The Rt Hon Baroness Hallett, as Chair of the UK Covid-19 Inquiry, has released the Inquiry’s third report, “Module 3: Impact of the Covid-19 pandemic on the healthcare systems of the United Kingdom” (HC 1730 – Module 3: The impact of the Covid-19 pandemic on the healthcare systems of the United Kingdom). Terms of Reference was limited to “preparations and the response to the pandemic” across the UK.
Module 3 is a hard read. It is very clear about the extent of the distress and harm that followed, “Some patients suffering from Covid-19 did not get the quality of treatment they needed [notwithstanding the efforts of healthcare workers] and some non-Covid-19 patients had their diagnoses and treatments delayed to the point where their conditions became untreatable. Many thousands of people died in hospitals and died alone.” It also recognises that the UK’s healthcare systems entered Covid 19 under severe strain, yet “coped, but only just”.
The NHS’ position pre-pandemic
The report situates many pandemic harms in the context of pre existing system fragility: workforce gaps (staff vacancies/ sickness absences), estate constraints (necessitating repurposing of existing space and establishing temporary hospitals to treat patients) and limited beds/ high bed occupancy (particularly in critical care). This context matters when reflecting on organisational decision making and resilience in a fast moving emergency.
Report recommendations
The Chair states there are “many lessons to be learned” and sets out 10 recommendations aimed at steps that can be taken now to improve response next time. These are a practical blueprint to lock in learning and strengthen future pandemic- readiness.
1. Ensure that decision-making on infection prevention and control is underpinned by clear structures and a cautious approach to transmission risk
Strengthening the body responsible for infection prevention and control guidance, broadening its membership to enhance its decision-making and improving the guidance itself.
Our comment: The key will be to ensure guidance and governance is robust, transparent and rationale.
2. Guidance for visiting restrictions
The report notes, “Restrictions meant that many patients died without the comfort of being surrounded by their loved ones and were deprived of the opportunity to say goodbye. This has had a devastating impact on bereaved family members.”
3. Better preparation for fit-testing
In order that workforce protection can scale at speed.
4. Improve data systems to identify individuals at high risk during a pandemic
Enabling individuals at highest risk of harm from infection to be more easily identified.
5. Prepare to scale up urgent and emergency care capacity (including surge capacity)
Measures taken across the UK to increase hospital capacity included suspension of non-urgent and elective care, pausing of cancer screening programmes in some countries, expediting hospital discharges, use of the private healthcare sector, changing staff-to-patient ratios of care and redeploying staff from other areas of healthcare to critical care, creation of temporary field hospitals.
Our comment: Trusts/boards will need to demonstrate in the event of another pandemic, or similar event, that they have auditable preparedness rather than reactive escalation.
6. Prepare for and test the ability to scale up hospital capacity
See above.
7. A framework to guide the allocation of intensive care resources in the extreme event of saturation
Our comment: legally this should clarify professional/legal expectations under crisis standards of care.
8. Systematically recording and publishing healthcare worker deaths
Our comment: this promotes transparency and organisational learning and supports a “duty of candour” culture.
9. A standardised process for advance care planning across the UK
Recording patients’ preferences for future care and treatment. The report notes the absence of a single UK-wide advance care planning document led to a lack of consistency and states, “The adoption of a standardised advance care planning document for use across the UK would help encourage people to discuss their wishes for treatment at the end of life and help ensure there is individualised decision-making for each and every patient.”
10. Psychological and emotional support for healthcare workers
Improving retention and increasing resilience.
The report is a tribute to the workforce, the Chair noting that:
- healthcare collapse was narrowly avoided due to, “the almost superhuman efforts of healthcare workers and all the staff who support them.”
- “When the next pandemic strikes, there may not be a workforce in the healthcare systems able or willing to work under the conditions that arose during the Covid-19 pandemic.”
- “healthcare systems teetered on the brink of total collapse and the people working in them made huge sacrifices to ensure that the care of patients continued. The commitment, dedication and sheer resolve of the healthcare workforce were remarkable. Both clinical and non-clinical staff endured considerable hardships, working long hours in extraordinarily difficult and pressured circumstances. For many healthcare workers, the Covid-19 pandemic had a significant and long-lasting impact on their mental health and wellbeing and exacerbated the stresses and strains of working in a healthcare system that lacked resilience.”
Positive takeaways & looking to the future
The lesson now is to turn emergency innovation into planned, tested capability. It could be said that care was being delivered at scale despite chronic pressures, and the crisis revealed where resilience needed strengthening; the creation/expansion of services and the need to scale urgent and emergency care is evidence of system agility, even where outcomes were imperfect; what looked like “improvisation” at the time was also operational redesign — redeployment, new pathways and triage implemented at speed.
Healthcare organisations will need to demonstrate in the event of another pandemic, or similar event, that they have auditable preparedness rather than reactive escalation.
For more information on the Covid-19 Inquiry and its impacts, contact our Public inquiries solicitors.