Theres a shortage of people to do the labs. Is it so coming to eventually. Your beds. The staff, one of the inputs for the total package of defense. The facilities, the isolation centers, a whole bunch of things. In the chart i sent you yesterday, i set out the planned numbers and actual numbers for how were doing to scale. So, if i can draw your attention to the easiest place to start s is people to start, facilities to be in relax and lodgistics and consumers. The dark line shows where we are at the moment. So, we have 15, basically 1539 total beds and spaces in sierra leone. 750 are currently provided by the u. K. All of those are stuffed. Were opening another suite of those facilities over england the next few days and with each organization weve agreed on, there is a staffing, a populated staffing plan from the u. K. And syrierra leone. So, the issue is to make sure from all the sources, which includes the nhs, for the available facilities that staff, at the moment, that is okay excement for the i talked about. So, the, we will be coming back to those fantastic volunteers. A thousand Public Servants at the moment, but what we need to do, is take the people as we need them for the particular rotations and facilities rather than in a more random way. Can i comment on the information that we have that cuba has committed 165 Health Professionals to work in the u. K. Treatment centers and where that quite significant number for a country thats actually quite small sent to the order yeah, so, i think the cubans, they were one of the first countries of the blocks that came to the london on 2 october. Talk talked to the minister then, they have they have staff in kerry town, lots of other ministries. They deserve a lot of credit for doing actual things on this and certainly, thats helped a lot in our facilities. I suppose that then begs the question that by your own words, have had a very Fast Response and yet, we appear and are not in any way whatsoever and havent reached the numbers that cuba has developed and assist with u. K. Treatment centers. The point is we have a staffing model for each facility and we have an open mind about exact exactly the nationality of who does what where. It was from our point of view, we have the same Critical Skills caps and the cuban offer. People and trust and so on. The i think the criticism is one and are we using what this, the volunteers actually engaging with one of the things that you have to have is the enthusiasm and commitment of volunteers and dont just leave those people lying, waiting for somebody to gi them a phone call. Thats all im asking. Many of my friends are out there. At the point we started this deployment, estimate varies my calculation is 10 . Cb dc is l 8 per person. 10 . And 70 of those were dying. Was incredibly dangerous and in my view and i think most people would agree to this, a total unacceptable thing to do for these volunteers who have put themselves on the line. Its still dangerous to do this. But because systems are now much better tested because theyve got proper training behind them, thats been one of the ways, the other, all of these people have come out in many areas, quite stretched and where nhs trusts have reasonably had to balance their own needs to the u. K. Population against the ability to restart and there have been many situations where theyve been quite nervous about that. Ive had a lot of phone calls where they have been nervous and reasonably so. I dont think you meant to imply that somehow, anybody in this economy was suggesting any members should be put into a situation that threatened either the health of their lives, so i swrus want to make that clear. I think you sort of implied. Didnt mean to imply that. I was trying to explain i think what we are trying to find out and the second may well have qualified why there has been a slowness in putting volunteers, its not to do with either the commitment of the volunteers, anybody else. But actually there are pressures on the nhs. But i come back and perhaps just to clarify the situation with the cuban volunteers or Health Workers. Should we be in u. K. Treatment centers would not be put into a situation where their lives are there and the health were endangered. On the first one, i think as everyone on the committee will know, has a tradition of a group of people who they send to emergencies. Theyre much better set up for this kind of situation. What would happen is the cuban doctors essentially took up the places we considered safe, more places behind and thats what the nhs doctors are now beginning to fill in in a phase way to make the introduction safer, but we want the same for any Health Care Workers, so the key is to do this in a way which is structured and safe. So, an agreement about workers and how long they do it and how the trusts from that and so on. Has there been a decision about enhanced compensation to encourage and support volunteers to go out because at the moment, you have to back fill that. So make a difference . The department will underwrite the finances. Weve tried to make sure the problem is not financial. So the problem is math fitting the actual actually, the r registered thing on a really good job. Theyve played a really Important Role in making sure the standards of the facilities are met with an appropriate cuban and other u. K. Health workers. We have are register of people but you could have a similar register for medical emergencies and be dealing with all of these issues in advance such as when that an outbreak becomes serious, we are in more of a position to the cuban one where we could send people more rapidly and do dealt with all thoeds domestic issues arise as a result. I think the one thing i wanted to add to the last answer is everyone would agree that one of the fantastic things about nhs is peoples sense of Public Service and when people deployed. Really got to play a great tribute to the star, there are gaps in this chef to fill which they have to fill. As he said, money is not the issue. Finding staff, particularly at this time of the year, can be challenging and others have really steppeded up to