National Resilience Committee

Thursday 2nd July 2026

(began 2 months, 4 weeks ago)

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10:30
None Portrait Speaker 1
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Thank you very much for coming to see us this morning and to help us with this important inquiry into national resilience. I know that some of your organisations have already submitted written evidence, which has already been extremely helpful, and I'm sure you're going to be able to build on that this morning. I should just remind you that this is a public session. It's being broadcast live, and in a couple of days you'll each receive a transcript of the session. And so if you spot any factual inaccuracies or other inaccuracies, that'll be your opportunity to make corrections.

And if you suddenly think of anything there that is missing, we'd welcome supplementary evidence in writing if and that would be the point to do it. Um, we've obviously got a lot of questions to ask the three of you. And could I just ask that before you give your first answer?Could you introduce yourself briefly so that we've got that on the record as well, please. Thank you. And I'll kick off with the first question, if I may. And I want to ask you all, um, we hear a lot about the call for a whole of society approach to preparedness and resilience.

And I would appreciate it if you could each comment on how you think that that whole of society approach should incorporate the emergency services and to what extent that is possible or should be possible through the structures and systems that connect national and local, whether they exist already or not. Um, so perhaps I could start with, um, Mr. Woodman.
10:32
None Portrait Speaker 2
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Good morning. So Alex Woodman, I'm the chief fire officer for Hertfordshire, but I'm National fire chiefs lead for resilience. And I'm sharing our group of LFS across the UK and the National Chairs Forum. So um, I think the opening point is that I think we do have a strong resilience system across the UK, but like with anything, I think it can be enhanced and could be better. I think the areas of expansion that we are looking at and some gaps, if I sit across the UK in its entirety, slightly different in the devolved, but the principle is is a very strong localised approach which is built through our local resilience forums.

The same, I think the areas of expansion that we are looking at and some gaps, if I put them forward at the start, is what I don't think we currently have at the moment is a convening authority or a lead agency for resilience. So clearly government takes that lead role, is a very strong, localised approach, which is built through our local resilience forums that sit across the UK in its entirety, slightly different in the devolved, but the principle is the same. I think the areas of expansion that we are looking at and some gaps, if I put them forward at the start, is what I don't think we currently have at the moment.

Is a convening authority or a lead agency for resilience. So clearly government takes that lead role. But in turn, what you look at, if I call us the delivery arm of that, we are very much currently required to operate under the Civil Contingencies Act, and we do that. But what I don't think we've got is a delivery arm, clearly, with the lead agency for the government's Resilience Action Plan and those other functions. Um, and I will do this as a bid, but this is something very much in the fire and rescue sector that we feel that we could play a key role in leading that across the UK because of the structures and the way that we operate.

So I think my my key points around it would be is that I do think we have a strong system. I think we have a culture of preparedness and resilience. I think the two words can mean many things to many people, which can be part of the challenge. But I think we have the opportunity to enhance that with things like a National Resilience Forum, lead agency for convening and delivering. And I think that would strengthen our delivery across what are currently our category one and category two responders in the.

CC.
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10:34
None Portrait Speaker 3
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Yes. Good morning. I'm Mark Williams. I'm the head of the National Police Coordination Centre for England and Wales. I'm also the Npcc lead for Civil Contingencies on behalf of the police chiefs. And just I suppose, building on what Alex said there, first of all, in relation to your question, it is possible and it should continue. Um and I do feel that policing is very well integrated into the resilience structures as is. We work very closely with our fire colleagues, other emergency services and other agencies in emergency preparedness and testing and exercising.

And as Alex said, very importantly at the local resilience forums across the country, about half of them are chaired by police officers in one way or t'other. Um, most of them are senior local officers for the area, often executive officers, um and where we don't share those groups, we, we, we sit on them. Um and we recognise that, you know, in terms of subsidiarity, um the best solutions often come at a local level and local partners and local solutions work very effectively in the vast majority of issues that are being addressed.

But a, as Alex has also pointed out, there are some gaps in how we connect national and local. That's something that certainly we would be very supportive of, of, um, playing our part in, I suppose in addition to, to your point, in terms of how do we contribute to that sort of shared resilience and resilience piece?I think as a service, we can and do provide leadership within local resilience structures at a local level. Um, we offer a 24 over seven national coverage and also a national mobilisation capability to support resilience day in, day out.

And also, I would hope we act as a trusted voice and communicator. Um, as a, as an institution locally, along with the fire service, along with other trusted agencies, which at times of crisis is incredibly important. So I do feel that in answer to your question, we, we are very well integrated already. We work very closely together. Only last week I was working with the Fire Chiefs Council to, on a CPD input explaining our approach to mobilisation and how we can learn from each other.

Um, and that sort of co coordination. Co-working is typical and common day in, day out across the country.
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10:37
None Portrait Speaker 4
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Good morning. Matt Killick I'm the chief operating officer for Saint John Ambulance. Um, so I don't sit here representing a statutory organisation. I sit here representing a charity. And I suppose my sort of view of this is from the third sector. Um I would agree with colleagues in what we said in many ways, in terms of actually the ability and the local focus on resilience and response. When it works, when it works well, it works exceptionally well.

The benefit of having the voluntary sector around the table, um, helps with that local understanding of need with actually the building of trust at a local level, the understanding of what those local communities may want or require from a response, both during that response and after that response as well. Um, the gap as I see it from a voluntary sector perspective, is that there's no mandate to involve the voluntary sector at local level or national level. And for me, that's a huge gap. If I think about Covid, whilst I don't want to bring people back to that rather challenging time, my role at that point was, um, director of Crisis response for the British Red cross.

What I saw from the moment Covid started to sort of close our front doors was the voluntary sector, local communities, faith groups stepping up and supporting their local neighbours, literally without being asked, without any requirement to mobilise at pace. What then happened was your larger organisations like Red cross, like Saint John coming in behind that with the right structures?Um, but what I saw as well with that is actually we then worked in partnership far more effectively with fire and rescue, with police, with ambulance, whether it be the fact that Saint John delivered NHS vaccinators and we recruited 30,000 volunteers to deliver the vaccination programme.

