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

This is the ninth 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.

Robin Swann MP, former Minister of Health of Northern Ireland, was the first person this week to give oral evidence. He agreed with the evidence from the Chief Medical Officer that the population of Northern Ireland didn’t have the healthcare service they needed at the start of the pandemic – with industrial action and the longest waiting lists in the UK being part of the problem. He spoke about how staffing levels for critical care nurses was not at the desired level during the pandemic, and that a shortage of nurses trained in critical care contributed to this problem.  

In her evidence, Jeane Freeman OBE, former Cabinet Secretary for Health and Sport, Scottish Government, spoke about putting the NHS in Scotland on an emergency footing and how this led to more cohesion in the healthcare response. She said it was her view that healthcare staff should use their own professional judgment about the type of mask they wore regardless of the guidance. She confirmed that there was a need to improve data collected on the ethnicity of healthcare workers pre-pandemic, and the limits on the data impacted how the impact of Covid on different ethnic minorities was addressed. She said entering the pandemic with fewer beds that were able to be modified to become ICU beds created problems.

Humza Yousaf MSP, former Cabinet Secretary for Health and Social Care in Scotland, used his evidence to talk about PPE. He said that significant progress had been made in the domestic production of PPE by the time he took up his role, and that disruption to the supply chain was localised and quickly resolved.

Vaughan Gething MS, former Minister for Health and Social Services, Welsh Government said that during the pandemic inability to access a critical care bed or ventilator would have been a sign that the NHS in Wales had become overwhelmed – this situation was avoided because they took extraordinary measures. He spoke about the field hospitals in Wales and how they were used for step down care and rehabilitation as not containing theatres meant they were often inappropriate for elective care. He said that while there were very real challenges with the distribution of PPE in Wales, they didn’t run out at a national level.

Baroness Eluned Morgan MS, First Minister of Wales and former Minister for Health and Social Services acknowledged there were important lessons to be learnt from the high levels of virus transmission in hospitals in Wales. She said Covid went around the country in waves and that health boards were able to react to an approaching waves, and make restrictions when required. She also said that as there are only 172 beds in the private sector in Wales and that using them to clear the backlog didn’t have much of an impact.

Matt Hancock, former Secretary of State for Health and Social Care, spoke about the decision to suspend all elective care in the pandemic – saying this was the right decision to prevent the NHS from being overwhelmed, and unable to offer any treatment at all.  He said it was better to delay some non-urgent operations to protect the NHS and patients themselves.

Speaking about the pressure on the health service, he said it wasn’t just about the number of patients but the huge numbers all suffering from exactly the same disease and therefore needing the same kind of treatment. On intensive care, he said surge capacity was crucial and that there was no way as many people could have been treated if the system had just relied on baseline capacity.

Mr Hancock said he was aware of ‘some voices’ calling for guidance around clinical prioritisation but that the need for this wasn’t a consensus or majority view. His view was that decisions shouldn’t be taken by Ministers, but by those as close to the patient as possible, noting that doctors make similar decisions all the time. He explored the idea of continuing some elective work with NHS England but reluctantly approved all work being paused. He went on to say that resuming elective care was a difficult balancing act – he wanted it restarted as soon as safely possible, however this was an NHS England decision.

He stated that the PPE stockpile was not as good as needed and noted that government procurement in normal times was too slow. He said England as a whole never ran out of PPE, whilst other areas did. Mr Hancock also confirmed that he asked for a system to be set up to monitor the death of healthcare workers from the virus.  

In his recommendations to the Inquiry, he said that in normal times having an NHS that can run at less than 100% capacity will help increase resilience. He also said that how the NHS uses data needs to improve.

Next week is the final week of hearings for Module 3. Former Secretary of State for Health and Social Care, Sir Sajid Javid, will give the final oral evidence of the module and then the Core Participants – including the Association, RCoA and FICM – will deliver their closing statements to the inquiry.