vaccine for 4-6 months Vaccine will take longer than 4-6 months

23. It is the role of officers to prepare options and recommendations for Ministers who ultimately make decisions and are accountable to Tynwald. We have noticed an unwelcome practice during the emergency of announcing decisions to the media, rather than Tynwald, even on sitting days. We recognise the importance of timely and effective public communication, which we expand on

17 https://www.gov.im/media/1348816/emergency-planning-manual-version-10.pdf accessed 31 May 2020 18 Appendix 4 19 Appendix 5 20 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/ 344695/PI_Response_Plan_13_Aug.pdf, PHE Gateway number 2014256, accessed 31 May 2020 21 Appendix 4 p15 of 20

7 below, but do not feel that this should have been at the expense of announcing decisions to Tynwald.

24. Proceedings of the Council of Ministers are statutorily confidential22 in order to allow a ‘safe space’ for decision making. However, once a decision has been made, it is not unreasonable to expect that the evidence relied on in making that decision is made public, unless there are good reasons not to. We note that Government has not seized the opportunity to present the evidence made available to them; we consider this a missed opportunity, and a move that would greatly add to public confidence in the decision making process.

Professional advice on risk

25. Dr Ewart provided an example of this when discussing how the decision had been made to allow ten people to meet outside. She said, ‘I gave advice, as in making sure people were aware of the options. I did not go beyond that to say, “I recommend this option” because there would have been no evidence to take me to do that.’23

26. We asked whether all of the data used in the decision framework24 could be published regularly. We agree that some health data is published daily25 but much of the social and economic data is not available. The Chief Minister gave a commitment to look into this26 and we were pleased to receive confirmation prior to our second evidence session that there is an intention to publish a wider range of the indicators set out in the Stay Safe document on a weekly basis27. We are very supportive of this development and the increased transparency that publication of a wider data set will bring.

27. We have also noted that, whilst we had an objective ‘colour-based’ alert system in terms of case numbers alone,28 the decision framework included other indicators where there is no objective system to ascertain what the current status is. The emphasis in press briefings on new cases alone has indicated a

22 Council of Ministers Act 1990 s6(2) 23 Ibid ll341-343 24 ‘Stay Safe Isle of Man Government medium-term response to COVID-19’ GD 2020/0013 p12 25 Hansard May 22 2020 ll111-113 26 Ibid l124; ll196-198 27 Appendix 3 28 ‘Stay Safe Isle of Man Government medium-term response to COVID-19’ GD 2020/0013 p.23

8 totemic indicator which does not reflect the Government’s policy of a balanced approach based on evidence when only a single indicator is routinely published.

28. Dr Ranson explained that using the data to assess risk in conjunction with expert opinion and consideration of possible outcomes in clinical decision making was a normal, everyday process in the health and social care environment.29 She went on to say that with COVID-19 a wider view is taken, with social and economic factors which also affect health being considered.30 We asked whether the risk assessments could be published and the Chief Secretary confirmed he would take this request to the Council of Ministers.31

Relaxation of Lockdown

29. We think that one of the key enablers for relaxation of the lockdown is that people have confidence in the preparedness of our response should there be a second wave of infection; without this we feel many people will be nervous about engaging with society again, even in a controlled way with social distancing measures.

30. In the light of some quite significant changes in socialisation, by 22 May there was permission to meet with two people from a single household inside and in a group of ten people from different households outside. On 28 May the Chief Minister announced in his daily briefing that these restrictions were being reviewed, along with the two metre distancing rule, with a view to the gradual lifting of restrictions.32 We wanted to understand Government’s plans for building the public’s confidence.

31. Dr Ranson highlighted the Health response section33 in the Stay Safe document and explained that, although the Department of Health and Social Care had been prepared before the first on-Island case of COVID-19,34 changes since that time, such as on-Island testing, had led to an improvement in the way in which they would respond and their capacity to do so.35

29 Ibid ll167-181 30 Ibid ll182-185 31 Ibid ll119-225 32 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-28-may- 2020/ accessed 31 May 2020 33 ‘Stay Safe Isle of Man Government medium-term response to COVID-19’ GD 2020/0013 pp14-16 34 Hansard 22 May 2020 l232 35 Ibid ll245-257

9 32. Dr Ewart explained that the decisions being taken are not based on perfect science, they are a pragmatic approach to restricting the number of interactions between households,36 and ‘it would be risky to open the valve too wide, too soon and risk generating a large number of new infections.’37 This lack of perfect science is perhaps why different places have taken different approaches. Guernsey,38 for example, has followed a household bubble model where a fixed number of households can interact inside or outside, but each household can only be in one bubble.

33. We asked whether allowing up to 10 people from up to 10 households to gather outside was a higher risk, especially given how many people an individual may come into contact with at different gatherings over a period of days, when a person may be infected but asymptomatic.

34. Dr Ewart explained that ‘in terms of outdoor interactions, the evidence is that very little transmission happens outdoors. It happens indoors and it happens within household groups mainly. So relaxing on outdoor gatherings in that way is in line with the evidence that we currently have.’39 This was reassuring, and is perhaps something which could be communicated more prominently; we feel that setting out the evidence base for change, coupled with sufficient notice for public query and adaptation is important. Our experience has been that the evidence base and reasons for the various decisions are not always made clear.

35. Understanding a risk in terms of its likelihood and impact in an individual’s own set of circumstances is fundamental to anyone being able to judge what action they take in response.40 Dr Ewart explained this is particularly relevant for the vulnerable and very vulnerable who need to take extra care as they have a greater risk of harm should they contract COVID-19; but they, like anyone else, must balance that risk against the effects of self-isolation;41 she explained, ‘the risk has to take into account the level of circulating virus in the community; if there is no virus, there is no increased risk for either group.’42 We highlighted the fact that, while shielding advice letters to people in these groups have

36 Ibid ll267-270 37 Ibid ll280-281 38 https://covid19.gov.gg/faqs/expanding-your-household-bubble/what-does-change-household- bubble-mean accessed 30 May 2020 39 Hansard 22 May 2020 ll319-321 40 Ibid ll357-358 41 Ibid ll359-384 42 Ibid ll367-369

10 broadly been welcomed, in some cases the timing had been confusing: letters arriving several weeks after lockdown began and some residents had received additional letters from the UK providing different information.43 Dr Ewart explained that this was largely due to inadequate record keeping; it took time to identify the people who would need to receive a letter.44 Information management in the Department of Health and Social Care was highlighted as a cause for concern in our previous reports on Noble’s Hospital.45 It is disappointing to note that poor record keeping has affected the distribution of important information to vulnerable people.

36. We would encourage more communication with the public which sets out the reasoning behind, and explanations for, decisions and guidance; those given by Dr Ewart in the evidence sessions have been very clear and we would support her view that regular updates are provided.46

37. In terms of lifting restrictions and giving time to check any effect of this, we have some concerns that there has been a move away from the initial plan of making a change and then allowing 8-14 days for this to bed in before more changes are made.47 To illustrate this point, we have noted the following relating to businesses:

Change48 Announced Start Lead in time – Date Working Days Phase 1 – 24 April Trades working alone, including gardeners, 21 Apr 24 Apr 2 days painters and decorators and construction may return to work.49

43 Oral Evidence 29 May 2020 http://www.tynwald.org.im/business/listen/AgainFiles/paces200529a.mp3 ll52:10 44 Ibid 53:30 45 Standing Committee of Tynwald on Public Accounts First Report for the Session 2017-2018 Overspending at Noble’s Hospital – First Report PP 2018/004 para 130-131; and Standing Committee of Tynwald on Public Accounts First Report for the Session 2018-2019 Overspending at Noble’s Hospital – One Year On PP 2019/0031 para 111-112; 46 Ibid 54:40 47 ‘Stay Safe Isle of Man Government medium-term response to COVID-19’ GD 2020/0013 p.11 48 All are subject to social distancing being possible with PPE where necessary. 49 https://www.gov.im/news/2020/apr/21/social-distancing-remains-in-place-as-island-takes-first- steps-forward-in-coronavirus-battle/ accessed 30 May 2020

11 Phase 2 – 7 May50 Garden centres may open51 7 May 11 May 3 days Some non-essential retail businesses may 7 May 18 May 5 days open52 (start date tbc 14 May) 53 Financial, professional and digital services 7 May 25 May 10 days (start date considered in next 2 weeks) 54 Confirmed from 25 May55 Estate agents may open56 14 May 18 May 2 days Libraries, campsites and auction houses may 18 May 20 May 1 day open; domestic cleaners may return to work57 Phase 3 – 21 May58 Self-catering accommodation59 21 May 25 May 1 day Non-essential private practice health 21 May 21 May 0 days therapies (physiotherapy, podiatry etc.)60 Lifestyle businesses, including beauticians, 21 May 01 Jun 5 days hairdressers, barbers, and tattoo artists61 Restaurants / Cafes outdoor areas62 21 May 01 Jun 5 days

50 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-28-may- 2020/ Accessed 30 May 2020 51 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-7-may- 2020/ accessed 30 May 2020 52 Ibid 53 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-14-may- 2020/ accessed 30 May 2020 54 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-7-may- 2020/ accessed 30 May 2020 55 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-21-may- 2020/ accessed 30 May 2020 56 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-14-may- 2020/ accessed 30 May 2020 57 https://covid19.gov.im/news-releases-statements/new-guidance-permits-outside-gatherings-of-up- to-10-people/ accessed 30 May 2020 58 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-28-may- 2020/ accessed 30 May 2020 59 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-21-may- 2020/ accessed 30 May 2020 60 Ibid 61 Ibid 62 Ibid

12 38. In his 28 May media briefing63 the Chief Minister stated that Stay Safe phase 2 began on 7 May and there had been no impact on the number of cases that could be linked to the changes.64 He confirmed that phase 3 started on 21 May and that phase 4 was now under consideration. However, given the incremental announcements and changes since 7 May, we think that confusion over the 8-14 day ‘change and check’ strategy, previously announced, is understandable. Not least because changes in our social interactions, health and education services are being introduced at the same time.