try and make that possible for their yes, i wanted to move on to where the money has been spent. Its gone up to 230, which a large amount is going to kerrytown treatment center. Actually being spent on that money, out of that money. Got a figure for that. Havent found one. And i know that youre working with other partners on that. So how much is being spent by the u. K. On kerrytown because you mentioned mr. Drake, 5 million somewhere. So, can i start to maybe 38 is allocated to kerrytown. Which is for Health Workers. Shes a 12 to 20bed facile thety. Then there is the safe children facility. Its going to over time have 80 beds in it. So, our commitment to kerrytown is 38 Million Pound sz. No now, we have obviously been continuing to work up other plans for things we will need to do. Not all of which have been announced yet, so i think over the Financial Year as a whole, were expecting to spend maybe about 270 Million Pounds and given what we are already planning to do to guard against the possibilities that there remains a significant problem into the second court of next year. Weve sort of planned and organized a second set of activities, which could take the second bill to 330. Id be very happy to give you a lot more of the breakdown if you would like. One of the things thats unclear, i think theres an acceptance amount. Lay that to one side. Its about the cost per beds. The ongoing costs. Whether whats temporary, permanent, what is there for them to take over and maybe convert into something long standing once the ebola crisis is gone. I know its very fast, but presumably, i would hope get more information on that because if this is public british tax pounds going in, we want to make sure its not going to run into the sounds eventually. Exactly and so just before focus completion on kerrytown, the, a lot of the facilities weve built or converted b have been done to meet an immediate need. So the expected life span is is not the same as were we building the Health System we talked about earlier. They will, they will have a life span and they will be main maintain ebola and so on. And some of them will be highly useful as part of rebuilding the overall public, especially premier Health System because theres a very heavy concentration on the western area, where wen we knew there would be a surge in plan for that. Weve built more facilities there, and then there will be a question, well, what can these things be used for. Some of them are that. There is bits and pieces for kerrytown. The program we faced was the doubling time at that point was every 30 days. It was ticking out. So, the choice was building something that would be able to repurpose, but might have taken us several weeks to months longer or going very fast because we could see that there was a real risk by this stage of the epidemic. Over 1,000 cases a week, which would have overwhelmed us and we had to get ahead of that curve or we would have been lost. That decision was taken quite literally. In an ideal world, it would have been better to do something that was not that. Lets bring this and i just want to, i mean, clearly, theres been stuff in the u. K. Press about all this. Charles mamboo being critical of you and saying its very, very slow. Handing over the facilities, have none an ebola facility. Thats a flavor of what ive picked up. The staff, those comments really do sting. In terms of the facility itself, ive come back there from a couple of weeks ago, obviously ran this morning just to give you an update. Just to tell you how far, but so far, weve treated 91 patients, we have 50 beds. 15 or 50. 50. From 80. We have a 17 survivors, of which an 8 and 9yearold girl, sisters, and 35 people who have died. In terms of our plan scale, that is actually on track. We had planned protocalls to not open the facility immediately. That would be wrong in terms of the training and the control. We are on track to reach 80 beds by the end of this month. Take us through some of the challenges because clearly, people out there, im not expert, thought you should have gone faster. 8,000 cases that we know declared by the government, probably underreported by say 50 . So thats 12,000, maybe as many as 16,000 in country in sierra leone. Weve got an 80bed facility and two weeks ago, the Prime Minister was asked by say it seems to be slow off the mark in getting this facility up and running. I think for the first two or three weeks, thats a fair response. It was a result of the speed it built. Theres only so much training you can do, which is vital because the first duty of care is is obviously to our own staff, Ministry Defense staff as well because if we were to jeopardize the health of that facility, we actually wouldnt have any beds there at all. That we were going to grow the facility. And have you had experiences . You were on the learning curve as well as growing the facile thety. Is that a fair criticism . It is. We have had a very steep learning curve. I think everyone involved in ebola who are the world Renowned Experts in this, has had to work out of their comfort zone, but it has been an Incredible Group effort to get to a point where we have over 450 individuals working in that staff in that facility at the moment. And the scale of it if i could just spend a second on that. With the 450 staff we have there, a lot of them only speak creole and the cubans only speak spanish and everything has to be translated. Theres about 1,000 metric tons of procurement and line items. So, we were very specific on scaling up as quickly as we could, but making sure some of the issues that the professor talked about were absolutely locked tight to ensure that the safety and security of our staff was paramount. If you dont mind, just to make a point about this. In august, everybody was saying that the existing institutions and facilities would not be able to cope. Nsf, who are the leaders in this space, were saying you need to bring in institutions. Including military and state institutions. By definition, none had ever run a ebola facility before. Its extremely dangerous. We had a series of conversations with a range of potential