Overview

The Inquiry’s second module examines core political and administrative decision making by the UK Government during the pandemic. Our opening statement at the start of this module sets out three key areas in which we believe the UK Government’s response to the pandemic failed to take a sufficiently precautionary approach, with huge impacts for healthcare staff and the public.

Opening statement made by the BMA, 04 October 2023

1. The BMA believes that the UK Government’s response to the pandemic was categorised by a failure to take a sufficiently precautionary approach, and by missed opportunities to learn lessons as the pandemic progressed.

2. These failures placed healthcare workers at greater risk of infection and death, put extra pressure on already stretched and stressed healthcare and public health systems, and caused moral distress and injury for doctors and healthcare workers who felt unable to provide the right level of care, including for non-Covid patients.

3. This statement highlights the BMA’s key concerns regarding matters within the scope of Module 2 under three broad categories:

First, decisions affecting public health

4. The UK Government’s actions to reduce the spread of Covid-19 were too slow, with Non-Pharmaceutical Interventions (NPIs) implemented too late and lifted too early. Examples include the failure to cancel mass gatherings and large sporting events in March 2020, which undoubtedly led to higher cases, hospitalisations, and very likely deaths, and the first UK-wide lockdown which only began on 23 March 2020, 11 days after contact tracing was abandoned. 

5. The mandating of face masks for the general public was also introduced far too late (and much later than in many other countries). Since 25 April, the BMA had been calling for the introduction of face coverings for the public. However, in England they only became mandatory on public transport and for outpatients and hospital visitors from 15 June. And it was not until 24 July that they were required in shops and supermarkets.

6. From June 2020 the BMA published its position on what was needed for the safe easing of restrictions, including: an effective test and trace system; ongoing surveillance of Covid-19; the use of certain NPIs, including mask wearing, reduced household mixing and better ventilation; and the need for greater support for vulnerable groups and action to reduce health inequalities. 

7. In the same period the BMA also highlighted the need to prepare for the coming winter and to learn lessons from the first wave. However, in its determination to ease restrictions, the UK Government missed a key opportunity in the summer of 2020 to better prepare for the second wave of Covid-19.

8. In respect of test and trace, there was a failure to adopt a strategy to detect and contain the spread of Covid-19 at scale. The decision to abandon contact tracing on 12 March 2020, 11 days before the UK went into lockdown, left the UK without any effective measures for controlling the pandemic at a critical time, and likely fuelled the number of infections as well as deaths.  

9. This decision was ostensibly because the UK was moving from the ‘contain’ to the ‘delay’ stage of the pandemic, although it later emerged that it was at least partly due to a lack of testing capacity. Contact tracing was not reinstated for several months, and when it resumed, it was delivered via an outsourced “National Test and Trace” programme.

10. The rationale for this decision, and the failure to properly utilise existing public sector testing infrastructure and contact tracing expertise, in favour of expensive private sector alternatives and new systems which yielded poor results, will require careful consideration.

11. The UK Government failed to provide clear, consistent and visible public health messaging, for example:

• a. There was unclear messaging between 16 and 23 March 2020, when the public were encouraged, but not required, to change their behaviour.
• b. The ‘Eat Out to Help Out’ initiative encouraged social mixing and confused public health messaging during 2020, suggesting that it was safe for people to socialise before vaccines were available and when the risks of Covid-19 remained high.
• c. In 2020 alone the government campaign around working from home initially encouraged it, then required it, then encouraged it again, then strongly discouraged it, then encouraged it again and then required it again. This pattern continued throughout 2021 and into 2022.

12. This lack of clarity and consistency, undermined the public’s understanding of, and confidence in, core public health messaging. 

13. Further, high-profile failures of MPs, senior advisors and civil servants to adhere to the rules, fuelled mistrust and misinformation, and further impacted the effectiveness of public health messaging. 

Second, the safety of healthcare workers

14. 81% of respondents to the BMA’s call for evidence as part of its Covid-19 Review said they did not feel fully protected during the first wave of the pandemic. 

15. While recognising the overlap with issues to be considered within Module 3, the BMA believes that central decision making in this area, including around the supply of PPE, Covid testing, workplace risk assessments and Infection Prevention and Control (IPC) guidance, require consideration in Module 2.  

16. There can be no doubt that the provision of PPE to healthcare workers during the pandemic was hopelessly inadequate. 

17. In the early weeks and months of the pandemic, shortages of vital PPE were especially acute, and the BMA heard from many of its members that they either did not have the right protective equipment, or enough of it.

18. The Inquiry was told by several witnesses in Module 1 that the UK never ran out of PPE nationally, but the fact is that doctors and other healthcare staff did not have the PPE they needed. This not only put them at physical risk from Covid-19 but also affected their mental health and wellbeing.

19. In correspondence to the Prime Minister, Public Health England and NHS England the BMA highlighted the discrepancy between levels of PPE recommended by the WHO and other nations, with the inadequate provision in the UK.

20. A key failure of government decision-making was, and continues to be, the failure to properly consider and acknowledge that Covid-19 is an airborne virus. This impacted on the protections available to healthcare workers.

21. Deficiencies in IPC guidance meant that Respiratory Protective Equipment, or RPE, which provides the greatest protection against aerosols, was not always provided to staff who were treating patients with confirmed or suspected Covid-19, and that fluid resistant surgical masks were wrongly deemed to be suitable protection.  

22. There is also evidence before the Inquiry that the lack of availability of respirators was because cost considerations were prioritised ahead of safety.

23. The failure to provide healthcare workers with the right level of protection has caused serious harm to many BMA members and the wider healthcare workforce, many of whom are still suffering today with long Covid acquired in their workplace.

24. There was also an initial lack of testing capacity, which meant that there were not enough tests for all patients and healthcare workers who needed one, leading to the unwitting transmission of Covid.

25. The lack of testing also had a significant impact on workforce capacity, with many NHS staff unnecessarily required to self-isolate, which exacerbated frontline staff shortages, especially at the outset of the pandemic. 

26. Risk assessments are mandatory under health and safety law and an important tool in ensuring that employees are safe and protected at work. Yet these were often not performed or were inadequate, particularly during the first wave of Covid-19.

27. In response to these failures the BMA asked NHS England in April 2020 to develop a national risk profiling framework to assist employers in conducting risk assessments. However, it was not until 24 June 2020, three months into the pandemic, that NHS England issued a letter reminding employers of their legal responsibilities to undertake risk assessments.

Third, Inequalities

28. The pandemic highlighted disparities within society, widened health inequalities, and impacted groups differently.

29. People from some ethnic minority backgrounds were more likely to become infected with and die from Covid-19. Shockingly, analysis by the Health Service Journal found that 94% of doctors who died up to April 2020 were from ethnic minority backgrounds, even though this group makes up only 44% of NHS medical staff.

30. The BMA was one of the first organisations to raise concerns about this issue. On 9 April 2020, the BMA’s chair of council wrote to the CEO of NHSE raising concerns about the disproportionate impact of Covid-19 on people from ethnic minority backgrounds and the high rates of Covid-19 deaths amongst this group, and called for an urgent investigation.

31. The BMA also raised concerns about other groups who were disproportionately impacted by the pandemic, such as those who were clinically vulnerable due to pre-existing medical conditions or other factors, older people and those living in care settings, and disabled people.  

32. The BMA suggests that central to the Inquiry’s module 2 investigation should be: an examination of the likely impact of NPIs and other government decisions on particular groups; the extent to which early warnings about disproportionate impacts were adequately taken into account; and the extent to which action was taken to mitigate disproportionate impacts.