39. However, with so few active cases now and no new cases (at the time of writing) for 10 days it is not a surprise that the rate at which Government is moving out of lockdown and opening up society, and in particular areas of the economy, is increasing. We understand how important it is for life to return to some form of normal. We are still concerned that without sufficient time between changes it will be difficult to identify the source of a new infection were one to arise, but we are somewhat reassured that the tracing mechanism is now well established and Dr Ewart confirmed that they would anticipate being able to use this to assist in managing localised outbreaks.65

40. The changes now being made are, however, leading to some apparent inconsistencies. We explored one example at the evidence session on 22 May. We asked what the difference in risk is between a family of four going round to a two-person household, or the same two-person household visiting the family of four.66 Dr Ewart confirmed there is no difference in risk67 and yet one is legal and one is illegal.68 Car sharing is another area which has been asked about; is there still a need to prohibit this provided the people are known to each other and thus could be traced if required?

41. What is also clear from the table above is that in some instances businesses do not appear to have been afforded adequate lead-in time to prepare for a safe reopening, and to digest the emerging Government guidance as it applies to

63 https://covid19.gov.im/news-releases-statements/chief-ministers-statement-on-covid-19-28-may- 2020/ accessed 30 May 2020 64 Ibid 65 Oral Evidence 29 May 2020 42:00 66 Hansard 22 May 2020 ll287-296 67 Ibid l298 68 DIRECTION Emergency Powers (Coronavirus) (Events and Gatherings) Regulations 2020, dated 20 May 2020, https://covid19.gov.im/media/1239/direction-events-and-gatherings-20-05-20- published.pdf accessed 31 May 2020

13 their businesses. In our view, and based on anecdotal feedback, this has led to inconsistent application and frustration amongst some business owners.

42. Such inconsistencies are probably inevitable in a fast moving situation. However, the risk is reduced if certain measures are taken. One way of dealing with this is below:

Identify elements of next phase

Review in light of Publish on website experience

Allow timefor business to Encourage public prepare and implement engagement

Refine in light of queries, and seek further professional advice

43. It is recognised that whilst this approach would reduce the chance of inconsistency, it would take longer with the knock-on economic cost. However, as the decision making cycles slow down, the efficacy of this approach increases.

44. We recognise, in this context, the ability to amend Emergency Powers Regulations forms a useful ‘backstop’ to catch mistakes and inconsistencies, although the scope to use them is limited in the tight timescale between the regulations being made and laid before Tynwald. Ultimately, this will only be resolved by a shift in how we think about legislating going forward.

Emergency Powers

45. As society is being opened up, we questioned whether it is still appropriate for the Island to be living in a state of emergency. On 22 May the Chief Minister said ‘we need these powers because of borders and gatherings, without them we

14 would be open to all sorts of legal challenge.’69 We believe that a move away from legislation and regulation into guidance and personal responsibility is another step which would improve public confidence and keep them engaged with what has been a fantastic community response for the longer term. We sense a reluctance to pursue this route.

46. We wrote to HM Attorney General to ask which regulations, made under the emergency powers, could not have been made using the Public Health Act 1990 (PHA 1990). In his reply,70 he explained that Regulations made under the Emergency Powers Act 1936 (EPA 1936) deal not only with matters directly connected to suppression of the virus, but also the social, economic and administrative issues that have arisen as a result.

47. We believe that use of the EPA 1936 to deal with the outbreak of Coronavirus on 16 March 2020 was reasonable and proportionate based on what was known at that time, the seriousness of the threat, the importance of being clear in public messaging, and the unknown and potentially wide-ranging, social and economic secondary impacts of the virus.

48. Subject to any serious deterioration, the peak of the health crisis has now passed, allowing reflection on the relative merits of how to eliminate our reliance on EPA 1936, and the transition to the ‘new normal’ and ultimately a long-term ‘normal normal’.

49. The Committee also welcomes the announcement that a timely review of the Emergency Powers legislation will be undertaken and a draft bill will go to public consultation before the end of the current administration.71

50. It is reassuring that most of the essential elements of protecting public safety can be achieved using the PHA 1990. Events and gatherings regulations, control of the borders and regulation of potentially infectious people can all be effectively regulated using this Act.72 We noted that the PHA 1990 does not permit terms of custody or fixed penalty notices, and that the Act would benefit from review in this respect. We also note that the EPA 1936 has provision for amendments to be tabled to secondary legislation. Whilst this is unusual, it has proved an effective mechanism to correct mistakes and challenge policy in a

69 Ibid ll459-460 70 Appendix 1 71 Tynwald Hansard 21 Apr 2020 ll654-656 72 Appendix 1 para 4

15 timely manner, which was welcome given the nature of these regulations, and we strongly suggest that this also be incorporated into an amended PHA 1990. If necessary for an effective transition, the PHA 1990 could be amended quickly in the same way as the EPA 1936 was.73

51. We note that not everything that Government has done could be achieved with the PHA 1990. However, analysing the legislation passed under EPA 1936 provides several ‘exit routes’. In some cases other legislation could be used - in many cases the Financial Provisions and Currency Act 2011 (e.g. Provision of Temporary Accommodation Regulations), in other cases the regulations are far less justifiable now than when they were made (e.g. Speed limit regulations), some were a ‘nice to have’ or efficiency measure rather than being strictly necessary and can now be abandoned (e.g. Suspension of Regular Service Licenses, Emergency Assistance by MHKs), whilst for others a long-term fix is required rather than the emergency sticking plaster that has been applied (e.g. Special Constable and Competition Regulations).

52. We believe that, just as it was important messaging to use the EPA 1936 in the first place, it is equally important to stop using them soon to preserve their credibility. The Chief Minister advised on the 29 May that all Departments have been asked to consolidate powers and to look at which are no longer needed;74 however he signalled that an extension to the state of emergency would almost certainly be required75 because infection rates have not been high and the Island is still vulnerable to a second wave.76 The Chief Secretary indicated that the use of continuation regulations77 is now being actively considered.78

53. There still seems to be a reluctance to move away from Emergency Powers at this point; we are firmly of the opinion that an expeditious extraction from emergency powers is now required. We look forward to Government transitioning away from emergency powers in the very near future, using the transitional powers only where absolutely necessary and where they can be individually justified.

73 Oral Evidence 29 May 2020 04:50 74 Ibid 01:36; 10:25; 12:00 75 Ibid 02:58; 15:55 76 Ibid 03:35 77 Emergency Powers Act 1936 s4A 78 Oral Evidence 29 May 2020 13:00

16 54. It was also noteworthy that the Attorney General’s letter highlighted the International Health Regulations which are enabled under Part IIA of PHA 1990 have not been incorporated into domestic legislation. These Regulations would have provided additional powers to bring WHO recommendations into domestic legislation. Interestingly, had this been done it would have prevented the Government from charging for quarantine at the Comis. We find it disappointing that Government departed from this international best practice, and also failed to provide greater detail in the legislation regarding quarantine so that it could be effectively tested, and possibly amended in Tynwald.

The Way Forward

Social distancing

55. As the number and scope of emergency powers regulations are reduced we asked about how far, and when, we can move away from regulation towards best practice guidance.79 In this context, social distancing was discussed and the Chief Minister suggested that, ‘until a vaccine is developed, we will still be looking at some form of social distancing and it will be a new Manx normal going forward until a satisfactory vaccine.’80 The Chief Minister agreed that in general this is the direction of travel, but added that some rules would still be necessary. As an example, in the recent change to allow two people to visit another household, the guidance suggested 15 minutes, but that this was not enforceable.81 We welcome such pragmatism and would encourage close consideration of how best to explain the move from simple binary rules to more complex notions of ‘risk and mitigation’ guidance which will allow individuals to make informed choices.

Masks

56. We asked about the use of masks, for example on public transport.82 Dr Ewart replied that guidance had been published on the Government website83 about six weeks ago,84 however, the science is not conclusive, ‘what there is, indicates that wearing masks in the community is unlikely to protect the wearer from

79 Ibid 16:40 80 Ibid 18:30 81 Ibid 19:00 82 Ibid 44:30 83 https://covid19.gov.im/health-wellbeing/guidance-for-wearing-face-masks-in-the-community-to- reduce-the-spread-of-covid-19/ accessed 31 May 2020 84 Oral Evidence 29 May 2020 44:45

17 infection by others, but may offer some degree of protection … (to) others from unwitting spread85 … if you can keep well away from others, it's not a big issue but obviously there are some things that we do, and the more we want to do that gets back to normal, or near normal, the closer people will have to be in proximity, so those are the circumstances when people should think about wearing a face covering and obviously public transport is a classic example of that.’86

57. We have noted that, based on advice from the Scientific Advisory Group for Emergencies (SAGE), the UK Government published new advice on the use of face coverings on 11 May 2020. Jo Churchill, Parliamentary Under Secretary of State (Minister for Prevention, Public Health and Primary Care), said, ‘Today, thanks to the evidence provided by our expert scientists, we are advising people to consider wearing a face covering if they can in enclosed public spaces where social distancing is impossible, for example on public transport or in shops. This may help prevent you spreading the virus to others. You do not need a clinical mask which is prioritised for our healthcare workers. Instead a face covering is sufficient and we encourage people to make these at home with items they will already own.’ 87

58. We note that the recent advice to the local hair and beauty sector does advise the use of face coverings for both stylist/therapist and client.88 We would urge the Council of Ministers to review this important matter in relation to use of face coverings in all confined spaces, including on public transport, in light of the new advice from SAGE.