And that's just one example of multitude of other aspects that happen both locally and nationally. That was all done through relatively robust but quite quick relationships being built behind the scenes. That was all being done with communications about how do we respond to this, which is great in many ways. But as we all know, partnerships should be built in peacetime. And actually what we aren't doing from a structural perspective in any way, shape or form to the level of rigor that we need, bearing in mind the risks that we are seeing in the next three, four years in this country is systematically putting in place the right structures, the right control.

And whilst I don't want to go on too much about funding, but there's lack of there's a lack of funding in the space for the voluntary sector. You know, if you think about the 20,000 volunteers that I have within Saint John Ambulance who are medically trained, they are part of probably most of the communities that are represented around this table. You know, they already understand the community. They already live on your streets. They already respond to local provision. And we're just one organisation amongst thousands who already have highly trained, highly vetted and highly able and willing people who will stand up at key moments of crises.

So for me, it's about actually putting in place that structural approach, whether it be legislation, whether it be better guidance with Lrfs, because the voluntary sector is there. I also think there's a risk that it's not fully understood. I think often people think of the voluntary sector as maybe your local charity shop. It absolutely is that in many ways. But because of the vibrancy, it's faith groups. It's large organisations like Red cross, like Saint John, like Scouts, but it's also a multitude of other organisations that make up a real rich tapestry, which in turn can be quite challenging to engage with in some ways.

But again, having the right structure, the right funding, the right approach to engage in that, I think could make a fundamental difference to any of the challenges that we see in the future.
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10:43
None Portrait Speaker 1
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Would you like to.
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10:44
None Portrait Speaker 3
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On, on, on that point, before I come back to concurrency and, and reservists, um, we have now established a full time senior officer in the role of liaison with military and other emergency services colleagues around the planning and preparedness for the risks and threats that we face in the the defence space. Um, and clearly that's quite a significant change of posture from, from that that existed for the past few decades, to be honest. Um, so a lot of work is ongoing to establish, um, and prepare, um, the police service for, for its role and what would be required of it in any heightened conflict situation.

Um, going back to concurrency, we, we regularly consider concurrency and everything that we plan for. Um a good example is the very practical current one is, um we know that the euros are coming to England, Wales, Scotland in 28, 2028. We know that that summer may also involve a G7 at some point during the year. I think there's possibly a G20 at the end of 27 coming to the UK. We know that in the summer demand spikes. We know that in recent years disorder, protest and other challenges, many of which stem from sort of geopolitics at a global level, um, play out on the streets across the country.

So we are already considering the concurrency of those events, our demand profile, our resources, and what training and capacity building we need to put in place in advance of that summer in particular. So that work is already started. We do that routinely now for major events and other operations that are taking place. We layer on top other reasonable worst case scenarios to establish whether or not we can sufficiently mobilise in a law and order space to cope with any demands. In terms of reservists, we, like Alex, have started the process of better understanding, um, the commitments that we have.

We carried out a survey in 2025 of those that are volunteer reservists. So that's those that at the moment are serving in the TA or in other voluntary roles. Um, there is a small proportion of them across a sort of 145,000 officers that are across England and Wales, about 0.2 to 0.9 percent in most of the forces offer some sort of voluntary support. What we don't yet know and what we are now surveying, and we'll get the results back, I hope this August is those that are in that strategic reserve.

Um, so that will give us greater clarity and more specific numbers. Um, and will help us with that planning, you know, should, should they be mobilised for any particular threat again, so the who owns them and how that plays out. I think for us, our assessment of that is that those that will likely be affected are those with specialist skills. Those have worked previously in EOD search. Um, you know, other capabilities like that. Um and that will have a knock on effect.

Of course, the delivery of local policing services at that time. Um, but it's work in progress. Thank you, thank you.
10:47
None Portrait Speaker 4
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Thank you. Um, I think to your first question, enough people, if I look right now with Saint John Ambulance specifically, we have about 20,000 volunteers, about 1400 staff. Um, I think right now. That's sufficient for what we do on a day to day basis in terms of our delivery profile, whether it be, you know, first aid at public events or other activity as well. However, if you then look for the next 3 to 4 years, if you look at the level of our volunteers who potentially either are reservists or indeed who are paramedics or other health care professionals in the NHS, straight away, there's a significant risk that a large proportion of those will be taken out of our workforce, and understandably so.

So the ability for us to look at that and understand from a concurrency perspective, do we have enough people in our workforce?Candidly, the answer is probably no. And so what we're looking at presently is how do we work with other voluntary sector organisations who understand command and control, who understand mobilisation at pace and actually bring together those collective skills?You know, we celebrate 150 years next year of Saint John Ambulance. Um, if you look back at, you know, both World War One and World War Two, we worked in partnership with the British Red cross and many other organisations.

That's a sort of footing we're getting back into behind the scenes to work out how we can collectively respond, and not just within the sector though, but actually how do we work across other commercial organisations where potentially they won't be doing the same activity?And actually we can mobilise those individuals as well. So again, it's a big piece of work to do behind the scenes, but it's a genuine risk that we're looking at right now.
10:49
None Portrait Speaker 3
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Thank you.
10:49
None Portrait Speaker 1
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Thank you, Lord oats.
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10:49
None Portrait Speaker 4
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Yeah, happily. Um, I think NRF saw an immense. Function locally. And as I mentioned earlier on, where they work well, they work exceptionally well. For me, the shift to moving from the sort of planning and preparedness for emergencies to the build to resilience, I think is a fundamental shift that needs to be put in place, you know, as a as a society, I don't think there is much recognition about the risks that we face in the coming few years, or the need to be resilient.

And what actually that means in reality. I remember when the term whole societal resilience was coined a few years ago, everyone scratching their heads trying to come up with a definition. If you go into Google now, there are 3000 definitions that are all pretty much say, the same sort of thing. Um, but I think there's a huge opportunity for the NRF function to be that core central conduit locally and actually to bring in, as I said, the voluntary sector. And the reason I keep on talking about the voluntary sector, as you probably heard, I'm very passionate about it, but actually they are the individuals in any way, shape or form, as Alex and colleagues have said, that actually understand the local community, understand the specific needs are there prior to that emergency happening?Are there post that emergency, uh, sort of finishing as well?They are the ones that potentially can support and understand what community resilience definitely means, whether it be an individual household or that community or the system that sits around that as well.

