Public Health Wales Annual Report 2020/21 1 of 263 Contents Section 1: Performance Overview and Well-being of Future Generations Report - page 10 Section 2: Accountability Report - page 57 Section 3: Financial Statements and Notes – page 187 2 of 263 Chair Introduction In concluding my Foreword for the 2019/20 Annual Report , I expressed my pride at the way in which Public Health Wales had mobilised very early on in response to COVID -19, a pandemic of the kind not seen for a century. I paid tribute to the swift response of our experts in health protection and microbiology services and to the willingness of staff across the organisation to step into new roles and adopt different ways of working. I expressed my confidence that, in the 2020/21 Annual Report, whatever the course of the pandemic and its implications, I would once again be recording my sense of pride and privilege in being the chair of this outstanding organisation, incorporating as it does staff of exceptional talent, dedication and commitment to the public health and protection of the people of Wales. And so it proves- COVID-19 has caused heartache and seen millions of lives lost across the world, including in Wales, and it has had such a devastating effect on us all .The year has called on everyone working in Public Health Wales to really dig deep and the response has been truly remarkable; people have worked selflessly and tirelessly to provide national system leadership, and we have come into our own as the National Public Health Institute for Wales. Achievements include: producing system-level plans and guidance, providing expert epidemiological advice, surveillance data and analysis; setting up much- needed helplines for the public and professionals; constantly updating the website to provide relevant information; helping Wales keep ahead by developing an international horizon scanning system; introducing a National Engagement Survey to help understand how people have been feeling during the year; making a significant contribution to vaccine research and the introduction of the Wales COVID-19 vaccination programme. Along the way, we have become world leaders in genomic sequencing, adopted a more data science approach to using and presenting data, led change , innovation and improvement at a pace never seen before and secured transformational change; we opened laboratories in weeks, rather than months and , in 6-8 weeks, transformed laboratory turnaround times across the nation. The Screening Division kept three of the national screening programmes going throughout the year, a phenomenal achievement. The fact that we have secured additional investment to expand our capacity for COVID-19 testing and our health protection service is also testament to the value placed on Public Health Wales’ system leadership role. And throughout the year, we have maintained good governance and secured an unqualified Audit opinion at the end of what has been the 3 of 263 most challenging year; this is a fitting tribute to Huw George’ inspirational leadership of an expert finance team. I am indebted to my Board colleagues for their unfailing preparedness to give far more of their time throughout the year, as the Board increased the frequency of its meetings, in response to COVID-19. The Board maintained its cohesion throughout, effectively balancing scrutiny and support during times of significant challenge. I owe particular thanks to the chairs, members, lead executives and all those who have supported the Audit and Corporate Governance Committee (ACGC) and Quality, Safety and Improvement Committee (QSIC). Both have met more frequently and have discharged a ‘heavy lifting’ role on behalf of the full Board. Kate Eden, as vice chair and QSIC chair, and Dyfed Edwards, as ACGC chair, have been by my side throughout the year and offered me their wise counsel; I thank them both. Executive colleagues have demonstrated yet again their command of their leadership role and responsibilities and Tracey has led the team and the organisation with her customary energy, passion and commitment. Effective leadership is never needed more than in times of an emergency and there can be no more serious emergency than that resulting from a global pandemic. Tracey has shown strength, resilience and total sense of purpose throughout this unparalleled year and Wales’ good fortune continues in having her as one of its senior public servants. COVID-19 has yet to run its course and we continue to mobilise in response to it, whilst also reactivating services and beginning what will be a ‘new’ recovery, capturing all the innovations made in the last year. I am humbled and privileged to have been appointed for a second term as the chair of Public Health Wales, I look forward to commenting next year on the further development of Public Health Wales, as the National Public Health Institute for Wales, and its key role in responding to the wider societal harms resulting from CoVID-19. The ground-breaking work of the Research and Evaluation Division and the World Health Organisation Collaborating Centre will be pivotal to this; the insights and evidence generated remind us the impact of COVID-10 on public Health are even more wide-reaching than the disease caused by the infection itself and will last far longer. I have every confidence that Public Health Wales’ expert and dedicated staff will be at the heart of Wales’ rebuilding and recovery. Jan Williams OBE Chair Public Health Wales 4 of 263 Chief Executive Introduction It is my pleasure to introduce our Annual Report for 2020/21. As the National Public Health Institute in Wales, our vision is ‘Working to achieve a healthier future for Wales’. This year, 2020/21, has been an exceptional year in the context of a global SARS-COV-2 Novel Coronavirus (COVID-19) pandemic, and I am so very proud to share with you the exceptional work that all of our people have done right across the organisation, to protect the people of Wales at such a challenging time. Within this Annual Report, we outline the changes and impact that the pandemic has had on our organisation and our work. Public Health Wales, the NHS in Wales and our local authority colleagues, have all faced unprecedented and increasing pressure in planning and providing services to meet the needs of those who are affected by the COVID-19 pandemic – and to keep up with the various phases in order to best protect and support our population. As a consequence, this year has seen our organisation mount an unprecedented health protection response to the coronavirus pandemic. The nature of our response to COVID-19 has evolved significantly during this time and has also been delivered in the context of the United Kingdom’s exit from the European Union. Our role in response to the COVID-19 pandemic is to provide system leadership and specialist advice on public health approaches and this has required the mobilisation of the full weight of the organisation’s resources as our highest priority since the end of February 2020. We have also provided analysis and expert advice to support the response to outbreaks at a local level, through expert epidemiological advice and surveillance data and analysis. We have had to adapt and deploy our people throughout the organisation in order to respond at scale and at pace which has involved new training, new experiences and new challenges for many of our staff who have acted in the most professional and committed way through the year. The exceptional nature of our response to COVID-19 has also required us to fundamentally assess the delivery of our previously agreed plans. It has challenged us to consider not only the immediate action we need to undertake to respond to the current pandemic, but also the longer-term direct and indirect public health implications on the people of Wales. As a result, we developed a revised in-year Operational Plan that set out the priority areas and specific action that Public Health Wales will deliver over during the next year. 5 of 263 There have been many extraordinary achievements and a wide range of delivery activities by our people throughout the year and the following examples only begin to touch the surface. These include setting up a National Contact Centre and National Health Protection Centre to provide expert and timely specialist health protection advice for issues escalated from regional Test Trace Protect (TTP) teams and a telephone advice line for professional enquiries in Wales. The development of the Public Health Protection Response Plan that underpinned the Welsh Government’s Test Trace Protect Strategy. In addition, our Communicable Disease Surveillance Centre (CDSC), and staff mobilised into it from other parts of the organisation, rapidly established timely surveillance and epidemiology data to support the COVID-19 pandemic - the scale of which has far exceeded anything previously experienced. Our Pathogen Genomics Unit (PenGU) has been working with key partners to sequence and analyse every available SARS-CoV-2 samples from patients in Wales. We have become a global leader in COVID-19 genomics, having sequenced and shared more SARS-CoV-2 genomes than any other country in the world except the United States and England. The Public Health Protection Response Plan recognised that measures to contain and control COVID-19, and the ill health it causes, can have significant unintended, potentially harmful impacts on people’s immediate and longer-term health and well-being. It was therefore critical to understand these as early as possible, monitor their development, explore relevant evidence and solutions for Wales, and inform policy and decision- making in order to mitigate and minimise harm wherever possible. Our World Health Organization Collaborating Centre has utilised our strong international links and partnerships to establish an International Horizon Scanning system for COVID-related issues, providing up to date policy summaries, intelligence and insights into other developments worldwide.