organizations. The First Organization who we thought had some able ility to this kind of thing, who were willing to take on the risk and do it at you know, safely, but up to speed to save the children, we pay tribute to them for being willing to do that. Actually, the scale is on track as he said. Nobody should be surprised if youve never done this before. If you face lots of problems, so, its not our view that this has been something that is being badly handled. There have been lots of problems to fick. We would loved to have done it faster, but overall, as the figure four on my chart shows to you, in part of contribution to the fantastic a bit ahead of where we planned it to be on the modeling. How long was it when you said save the children, were very grateful and we are as well, the first beds open. Ill have to sort of refresh my memory. So, during the course of the second half of august, after the declaring of the emergency, in other words, save the children and we had a series of discussions. F i was involved in them. We were discussing this with lots of other people as well. Had to do a lot of their diligence. They said to us repeatedly, weve never done this before. We dont know if we can do it. So i think the decision was on the 8th of september that we all afreed we would do it. The facility then opened. Took a patient on the 5th of november. There was an eightweek period. Now why did you, why did it take until the 8th of september and then obviously its going to take while to build the facility. The reason is is because there arent many institutions which have the capability of doing shorten be time because there are fewer people to speed it to. Well, but if they in fairness to them, we had a series of conversations with them before they were willing to take it on. We had the same set of converon a trivial thing for the u. K. To deploy its military capab capability. Our fa august, a hospital ship, essentially, could have been out there really by the beginning of september, if you, if the action had been taken. To be clear, its not that Nothing Happened before kerrytown. The key thing in all these responses is to build on whats already there, so a lot of the uk response was on bolstering up. The trouble with that answer, professor, is at least from the press reports that we read, there wasnt much there and what was there was completely overwhelmed by the scale of the outbreak to the debtriment of the treatment of any other endemic condition as all. So, made multiple points there. Ill take the one on the last one. On the part of diseases, absolutely. Theres a high chance that when we look back on this especially dem ic, more people who have not got ebola will have died as a result of the ebola epidemic. There are two big problems of the epidemic. It chews up the Health Service by panicking people quite reasonably, by killing Health Care Workers in an already challenging situation. All of these will have gone up significantly during this point of time. That is a very major issue. The second problem, its a disease of panic and has led to some irrational responses, which compounded this because people stop having Economic Activity with the countries affected and that has an impact on the poorest people, so theyre a whole series from effects. Thats something i think we want to come back to. What i dont understand, were sitting here in the comfort of the palace of westminster. The criticisms have come from people on the ground. You sort of feel something is happening there. Maybe you can take us through a little bit the challenges that you faced, which may have been frustrating and may have you know, made delivery tougher than you originally thought. It would be. And you should feel free in this committee to talk about corruption. You can do so freely if you want. A logical answer, then people on the ground give their answer. There has been a period, there was a delay between march and july, which we talked about, but then once the scale started, there was a delay while it was a scale up, but not many open and the disease continuing to go up. It is continuing to go up, it is likely to some time between now and the middle of january, come down to you. Very dangerous, the reproductive number, we started off around 1. 6, has drifted down and probably beginning across the bun line, which is where it stayed in the population sometime in the next few weeks. Now, in that period, people are understandably frustrated. They see the money going in, the numbers going up and they say a lot of from now on, the number of beds exceeds. This has been a bumpy period. Yes on the challenges and corruption. Yes. That number, is that taking into so, theres been clearly all the way through, been a fwap between the number which are there and the number which are reported and initially in the epidemic, we thought it was about two and a half times ro h roughly. Obviously, difficult to tell. As time has gone on, probably that quap gap has narrowed, but its difficult to estimate that. But i would therefore assume that trajectory, if anything, because of that, the trajectory would do the same thing as flattering the numbers. I think our expectation of this will plateau, while even now, were not picking up all cases. What will happen is there will be some areas that will not happen. Some are Getting Better. What are were talking about there is the overall picture. Still getting up in two of the districts at least in sier sierra leone, but its gone wyatt quite a long way down. There are three key challenges. Do adequate and efficient training and obviously, its only when youre beginning to use a facility that you stress tes it in terms of everything from septic tanks to water sources to speed enough to build and burn 331 sacks a day of this kind of personal protective equipment. Thats one. Then the staff build up. Then the third one is the issue about training the people who spray down the Health Workers coming out of the red zone. It takes about 20 minutes to take off your ppe. The issue about spraying people down is vital. Thats heavily chlorinated water and thats one of the times you can catch the diseas