So I think there's huge scope for LF I think there's more funding needed for LFS, I think there's more support and training needed for LFS. I think there's more guidance. And as I said, you know, the prescription around engaging with and not just having due regard to the voluntary sector, you know, as is currently within the CC, a, all of those things are really critical. And I think without that, we're not going to see that sort of success happening when the worst is going to happen.

And unfortunately, as we all know, it's not if it's going to be when.
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10:53
None Portrait Speaker 3
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Yes, yes. If I may just quickly, just in support of my experience during Covid. Um, at a time when I was working in Scotland was that we, we sought support from the third sector through a single representative because of the, the scale and size of the number of agencies involved. Excuse me. And it worked very effectively. It was a British Red cross on that occasion, but they represented third sector and other agencies as well. So I think there are ways through this, but nevertheless, it deserves greater thought and consideration in that space.

Sorry going back though to to Lrfs and their effectiveness again, I would agree. I see I consider them very much the building block of wholesale society resilience. Um and rightly so. There are there are ready made effective structure that is in place across the country and can be taken advantage of. If there were areas that we wanted to, I suppose, develop and improve, then data sharing and, and risk intelligence. Um, some of that would then require some cognizance of things like vetting and other information sharing limits.

I know there is work on going to try and ease some of those challenges. Um, further are more realistic, um, multi-agency exercising and a real role in that testing and exercising space and ownership and responsibility. There. Communication with the public, I think critically, you know, um, what LFS are, what they do and what they offer. Um, I'm sure that's again, an area that could be developed further, but underpinning a lot of that is, I think a need for greater funding and greater strengthening of their statutory responsibilities.

Uh, bodies, which I very much support.
10:55
10:55
None Portrait Speaker 2
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So I think, as I said at the start, what I'm currently chairing is our national group, which brings together all of the LRF forums across the UK. We've, uh, regionalized our structures. I think there's an element where this work is underway now about brigading, coordinating, structuring, making sure that we make it easier for people to operate. The 38 across England are absolutely invaluable, as Matt has said, and about how that localism, understanding hyperlocal is crucial. I think what hasn't been structured in the past is make it easy for.

If you are a national group, how do you bolt in 38 different ways and probably add value to what you're saying?So I think having the duty across the board is crucial. We need to make the system work for people where there is a national conversation that we are trying to bring to the fore. So you speak on behalf of and we structure, we see that national picture, but the local delivery is still as crucial so that you've got its basic command and control of what we are doing.

So we are starting to implement and bring that in so that we have local, regional and national coordination. And then we bring together with key system leaders in a round table so that you can speak at that national level. And to your point, do you actually need someone 38 different ways?Probably not, but you need to have the ability to pull a lever and have that support coming in at the hyperlocal when you need it. I think that would create a far stronger strategic conversation to our preparedness.

And then, dare I say, when we do have to respond to those major incidents, the ability to have that convening power of those faces around the table would really strengthen those local responses.
10:56
None Portrait Speaker 5
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System.
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None Portrait Speaker 3
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Perhaps if I, if I take that question. Um, yeah. I mean, obviously we will need to await the outcome of Lord Hogan-howe work in terms of the structures and how policing may look in the years ahead. But clearly, reform is is upon upon us and there will be changes. So there will be an impact on lrfs in some way, shape or form, exactly what that is, is hard to, to, to say at this stage before we have perhaps greater clarity on, um, how many forces there might be and what the geographic spread of them look like.

Um, I think though whilst it may present some challenges in that space, it presents opportunities. Um and that refreshing of the structure and potentially a consideration of the structure and how it best serves our works alongside policing, um, is going to be very important. And if we touch on Scotland, where I work for the majority of my service, um, there is a, I suppose more of a, I'd say command and control model. That's not wholly accurate, but there is a, there is a number of layers within the resilience partnership structure.

There is local, regional and national. Um, and the regional structures I always found to be hugely beneficial. They were supported by funded resilience officials, Scottish Government officials. Um they brought a coordination and an oversight to, to local support and local activity. And they linked into the Scottish Strategic Resilience Partnership, which provided a assurance function for what was happening at the local and regional level. So there was a natural structure, um which in preparedness worked well. Um that will, will fit a model in the years ahead.

It's hard to say, but clearly there may be lessons to learn from from that because there were benefits. Um, and yeah, I would choose to look upon the force restructuring as an opportunity to actually refresh, reconsider, and given the environment and the whole society structures we are seeking to achieve collectively, this offers a really, you know, once in a once in a long period opportunity.
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None Portrait Speaker 1
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Lady Northover um.
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None Portrait Speaker 2
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I think the CCI in its own right. It is pretty clear in most places it does require a duty on, uh, category one and category responders. I have to say, that's not language that I like because it creates a tiered system. And I think, as we've said, when you have crisis and preparedness, it's not always the agencies you think that are the ones that are leading. You know, our voluntary sector colleagues lead massively in response, you know, humanitarian assistance in crisis.

You need a roundtable of people. So I think sometimes the language can not be helpful in there. I think one of the areas that we've discussed over the years is what is missing is that lead agency at the moment, it tells many people what to do, and the Lrfs bring people together. We've heard about some of the challenges about representation. One of the areas that we are discussing from fire, and our position is, is that this is where the Fire and Rescue Service could play a valuable role with its convening power.

We've we've spoke of trust. Um, and one of the comparisons we've given is that if you look at the way that the government delivers its contest strategy, different subject matter, but the police are a lead authority for that. And we have really strong multi-agency structures underneath it at the moment. If you look at resilience, government doesn't necessarily have that delivery arm in that way. And I think that's a role that the Fire and Rescue Service could play in the future about having that convening authority with chief fire officers, bringing people together in that geography that they operate in to deliver an arm of, doesn't take away from others responsibility, but creates a very good structure that we've seen in other areas with the lead agency to work across all of those partnerships to help deliver the requirements of the CCA.
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None Portrait Speaker 1
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Lake.
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None Portrait Speaker 2
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I'll I'll go first and again see if colleagues agree. Um, I, I would play this back the other way round and say, what do our public expect when something's gone wrong?They don't really care who's doing it. They just want to be looked after in crisis. And they have an expectation that the system will work for them. I think the gaps come where we don't respond and coordinate as a system. So, uh, across the UK, if you dial 999 now to a crisis, you will get an excellent blue light response.

