Horrified to find myself caring for friends and colleagues on ITU. I’m tired of being the last person to ever speak to people before I anaesthetise, intubate and ventilate them and for them then to die. Tired of passing last words between husbands and wives, parents and children. There is no escape from it. I see dead colleagues in the Trust News emails, local and national press. I dream about it intermittently at night. I’m intermittently consumed by the ocean of sadness it has caused.

2. We know that experiences such as these will be at the forefront of your mind during this module, as will the need to consider what more could and should have been done to mitigate these impacts.

3. The BMA believes that, while a pandemic or health emergency is always likely to put enormous strain on healthcare systems and the people who work within them, the extent of the impact was not inevitable.

4. The impacts on staff and patients were made worse by the fact that healthcare systems entered the pandemic significantly under-resourced, and then, once Covid-19 arrived, decision-makers failed to protect staff from harm.

5. The UK entered the pandemic with too few doctors, hospital beds and critical care beds, alongside high staff vacancy rates, growing waiting lists, unfit estates, large maintenance backlogs and substandard IT infrastructure.

6. This exacerbated the severe disruption to healthcare during the pandemic, and necessitated unprecedented large-scale measures to ensure there were enough staff to maintain critical care capacity.

7. The consequences of entering the pandemic significantly under-resourced, and of the severe disruption that followed, are still impacting healthcare systems today, with millions on waiting lists for treatment.

8. Regarding the protection of healthcare workers, the nature of their work means they are more likely to be exposed to infectious diseases, and as such it is vital that adequate protections are put in place.

9. However, at every turn during the pandemic, healthcare workers were not protected from harm. Staggeringly, over four in five respondents to a BMA survey said that they did not feel fully protected during the first wave.

10. The supply of PPE was woefully inadequate, and during the early months of the pandemic, PPE shortages meant that staff had to go without PPE, reuse single-use items, use items that were out of date with multiple expiry stickers visibly layered on top of each other, or use homemade and donated items.

11. In addition to these severe shortages, the inadequacies of the IPC guidance meant that any items that staff did have, often failed to provide adequate protection from an airborne virus.

12. Although the understanding of the significance of aerosol transmission evolved during the pandemic, it was well known at the start of the pandemic that there was the potential for aerosol spread. It was also known that Respiratory Protective Equipment, such as FFP3 respirators, provided far greater protection against an airborne virus than a Fluid-Resistant Surgical Mask. Based on these two pieces of knowledge, the IPC guidance should have taken a precautionary approach to protecting the lives of staff and patients by recommending that all staff working with Covid-19 patients use FFP3 respirators to protect them from infection.

13. Shockingly, despite the growing weight of evidence of aerosol transmission as the pandemic progressed, the IPC guidance continued to put staff and patients at risk of infection, and of spreading that infection, by recommending surgical masks for routine care of patients with Covid-19.

14. Implementing effective infection control measures was made even more challenging due to poor ventilation in some buildings and a lack of space to separate Covid from non-Covid patients.

15. It is the BMA’s view that lives could have been saved if those responsible for producing the IPC guidance, as well as Britain’s national regulator for workplace health and safety - the Health and Safety Executive - had taken a precautionary approach to protecting healthcare workers and patients. It is vital for this module of the Inquiry to examine the actions of these bodies including the extent to which considerations of cost and supply were elevated above safety.

16. The impact of Covid-19 was not experienced equally, and it brutally exposed the fault lines of inequality which already existed. Inequalities manifested in a multitude of ways for both staff and patients, including along lines of disability, ethnicity and gender. This had consequences for infection, mortality, mental health, working lives and so much more. For staff, there were inequitable experiences related to feeling protected, having access to adequate and well-fitting PPE, confidence in risk assessments, and feeling able to speak out or raise safety concerns. To give just one example, the Health Service Journal estimates that over 60% of the NHS staff who died in the first month of the pandemic were from ethnic minority backgrounds.

17. In the words of a Consultant working in England:
 

We had no choice but to work in an environment which we knew to be unsafe. …headlines of health worker deaths… the ethnic risk factors, and age made me look at my department and wonder which of us may not be here. Every colleague of mine extended their life insurance. We received the bare minimum protection.

18. For many staff, the experience of providing care during the pandemic came at a great personal cost to their mental health. Their accounts describe experiences of trauma, grief, exhaustion, burnout, chronic stress, anxiety and fear.

19. Similarly, long Covid has severely impacted the lives of staff and patients, leaving them unable to work, train and undertake day-to-day activities. In the words of a Resident Doctor working in Scotland:

I caught Covid in March 2020 from a colleague at work. I have been mostly bedbound since. My life as I knew it has ended. These are supposed to be the best years of my life but I'm spending them alone, in bed, feeling like I'm dying almost all the time.

20. The impacts of the pandemic did not simply end when restrictions were lifted. The repercussions continue today, with a recent survey by NHS Charities Together finding that over three in four NHS staff are currently struggling with their mental health.

21. In addition, the failure to adequately invest in the UK’s health services prior to the pandemic meant that staff were unable to provide the level of care they wanted, leading in some cases to moral distress and injury, with devastating consequences for patients, the long-term impacts of which are still being experienced.

22. The scale of this disruption was unprecedented in the history of the NHS and, the BMA argues that it would have been less severe if the UK had entered the pandemic better resourced.

23. As made clear in the Inquiry’s Module 1 report, the question is not ‘if’ another pandemic occurs, but ‘when’. As with Covid-19, healthcare staff and systems will be at the forefront of any future pandemic response, and they need to be in a significantly better position to cope when this occurs. The preventable failures that led to harrowing experiences for staff and patients cannot be allowed to happen again.

24. To prevent this, it will be important for recommendations to be made in the following areas.

25. First, recommendations that will lead to better-resourced healthcare systems with sufficient capacity for both day-to-day and emergency situations, and which support staff physical and mental health.

26. Second, recommendations that lead to better protection of healthcare staff in all settings. This includes a precautionary approach to staff protection, as well as ensuring that, where unequal impacts exist, these are swiftly identified and mitigated.

27. Third, recommendations that will address health inequalities and improve population health, which will improve the UK’s resilience to a future health emergency and help to reduce the impact on health services.

28. Ultimately, as highlighted in the Inquiry’s Module 1 report, unless lessons are learned and fundamental change is implemented, the effort and cost of the Covid-19 pandemic will have been in vain, and for healthcare staff and patients across all nations of the UK, this has already been monumentally high.