Health Minister Refused to Speak Directly to Medical Director

David Ashford refused to speak directly to the island’s top doctor during the first weeks of the pandemic. 

Treasury Minister David Ashford was the DHSC Minister during the height of the pandemic.

The tribunal into Dr Rosalind Ranson’s dismissal by DHSC considered Mr Ashford’s evidence to be reflecting the best of his recollection, ‘albeit not always consistent or easy to support’. Dr Ranson’s legal counsel Oliver Segal went further to say that Mr Ashford’s evidence could be summarised as ‘practised and diplomatic seemingly guided by the principle of deniability of anything potentially inconvenient unless/until objective evidence was available to the contrary’.

The report makes clear that it is not the tribunal’s role to question whether the government made the correct decisions over Covid. However, it does raise questions about who was advising what and when.

At the start of the pandemic, former interim CEO Kathryn Magson created a command structure for advice which ran through three branches (bronze, silver and gold) before reaching CoMin. At the same time, Dr Ranson created two medical groups, the Senior Medical Leadership Team and the Clinical Advisory Group (CAG). Between them, they represented the island’s doctors and consultants. 

In March 2020, the government’s policy was to follow Public Health England’s (PHE) advice. However, CAG disagreed, saying this advice was ‘flawed’ and ‘unsuitable for the Isle of Man’. Miss Magson was aware of this opinion and on March 11 2020 she wanted Dr Ranson to bring CAG’s input to a strategy meeting on March 13.

The tribunal report says: ‘Based on in-depth investigations and discussions in her two Groups, Dr Ranson’s presentations were created to brief Ministers. Both Groups urged that a much more robust approach than that of PHE should be taken, including closing the borders. That viewpoint appeared to Dr Ranson not to be welcomed by Miss Magson.

‘This was especially so in Dr Ranson’s evidence after an announcement by Minister Ashford on the morning of Friday 13th March 2020 that the island’s policy would follow that of PHE so that the borders were not closed. The ministerial announcement referred to Covid-19 being mild in 90% of cases. There was no reference to advice to contact 111 about testing. There was an indication that self-isolation should be for seven days. The planned strategy was to follow the PHE approach of “Delay.” This encompassed delaying the spread to buy time to gear up to be better prepared for Covid-19’s peak impact.’

By this time CAG had already advised closing the borders, information which had been passed on to Miss Magson. The delay strategy being followed by Mr Ashford and the government, therefore, was going against the advice of the island’s senior doctors. This put Dr Ranson in the difficult position of trying to support Miss Magson while being under pressure from the island’s medical professionals who wanted to ensure their view was at least being heard.

The report adds: ‘Additionally after Dr Ewart returned, the approach of the Public Health Directorate also clashed with those of the island’s wider medical profession. Dr Ewart preferred to follow the path taken in England, an approach no doubt pleasing to Miss Magson in view of her association with the public stance adopted on 13th March by Minister Ashford.’

It also goes on to note that even at the start of the tribunal, Dr Ranson still didn’t know to what extent Mr Ashford and CoMin were briefed by Miss Magson on CAG’s advice to shut the border. And that it was clear that, at the meeting on March 13, Miss Magson was angered that Dr Ranson had spoken out against the government’s policy which had been announced by Mr Ashford.

The Refusal

The tribunal itself focused on whether Dr Ranson has suffered and ultimately been dismissed from her role because of whistleblowing. One of these protected disclosures that she made was to Enterprise Minister Dr Alex Allinson which came about because she believed Miss Magson wasn’t passing on information to CoMin. 

This was the second such conversation between the two, with the first taking place on April 10 2020 which was initiated by Dr Allinson in his capacity as a medical professional. Dr Allinson’s evidence said that ‘he had been informed that Dr Ranson was feeling somewhat isolated and so he had made the initial move by text on 9th April’. In effect, this was a supportive gesture to a medical colleague. 

Typically any conversation between the two could not have been a protected disclosure as Dr Allinson was not the Minister in charge of DHSC, however, the tribunal considered a wider definition of a protected disclosure that ‘if the disclosure is of an exceptionally serious nature, Dr Allinson would be appropriate’.

The report says: ‘The Tribunal considered that if the fuller version of what Dr Ranson had pleaded had got across to Dr Allinson and then to Minister Ashford, the conditions in section 56(1) as well as under section 55 (1)(a) were met. Rightly, there was no challenge to Dr Ranson having a reasonable belief in what she passed on.’