Your LFS will go into activation, we will put in place strategic coordination groups. The risk comes, I think, when we look at particularly the humanitarian assistance side of delivery, that part of the system, I don't think, mobilizes in the same way. And I think whether you're impacted by flood, whether you're evacuated as a result of fire, when our communities need that humanitarian assistance, bringing in our local government colleagues, being able to work across the voluntary sector, the system doesn't currently work to mobilise in the same way.

Convene that roundtable at pace to be able to deliver those services. And I think that's where we need to really shift to make sure that there is a single system approach, not a really good blue light response. And then a couple of days later, we start getting that humanitarian assistance bit. Right. And I think that's something we need to learn from previous public inquiries that tell us that we are very good at gripping, structuring and putting things in place. What we need to evolve in is having system leadership to properly put our arms around crisis in all of its phases.

No.
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None Portrait Speaker 1
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Do you have.
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None Portrait Speaker 7
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Um.
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None Portrait Speaker 4
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Just very quickly I just. Um, there's a question mark for me to say. I absolutely agree that if you dial 999 now, you'll get a great service from our blue light blue light responders. The only challenge that I would have in that space is that there's not enough resource already in those services. So if I think just last week when we had the red heat warning, we had multiple ambulance trusts contact Saint John to say, can you help us?And rightly so, because that's part of our position.

Um, but you had 3 or 4 days of quite significant heat and one ambulance trust. You had over 400 calls waiting in the stack to be allocated to an ambulance. Now that is one week of heat. If we have got back to the concurrent concurrency issue that we mentioned earlier on, if you've got these issues coming up, whether it be conflict on domestic soil or something happening in Europe that impacts us domestically here as well, our blue light services will be stretched exceptionally stretched.

Already. All of our services and NHS trusts are under immense pressure. How we recognize and understand that and genuinely grip that and not wait for it to happen and then respond, I think is probably one of the biggest challenges that we will face. There are solutions that are out there, but I think at the moment our systems are already significantly under immense pressure and I can't see them getting any better moving forward, despite the best efforts from everybody who are around the table.
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None Portrait Speaker 4
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No, but we do so. So there's a couple of different aspects to the organisation. So we are the largest commercial trainer of first aid training out there. Um, and also as part of our new strategy, we've got the ambition to train over 800,000 people a year in first aid skills. So for us, you know, training the public is core to what we do. And that's everything from, yes, we'll have a recession. If you go to your local fete all the way through to we'll be doing training in schools and other aspects as well.

So it's a real sort of cross-section of how we do that. Um, and luckily synonymous with our, with our brand and who we are. People recognise us for delivering that as well. So I think there's a huge opportunity here. The bit that I suppose I'm sort of reflecting on is there's a, there's a need, I think, for the three of our agencies to come together to work more effectively, because we're talking probably about similar members of the public, those individuals who've got a propensity to act or who want to be trained.

Um, there's a flip side to this that we've started to see, though, in especially around first aid training, is the confidence to act irrespective of if you've got the right training or not. So actually, because we tend to be in a far more litigious society, people now are slightly more worried about stepping forward and helping. So we're not seeing this as a as a, an epidemic in that sense. But it's definitely an issue. Um, we launched a campaign a couple of years ago called CPR bras, which is very simple actually.

You know, if you're having a heart attack and you're wearing a bra, the guidance is the bra comes off, especially if it's underwired because actually that can get in the way of putting the pads effectively on someone's chest. Now, I don't want to speak for the ladies around the table, but I'm pretty certain you'd like to live opposed to modesty being potentially taken away from you for a few minutes. So I'm not not presuming to assume. Um, but again, we're recognising that actually the confidence for people to act when they have training is a key component of that training piece as well.

So I think there's an ability for us to think about that more effectively.
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None Portrait Speaker 4
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I start on that one. Um, it's interesting. We haven't been consulted in Saint John, as I understand. Um, but that's the nature of many of these sort of initiatives that that sort of develop. And we're more than happy to be involved fully. Um, when I looked into this, what was interesting, as I understand it, there are, I think it's quite a tightly focused programme. There are five core areas. So it's financial literacy, democracy and government, law and rights, media literacy and climate education, as I understand it could be wrong.

Um, and that was quite interesting for me because I'm being held up. Where's resilience within that?That should be front and centre number one. And actually resilience is not just first aid. Resilience is everything we've spoken about today. Um, and actually young people, they are, we use it slightly cliched, but they are, they are the next generation. Um, but for them actually, you know, in Saint John, we have over 20,000 young people who form our cadets.

I have the privilege of meeting two of them yesterday, Dylan and Emily English. And Emily is our National Cadet of the year. She is one of the most articulate, impressive people I have come across in a long time. Along with Dylan, who's our outgoing cadet of the year, they work alongside the lady law lady Lord mayors, um, or the Lord Mayor of London every single year. It's a really prestigious role, and they have a really vocal opportunity to talk about the needs of young people as well.

But I think you can engage with young people where it doesn't have to be scary, or it's not about saying, right, go and do drills where you're going to go and sit under a table because something may happen. You can make it fun and enjoyable, which means actually that education sticks. I think there's a huge opportunity if we're developing a citizenship programme, that resilience is a fundamental strand of that component and actually embodies everything that we've been speaking about today, because young people are exceptionally smart. You know, they were over half a million young people do scouting where I used to work every single year.