Immunity and testing

59. We noted that many of the options in level 2 and some of those at level 389 of the Stay Safe document have now been implemented and we asked what the plan was for moving forward.90 The Chief Minister explained that data was key,

85 Ibid 45:10 86 Ibid 47:05 87 https://www.gov.uk/government/news/public-advised-to-cover-faces-in-enclosed-spaces accessed 2 Jun 2020 88 https://covid19.gov.im/media/1253/hair-beauty-guidance.pdf accessed 2 Jun 2020 89 ‘Stay Safe Isle of Man Government medium-term response to COVID-19’ GD 2020/0013 pp11; 20-21 90 Oral Evidence 29 May 2020 28:00

18 the number of days with no new cases was significant as was the testing strategy, including the new antibody testing.91

60. We asked Dr Ewart about the current scientific understanding of immunity, and the implications for our testing strategy now that the number of active cases remaining on the Island is so low and that antibody testing is available.92 She explained that it is important not to give people a false sense of security; COVID- 19 immunity is not known, but the information is epidemiologically helpful. It will be possible to get a better estimate of the percentage of the population who have been infected, along with information relating to grouping by age, gender, geographically etc.93 However, it was not an ‘immunity passport’94 based on current science, but hopefully it would be more useful as more studies are published95.

Borders

61. We asked what consideration had been given to the guidelines which may be needed in order to open the borders.96 The Chief Minister advised that this was being considered, for example opening corridors to certain jurisdictions;97 however, there are no firm decisions yet.98 He went on to explain that it was important to protect what we have achieved on Island, to do all we can to prevent a second wave. He said, ‘I don't think we'll have a totally open border for a long time but there will be corridors and certain changes that can be made to ease the situation.’99 We suggested that looking at travel through the Republic of Ireland, where the growth in daily new cases is significantly lower than the UK,100 first may be an option.101

62. Reopening our Island’s borders is not a binary decision. As at 18th May, over 500 individuals had come to the Isle of Man as key workers, in addition to returning

91 Ibid 28:35 92 Ibid 57:10 93 Ibid 58:15 94 Ibid 58:24 95 Ibid 59:55 96 Ibid 33:45 97 Ibid 34:25 98 Ibid 34:55 99 Ibid 36:05 100 Annex 2 101 Oral Evidence 29 May 2020 60:05

19 residents,102 and different rules have applied to different categories ranging from testing through to self-isolation or quarantine.

63. We expect that over the coming weeks and months, a risk-based approach will be taken to others seeking to come to the Island. Announcements have already been made regarding an increased capacity for returning residents, which we welcome as it will bring to an end perhaps the most unfortunate chapter in the emergency period. There have also been announcements regarding compassionate visits both to and from the Island, as well as arrangements for returning students and their belongings. Whilst the UK infection levels are high, we expect these decisions to be risk-based and proportionate; there remains a reasonable case for home quarantine or self-isolation at this time.

64. We remain concerned that there is no objective test for reopening the border to free movement which has been agreed with the medical experts. We asked the Chief Minister if he had anything to share with the Committee on this topic. The Chief Minister said that this is a steady, managed process and steps are being taken towards this, returning residents, people moving here to live and travel on compassionate grounds, but that any decisions would involve not just an assessment of cases on the Island, but inevitably an assessment of the UK infection and testing rates.103 We believe that a published set of criteria for the staged reopening of the border would help public confidence and understanding of this final crucial phase of the new normal.

65. When the borders do open, even in a controlled way, the risk of new cases on the Island is increased; we asked what the plan was in the case of a resurgence.104 Dr Ewart replied that definitive plans were not possible but ‘it is part of the underlying approach, which is perhaps best described as being ready to supress, release, supress, release, supress, release.’105 She went on to say that, because the Island’s test, trace and isolate system is well established, it is possible that sporadic, isolated outbreaks may be brought under control without having to return to restrictive measures.106

102 Appendix 6 103 Oral Evidence 29 May 2020 36:30 104 Oral Evidence 29 May 2020 39:15 105 Ibid 39:40 106 Ibid 41:38

20 Communication

66. The Chief Minister highlighted a range of different ways in which Government has kept the public informed throughout this period: the Stay Safe medium term plan, twice-weekly departmental briefings to Tynwald Members, daily media briefings to the public, a ‘questions from the public’ briefing is in planning, communication on social media, advertisements in the newspapers, the website and the community helpline.107 In addition, there have been meetings with business sectors and third sector organisations where more detailed sector- specific discussions have taken place.108

67. There is no doubt that there is a significant amount being said on a daily basis and, unfortunately, as things change so quickly, we think this is becoming confusing. We asked whether there was a communications strategy and if this could be shared.109

68. We asked the Chief Minister if he would consider setting out alert levels on the Government website,110 like Ireland111 and New Zealand.112 He replied that the information is in the Stay Safe report113 and that because the circumstances can change so quickly, as happened in Guernsey and Jersey, the timing of our transition is constantly under review based on data.114

69. The COVID-19 website still has online self-assessment as the top item on the homepage,115 despite no new cases. Contrast this with the New Zealand website which headlines with ‘What you need to know,’116 with a direct link to more information about the current alert level,117 i.e. what people need to know about what they are doing today. The information our people need is probably all on the COVID-19 website, but what would help people the most today is not what they are seeing first.

107 Ibid 48:10 108 Ibid 50:50 109 Ibid 51:40 110 Ibid 30:10 111 https://www.gov.ie/en/press-release/e5e599-government-publishes-roadmap-to-ease-covid-19- restrictions-and-reope/ accessed 31 May 2020 112 https://covid19.govt.nz/alert-system/ accessed 31 May 2020 113 Oral Evidence 29 May 2020 31:04 114 Ibid 31:04 115 https://covid19.gov.im/ accessed 30 May 2020 116 https://covid19.govt.nz/ accessed 30 May 2020 117 https://covid19.govt.nz/alert-system/alert-level-2/ accessed 30 May 2020

21 70. We would therefore simply suggest that, in order to maintain public confidence along with steps to move us out of a state of emergency as soon as possible, that messaging needs to be reviewed and simplified. Information for the general public about the current position should be on an easy-to-find page on the website, published weekly in the press and on leaflets distributed to community settings. More detailed information for business owners and other specific groups can then be accessed, as now, via links.

71. During this inquiry, we heard evidence from Dr Ewart from a public health perspective, and Mrs Magson and Dr Ranson have provided a clinical perspective118. However, we have not been able to easily ascertain what the dividing lines of their jurisdiction are, and who has been asked to give advice on which policy issues. It came as a surprise to the Committee that Dr Ewart had not been asked for her opinion on repatriation.119 Medical advice was sought from the Senior Clinical and Public Health Advisory Group, chaired by Dr Ranson. We would welcome clarity about the expected roles. Building on our earlier comments, we believe that now the immediate medical emergency has passed, moving forward Public Health must take the lead on the communication of key public messages and that a transparent evidence base would assist the public’s understanding.

J P Watterson (Chairman) R E Callister J M Edge J Poole-Wilson C R Robertshaw

June 2020

118 Hansard 22 May 2020 119 Appendix 2 ‘The policy on repatriation was, of course, a political decision. I was not asked for, and did not give, any direct Public Health advice to government on this.’

22 ANNEX 1: PAC EMERGENCY SCRUTINY - BRIEFING PAPER PUBLIC ACCOUNTS COMMITTEE - EMERGENCY SCRUTINY

Coronavirus: Exiting from the emergency DATED 20/05/2020 BRIEFING PAPER

CONTENTS

Isle of Man Government’s Exit Strategy ...... 2

Responses to the strategy ...... 3

Strategies from other jurisdictions ...... 3

United Kingdom ...... 3

Republic of Ireland ...... 3

Jersey ...... 3

Guernsey ...... 4

Other international approaches to exiting lockdown ...... 4

Guidance from NGOs and other organisations ...... 5

World Health Organization ...... 5 WHO European Region ...... 5

Institute for Government ...... 6

Organisation for Economic Cooperation and Development ...... 6

Key concepts ...... 7

Reproduction number (R0) ...... 7

Viral load ...... 7

FURTHER READING

EXIT STRATEGIES AROUND THE WORLD

BBC News (19 May 2020): ‘Coronavirus: How lockdown is being lifted across Europe’: https://www.bbc.co.uk/news/explainers-52575313

Politico (updated 13 May 2020): ‘Europe’s coronavirus lockdown exit strategies compared’: https://www.politico.eu/article/europes-coronavirus-lockdown-exit-strategies-compared/

IMFBlog (12 May 2020): ‘Emerging from the Great Lockdown in Asia and Europe’: https://blogs.imf.org/2020/05/12/emerging-from-the-great-lockdown-in-asia-and-europe/

The Guardian (18 Apr 2020): ‘The exit strategy: how countries around the world are preparing for life after Covid-19’: https://www.theguardian.com/world/2020/apr/19/the-exit-strategy-how-countries- around-the-world-are-preparing-for-life-after-covid-19

RESTARTING ECONOMIES

McKinsey & Company (6 Apr 2020): ‘How to restart national economics during the coronavirus crisis’: https://www.mckinsey.com/industries/public-sector/our-insights/how-to-restart-national-economies- during-the-coronavirus-crisis

IMF Special Series Notes on the economic effects of COVID-19: https://www.imf.org/en/Publications/SPROLLs/covid19-special-notes

