About this report

This report looks at how well the medical profession across the UK was protected from COVID-19. It explores whether the protection afforded to medical professionals was suitable and sufficient to counter the substantial risk to which they were being exposed.

Health systems

The wider health and public health systems entered the pandemic under-resourced

Before the pandemic, health systems across the UK were operating in an environment of scarcity; general health spending was below that of comparable countries and there were chronic shortages of nurses, doctors and beds.

A better staffed and better resourced system would have been more able to deal with the acute spike in demand and high staff absence rate caused by the pandemic.

Key recommendations

• Maintain adequate workforce, investment, and future workforce plans including how many staff are needed to meet current and future demands.
• Improve capital investment, modernise physical infrastructure and improve ventilation of the NHS estate by implementing clear standards, with funding and equipment to meet them.

Pandemic planning

Key lessons from pandemic planning exercises were ignored

While there had already been two coronavirus pandemics in the 21st century, the UK Government prepared for the ‘wrong’ kind of pandemic by assuming that the major risk to public health was from an influenza-style pandemic. Preparations therefore centred on the treatment of disease rather than strategies to detect and contain potential cases.

Moreover, the UK and devolved governments conducted several pandemic planning exercises prior to COVID-19 and yet failed to act on the some of the key recommendations, particularly those related to stockpiles of PPE.

Key recommendations

• UK and devolved governments should continue to carry out pandemic preparedness exercises for the most likely types of infections.
• UK and devolved governments must act on the lessons learned.

Questions for the inquiries

• How was the initial policy response to the pandemic decided?
• How much influence did previous exercises have on the Government’s approach?

Infection prevention and control

Guidance on infection prevention and control (IPC) was inadequate, poorly communicated and difficult to implement

IPC guidance was slow to be released and slow to adapt to a rapidly changing situation. The guidance was often unclear, contradictory, poorly communicated and difficult to implement at a local level. It was also out of step with international organisations such as the WHO (World Health Organisation) and ECDC (European Centre for Disease Prevention and Control).

Moreover, it did not remind employers of their pre-existing obligations under health and safety law and was not updated in light of evidence demonstrating that transmission occurred through actions such as coughing and breathing, rather than only during aerosol-generating procedures (AGPs).

As of report publication, healthcare workers in the UK are still being denied the appropriate level of protection when treating COVID-19 positive patients. 

Key recommendations

• Ensure health and safety law is adequately publicised, enforced and promptly supported by appropriate guidance.
• IPC guidance should be updated rapidly in response to fast-changing situations and evidence, be communicated effectively, and highlight existing rights and responsibilities under health and safety law.
• Ensure there is a supportive culture across the wider health system so all feel able to speak out and raise their concerns.

Questions for the inquiries

• What was the process for consulting stakeholders about the IPC guidance and how did this change over the course of the pandemic?
• What does the IPC Cell understand the role of airborne transmission to be? Why was guidance around aerosol transmission updated then revoked?

COVID testing

Testing capacity was insufficient at the beginning of the pandemic

The UK Government drastically overestimated the UK’s capacity to perform COVID-19 tests at the pace and to the volumes required. This initial lack of capacity meant that even though testing was reserved for health and social care settings, there were not enough tests for all patients who needed one. This had severe implications for many people living in care homes due to the lack of testing available for patients being discharged.

Key recommendations

• Public health systems should be resourced and funded to have adequate contact tracing capacity.
• Systems should be able to rapidly scale up testing for future variants or pandemics.

Questions for the inquiries

• How long into the first wave did it take governments to understand that mass testing was of critical importance in controlling COVID-19?

PPE

PPE (personal protective equipment) supplies were insufficient, and processes for training and ensuring safe fit were inadequate

The initial stages of the pandemic saw widespread PPE shortages. The subsequent scramble to secure more supplies led to PPE being procured from organisations with no experience, deliveries of PPE that were unsuitable for use and a lack of transparency surrounding the deals struck to source PPE.

This meant that medical professionals on the frontline often had to go without PPE, reuse single-use items, use expired PPE or use homemade and donated items.

Many also felt pressured to work without adequate protection, with disparities in who felt able to speak out.

Key recommendations

• Maintain an adequate rotating stockpile of PPE and have plans to quickly scale up procurement and manufacturing if required.
• The medical workforce is diverse which means the PPE we procure needs to be suitable to different face and body shapes, varying hair textures, head coverings, and facial hair so all workers can access adequate protection.
• PPE should be provided with centrally coordinated guidance and practical training on how to fit test, use, and dispose of it safely.

Questions for the inquiries

• Why was the national stockpile not configured to deal with COVID-19?
• What needs to be done to ensure that the stockpile is appropriate to deal with a variety of threats?

Risk assessment

Risk assessments weren’t consistently carried out or implemented

Many doctors were not risk assessed or their risk assessments were significantly delayed. This left doctors unjustifiably exposed to COVID-19 and demonstrates how they were expected to carry on working regardless.

When risk assessments did take place, many doctors felt they were ineffective at protecting them; this was particularly the case amongst doctors working in hospital settings and those from ethnic minority backgrounds.

Key recommendations

• Carrying out risk assessments as required by law and acting upon them should be prioritised in all stages of a pandemic response.
• Invest in significantly increasing the occupational medicine workforce.

Vaccination rollout

The vaccination programme was a success overall, with a few issues around early rollout

Medical professionals reported high levels of satisfaction with the vaccination programme and were rightly prioritised given their occupational exposure to COVID-19.

Some groups more commonly reported difficulties in accessing their first vaccination, particularly junior doctors, GP locums, medical students who were not yet deployed and doctors working in private practice.

In some cases, non-patient-facing staff and management were able to book and receive their vaccine before patient-facing staff, which was an understandable source of frustration for some.

Overall the vaccination rollout was however perceived positively with many medical professionals rightly proud of the role they played in making it happen.

Key recommendations

• Vaccine procurement was a massive success and should be used as a model for how to effectively fund scientific research in a fast-moving situation.
• Any future vaccination programmes should consider the range of potential barriers to access which could be experienced and identify ways to ensure access is equitable.

Questions for the inquiries

• What can be learned from the enormous success of the vaccine rollout and critical role played by the NHS and medical profession to better facilitate future public health campaigns?