You know, they've got the ability to step up and actually be interested in what's happening around them as well. My two daughters regularly take me to task about a whole range of aspects as well. So I think, as I'm sure many of your grandchildren and children do as well. So I think if it's not in, it doesn't appear to be in that programme. I think if it's not in that programme, it's an immense missed opportunity which we must look.
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None Portrait Speaker 1
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At, Mr. Williams.
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None Portrait Speaker 3
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Yeah, I think this is a real challenge, how we get the communication right for the right people because um, you know, communicating with younger people or students who are arguably more reliant on digital social media and other channels, like that means that, for example, they're more susceptible to disinformation and, and, and the way that that is, is often used by malign actors, um, that undermine efforts, you know, made in those spaces, vulnerable members of the community may rely on a small number of trusted friends or family. Those in lower socio economic groups may not, um, react well to um, direction to stockpile food and, and other such things when they're more concerned about day in, day out, putting food on a table.

And so we've got to be really balanced and nuanced in how we engage this debate and how we communicate effectively around this approach. We don't want people to panic, but we do want people to be more prepared. We do want people to to engage with each other. We do want people to feel part of a community. These are these are big societal issues that we're addressing. And I don't think they'll all be solved quickly or with a a single communication plan or strategy that comes out, you know, centrally.

Um, so I think we need to enter into this, you know, with our eyes open, but equally start that journey and nuance and consider and carefully step incrementally through the, through the sort of journey that I think lies in front of us in terms of re-engaging communities, re-engaging society, enhancing their empowerment and resilience on a personal and family community level, because it will need to be targeted and, and channelled in certain ways for certain groups.
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None Portrait Speaker 1
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Thank you, Lady Paul.
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None Portrait Speaker 1
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Top of your list.
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None Portrait Speaker 12
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You awake.
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None Portrait Speaker 2
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First.
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None Portrait Speaker 1
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Go first.
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None Portrait Speaker 7
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I agree with colleagues. It's strangely. And actually, just to add to that, I mean, obviously I want to speak for the voluntary sector. You know, there are hundreds of thousands of highly skilled, highly trained volunteers that are already out there and volunteers doesn't really do them. I think the service, you know, I've got volunteers that will do a full time job and then come and do another full time job. You know, in terms of hours every single week for Saint John.

And you can see that in droves across the entire sector. But I think, you know, as I mentioned earlier on, the voluntary sector is not formally recognized within these structures. And for me, that would be my biggest sort of clarion call here. You know, for us to be seen as a core component of building national resilience. And I think actually, by doing that, you've got there's a real risk in some conversations of these new entities being created, new forces being created.

You don't need to do that. You've got organisations, systems, structures, processes already there, but they are there by virtue of the fact that they are able to fundraise and do what they do. And frankly, resilience is a by of that. That's great in many ways, but it's an immense risk for any type of sustained approach. So back to the funding issue. Funding is really important. But fundamentally recognising the voluntary sector and ensuring they are part of both national and local structures and actually enable a standing capability and capacity opposed to what sort of happens now in some areas where it's a bit more of an emergency.

Add on.
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None Portrait Speaker 1
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Well, your three top line recommendations are very clear and very strong and very helpful. Thank you very much indeed for your time today. Um, and I can now close the public session. Good morning and welcome. Thanks for coming to help us with this very important inquiry. I should just remind you that it is a public session. We're being broadcast live. In a couple of days. You will each receive a transcript of the session.

So there'll be an opportunity to make any minor corrections that need doing. And of course, if you think of anything afterwards that you wish you'd said, we would always welcome supplementary evidence in writing if if you need to. Um, we've obviously got a lot of questions to ask you and could I ask that just before you give your first answer, could you introduce yourself very briefly?So we've got that on the record as well. Thank you. So I'll start with the first question and ask you a.

Sort of general scene setting question really to describe how and where the UK's health care products, including medicines, are currently made and what the implications are for the for supply chain resilience. Um, we've had written evidence, for example, that we get, we import 90% of our penicillin from China, uh, which was a statistic that rather alarmed me. Um, and I think that we also import a very significant proportion of other antibiotics. And so I wonder if you could comment on that in your general answer about, um, how and where we get our products from and what the implications are for the supply chain.

Perhaps I could start with, um. With Andrew new, um, from the supply. Chain.
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None Portrait Speaker 11
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Absolutely.
11:36
None Portrait Speaker 13
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Thank you very much. And thank you much for the invitation. So Andrew new on the chief executive for the NHS supply chain. So it's a company owned by NHS England and is responsible for buying and fulfilling. At the moment, around two thirds of the Non-medicinal products to the health service in England, including everything from CT and MRI scanners and large diagnostic equipment through to food and stationery going all the way through implantable devices and consumables. So a broad variety of things that are consumed across the health service.

And of those medical devices and implantables. Around a third have their final manufacturing location in Europe, around 20% in North America, and around 20% in the Far East, the balance being domestic. But I think it's key to note that the supply chains that sit underneath our major suppliers are truly global. So although we may receive a large piece of diagnostic equipment manufactured in North America, um, a large proportion of the components that go into it will be managed in the Far East. They'll be managed across Europe and therefore they'll be consolidated at their point of assembly.

And the same happens typically across the west coast of Ireland in how medical devices are implantable tend to be made, and then moved into the UK as part of an import. So we're a truly global supply chain. Um, the majority of manufacturing happens outside the country and therefore we integrate that together through the NHS supply chain and into the NHS in England.
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None Portrait Speaker 7
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Hello. Good morning.
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None Portrait Speaker 1
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You and Mr. Samuels.
11:38
None Portrait Speaker 15
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I'm Mark Samuels, I'm the chief executive of medicines UK with the trade body representing 45 pharmaceutical companies that supply around nine out of ten NHS medicines, though not all. Most are generic and biosimilar medicines. To answer your question around manufacturing, so the UK manufacturers, almost a quarter of its medicines here in Britain, which is uh a good. Proportion for any country that's a good success. We get about a third of our medicines from India and a third from the EU. Of course, finished medicines are not the whole story because we have to look at medicine ingredients as well.

Um, about half of active pharmaceutical ingredients come from China and about half come from India. That is a proportion that's changed over time. It used to be far more came from China. But the Indian government decided as a matter of policy that it wanted to be more self-sufficient. So it's invested in active pharmaceutical ingredient manufacturing, which does show that it can be done and turned around. If we were to take that seriously. Um, about. Two thirds of the NHS generic medicines cost less than the price of half a first class stamp for a month's supply.