ACADEMIC RESEARCH AND COMMENTARY

Castellani, Brian and Caiado, Camila (18 May 2020): ‘Coronavirus: why we need local models to successfully exit lockdown’, theconversation.com: https://theconversation.com/coronavirus-why-we- need-local-models-to-successfully-exit-lockdown-138358

Woolley, Thomas (15 May 2020): ‘Coronavirus: Why the maths behind ‘COVID alert levels’ makes no sense’, theconversation.com: https://theconversation.com/coronavirus-why-the-maths-behind-covid- alert-levels-makes-no-sense-138634

UK Parliament POST (7 May 2020): Light switches and clusters: social distancing strategies for COVID- 19: https://post.parliament.uk/analysis/light-switches-and-clusters-social-distancing-strategies-for- covid-19/

29 Date Published 20/05/2020 Coronavirus: Exiting from the emergency Page 8

UK Parliament POST (29 Apr 2020): Face masks, face coverings and COVID-19: https://post.parliament.uk/analysis/face-masks-face-coverings-and-covid-19/

Rawaf, Salman et al (26 Apr 2020): ‘Unlocking towns and cities: COVID-19 exit strategy’ in: Eastern Mediterranean Health Journal, emro.who.int: http://www.emro.who.int/in- press/commentaries/unlocking-towns-and-cities-covid-19-exit-strategy.html

ROLE OF PARLIAMENT DURING THE PANDEMIC

House of Commons Library (4 May 2020): Coronavirus: Parliamentary consent for the lockdown in England: https://commonslibrary.parliament.uk/parliament-and-elections/parliament/coronavirus- parliamentary-consent-for-the-lockdown-in-england/

Institute for Government (17 Apr 2020): Parliament’s role in the coronavirus crisis: https://www.instituteforgovernment.org.uk/publications/parliament-role-coronavirus

SOURCES

All links accessed on 20th May 2020. Links to tynwald.org.im and legislation.gov.im are not included.

ISLE OF MAN GOVERNMENT’S EXIT STRATEGY

Isle of Man Government (03 May 2020): Government publishes medium-term response to COVID-19. https://covid19.gov.im/news-releases-statements/government-publishes-medium-term-response-to- covid-19/

Island Global Research: Impact of COVID-19: Looking to the future. https://mmo.aiircdn.com/61/5ec3ecc1c5362.pdf

STRATEGIES FROM OTHER JURISDICTIONS

Senedd Research (15 May 2020): Coronavirus: comparing UK exit strategies. https://seneddresearch.blog/2020/05/15/coronavirus-comparing-uk-exit-strategies/

Government of Ireland (18 May 2020): Roadmap for reopening society and business. https://www.gov.ie/en/news/58bc8b-taoiseach-announces-roadmap-for-reopening-society-and- business-and-u/

Dáil Debate (30 Apr 2020), Vol. 992 No.8. https://www.oireachtas.ie/en/debates/debate/dail/2020-04- 30/3/#spk_8

Government of Jersey (1 May 2020): A framework for phasing out lockdown. https://www.gov.je/news/2020/pages/SafeExitLockdown.aspx

Government of Jersey: Jersey Safe Exit Framwork. https://www.gov.je/Health/Coronavirus/SafeExitFramework/Pages/ExitFramework.aspx

Government of Jersey (1 May 2020): Public Health Policy – Framework for a Safe Exit from the COVID- 19 Pandemic. https://www.gov.je/SiteCollectionDocuments/Government%20and%20administration/ID%20Public%2 0Health%20Strategy%20Framework%20for%20a%20Safe%20Exit.pdf

States of Guernsey (1 May 2020): Exit from Lockdown – A Bailiwick Framework. https://www.gov.gg/exitframework

30 Date Published 20/05/2020 Coronavirus: Exiting from the emergency Page 9

States of Guernsey: Guernsey’s Exit from Lockdown. https://covid19.gov.gg/guidance/exit

States of Guernsey (14 May 2020): Exit from Lockdown – Bailiwick of Guernsey Framework: https://covid19.gov.gg/guidance/exit

States of Guernsey Committee for Health and Social Care (3 May 2020): Exit from Lockdown – A Framework for Lifting the COVID-19 Restrictions in the Bailiwick of Guernsey. https://covid19.gov.gg/sites/default/files/2020- 05/Guernsey%27s%20Framework%20for%20Exiting%20Lockdown%20-%205%20May.pdf

BBC News (15 May 2020): Coronavirus: Guernsey to ease lockdown further. https://www.bbc.co.uk/news/world-europe-guernsey-52679013

UK Parliament POST (18 May 2020): COVID-19 and international approaches to exiting lockdown. https://post.parliament.uk/analysis/covid-19-and-international-approaches-to-exiting-lockdown/

GUIDANCE FROM NGOS AND OTHER ORGANISATIONS

World Health Organization (16 Apr 2020): Considerations in adjusting public health and social measures in the context of COVID-19: interim guidance. https://apps.who.int/iris/handle/10665/331773

World Health Organization (10 May 2020): Considerations for public health and social measures in the workplace in the context of COVID-19 - Annex to Considerations in adjusting public health and social measures in the context of COVID-19. https://www.who.int/publications-detail/considerations-for- public-health-and-social-measures-in-the-workplace-in-the-context-of-covid-19

World Health Organization – Regional Office for Europe (24 Apr 2020): Strengthening and adjusting public health measures throughout the COVID-19 transition phases. Policy considerations for the WHO European Region. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid- 19/technical-guidance/2020/strengthening-and-adjusting-public-health-measures-throughout-the- covid-19-transition-phases.-policy-considerations-for-the-who-european-region,-24-april-2020

World Health Organization – Regional Office for Europe (24 Apr 2020): WHO/Europe publishes considerations for gradual easing of COVID-19 measures. http://www.euro.who.int/en/health- topics/health-emergencies/coronavirus-covid-19/news/news/2020/4/whoeurope-publishes- considerations-for-gradual-easing-of-covid-19-measures

Institute for Government (30 Apr 2020): Lifting lockdown: how to approach a coronavirus exit strategy. https://www.instituteforgovernment.org.uk/publications/lifting-lockdown-coronavirus-exit- strategy

OECD (4 May 2020): Testing for COVID-19: A way to lift confinement restrictions. http://www.oecd.org/coronavirus/policy-responses/testing-for-covid-19-a-way-to-lift-confinement- restrictions-89756248/

KEY CONCEPTS

BBC News (18 May 2020): Coronavirus: What is the R number and how is it calculated? https://www.bbc.co.uk/news/health-52473523

Gaglia, Marta and Lakdawala, Seema (14 Apr 2020): What we do and do not know about COVID-19’s infectious dose and viral load. https://theconversation.com/what-we-do-and-do-not-know-about-covid- 19s-infectious-dose-and-viral-load-135991

31 Date Published 20/05/2020

32 ANNEX 2 Cases Comparison - United Kingdom and the Republic of Ireland

New cases per day Per million population IRELAND UK IRELAND UK 24/05/2020 59 1625 12.03 24.38 25/05/2020 37 2004 7.54 30.07 26/05/2020 73 2013 14.89 30.20 27/05/2020 46 1887 9.38 28.31 28/05/2020 39 2095 7.95 31.43 29/05/2020 59 2445 12.03 36.68 30/05/2020 66 1936 13.46 29.05

ROI population 4,904,000 (Eurostat) UK population 66,650,000 (Eurostat)

Case data

https://en.wikipedia.org/wiki/COVID -19_pandemic_in_the_United_Kingdom

https://en.wikipedia.org/wiki/COVID-19_pandemic_in_the_Republic_of_Ireland

33 34

APPENDIX 1 Letter from HM Attorney General 27 May 2020

35 36 Belgravia House 34-44 Circular Road, Douglas Isle of Man, IM1 1AE [Contact details redacted]

27 May 2020 The Hon Juan Watterson SHK Chairman of the Public Accounts Committee Your ref: Legislative Buildings Our ref: JQ/JR/AGCH.2251 DOUGLAS Please quote on all correspondence

Dear Mr Speaker,

Re: Powers under the Public Health Act 1990

I refer to your letter of the 22nd May 2020 in which letter you asked me to advise on —

"what regulations have been made under the emergency powers that could not have been achieved using the Public Health Act 1990".

In response to your question, please find set out below my retrospective appraisal of the position. I have numbered my paragraphs for the Committee's ease of reference.

1. I am sure that you are already aware that the emergency, as it unfolded, brought many challenges for the executive, including how best to legislate to achieve the required outcomes, such as effective social behaviours. I recognise that at first glance it may appear as though it was unnecessary to use the emergency powers to legislate for the various emerging concerns and scenarios, which clearly all related to an emerging serious Public Health issue. However, the Regulations were required to legislate for much broader changes and scenarios, some with economic impacts and some requiring the introduction of custodial sanctions.

2. I also offer the observation that, from the public's perspective, using the emergency powers to make Regulations conveys the extreme urgency of the situation and identifies the measures introduced in a clearly accessible format, which can be noted from the very helpful list available on the Tynwald website of the Statutory Documents 'as made'. The use of Emergency powers also leads to improved levels of flexibility of response and parliamentary scrutiny, which I outline my thoughts upon at paragraphs 8 and 12 below.

3. I can confirm that the majority of the emergency powers Regulations could not have been made under the Public Health Act 1990 (PHA 1990) so as to make the same provision as the SDs made under the Emergency Powers Act 1936. Many of the Regulations share characteristics which are not provided for within the PHA 1990 which I outline in more detail below. There appear to be only limited Regulations that could have been made under the PHA 1990; the Emergency Powers (Coronavirus) (Educational Institutions) Regulations 2020 appears to be one such instrument.

