Health services in the UK entered the pandemic ‘ill-prepared’ and in a ‘parlous state’ with the NHS coming close to ‘collapse’ on numerous occasions, the report for the third module of the Covid-19 Inquiry has concluded. 

Healthcare systems throughout the UK ‘teetered on the brink of collapse’ and were saved from disaster only due to the ‘almost superhuman’ efforts of the doctors and other healthcare staff running them. 

In her introduction to the report published today [19 March], inquiry chair Baroness Hallett made damning reference to a health service already struggling with severe workforce shortages, ageing infrastructure and insufficient numbers of beds and high bed occupancy rates at the outset of the pandemic. 

She added that the urgency to respond to the scale of the unfolding public health crisis meant that healthcare staff were redeployed to hospital frontlines leaving other areas of healthcare understaffed and staff-to-patient ratios diluted. 

Baroness Hallett further stated that initiatives to recruit new staff and encouraged retired healthcare professionals to return to work were implemented, these measures ultimately proved to be not enough to bolster the numbers of critical care staff needed.  

She did, however, recognise and acknowledge the extraordinary commitment of the healthcare professionals who expressed interest.  

These shortcomings ultimately meant that patients admitted with covid and with non-covid medical needs did not receive the standard of treatment staff would have wanted to provide or saw delays to their diagnoses and care which in some cases meant their conditions became untreatable. 

Baroness Hallett said: ‘This third UK Covid-19 Inquiry report concerns the impact of the pandemic on the UK's healthcare systems. I can summarise that impact as: we coped, but only just. 

‘The healthcare systems came close to collapse. Healthcare workers carried the burden of caring for the sick in unprecedented numbers. It came at a huge cost to them, their families, their patients and the loved ones of patients. Collapse was only narrowly avoided thanks to the extraordinary efforts of all those working in healthcare across the UK. 

‘Despite those efforts, some patients did not get the level of care they would usually receive. The enormous strain placed upon the healthcare systems was unprecedented. Those working within it were obliged to work under intolerable pressure for months on end.’ 

Baroness Hallett’s findings echoed many of the changes that have been called for by the BMA.  

These include increasing capacity in urgent and emergency care, improving data collection to better identify high risk patients and record staff deaths and boosting support for healthcare workers. 

Baroness Hallett warned that failure by the Government and future governments to heed these recommendations risked placing the NHS in an even worse position in the event of a future pandemic. 

She said: ‘I urge the governments of the UK to implement my recommendations and to do so as a matter of urgency. 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.’ 

Responding to today’s report, BMA council chair Tom Dolphin said that Baroness Hallett’s findings and recommendations had vindicated many of the concerns raised by the BMA both in its evidence to the inquiry and in subsequent lobbying efforts. 

Welcoming the report’s recognition of both the critical role of healthcare staff and the fact that the NHS entered the pandemic in an already unprepared and weakened state, Dr Dolphin warned that the Government would need to go beyond the reports’ ten topline recommendations, if the health service was to meet the challenge of a future pandemic. 

He said: ‘Speaking on behalf of all doctors who worked through the pandemic, today’s module speaks most personally to the experiences of the human beings at the centre of the NHS’s response. 

‘We are glad to see Baroness Hallett specifically recognise that the fact we did not see the NHS collapse entirely is due to the dedication, commitment, and ultimately sacrifice, of healthcare staff, who she acknowledges ultimately put their patients before their own wellbeing and family life. 

‘Tragically, many – and disproportionately those from ethnic minorities – paid with their lives.’ 

He added: ‘There is welcome recognition that the NHS went into the pandemic overstretched and understaffed. This has not changed. While there is a recommendation to put in place plans to ‘scale-up’ capacity in the event of a new pandemic, when we’re running at our limits all the time, this flex cannot happen. The Government must go further, and increase capacity in non-pandemic times. This means more staff, and keeping and supporting the staff we have. 

‘The report makes a number of recommendations, but we urge the Government to look beyond just these and reflect properly on the full findings and the stark message they send about how both staff and patients were failed, and what needs to change to stop this happening ever again.’ 