So that has a, an immense impact on supply chains. It means they're stretched globally to find the most affordable ingredients for manufacturing. And it means all the resilience is taken out of it because all the reserves are taken out. So I'm happy to talk about that and answer some questions around that. I don't think we especially need vast sums, more money, but I do think the money that we do have, the existing budgets that could be spent far more wisely. So I'm happy to come on to that.

But there are some fairly sizeable budgets that I think have been ill spent and would have been much better spent on national resilience. And indeed, there are the ways of sustaining such a a low margin industry. Um, is to ensure that unnecessary red tape and bureaucracy is minimised to, to help companies supply the NHS affordably.
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None Portrait Speaker 15
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Um, well, we can always do more. It's always wise to manufacture domestically if you can. We'll never manufacture everything here. So that means international relations are are very important. Um, the government has a trade agreement with India that has an MOU on medicine supply. If that were fleshed out in more detail, that would obviously be very valuable given we get a third of our medicines from India. Um the relationship with the EU is critical given we also get a third of our medicines from the EU crucial.

In the EU relationship is the current huge disincentive for companies to invest in UK manufacturing because the current agreement with the EU says that if you're a company and you have manufacturing plant in the EU, you can export to the UK, no problem. But if you manufacture in the UK, you cannot export to the EU. So it's a one way street. We've lost about 7000 manufacturing jobs in the UK since that agreement, we have been asking pretty loudly for mutual recognition. Uh for UK manufacturing and EU manufacturing.

That will be really helpful. The government, to its credit, does have a something called a life sciences Innovative Manufacturing fund, which is a £520 million fund that is necessary, but it's in no way sufficient. So we welcome that. But more could be done. I mean, the antibiotic example you gave is illustrative. So we have almost no antibiotic manufacturing left in the UK. Last manufacturing plant for antibiotics in England closed last year. There's a negligible amount left.

So we've in effect entirely reliant on overseas antibiotics. That would be a strain in a pandemic. And if we were in, as has been widely publicised, if we're in a war situation in 2030, then we obviously would be in, uh, remarkably deep trouble. Just the last point on that, I do think there's money that could be invested, that could have been invested to solve things like that. So, for example. The, um, life science. Sector plan has three pillars, not one of those pillars is resilience.

Um it has 33 actions. Not one of those actions applies to generic medicines even though they're nine out of medicines used by the NHS and the. Can invest £600 million in something called Health Data Research UK. So. I'm sure that's a good thing, but it would have been helpful from a resilience perspective. We've looked at the trade offs between. Do we put £600 million into an NHS project to support health data research, or do we put £600 million into strengthening the UK's active pharmaceutical ingredient manufacturing and antibiotic manufacturing?It costs ballpark £150 million to set up a new antibiotic manufacturing plant, so we could have had four of them for the same money.

Um, so I do feel strongly, as you can hear, that resilience needs to be a much stronger priority for this or indeed any future government.
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None Portrait Speaker 1
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Thank you.
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None Portrait Speaker 12
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Thank you.
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None Portrait Speaker 13
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Yes. So just in terms of the device manufacturing, um, we are an integrated part of global supply chains here where the products for the majority are very similar, consumed in all countries. Um, and therefore this isn't just a UK or an England thing. This would have to include a global repositioning of where those products are manufactured. Um our view has always been that although there is some potential to increase manufacturing in the UK for products, the investment has always been a challenge because of the length of funding cycles and therefore the investment cycles.

When I met with the supplier six months or so ago and asked him the question of how long would you need an agreement with the NHS in England if you were providing a third of a certain category of product?There was a ten year contract to warrant the investment in infrastructure and typically work on far shorter cycle than that across the system. Um, however, um the, the UK and the National Health Service is a fantastic place for innovative new products that enhance that future ways of delivering care.

And it's critical that we use the establishment that we have to scale and adopt new innovative technologies, creating new businesses in the UK and using those new businesses as a way of building resilience in a way that the future care is delivered, rather than trying to reposition those global markets to where it has always been done. Um, the health service is moving so quickly that I think that forward view is probably more helpful than the backward one.
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None Portrait Speaker 10
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Yes.
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None Portrait Speaker 5
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Thank you.
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None Portrait Speaker 1
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Thank you.
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11:50
None Portrait Speaker 13
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So, um, NHS supply chain works closely with the Department of Health and Social Care on the pandemic preparedness activity, particularly with ensuring that there is flexibility in response to different types of these major incidents. And the Department of Health own a major stockpile of medical equipment available, particularly personal protective equipment. In those circumstances, we operate in integrate that activity into business as usual activity for the NHS to ensure those products are flowing on a regular basis, um, at the moment, the NHS supply chain, physical infrastructure is roughly the same size as it was in Covid.

We've added a few hundred thousand square feet of physical space, but not a huge amount. We have working across government, put forward a proposal and had it approved by Treasury to materially, materially enhance the size and range of products that can be held across the NHS supply chain. So whilst there's currently around 7000 different items held in stock across a variety of locations, and with approximately 4 to 6 weeks of depth in there in future, we were looking to double the range of products and increase the depth for products where there is a material risk of issues.

Um, today there are approximately 350 products where we're aware that there are some risks around supply resilience. And they're used frequently in the health service. So we've increased the depth to have 6 to 8 weeks of stock in the UK available to distribute at any one time, which will give us enough time to then work with global manufacturers to ensure that we can fill behind and go forward. So, um, we've moved around supply resilience and they're used frequently in the health service. So we've increased the depth to have 6 to 8 weeks of stock in the UK available to distribute at any one time, which will give us enough time.

Today there are approximately 350 products where we're aware that there are some risks to eight weeks of stock in the UK available to distribute at any one time, which will give us enough time to then work with global manufacturers to ensure that we can fill behind and go forward. So, um, we've moved away since, um, the end of Covid. We've not moved to where we wish to be yet. Um, today there are approximately 350 products where we're aware that there are some risks around supply resilience.

