'We coped, but only just' - Inquiry says the NHS narrowly avoided collapse during Covid-19

The UK Covid Inquiry has found that the NHS ‘only just’ coped as it handled the pandemic.

Baroness Hallett’s third report from the inquiry, focusing on the impact of healthcare systems has been released today

The report found the NHS was ‘overwhelmed and close to collapse’ throughout the pandemic and was only narrowly saved due to the ‘extraordinary efforts’ of those working in the healthcare system.

The chair said the staff’s commitment and dedication was ‘remarkable’.

NHS 'overstretched' before the pandemic, but the staff kept it going

The report says healthcare systems entered the pandemic ill-prepared and overstretched with the NHS described as in a ‘precarious state’.

Baroness Hallett said it was ‘unsurprising’ how devastating the pandemic was on healthcare systems, describing the response to the pandemic as ‘we coped, but only just’.

Politicians, including Health Secretary at the time Matt Hancock, were criticised, being described as 'reluctant' to accept how overwhelmed the NHS was.

Some patients did not get an expected level of care during pandemic

Despite the recognition of the work healthcare workers put in to keep the system working, the inquiry found some patients did not get the standard level of care that was expected.

It listed some of these failures as:

• Some not admitted to hospital when they should have been
• Those taken to hospital in ambulances often waited hours to be admitted, which put both themselves and the ambulance crews at risk.
• Healthcare staff had to be redeployed to the front line, leaving gaps in other areas of health care.
• The staff to patient ratio was often diluted
• The supply of medical equipment was of ‘significant’ concern
• Some patients were not admitted to intensive care despite the seriousness of their condition

The inquiry noted that millions of non-urgent surgical procedures were cancelled, with some patients having treatment delayed to a point where their conditions became untreatable. It also found vital cancer screening programs were paused in the devolved nations of Scotland, Wales and Northern Ireland.

Huge strain put on healthcare workers

The strain put onto healthcare systems by the pandemic were described as ‘unprecedented’ in today's report, with healthcare workers feeling obliged to work under ‘intolerable’ pressure for large periods of time.

It said the pandemic caused large levels of mental health and wellbeing issues for many members of staff, and worsened stress levels of working in a healthcare system that already lacked resilience.

The report noted the many deaths of healthcare workers due to the pandemic, particularly workers from ethnic minority backgrounds which was noted as a particular concern given the diversity of the NHS workforce.

The report said a need for better pre-pandemic healthcare planning was a constant theme throughout this module.

Preventing the spread of covid was 'flawed' early on

Focus on preventing the spread of covid, particularly in the early days of the pandemic, was described in the report as ‘flawed’.

Assumptions about the virus spreading through contact transmission failed to recognise the extent to which the virus was spread through airborne transmission.

Baroness Hallett's report recommended that future guidance should assume all plausible ways of transmission are possible until sufficient evidence proves otherwise.

Visiting restrictions needed but had huge problems

The report recognised that, due to the significant numbers of people infected with Covid-19 requiring hospitalisation, visiting restrictions became the trade off to limit the spread of the infection.

It highlighted that some vulnerable patients, including those with dementia or learning disabilities and some pregnant women were left without ‘vital’ support when receiving care.

It also noted the painful reality for many of loved ones being refused end of life visits, and dying alone in hospital. This had a devastating impact, not just on bereaved families, but also greatly impacted the healthcare workers.

Wider impact on health services during the pandemic

During the pandemic, many people turned to the 111 service for medical advice and information as the first contact with the healthcare system.

The inquiry recognised the extra strain put onto this service, and said many were waiting on the calls for over an hour, with some abandoning calls all together.

Long Covid also be came a direct long term impact of the virus. The inquiry recognised some dealt with life changing and enduring symptoms.

The inquiry noted that even now, access to care for those suffering from long covid remains variable across all four nations and, whilst research into long covid continues, it has been significantly scaled back.

Recommendations

The inquiry has decided on 10 necessary recommendations to prevent the overwhelming of healthcare systems by another pandemic.

These recommendations include:

• Increasing capacity in urgent and emergency care to ensure hospitals have the ability to implement surge capacity.
• Strengthening the body responsible for infection prevention and control guidance.
• Improving data collection to allow those at the highest risk of harm from infection to be more easily identified and record deaths of healthcare workers more accurately.
• Promoting a standardised process and documentation for advance care planning.
• Increase psychological and emotional support for healthcare workers with the aim to improve resilience and staff retention
• Publishing guidance to help decision-makers by providing clear criteria for clinical decisions if critical care resources become completely exhausted.

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