One huge thing Wales should do differently if there was another pandemic like Covid

He was the familiar face on our screens during the Covid pandemic in Wales. Chief Medical Officer Sir Frank Atherton's face and words were beamed into our living rooms as we learned to deal with the new world of lockdowns and the ever present threat of the virus.

This week in a wide-ranging interview with Sir Frank after he decided to step down from his role, he spoke about Wales' response to the Covid pandemic and what he would change next time around. Most things he wouldn't do differently, but when it came to schools, he felt Wales should do "everything we could to keep schools open as much as we can". He also admitted he did not improve the nation’s health as much as he’d hoped when he took the job. He said inequality had “widened” in Wales in the last eight and a half years and that “some fundamental problems have not improved”.

He named the pandemic as one of the reasons why progress improving the nation’s health had been slower than hoped, but said it was more down to the global economic downturn affecting the UK and the cost-of-living crisis. These two issues had affected health in Wales and the work to improve it, he said. Stay informed on the latest health news by signing up to our newsletter here

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Sir Frank became Wales’ CMO in 2016 after being deputy chief medical officer of health in Canada. Recalling the time he came to Wales he said: “I remember very well coming from Canada because I looked long and hard at health statistics here. My feeling was the health of the population in Wales was lower than it should be and the inequality wider. It was not where things needed to be.

“As I leave some of those fundamental problems have not improved. A sad part of leaving is that inequalities have widened over time. That was partly down to Covid, but more to do with economic winds.”

Sir Frank said he was well aware of the crises in the Welsh NHS as he left his role - record waiting times, cancer targets not being met, patients dying in hospital corridors and GPs working 16 hour days among them. But he said the economy and other factors, not the NHS, were the drivers of inequality that could affect people’s health.

“The NHS is not really a big influence on inequalities. It’s more to do with the living circumstances of people, housing, jobs and employment - these are things that make a huge difference.”

Everything was turned upside down when Covid hit in 2020, he said, and the focus had to be on communicable disease. Sir Frank provided independent advice that led Wales’ response to the pandemic and received a knighthood in 2021 for his services to public health.

He also gave evidence to the Covid Inquiry in which he was quizzed on a number of issues including the transfer of elderly patients from hospitals to care homes during the pandemic without a test, even when they had Covid symptoms. He told the inquiry at the time it was not an "easy decision" for ministers to make with discharging patients back to care homes, but he added that "care homes ought to be able to manage cases of infectious diseases by isolating people within there."

He also admitted mass gatherings should have been cancelled sooner in Wales and that he now thought he should have recommended face coverings sooner than he did.

But, looking back on that time and the decisions that were made, Sir Frank in his interview this week said he would not have done anything differently. Lockdowns and school closures were necessary to slow transmission and the pandemic also meant other important work went on hold, he said, adding: “Covid did dominate for four years. Half my tenure was focused very strongly on communicable diseases, so I did not achieve all I wanted to.

“Lockdowns were absolutely necessary. We were watching what was happening in Italy. School closures were more contentious. We should do everything in any future pandemic to keep schools open as much as we can. It (closing schools) was the right decision at the time and helped bring transmission down. So it was effective. I don’t regret it (shutting schools) but if we were to face a similar situation would do everything we could to keep schools open as much as we can.”

Looking back on his career in Wales he said his position was a privilege. Good work had been done to improve health, even if not as much as he’d planned, he said. He said Wales could “celebrate” the work cutting smoking rates during his tenure. Obesity was still a “major challenge” and slow to turn around, he added, but said work had begun on tackling it.

Imposing minimum unit pricing on alcohol and the 20mph speed limit had also improved public health in terms of reducing illness, injury and death rates. and Sir Frank advised decision makers not to shy away from using the law to improve health outcomes.

“My advice to politicians is to remain confident to use the levers at their disposal - regulation and legislation.” But he said there were obstacles around tackling the negative health effects of industries such as gambling, tobacco, food and alcohol.

More effort and money should go on prevention rather than cure, he said. While more money was always needed the NHS could work harder at better communication. He added: “There is never enough money in the system. More than half the devolved budget goes on health and there’s no doubt it needs to be more efficient. We don’t spend enough on prevention. For the last 40 years we have neglected the capital infrastructure of the health service in the UK and buildings are crumbling.

“The NHS can always be better run, of course, and I often think about the gaps in the health service. The first is the gap between health and social care and also between GPs and hospitals and the gap between doctors and managers.”

Sir Frank had public health postings in Malawi, the former Yugoslavia, Tanzania, and Bangladesh before coming to Wales. His last job before moving to Cardiff was as deputy chief medical officer in Nova Scotia in Canada. The Welsh Government has said the Chief Medical Officer’s successor will be announced in due course.

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