And they're used frequently in the health service. So we've increased the depth to have 6 to 8 weeks of stock in the UK available to distribute at any one time, which will give us enough time to then work with global manufacturers to ensure that we can fill behind and go forward. So, um, we've moved away since, um, the end of Covid. We've not moved to where we wish to be yet. My expectation is in the next two and a half to three years, we will have built the infrastructure and deployed the technology to be far more flexible, adaptable and be able to respond to the standard that we should expect where we have surges in demand in the future.
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None Portrait Speaker 10
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Yes. Thank you.
11:54
None Portrait Speaker 17
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Um, am I unmuted, chair?
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None Portrait Speaker 15
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Um, on the first point. So stockpiles are part of the answer, but not the whole answer. Um, and there's several aspects to that. Um the government has got a list. DHS has got a list of critical medicines. They've worked that through. Um, we know from the pandemic that stockpiling was part of the reason we didn't run out of medicines. It was sheer, uh, luck that we had a stockpile before the Covid pandemic because we'd actually built up a stockpile in anticipation of there being issues, getting medicines into the country for the Brexit transition.

It turned out there weren't any issues with that, but the pandemic struck. So we had a stockpile of medicines. Um, the. The tricky bit of that is who's going to pay when two thirds of medicines cost less than half the price of a postage stamp, manufacturers are going to struggle, uh, to pay for a stockpile. And the UK is in competition with other countries for stock allocations already. So a limited government stockpile is probably part of the answer, provided it's it's it's not paid for by the industry.

Um, having agility and domestic manufacturing is, is part of the answer. If you've got a manufacturing plant in the UK. You will quite often store about a year's worth of medicine ingredients. So if there were a time limited crisis, it actually would help mitigate our reliance on other countries for medicine ingredients. And we also learned during the pandemic that some manufacturing plants can be agile. So if we run out of one thing, we can switch to another. That happened with the, um.

Oxford Covid vaccine, where AstraZeneca did not have the capacity to manufacture enough of the vaccine for the vaccine rollout in the UK. But another country, Wockhardt, had the manufacturing plant in Wales, and they could switch that to manufacturing. Um the Oxford vaccine. So it's thanks to that Welsh manufacturing capacity in Wrexham that we actually had successful first rollout of the vaccine during the pandemic. It's that kind of combination of factors, not just stockpiles alone, that are important in mitigating crisis. Um, just on, um, briefly to answer your second question on the free trade agreement, so I understand from the colleagues that they are seeking to flesh out the MOU with India on medicines supply, but I don't know, uh, the level of progress with that yet.
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None Portrait Speaker 15
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Well, uh, let's start with the positive. So having a national health service in secondary care has provided the opportunity to strengthen, um. Resilience. NHS England, to its credit, is looking at procurement of medicines in tenders. And it's uh. Putting in the tender waiting a reliability of supply criteria. So I think that is helpful and interesting and deserves credit for that. The Resilience Directorate in the Department of Health and Social Care, are have got some expert and highly experienced people in dealing with shortages.

Um, and that's also very helpful from a national perspective. It also brings a concern because we've got some of those people have got fantastic know how that they've gained from, um, the pandemic. And we do need to make sure that we retain that know how, um, given all the challenges as to headcount reductions that are going on in England, DHCI think I'd be very concerned if we were to lose some of the most expert people, um, in resilience. Um, but they're currently there and um, that is helpful.

Primary care is a little more challenging because, um. The upside is, is if there's a shortage, um, there is the opportunity to increase prices and therefore more encouragement to bring medicines into the UK. Um, the downside is community pharmacies have been financially under immense challenges to um, just keep the lights on, um, let alone thrive. That's led them to use. Algorithms for their procurement of medicines, which has driven some of the shortages we've seen. So the national picture is, as always, it's got pluses and minuses.
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None Portrait Speaker 11
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International.
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None Portrait Speaker 11
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Any lessons from.
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None Portrait Speaker 13
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So I think that there's certainly some material benefits of the national organisations within our broader health service working so well together in collaboration now is better than it was five years ago when I joined. And I'm told it's better. Never has been. But having Lawrence at the MHRA having nice. Having the department, having an interest in the room, to be able to have conversations means that you can get to points of decision quickly and efficiently, particularly when under challenge, and when we need to draw people together for resilience type matters.

Actually, there is a moment of drawing the system together to ensure continuity of care can happen. I think we're reasonably uniquely placed to be able to do that at a national level. So there's some real benefits to to be able to bring the whole national team together and make decisions quickly and make change happen in support of patients and and taxpayers. I think there are there are challenges that our service does create. Um, we, we have a service that's very much focused, um, through local trusts with local populations and their accountability as to those who deliver exceptional care and value for money for the taxpayer.

There are also times in a resilience scenario, for example, where that becomes a real challenge, where local decisions are being made that might not go into the greater good of a national health service. And trying to coordinate those two things together can be exceptionally challenging. Um, and that's a, um, a part of the balance that you've got to find when you want something that's devolved and pushed out to be as local as possible, but also take the best of the national piece that comes alongside it. It's a compromise and it's a compromise that we recognise.
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None Portrait Speaker 18
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Yes.
12:09
None Portrait Speaker 15
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Yes. So we were involved in the most recent exercise. Uh, I thought it was well organised, incredibly important to do. I was pleased and relieved that the government was doing something like Exercise Pegasus. Um there was. An element of fighting the last war because it did seem to mirror what we'd just been through with Covid. I suppose that's inevitable. It's tricky to avoid that. Um, and, uh, from my own sector, I'd say there was a.

Perhaps taken for granted, uh, the supply of established medicines because one of the introductions was what along the lines of what would happen if supplies were were interrupted from India and China. And I don't think everyone realised that the NHS would probably immediately grind to a halt because we run out of medicines quite quickly. So, uh. I think that was a surprise to many. But then that's part of the point of these exercises that they're learning comes out of them. So.

I hope it goes ahead. Again, I do think it's vital that we stop taking for granted established medicines, governments of all persuasions over many years have focused on the possibility of tomorrow's new medicines. Those are um. Um, forgetting about the fact that we need today's medicines that are well established in the NHS and the supply of those I think um needs to be further taken into account in the next exercise. Pegasus. And not just for geopolitical reasons, but obviously if we're reliant on um, China for, pharmaceutical.