1 37 4. To clarify the observation above, provision can be made in regulations under Part IIA of the Public Health Act 1990 ("the PHA 1990") in respect of persons, things and premises covering (broadly) the following:

(a) restrictions/prohibitions on —

Movement (including keeping a child away from school); Events & gatherings; Closure of businesses; The handling, transport, burial or cremation of dead bodies or the handling, transport or disposal of human remains.

(b) requirements on a person to —

submit to medical examination (but not medical treatment), be removed to or detained in a hospital or other suitable establishment, be kept in quarantine or isolation, be disinfected or decontaminated, wear protective clothing, provide information, have their health monitored, attend training or advice sessions, or be restricted as to where they go or with whom they have contact or from working or trading.

What Part IIA of the PHA does not enable are regulations with an economic content (such as rent and mortgage holidays, protection from eviction).

5. The following emergency power Statutory Documents make equivalent (but not identical) provision to the PHA 1990 "provisions" —

The Emergency Powers (Coronavirus) (Prohibitions on Movement) Regulations 2020 - The Emergency Powers (Closure of Premises) Regulations 2020 The Emergency Powers (Coronavirus) (Potentially Infectious Persons) Regulations 2020 The Emergency Powers (Coronavirus) (Child Care Services) Regulations 2020 The Emergency Powers (Coronavirus) (Educational Institutions) Regulations 2020 The Emergency Powers (Coronavirus) (Events and Gatherings) Regulations 2020 The Emergency Powers (Coronavirus) (Entry Restrictions) Regulations 2020 The Emergency Powers (Coronavirus) (Port Operations) Regulations 2020 The Emergency Powers (Coronavirus) (Schools) Regulations 2020 The Emergency Powers (Coronavirus) (Closure of Premises) Regulations 2020.

Importantly, each of the Statutory Documents listed above (with the exception of the Educational Institutions Regulations and the Schools Regulations) makes a breach of the Regulations (or guidance/directions issued under them), an offence punishable on conviction before the High Bailiff to 3 months' custody, a fine not exceeding level 5, or both.

(a) The punishment by way of custody could not be provided for in regulations made under the PHA 1990 because that Act provides for a breach of regulations made under Part IIA to be punishable by a fine and not otherwise (see section 51F). There is, in fact, an express prohibition in the PHA 1990 on regulations providing for a sentence of custody (see section 51F).

38 (b) I am aware that Members have commented on a number of occasions, most notably when discussing the Fixed Penalty Regulations, that there is a need to have a custodial penalty for serious incidents (involving infected/potentially infected persons). The PHA 1990 simply would not have permitted that.

(c) As you will see, whilst the areas in respect of which provision may be made are similar in the two Acts; only the Emergency Powers Act 1936 provides for custody by way of punishment. Accordingly, regulations under the PHA 1990 would have prevented the Government from having in its arsenal what it considered to be necessary because of the nature of the emergency it faced - a power of imprisonment (whether "in terrorem" or otherwise).

6. The other emergency regulations (some 30 or so principal regulations ignoring amending regulations) do not come, or comfortably come, within the contemplation of the PHA 1990. They deal with a range of subject matters — some of which are:

"social" (e.g., Emergency Powers (Coronavirus) (Provision of Temporary Accommodation) Regulations 2020), others relating to the provision of services (e.g. Emergency Powers (Coronavirus) (Suspension of Regular Service Licences) Regulations 2020), others relate to economic matters (e.g. Emergency Powers (Coronavirus) (Competition) Regulations 2020), and others concerned with the maintenance of the Island's infrastructure (e.g. the Emergency Powers (Coronavirus) (Infrastructure Support) Regulations 2020).

(a) To take but three examples, none of the following Statutory Documents could have been made under the PHA 1990 —

i. The Emergency Powers (Coronavirus) Fixed Penalty Regulations 2020 — there being no provision in that Act for fixed penalties but only for the imposition of fines on the standard scale;

ii. The Emergency Powers (Coronavirus) (Emergency Assistance by members of the Keys) Regulations 2020 — because they do not concern individuals who are, or may be, contaminated; and

iii. The Emergency Powers (Coronavirus) (Special Constables) Regulations 2020 because they likewise do not concern individuals who are, or may be, contaminated.

(b) The fact that the vast majority of the emergency regulations are not in the contemplation of Part IIA of the PHA 1990 is not surprising when one considers its purpose and background. In that context Part II (now repealed) of the PHA 1990 is illuminating not least because it very specifically focused on infectious diseases. It referred, in section 17(1), to making regulations "with a view to the treatment of epidemic, endemic or infectious diseases and for preventing the spread of any such disease". In many respects, it looked to do what the Emergency Powers Act 1936 could do — albeit in a more limited way.

(c) In contrast, the purpose of the new Part IIA of the PHA 1990 (containing section 51A et seq.) is expressed to be to prevent "danger to public health, prevent the spread of infection or contamination, to give effect to international agreements" (see s51B). There is nothing in Part IIA, which refers explicitly to an emergency, a pandemic or 3 39 indeed even an epidemic. This is in sharp contrast to the repealed Part II of the PHA 1990 and is reflective of a change of approach.

(d) The new Part IIA majors on more modern concerns such as contamination by chemicals or radiation. That much is evident from its purposes (above).

This change in emphasis and purpose is a direct consequence of an "all hazards" approach to dealing with such health threats taken up by the World Health Organization. This is reflected in the International Health Regulations 2005 ("IHR") which are the means by which WHO aims to prevent and control the international spread of disease, by action that is commensurate with and restricted to public health risks, and which avoids unnecessary interference with international traffic and trade. The new IHR are concerned with infectious diseases generally, and also with contamination. Wholly consistent with this new approach and purpose, you will note that Part IIA PHA 1990 enables the IHR to be implemented, including WHO recommendations issued under them, into the domestic legislation. For information, the Island has not appeared to have done so.

7. Importantly, the vast majority of the emergency regulations cannot be said to be incidental or supplemental to the things in respect of which provision can be made in regulations under the PHA 1990 powers. The things these other emergency regulations cover are substantive matters in their own right and are not matters which are incidental in the sense of being "a necessary or expedient incident of the principal business" of the PHA 1990. To reiterate, they are "principal" matters themselves, which are not contemplated by the PHA 1990.

8. It is true that some provision in limited circumstances could have been made under PHA 1990. However, had we done so, Members could have moved amendments to regulations under the 1936 Act but not to those under PHA 1990. I suggest such divergent approaches at a time of national crisis would not have been helpful. A further point is that the 1936 Act confers power to make any provision which might be made by an Act of Tynwald, whereas Part IIA of PHA 1990 is much more limited in its capacity to make amendments or modifications to primary legislation: the only amendments which may be made to such legislation under the powers in Part IIA are those required to give effect to international agreements (see section 51F(3)).

9. In the light of the above, it was (and is) considered that any attempt to use the PHA 1990 to cover these matters would be, if not ultra vires, very obviously an "unusual" use of the powers. An unusual use of powers would be "colourable" and resulting instruments therefore challengeable.

10. The PHA for all its merits—

(a) does not provide vires to cover the full range of matters covered in the suite of SDs made under the Emergency Powers Act 1936; and

(b) where it does provide vires in terms of topics/subject matter that are also in the contemplation of the Emergency Powers Act 1936, it is too restrictive in that it neither allows for custody as a punishment nor coincidentally for medical treatment to be a condition or requirement imposed on a person or group of people.

11. Based on the above, it was considered appropriate to use the Emergency Powers Act 1936 in preference to the PHA 1990 in implementing the executive's strategy for the Island in

4 40 respect of the emergency. Trite though it is to say it, where the executive has a choice of "bases" on which to found legislation, it is open to it to choose the one which gives best effect to the policy (whether that be in terms of coverage, speed of implementation, or both). In the circumstances and given the range of matters to be covered, the executive favoured the 1936 Act.

In that respect you and Hon Members will doubtless be aware that the courts themselves will not interfere in choices made by the executive unless there is an absence of reasonable justification for the choice made; see, for example:

- R v KRJ [2016] 5 LRC 461 (2016 SCC 31 — Canada; European Commission v Portugal (Case C-392/99) - [2003] All ER (D) 193 (Apr) — "However, that is a choice of legislative technique for the national legislature to make, and not for the Commission to criticise..."; - Banks v Revenue and Customs Commissioners [2020] UKUT 101 (TCC) UK Upper Tribunal (Tax and Chancery Chamber; R (on the application of TP and another) v Secretary of State for Work and Pensions (Equality and Human Rights Commission intervening) - "In matters relating to economic or social measures, the courts will generally respect the choice of the government unless that choice is manifestly without reasonable foundation.".

12. I am aware that Members have also commented on a number of occasions that use of the regulation-making powers under the PHA would have provided Members with a better opportunity to scrutinise the regulations brought into effect under the Emergency Powers Act. As against that, however, one could argue that the 1936 Act actively provides Tynwald with a greater power of scrutiny than the PHA, given that all Regulations under the 1936 Act must be brought to Tynwald within seven days of their making, when Tynwald can (and has) amended their provisions and when Tynwald can resolve that they continue in place or not. On the other hand, regulations made under the PHA are subject to a simple affirmative procedure and then only at a convenient sitting of Tynwald.

