• Peter Kunzmann, RCoA Head of Policy and Public Affairs
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Intensivists and anaesthetists were vital to the Covid-19 response. Without their skill, dedication, and considerable personal sacrifice, the country could not have dealt with the pandemic as it did.

This was a key reason why the RCoA, FICM, and the Association of Anaesthetists, applied to be, and were accepted as, a joint ‘core participant’ in the ongoing UK Covid-19 Inquiry. We felt it was essential for our members’ stories to be heard and for the health-service deficiencies they witnessed to be addressed before another pandemic occurs.

The contribution of anaesthetists and intensivists to the Covid-19 response was invaluable in and of itself. However, it was even more remarkable given that prior to the pandemic both groups faced (and still continue to face) unacceptable shortages in terms of staffing and resources.

For example, the highest recommended fill rate of intensive care beds is 85% – however, as early as 2018, NHS England data suggested that intensive care units were already facing fill rates of 87%. FICM also collected survey data in the same year that showed that the fill rate was almost at the limit in Scotland at 84%, and way above it in Wales and Northern Ireland, with both at 95%. Regarding anaesthesia, the UK was 1,400 anaesthetists short on the eve of the pandemic, leaving the profession hugely overstretched and probably contributing to why the elective backlog had been growing for years.

When the pandemic hit, this all came to a head. ICUs were inundated with Covid-19 cases and were forced to rapidly expand. Intensivists had to cancel leave and suspend non-clinical duties. Many anaesthetists, including anaesthetists in training, were also redeployed to ICUs to help. While this succeeded in boosting intensive-care staffing, it contributed to the reasons why hospitals had to dramatically scale back, or even stop, other services like elective surgery. It also hindered both anaesthetists in training and intensivists in training, who faced a very different casemix to normal, and often had to change the balance of their work away from learning and towards service delivery.

Ultimately, therefore, while ICU capacity was increased, it came at considerable cost to the health and wellbeing of staff, the education of doctors in training, and to other vital NHS services.

There were also a host of other issues that our members faced, such as shortages of suitable PPE, poor access to testing, insufficient numbers of ventilators, and poor hospital layouts, all of which hampered the delivery of care. Restrictions on family and friends visiting patients also affected staff, who often had to provide additional emotional support to patients in the absence of their loved ones. All these pressures, and more, took their toll on mental health and wellbeing. By July 2020, 64% of respondents to an RCoA survey were reporting mental distress.

We believed all this information was vital to the Inquiry, and we submitted detailed written evidence in December 2023, an oral opening statement in September 2024  answered oral questions from the Inquiry in October 2024, and gave a closing statement in November 2024.

As mentioned, part of our motivation for participating in the Inquiry was to ensure that the health service is better prepared for any future pandemic. To achieve this, we have recommended that intensive care capacity should be viewed as a national resource. Improving that capacity would provide much more resilience in the event of a crisis. Properly resourced intensive care would also reduce the need to stop or scale back other hospital services, such as elective surgery, in pandemic situations. All this requires investment in staff, beds, infrastructure, and equipment.

Investment is alsoneeded to increase anaesthetist numbers, which would in turn help to address some of the backlog in healthcare services. Training is key to this. Capacity in intensive care and anaesthesia could be rapidly increased if funding were allocated to allow doctors, currently at foundation level, to enter specialty training. In anaesthesia, for instance, a doctor starting core training can start to provide a degree of independent patient care within six months. However, at present, there are around 6.5 applications for every core anaesthetic training place available. Increasing the number of core training places is, therefore, vital. Any investment in core training must also be matched with investment at ST4 level to prevent the re-emergence of the core:higher bottleneck that affected so many anaesthetists in training in the recent past.

Hospital layout should also be considered when creating new estate or modifying existing space so that it can better cope with pandemic situations. This includes scenarios where some patients need to be separated and where other hospital areas need to rapidly be converted to ICUs. Also, central stockpiles of PPE should be maintained to better protect healthcare workers from risk.

We hope that our involvement has demonstrated to the Inquiry the vital role our members played – and that the Inquiry’s recommendations will help shape future policy decisions for the better.