Treatments and there's an earthquake or they have an outbreak of another infectious disease. You know, there are, or there's a shipping is disrupted, whether it's, as we've seen with the Middle East and as we've seen previously with the Suez Canal, um, you know, all these things can, can affect supply of medicines. So hopefully the next exercise, Pegasus will.
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None Portrait Speaker 13
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So we're an active part in Pegasus activity. Clearly, we operate some of the pandemic preparedness stockpiling activity on behalf of the Department of Health and Social Care. So my team are an integrated part of that testing. And I agree it was well run, well thought through. Um, and for us, it had a number of different streams associated to personal protective equipment, but also into medical devices and all other things required to operate across the NHS. Um, there are a broad number of learnings that have come from that activity that are currently being implemented across various parts of the health service.

For us, it's the integration between the activity we do as a business as usual, day to day thing versus the activity that would be required in a pandemic and ensuring that the scaling of the two of them can work alongside one another, to the point that we've made some physical choices around our office locations to mean that if you have that kind of pandemic response, where would we resource different bits of the organisation?Because in Covid, for example, mass scaling required to ensure that personal protective equipment is required, the number of people involved is the whole size of my commercial organisation, so I can't move everyone to do that task at the same time that they still need to be able to buy all of the blood products and all the other things that are consumed across the health service.

So we had a very good test of our own processes, a very good test of those that are provided to us by the department. Um, and lessons have been learned along the way, and we'll look forward to the next one. I think there'll be more. We'll learn as we test different avenues to ensure that we're prepared. One of the challenges in the health service is the financial challenge, in that it is likely that we could embed greater resilience into products that are consumed every day that would enable us to scale more rapidly when under different types of pressure.

But in the health service, the the cost of those products is greater than we pay today. And we are aware that there's financial constraints in the service. So the timing of how to implement those kind of truly resilient supply chain solutions, um, is a choice that we need to continue to make and make every time we refresh contracts. And every time we make new decisions, we do weight resilience as a material part of all decisions that we make around ensuring that products will be available when they're needed by clinical experts to care for people.
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None Portrait Speaker 13
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Organisation within the NHS supply chain. Yeah. So the resilience of ourselves is getting stronger. And over that next two and a half to three year period of time, I will sleep better at night around a whole host of different risks that we have to monitor and manage. Um, but that's good investment being made by government and the priority thing that will support the whole of the NHS in its resilience. Um, we then look at the resilience of the supply chain, um the supply chain to the NHS is a vast thing.

There are 700 plus thousand different products that could be consumed in the NHS in any day, um over an average three year period, there's around 165,000 different products bought there, bought from thousands of different suppliers, and have the depth of assurance across all of those would be a mass undertaking that I think would be beyond anyone's technical ability to do so. We have to prioritise where we see products with the highest risk, highest impact on the health service. Now there could be products with embedded IP, they could be products that are embedded into care pathways that would require changing clinical practice to implement an alternative.

Um, or they could be products where we've historically seen vulnerabilities across the supply chain. We take an assessment at the point of tender based on government best practices around supplier selection activity. We also continue to monitor throughout the life through something called the G SIP programme, which is our global supply chain information programme, to look for issues and incidences of challenges around products being used or suppliers to the NHS. Um, and we take proactive measures across those that we stratify as being the highest risk with the highest impact, um, to work with them on how they may wish to improve their levels of cyber security.

Um, there have been issues over the last 12 months where we have had significant compromises across suppliers within the supply chain. And therefore we recognise that the alternatives management and that agility of the national thing coming together to solve problems is critical. And whilst we can be always be better in the prevention and proactive activity, we actually do have a service is exceptionally good at the responsive, reactive problem solving activity. Um, which is one of the reasons why I'm confident in when I look across the supply chain that I've not had any disasters happening today, it's one of those.

And if an issue does happen, we will respond rapidly to it and we'll do it as a team and therefore will prevent any major issues happening towards patient care.
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None Portrait Speaker 18
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So so if I start.
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None Portrait Speaker 13
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Um, so my experience recently and this is, this is point activity rather than a massive, massive spike. Um, is that where specific?Adducts that can have a material impact on patient care. Um, become unavailable and we move into a position of kind of controlling how much of the demand can be fulfilled. The service pulls together well to deliver the outcomes required, including the clinical workforce, um, who are happy to make compromises and change their ways of working to ensure that that patient experience is maintained.

Um, I think you'd have seen recently we've had some bone cement issues with the supplier availability challenge. It required an alternative product to be sourced rapidly, made available rapidly, and the service worked as one solution to ensure that there was continuity of care happening across as a whole. Now, whether that would scale if you had 150 problems happening at the same time, the same processes would be followed, but clearly there would be resource constraints. And those individuals undertaking activity. Um, the, the service works exceptionally well together in a crisis.

Um, my concern would be around the workforce and their ability to deal with that crisis for six, eight, ten, 12, 26 weeks in a row. And I think that's where we'd have to ensure we were far smarter in rotating people through making sure we've got effective support for our people who will be fundamental. It's not something that AI is going to fix. It will be a people thing. Yeah.
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None Portrait Speaker 6
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Thank you.
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None Portrait Speaker 13
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I speaking to colleagues before um came in and said, I have to remember that I could design a health service around having a really resilient supply chain, but it would probably be a terrible health service because actually it has to focus on patient care and value for money in the broadest sense, and therefore, I recognise the compromises that are made and therefore the response we need to make to ensure we have resilient global supply chains to support. Um, it should be said there is a lot going on that is enhancing the resilience of the health service and whether it's our own modernisation, our support for trusts on their inventory management services, um, putting in new technology and solutions to get visibility of data across trusts to ensure there's mutual aid where there are challenges, the behavioral activity, there's a lot happening that's enhancing the performance, efficiency and effectiveness of the NHS, but also building resilience.

And I think that should be celebrated. My one thing is make that go much faster and we would be in a great place sooner. But I think if I was to ask for one thing, I would say give that priority to integrating the day to day activities with the requirements of resilience in the things that we do and afford the service, that flexibility to make decisions where it may not be the lowest cost solution, but is one that we know will stand up to scrutiny and challenge if we had a major event make that a greater priority for us, and I think we would design a more resilient supply chain and better service for our nation.
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This debate has concluded
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