Yours sincerely

[Signature: John Quinn]

John g uinn QC, MLC HM Attorney General

5 41 42

APPENDIX 2 Email from Dr Henrietta Ewart Director of Public Health 14 May 2020

43 44 Joann Corkish

From: Ewart, Henrietta Sent: 14 May 2020 18:19 To: Watterson, Juan (SHK) Cc: Ranson, Rosalind Subject: RE: Medical advice

Dear Mr Watterson, Thank you for your email. The policy on repatriation was, of course, a political decision. I was not asked for, and did not give, any direct Public Health advice to government on this. Medical advice was sought from the Senior Clinical and Public Health Advisory Group. The advice from this group was based on concern that even a small number of ‘imported cases’ could have ‘seeded’ community spread on island which could have had a significant effect on the epidemic curve here and on health service capacity. I think this assessment was appropriate at the time it was made. You will probably remember that the sharp ‘take off ‘ in numbers in the UK (and its dispersion across the country) can largely be related to individuals and families returning from ski-ing trips in Northern Italy around the February half-term period, and we were also witnessing the epidemic in Northern Italy and its impact in terms of overwhelming health service capacity and mortality.

I would not, therefore, have challenged the clinical risk assessment at the time that it was given. The issue now is whether levels of community transmission in the UK are now significantly higher than ours to present a significant ongoing risk of seeding new outbreaks on island if we relaxed the arrangements for repatriation, particularly given the strong ‘test, trace and isolate’ procedures we have in place. The Senior Clinical and Public Health Advisory Group keeps ‘review of the arrangements for repatriation’ as a standing item on its agenda. I have copied in Dr Rosalind Ranson, Medical Director, to ensure that your email is shared with the Group and taken into consideration when this is next discussed.

Kind regards, Henrietta

Dr Henrietta Ewart Director of Public Health

Public Health Directorate, Cabinet Office, Isle of Man Government, Cronk Coar, Strang, Douglas, IM4 4RJ. [Contact details redacted]

45 From: Watterson, Juan (SHK) Sent: 14 May 2020 17:47 To: Ewart, Henrietta Subject: Medical advice

Dear Dr Ewart

I hope you don’t mind me contacting you directly, as even after reflection I remain confused about the relationship between our current data and decision making regarding returning residents.

Just to reprise the facts: · New case numbers have been “green”, indeed virtually non-existent for the last week at least. · We have plentiful hospital capacity, which is still at enhanced levels · We have plentiful ICU capacity which is still at enhanced levels · Our test and trace capacity is significantly underutilised · No significant additional flow through effects expected based on policy decisions. (The last significant decision was on re-opening the construction sector, which has had a significant time to flow through into case numbers.) · Returning residents are restricted to 30 per week · A proportion of these will be travelling as a complete household (but that statistic has not been made available) · The risk profile is the same for anyone returning from the UK, irrespective of their reason (although I accept that patient transfer measures may mitigate this risk). · Some key workers are able to isolate at home (numbers unknown) · 5,000 or so have been returned to economic activity supported by medical advice on the risks, provided social distancing is maintained.

Before we start to reduce our ICU / hospital capacity in light of negligible demand, surely it makes sense to bring back these residents?

Why would restricting an entire household to home quarantine be an adequate preventative measure to control the reproduction rate?

Can you confirm that no assessment is made of the physical or mental health of returning residents in order to make a balanced decision on medical risk grounds?

I would be interested to learn more about what objective and subjective considerations have been given to this, to better understand the advice that is frequently cited by Council of Ministers. I hope you will not mind me asking it of you direct as the only person qualified to give it.

Yours sincerely

The Hon. Juan Watterson BA(Hons) BFP FRSA FCA CMgr FCMI SHK Speaker of the House of Keys Member of the House of Keys for Rushen Legislative Buildings Douglas ISLE OF MAN IM1 3PW

[Contact details redacted]

APPENDIX 3 Email from Peter Boxer Executive Director Crown and External Relations Directorate 29 May 2020

47 48 Archived: 01 June 2020 18:12:21 From: [Juan Watterson SHK] Sent: 29 May 2020 10:28:33 To: [Jane Poole-Wilson, Chris Robertshaw, Rob Callister, Julie Edge] Cc: [Joann Corkish, Lawrie Hooper] Subject: FW: Indicator Template.docx Importance: Normal Attachments: Indicator Template.docx ;

From: Boxer, Peter Sent: 29 May 2020 10:28 To: Watterson, Juan (SHK) Cc: Chief Minister; Greenhow, Will Subject: Indicator Template.docx

Dear Mr Speaker

At the last PAC, the Chief Minister confirmed that we were hoping to publish more of the key indicators that COMIN uses as part of its decision making process.

We are close to being able to do so. We are hoping early next week. We are in the process of trying to make it easy to understand and engage with for the public.

In the meantime, the Chief Minister thought you might find it useful to see the probable rubrics that we will be using. We would anticipate this being updated weekly.

All best regards

Peter

Peter Boxer Executive Director

Crown & External Relations Directorate Cabinet Office l Isle of Man Government l 3rd Floor Government Office l Bucks Road l Douglas l Isle of Man l IM1 3PN [Contact details redacted]

Isle of Man. Giving you freedom to flourish

49 Virus - Overall Status - RAG Indicator Level 1 Day Change 5 day change Status Number of 111 Calls Concluded Tests Cases 3 Day average of new cases Clusters Health - Overall Status - RAG Indicator Level 1 Day Change 5 day change Status DHSC Staff absence Community bed capacity ITU capacity Nobles capacity Society - Overall Status - RAG Indicator Level 5 day Same week last change year Number of Police incidents relate to breaches Total number of convictions due to COVID related breaches Domestic Abuse calls to the police Mental Health Calls General Poverty indicators Police absence Economy - Overall Status - RAG

Indicator Level 1 day 5 day Jobseekers/unemployed Number of employees supported by the Salary Support Scheme: March 2020 April 2020 Manx Earnings Replacement Allowance applications (MERA) Manx Industrial Relations service forward concerns

APPENDIX 4 Isle of Man Interim Strategic Pandemic Influenza Plan 2020

51 52 February 2020

Isle of Man Interim Strategic Pandemic Influenza Plan 2020

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1. Introduction

1.1 Each year, seasonal influenza affects many thousands of people in the UK and hundreds of people across the Isle of Man. Occurring mainly in winter, influenza is an infectious respiratory disease capable of producing symptoms ranging from those similar to a common cold, through to very severe or even fatal disease. It brings about variable effects in successive winters and in some years causes intense pressure on our health and social care services and significant levels of absence from the workplace and schools.

Seasonal influenza is different to pandemic influenza. While seasonal influenza affects people to varying degrees, normally young children, those over 65, pregnant women and those with long term health conditions are most at risk. A pandemic flu is normally a new strain of the flu A virus and will spread across the world, infecting many more people than seasonal flu because of a lack of immunity to the virus.

An Influenza Pandemic is the highest risk on the Isle of Man risk register, meaning that this is an event that will definitely occur, and the only uncertainty about it is when it will happen. The impact of an influenza pandemic can be dramatic for not only our health service, but also for the wider population, due to our limited access to external support and material and human resources. Therefore preparation is key to minimise loss and impact on the public’s health.

1.2 With unpredictable frequency, novel influenza viruses emerge or re-emerge to cause an influenza pandemic. When this happens, it is likely that global spread will ensue rapidly, affecting large numbers of the population because there will be little or no immunity to this strain. However, until such an event occurs, the impact, expressed as the severity of the illness and proportion of the population that will be most severely affected, will be unknown. As a guide, the impact could range from a 1918-type pandemic, where severe disease was mainly seen in young adults and there was

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significant illness and death, to a 2009 pandemic, where the illness was mild in most groups of the population. 1

1.3 The World Health Organization (WHO) defines a pandemic as: “the worldwide spread of a new disease. An influenza pandemic occurs when a new influenza virus emerges and spreads around the world, and most people do not have immunity.” 2

1.4 When an influenza pandemic occurs, large swathes of the population may become infected by the new virus over a relatively short period of time. It may be associated with mild to moderate illness in the population (which may or may not be widespread), or significant severe illness and mortality in certain age or patient groups, and may significantly disrupt the normal functioning of our society. It is necessary to mobilise the collective efforts of society in order to manage the impact of a pandemic.

1.5 In many respects, pandemic influenza can be responded to in the same way as seasonal influenza. The same good hygiene measures can reduce the spread of infection. The same self-care measures – staying at home, keeping warm, drinking plenty of fluids and the use of over the counter cold and ‘flu medicines - should be sufficient to meet the needs of most patients infected with an influenza virus that causes mild to moderate symptoms.

1.6 However, additional plans, over and above those for seasonal influenza, are needed for pandemic influenza to:

 Ensure we monitor intelligence provided by the World Health Organization (WHO), the European Centre for Disease Control (ECDC) and Public Health England (PHE) so as to be aware should a new virus emerge. Intelligence monitoring of these organizations will enable us to ascertain the severity of illness, the age groups and populations most

1 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/344696/PI_ Strategic_Framework_13_Aug.pdf

2WHO website: “Pandemic (H1N1) 2009: frequently asked questions: what is a pandemic?”

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affected, how transmissible the new virus is and to know when it arrives in the UK or on the European mainland.

 Take account of the potentially much greater number of people who will become ill with influenza and / or experience more severe symptoms and of the resulting potential impact on our island’s health systems and wider economies

 Prepare for an influenza pandemic that may have a high impact on our health systems and the wider societies of our island.

1.7 Whilst influenza pandemics have been relatively infrequent over the past century, a new pandemic could emerge at any time. Plans for responding to any influenza pandemic build on and enhance normal business continuity planning for more routine pressures, such as bad weather and winter illness. Pandemic preparedness is therefore an integral part of wider emergency response and preparedness.

2. Strategic Approach

2.1 The overall objectives of the Isle of Man strategic approach is to:

 minimise the potential health impact of a pandemic  minimise the potential impact of a pandemic on society, the economy and public services  instil and maintain trust and confidence.

