Week eight of the public hearings for Module 3 of the Covid-19 Inquiry

This is the eighth in a series of weekly updates from the public hearings for Module 3 of the UK Covid-19 Inquiry, in which the RCoA, FICM and Association of Anaesthetists are jointly a Core Participant. Our thanks to the Association of Anaesthetists for producing these updates to share with members.

This week is the seventh week of our involvement as core participants with the Royal College of Anaesthetists (RCoA), and The Faculty of Intensive Care Medicine (FICM), in Module 3 of the Covid-19 UK Public Inquiry.

The week’s oral evidence sessions began with a hearing from Patricia Temple, a Band 5 staff nurse, who provided impact evidence about issues with PPE, her experience using FFP3 masks which she hadn’t been fit tested for, and how contracting Covid affected her.

In the same session, Rosemary Gallagher MBE, Professional Lead for Infection Prevention and Control (IPC) at the Royal College of Nursing (RCN), spoke about the importance of not having ‘one size fits all’ guidance for nurses due to the large number of different settings they work in, and the confusion felt by some members when colleagues in other countries were offered different levels of PPE to what was available for them.

She told the Inquiry that the RCN would like to see more data collected around protected characteristics and how they link to infections and deaths in pandemics. On IPC guidance, Ms Gallagher said it does not exist in isolation and must be seen in the context of where a healthcare worker is working, as well as making sure it is aligned with the relevant legislation and regulations.

Nick Kaye, Chair of the National Pharmacy Association, spoke about the strain community pharmacy was undergoing during the pandemic as well as the role pharmacists played in delivering medications to those shielding.

Tuesday’s hearing focused on public health with the inquiry hearing from Professor Fu-Meng Khaw, National Director of Health Protection and Screening Services and Executive Medical Director of Public Health Wales. Professor Khaw spoke about how data was collected throughout the pandemic - he said around 70% of data around health care worker mortality was not reported as the question was left blank by those completing the relevant forms. He also noted that ethnicity was another field often not completed on mortality forms.

Professor Khaw recommended that the four nations of the UK work together on any future pandemic guidance and that requested that devolved nations are involved in the guidance process from the start.

Aidan Dawson, Chief Executive of the Public Health Agency Northern Ireland, confirmed that a significant review of agency been taking place since end of pandemic. He noted that data on ethnicity and disability kept in Northern Ireland was very poor and that no data was kept on staff deaths from Covid or those that are suffering from Long Covid.

Laura Imrie, Clinical Lead for NHS Scotland Assure and Antimicrobial Resistance & Healthcare Associated Infection, spoke about how infection control guidance changed throughout the pandemic and the need for risk-based assessments. She stated that if there was another pandemic its likely there would be a recommendation for enhanced mask wearing straightaway, instead of waiting to see if people could be pre or asymptomatic.

Evidence from public health experts continued with Professor Nick Phin, Director of Public Health Science and Medical Director, who spoke about the creation of Public Health Scotland, and how the body created greater resilience in the system and helped the countries response to the pandemic. He also spoke about difference between health inequalities and healthcare inequalities and noted the awareness of health inequalities pre -pandemic and the likelihood that a pandemic would exacerbate them.

Professor Phin also spoke about how the impact of the pandemic on different ethnic groups varied as the pandemic progressed and different variants were discovered. He told the Inquiry about the operational differences in how the NHS operated in England and Scotland, and highlighted how the lack of an NHS England style body in Scotland impacts the ability to present a national picture.

Professor Dame Jenny Harries, Chief Executive of UK Health Security Agency and former Deputy Chief Medical Officer for England, told the Inquiry that databases need to be able to talk to each other for a future pandemic to enable the identification of clinical vulnerable patients early on. On the topic of data, she said ethnicity not being systematically recorded also causes issues with data quality and that coding of data must be consistent and accurate. She praised NHS Digital for the work it did on collection of datasets during the pandemic. Professor Harries also commented that patients need to understand why it is beneficial to share data and to make sure they are given assurances that the data will be used safely.

She said the risk for healthcare workers of contracting the virus was higher in the community that it was in the workplace – citing the example of people traveling to work together in cars without wearing masks. Professor Harries also spoke of the importance of trust if public health interventions are to be successful.

Professor Sir Stephen Powis, National Medical Director, NHS England, also began his oral evidence. This will be concluded next week when the Inquiry will also hear evidence from Amanda Pritchard, Chief Executive, NHS England and representatives of NHS Wales. All of these sessions will be covered in full in next week’s update.