In emphasising the poor state in which the UK’s health systems entered the pandemic in early 2020, the report also makes clear that subsequent decision-making exacerbated pressures and left healthcare staff inadequately protected. 

This includes the UK’s approach to infection prevention and control (IPC) which the Inquiry concluded was ‘fundamentally flawed’, with insufficient recognition of aerosol transmission.  

It notes that this reality was further compounded by inadequacies in the provision of PPE (personal protective equipment), supplies of which were highly constrained particularly during the early stages of the pandemic.  

The reports states that this failure ultimately forced healthcare staff to work in unsuitable and unsafe conditions putting their and their relatives’ health at risk. 

In its recommendations the inquiry states that, in future, decision-makers should take a precautionary approach to possible transmission routes, rather than requiring evidence before precautions are taken, in line with the BMA’s own position. 

The association however has expressed disappointment that the report ruled that there was no conclusive evidence to support the adoption of FFP3 respirators for healthcare staff, despite studies indicating that this form of PPE provided significantly greater protection compared to surgical masks. 

In a chapter dedicated to examining the impact of the pandemic upon the mental health and wellbeing of healthcare staff, the report points to a variety of factors that all contributed to increased stress and pressure. 

These include the fact that many staff found their pre-pandemic roles and working environments being rapidly and drastically changed in order to meet the rising numbers of severely ill patients. 

The report also noted that shortages in basic equipment and an exposure to overwhelming numbers of patient deaths had a dramatic and lasting impact upon many staff. 

London consultant anaesthetist Kevin Fong was one of many doctors who gave evidence to the module 3 hearings in 2024, likening the experience of healthcare staff to that of having to face ‘a terrorist attack every day’. 

Dr Fong also recalled the lasting trauma and horror of healthcare staff being forced to place their deceased patients into transparent plastic sacks due to shortages of body bags.   

He told the inquiry: ‘We went to another unit where things got so bad, they were so short of resources, they ran out of body bags and they were instead issued with 9-foot clear plastic sacks and cable ties, and those nurses talk about being really traumatised by that because they had recurring nightmares about feeling like they were just throwing bodies away.  

‘These people are used to seeing death but not on that scale and not like that. And whatever the figures show you, the experience for them was indescribable.’ 

Meanwhile London GP Tilna Tilakkumar, who cared for patients as a resident doctor during the pandemic, told the inquiry how at one point she was left as the only doctor on the ward due to other staff having all fallen ill. 

Speaking to the Inquiry in 2024, Dr Tilakkumar said that an absence of top-down guidance over how to best manage and treat patients with covid had been akin to ‘trying to organise chaos’. 

Reflecting on the report’s findings regarding the pandemic’s devastating effect on healthcare staff’s wellbeing Dr Dolphin said: ‘The impact on staff was not just related to their own physical risk, but the trauma and moral injury suffered due to not being able to provide care to everyone, or the level of care they needed. As colleagues recount in terrible detail, we were seeing a level of death and suffering most had never experienced before. 

‘The cumulative impact of daily moral dilemmas was and continues to be devastating. As the report notes, by 2021, two-thirds of doctors responding to a BMA survey were suffering from a work-related mental health condition. These effects live on, with a third of doctors telling the most recent NHS staff survey they are experiencing burnout.’ 

In the conclusions to her report, Baroness Hallett makes a total of ten recommendations which she urges UK governments to implement fully and in a timely manner. 

Commissioned under then Prime Minister Boris Johnson’s government in 2022, the Covid Inquiry seeks to provide a root and branch assessment of the UK’s response to the pandemic and what lessons can be learned for the future. 

Chaired by Baroness Hallett and comprising of 10 modules, the remaining seven reports are expected to be published no later than next summer, with oral hearings for the inquiry’s tenth and final module having concluded on 5 March this year. 

As a core participant to modules 1-5 of the Inquiry, the BMA has sought to contribute its own insights into the inquiry’s evidence process, drawing upon the findings of its own 2021 review into Covid-19 and the reported experiences of its members.