2.2 These are underpinned by three key principles:

 precautionary – preparing for the worst;  proportionality – the response reflecting the actual risk;  flexibility – having a range of options and levels of response.

2.3 Our response and advice will be:  evidence-based or based on best practice in the absence of evidence;

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 based on ethical principles;  based on established practice and systems as far as possible;  co-ordinated across the Island with public, private and voluntary sectors  Linked to and following PHE advice and pathways:

This strategic approach has been modified from Public Health England’s Pandemic Influenza Strategic Response, 2014.3

3. Purpose of this Document

3.1 The Isle of Man has been preparing for an influenza pandemic for some years. Our preparations were tested by the H1N1 (2009) influenza pandemic, although, in comparison with previous influenza pandemics, the H1N1 (2009) influenza pandemic was mild. This document describes the Isle of Man’s strategic approach to planning for, and responding to, the demands of an influenza pandemic. It builds on previous pandemic planning and takes into account the local and national experience and lessons learnt in the H1N1 (2009) influenza pandemic. This learning includes:

 the need to ensure unified health messages for the public and the media;  that our plans need to ensure a response that is proportionate to meet the differing demands of pandemic influenza viruses of milder and more severe impact, but we must still be prepared for “worst case” planning assumptions;  that we take into account the learning from behavioural scientists about how people are likely to think, feel and behave during an influenza pandemic;  that we ensure plans include dealing with subsequent seasonal influenza outbreaks (that is, the ‘sting in the tail’ in subsequent years that follows a pandemic).  That we work closely with the UK, in particular the UK DHSC and PHE

3 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/344696/PI_ Strategic_Framework_13_Aug.pdf

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3.2 In addition, all parts of the public service are expected to have up to date business continuity plans which would support maintenance of critical services during a pandemic.

4. World Health Organization Pandemic Influenza Alert Levels

4.1 The World Health Organization (WHO) is responsible for identifying and declaring an influenza pandemic based on the global situation. Following a revision of their guidance in May 2017, the WHO introduced a new risk- based approach to pandemic influenza risk management. This encourages countries to firstly take into account the WHO’s own global risk assessment of each influenza virus with pandemic potential that is infecting humans, and then to use this information to develop their own flexible plans and management decisions for the benefit of their country’s specific situation and needs, based on a local risk assessment. We will adopt this model in the Isle of Man.

4.2 The revised WHO global phases are termed interpandemic, alert, pandemic and transition and they are designed to describe the spread of a new influenza subtype, taking account of the disease it causes, around the world. This risk-based approach to pandemic influenza phases is described in Appendix 4.

4.3 In developing their revised guidance, the WHO recognize that as pandemic viruses emerge, countries and regions face different risks at different times. The impact of the H1N1 (2009) influenza pandemic across the UK varied significantly, particularly in the early stages.

In the UK, the Department of Health is likely to adopt a consistent overall approach to dealing with the pandemic – so as to ensure an effective clinical and operational response, optimise use of limited resources and to maintain public confidence. Decisions about the nature of the UK’s national response to the pandemic – for example who should be given priority for vaccination and how antiviral medicines will be used – will be taken by UK

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Ministers based on scientific and clinical advice and will be reported on by national media. This may present a challenge locally as there may be good reasons why a different approach is needed to protect the population of a small island. For example, given the size of the island we may experience a single rapid pandemic wave which puts greatest pressure on healthcare services over a concentrated shorter period of time. In addition, the limited intensive care beds on island may necessitate local health teams to respond in a different way (and perhaps sooner) than that of the UK.

5. Planning assumptions

5.1 PHE will be the lead for microbiological, epidemiological and modelling advice.

5.2 A pandemic is most likely to be caused by a new subtype of the Influenza A virus but the plans could be adapted and deployed for scenarios such as an outbreak of another infectious disease, e.g. Severe Acute Respiratory Syndrome (SARS) in health care settings, with an altogether different pattern of infectivity. An influenza pandemic could emerge at anytime and anywhere in the world, including in the Isle of Man. It could emerge at any time of the year. Regardless of where or when it emerges, it is likely to reach the Island very quickly.

5.3 It will not be possible to stop the spread of, or to eradicate, the pandemic influenza virus, either in the country of origin or in the Isle of Man, as it will spread too rapidly and too widely. From the first case in the UK, it could be a further one to two weeks until sporadic cases and small clusters of disease are occurring in our island.

5.4 Following an influenza pandemic, the new virus is likely to re-emerge as one of a number of seasonal influenza viruses and based on observations of previous pandemics, subsequent winters are likely to see a higher level of seasonal flu activity compared to pre-pandemic winters.

5.5 The transmissibility of the pandemic virus, and the proportion of people in which severe symptoms occur, will not be known in advance.

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5.6 All ages are likely to be affected but those with certain underlying medical conditions, pregnant women, children and otherwise fit younger adults could be at relatively greater risk, as older people may have some residual immunity from previous exposure to a similar virus earlier in their lifetime. However the elderly have increasing co-morbidity with age. The exact pattern will only become apparent as the pandemic progresses.

5.7 The UK and the Isle of Man’s response to a future pandemic now takes the form of a series of phases that may be initiated at the time the WHO declares an influenza-related public health emergency of international concern (PHEIC) or based on reliable intelligence. The phases are: detection, assessment, treatment, escalation and recovery.

5.8 Each phase sets out the actions and priorities for the response, reflecting the situation as it affects the Isle of Man. Not all the phases may be activated during a pandemic and, because the phases reflect the circumstances on the ground at the time, it is possible to jump or move back and forth between phases.

5.9 The initial response consists of two distinct phases – detection and assessment. These may be relatively short depending on the speed of spread or the impact on individuals and communities.

5.10 Detection – the focus in this stage relates to:  intelligence gathering;  enhanced surveillance;  development of diagnostics;  information and communications to the public, the media and health professionals.

5.11 Assessment and Containment – the focus here relates to:  the collection and analysis of clinical and epidemiological data;  reducing the risk of transmission within local communities by: o actively finding cases (number of cases will be determined at the time of a response); o self-isolation of cases and suspected cases ;

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o treatment of cases/suspected cases and, depending on a risk assessment of the impact, the possible use of antiviral prophylaxis to prevent further spread of infection among contacts.

5.12 Once cases are established here, the response will change to a more treatment focused period, consisting of two phases – treatment and escalation. Whilst escalation measures may not be needed in another pandemic which became characterised as relatively mild, it would be prudent to prepare for this.

5.13 Treatment – the focus in this stage would be:  the treatment of individual cases, including making it possible for symptomatic individuals to access antivirals, if necessary;  enhancement of the health response and public health measures;  preparing for targeted vaccinations as the vaccine becomes available (depending upon the development of the pandemic);  ensuring that necessary detailed surveillance activity continues in relation to samples of community cases, hospitalised cases and deaths.

5.14 Escalation – the focus in this stage would be:  escalation of surge management arrangements in health and other sectors;  prioritisation and triage of service delivery with the aim of maintaining essential services;  scaling down or cessation of non-essential services to release staff for response;  resilience measures, encompassing robust contingency plans.

5.15 Once influenza activity is either significantly reduced compared to the peak, or activity is considered to be within acceptable parameters, then the response will move into recovery.4

5.16 Recovery – the focus in this stage will be:

4 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/344696/PI_ Strategic_Framework_13_Aug.pdf

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 normalisation of services, perhaps to a new definition of what constitutes normal service;  restoration of business as usual services, including an element of catching up with activity that may have been scaled down;  post-incident review of response;  taking steps to address staff exhaustion, general mental health and wellbeing ;  planning and preparation for resurgence of influenza (second wave), including activities carried out in the detection phase;  continuing to consider targeted vaccination, when available;  preparing for post-pandemic seasonal influenza and winter pressures.

5.17 The planning assumptions are outlined in Appendix 1

6. Key roles and responsibilities of the Public Health Directorate

6.1 The UK pandemic influenza strategy describes a number of key aspects of the planning and response to a pandemic; these include:  developing and promoting plans in the pre-pandemic period;  exercising plans and training staff in their roles;  detecting and assessing the impact of the virus and identifying the groups most at risk of severe illness;  reducing the risk of transmission of infection through appropriate behavioural interventions, promoting the provision of personal protective equipment to front line health and social care staff via DHSC/Manx Care;  minimising serious illness and death through rapid access to antiviral medicines, antibiotics and healthcare via DHSC/Manx Care  communicating with healthcare professionals and the public;  protecting the public through vaccination when available via DHSC/Manx Care.

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6.2 Preparedness – In the pre-pandemic period, the work of the Public Health Directorate in the Isle of Man will support and assist in developing and testing pandemic planning and preparedness.

6.3 Detection and assessment – The implementation of a proportionate response to a pandemic will depend on a detailed assessment of the clinical and epidemiological aspects of the new virus impact of the pandemic, and the effectiveness of the countermeasures. This is a central responsibility of the Public Health Directorate, based on liaison with PHE but will require input from other health and social care professionals and the community.

6.4 Reducing the spread – Following PHE lead Public Health Directorate will have a key role in providing guidance, based on best available evidence, on infection control measures to be adopted.

6.5 International travel – Public Health takes advice and lead from FCO and PHE and coordinates and disseminates information as required.

6.6 Minimising serious illness and death – in line with guidance from PHE.

6.7 Public health measures – Public Health will:  evaluate the evidence and advise on the potential benefits of school closures, offsetting this against the subsequent economic and social impact of these closures;  advise on the potential impact of restrictions on public gatherings and public transport.  advise on any further appropriate public health measures.