At the second conversation on April 25, Dr Ranson told Dr Allinson about her concerns that medical advice was not being passed up through the chains of command. He agreed to suggest to Mr Ashford that he should receive information directly from her and others.

All of this led to a CoMin meeting where Dr Allinson spoke to Mr Ashford about the concerns raised by Dr Ranson and her request to speak to him directly. The date of this meeting is not specified, however it is understood to be shortly after the second conversation between Dr Allinson and Dr Ranson.

Dr Allinson’s evidence is summarised by the report as ‘Minister Ashford made clear that he would not hear from Dr Ranson direct’. It adds: ‘He would only hear from Miss Magson, coming through the command structure. Minister Ashford, in his evidence to the Tribunal, did not deny that there could have been a brief discussion like this but he had no recollection of it. He said that he would not challenge whatever Minister Allinson had said of the discussion. Significantly though, he added that he would not have divulged a Minister-to-Minister discussion to Miss Magson.’

The importance of this from a legal point of view is that there is no evidence that Mr Ashford spoke about this to Miss Magson, therefore it was discounted as a potential example of a protected disclosure being made that led to her suffering detrimental treatment.

However, the wider importance is that one minister, being Dr Allinson, told the tribunal that the Minister responsible for Health refused to speak directly to the doctor who was employed as the island’s senior clinician during a global pandemic, instead insisting on remaining fixed into a system which only allowed the views supported by a CEO with no medical training, based in the UK, to reach the top of government.

Her State of Mind

The tribunal also noted that on more than one occasion, Mr Ashford was engaged in talks and email exchanges that related to the health and mental health of Dr Ranson. 

In March 2020, she was removed from a planned press conference appearance. The reason given by Mr Ashford is that the decision was taken because: ‘Concerns were raised (I believe from Kathryn, the Director of Public Health, Henrietta Ewart, and some of Dr Ranson’s medical colleagues) that Dr Ranson was not taking any breaks and was becoming more and more tired with each passing day. 

However, the tribunal noted that when Dr Ranson had addressed Mr Ashford, Mr Quayle and the then lead government communications Liz Aelberry, they had been ‘impressed’ with her work and there was ‘no sign of problems or cause for concern with Dr Ranson’s behaviour or health’. 

The tribunal later noted that instead of this being an issue of concern over Dr Ranson’s health, they considered it was ‘Miss Magson interfering with the requirements of the Chief Minister and Minister Ashford and of Ms Aelberry because it did not suit the DHSC message that Miss Magson wanted Ministers and the public to hear’. In essence, Ministers were being blocked from hearing advice from senior doctors because a non-medically trained civil servant decided it was for the best. 

This is furthered by a message from Miss Magson in which, knowing that Dr Ranson’s recorded video was not in line with the government’s version of events so far, wrote: ‘We are in danger of DHSC being undermined by all this and that will be worse for us all.’

The report says: ‘This comment supports Dr Ranson’s earlier fears that the views of the island’s medical professionals had somehow not been getting through – consistent with the confirmation that she had asked for in her 25th March email.’

Dr Glover

The evidence of Dr Rachel Glover, who was supporting the DHSC at this time with advice on genomics, said the system put in place to communicate the latest developments was not working. Dr Glover said she believed that Miss Magson was the cause of the ‘information blockage’. Not bound by the same restraints as others at this time, this drove Dr Glover to begin to communicate with MHKs and CoMin directly. 

The report says: ‘Dr Glover had expressed her concerns about this privately to Minister Ashford by email on 15th May 2020 and in-person on 2nd September 2020. The Minister had assured her that the meeting was entirely confidential but Dr Glover had evidence that showed that Miss Magson had become aware of it but the Minister denied leakage.’

A Cardiac Case

On October 23 2020, Miss Magson wrote to Mr Ashford complaining of spending over two hours on a conference call with Dr Ranson, the email said: ‘She spent 2 hours telling me Council of Ministers don’t understand the strategic ask so she is going to look very silly coming in saying that, and are worried she remains so behind still. I am writing the presentation with STE and HE this weekend with Rizwan and will involve RR but said I would talk to you and Will about her coming too. I might send you the presentation later this weekend to check-in and ensure it’s hitting the mark.’

Mr Ashford replied shortly afterwards to say: ‘I do worry with the state of mind she’s in. We can’t have a presentation where officers are contradicting each other the CM would finally be a cardiac case.’

Since the election last year, Mr Ashford has since been named as the island’s Treasury Minister and was succeeded at DHSC by Lawrie Hooper.