6.8 Communications – Communication to the public will be a key responsibility of the government for the duration and aftermath of a pandemic. Where possible, key messages will be prepared and shared depending on circumstances, timescales and needs.

 The corporate communications team in the Cabinet Office will work with Public Health to decide and deliver key messages and communications.

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7. Co-ordination and response

7.1 The Director of Public Health (DPH) leads the IOM Government response in the initial stages. The DPH would convene a Pandemic Influenza Expert Group which would become the Tactical Coordinating Group (Silver), with the activation of the Major Incident Plan (see Figure 1). This would become the pandemic hub.

7.2 The DPH would provide regular briefings to the Chief Officer Group.

7.3 The DPH will brief the Emergency Planning Strategic Group (EPSG) and the Chief Secretary. The EPSG is the strategic level, multi-agency body responsible for emergency planning in the Isle of Man and will meet and, if necessary, will convene a Gold (Strategic) Group response, setting the aims and objectives and strategy for the Silver (Tactical) Group. They may also determine the media strategy and take responsibility for other specialist cells e.g. logistics, scientific or recovery. The Bronze (Operational) Group will be constituted, as outlined in Figure 1, to oversee the operational response to an influenza pandemic. All meetings relating to pandemic influenza should have a Loggist present, who will record all policy decisions made and actions assigned, as this will give a record for future scrutiny if needed.

7.4 Figure 1 illustrates the possible constitution of these groups. This will be varied according to need at the time of the pandemic.

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8. Responsibilities

8.1 All Departments are responsible for their own planning. Accountable Officers are responsible for:

 Ensuring they have an up to date, tested and appropriate business continuity plan or plans.  ensuring dissemination of this policy;  promoting awareness of this policy;  ensuring staff in their area are fit to work.

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Appendix 1: Planning assumptions

In developing its response to a new pandemic, Public Health England advised that account should be taken of the following assumptions to underpin the UK strategy. It is reasonable for similar assumptions to underpin the Island’s pandemic flu planning :  the plan should be adaptable, to be used in outbreaks of other infectious diseases;  stopping the spread or introduction of the pandemic virus into the UK and the Island is unlikely to be a feasible option;  any pandemic activity in the UK and the Isle of Man may last for a significant period of time and therefore a sustained response may be required;  a novel virus would reach the UK and the Isle of Man very quickly;  once established in the UK, sporadic cases and clusters will be occurring across the country in 1-2 weeks;  the Isle of Man will be at risk of spread from the UK and other neighbouring jurisdictions;  about 50% of the population may be affected;  up to 50% of staff may be affected over the period of the pandemic, either directly by the illness or by caring responsibilities, thereby creating potential pressures on the response;  the severity of the virus will be unknown and the groups of the population most affected will be unknown, as will the efficacy of antivirals;  no vaccine will be available for 4-6 months.

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Appendix 2: Lessons learned from 2009 H1N1 Influenza Pandemic

 Uncertainty - there will be little or no information at the outset of a new pandemic about the severity of the illness and we will need to look for information emerging from UK and European authorities as they gather accurate and detailed surveillance data on numbers affected, and hospital and critical care admissions.

 Speed - we have to be prepared for the number of cases and demand for services to develop with great pace, requiring an agile yet coordinated response.

 Hotspots - the demands of the pandemic are unlikely to be uniform and different UK areas will be under pressure at different times.

 There may be implications for services we source from the UK; we may ourselves become a ‘hot-spot’.

 Information - the media, public and professional appetite for information is likely to be intense at times – frequent and consistently coordinated communications will help prevent conflicting messages and confusion. Consideration must be given to the fact that the public is largely exposed to UK media based, mainly through the means of digital information.

 Duration - a pandemic wave can be expected to continue for many weeks in the UK but could pass through our island community at a much quicker pace and impacting harder upon our limited island healthcare resources. In time, further waves may also occur.

 Cross-sector - whilst our health departments will be under particular pressure, the response will span different departments, requiring close working and mutual support.

 Collaboration – Cooperation at a regional level is essential to minimize the adverse health, social and financial effects of a pandemic and its aftermath.

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Strengthening links with health policy bodies in the UK should also be prioritised on order to protect the Isle of Man’s interests (ie. access to antivirals and pandemic vaccines).

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Appendix 3: Ethical principles for pandemic preparedness

 Pandemic preparedness and response will inevitably lead our governments, organisations and individuals to face difficult decisions and choices that may impact on the freedom, health and in some cases prospects of survival of individuals.

 Decisions will be needed on how to make the fairest use of resources and capacity, in proportion to the demands of the pandemic alongside other pressures that may be in place at the same time, in order to minimise the harm caused by the pandemic as a whole.

 Given the potential level of additional demand, capacity limitations, staffing constraints and potential shortages of essential medical material, including medicines, hard choices and compromises may be particularly necessary in the fields of health and social care.

 Coherent and transparent communication is vital. People are more likely to understand and accept the need for, and the consequences of, difficult decisions if these have been made in an open and inclusive way.

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Appendix 4 – WHO Pandemic Phases

Interpandemic phase: This is the period between influenza pandemics.

4.4 Alert phase: This is the phase when influenza caused by a new subtype has been identified in humans. Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.

4.5 Pandemic phase: This is the period of global spread of human influenza caused by a new subtype. Movement between the interpandemic, alert and pandemic phases may occur quickly or gradually as indicated by the global risk assessment, principally based on virological, epidemiological and clinical data.

4.6 Transition phase: As the assessed global risk reduces, de-escalation of global actions may occur, and reduction in response activities or movement towards recovery actions by countries may be appropriate, according to their own risk assessments.

Figure 2: The continuum of pandemic phases showing WHO actions

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Source: World health Organization, 2017, Global Influenza Programme, Guidance for surveillance during an influenza pandemic – 2017 update (available online) Reference List

Public Health England, 2013, Pandemic Influenza Strategic Framework

World health Organization, 2017, Global Influenza Programme, Guidance for surveillance during an influenza pandemic – 2017 update

World Health Organisation, “Pandemic (H1N1) 2009: frequently asked questions: what is a pandemic?”

Channel Islands Strategic Pandemic Influenza Plan 2019 Author

This plan remains the responsibility of the Public Health Directorate, DHSC.

It is prepared by the Emergency Planning Unit, Department of Home Affairs.

Review Date

February 2021

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APPENDIX 5 Isle of Man Government Pandemic Flu A Strategic Plan for Preparing and Recovering from an Influenza Pandemic in the Isle of Man 2009

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APPENDIX 6 Letter from Hon Chris Thomas MHK 20 May 2020

125 126 Minister for Policy and Reform Cabinet Office Government Office DOUGLAS Isle of Man IM1 3PN

[Contact details redacted]

Our ref: CT/VC

20 May 2020

Dear Mr President, Mr Speaker, Honourable Members,

At the sitting of Tynwald on 12 May 2020, I committed to providing more precise information about the number of key worker exemptions issued under the Emergency Powers (Coronavirus) (Entry Restrictions) Regulations 2020 as amended and the subsequent Emergency Powers (Coronavirus) (Entry Restrictions) (No. 2) Regulations. As I put it then, accuracy and clarity in perception about that figure is important.

Firstly I would like to counter the narrative that appears to be running that these exemptions have been issued freely and without due regard. This is not the case. These statutory exemptions can only be issued if the failure to allow the person to travel poses a greater risk to public safety and the life of the community, as a direct or indirect result of the incidence or transmission of Coronavirus; and measures are put in place to mitigate any risks associated with making an exemption notice.

Secondly, as both a Minister and a Member of House of Keys, I would like to express my sincere thanks and appreciation to the officers who have worked day and night, on weekdays and at weekends, to administer the evolving exemptions regime since the difficult decision was taken to close our border.

Moreover, as the regime has evolved, from initially allowing keyworkers and patient transfers, to then include repatriated residents and most recently compassionate travel, demand for exemptions has increased exponentially and the complexity of administering the process has increased consistently. The understanding and empathy of the officers involved has been remarkable.

The table below details figures held by the team administering the exemptions in the Cabinet Office as at 18 May 2020:

A person who the Department of Infrastructure has certified is vital to the 399 Island’s critical national infrastructure A person who the Department of Health and Social Care has certified is a medical expert or professional whose skills are essential to the Island’s 47 medical infrastructure and the health of its community; A person who the Department of Health and Social Care has certified is a supplier of goods or services that are essential for the Island’s 12 infrastructure or the health of its community A person who the Department of Home Affairs has certified is a police officer or a fire officer employed by that Department or in respect of whom 7 an offer of employment as a police officer or a fire officer in that Department has been made Exempted by Chief Secretary (previously Council of Ministers) 1 36

1 Majority are police and fire before the regulations changed to allow DHA to certify, plus various military personnel e.g. those serving overseas and returning. 127 As the Chief Minister has stated the number of critical national infrastructure exemptions may appear high at first sight, but nearly half of these were for shipping operators and another third for air operators, who often work shifts and rotas to maintain the Island’s transport links. Other critical national infrastructure exemptions include the engineers and delivery drivers coming to the Island to deliver vital supplies or fix critical infrastructure, for example the key workers who commissioned the new oxygen generating plant at the hospital.

I hope that this more detailed information is useful immediately to Honourable Members, and these statistics will now be published regularly as part of the series of open data on Government’s COVID-19 website https://covid19.gov.im/open-data/

Yours sincerely [Signature: Chris Thomas]

Hon C C Thomas MHK Minister for Policy and Reform

128 Parliamentary Copyright available from:

The Tynwald Library Legislative Buildings DOUGLAS Isle of Man, IM1 3PW British Isles June 2020

Tel: 01624685520 e-mail: [email protected] Price: £19.00

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