Covid inquiry turns focus to impact on nurses and healthcare

Chaired by Baroness Heather Hallett, the inquiry – which started its hearings last year – aims to analyse the UK preparedness and response to the pandemic and make recommendations for future national emergencies.

“The myriad effects of the pandemic are still keenly felt by those providing healthcare and those receiving healthcare in the UK today”

Jacqueline Carey

So far, it has heard evidence from lawmakers, aides and other people within government as well as health leaders involved in the initial response to Covid-19 in 2020.

Module 3 of the UK Covid-19 Inquiry, which covers the impact of the pandemic on healthcare systems across the four nations, began yesterday (9 September).

It started with a moving video featuring the voices of healthcare workers, the bereaved and Covid-19 survivors about their experiences in hospitals and other health settings during the peak of the pandemic.

Doctors, pharmacists and paramedics spoke in the video about the challenges of the pandemic period – such as having to prioritise some patients over others.

They also spoke about the healthcare inequalities which ran rampant during Covid-19, particularly among minority ethnic people.

Also featured in the video was children’s author Michael Rosen, who survived a particularly acute Covid-19 infection shortly after the first national lockdown began – but was left with long-term health conditions as a result.

Mr Rosen said in the video: “In my [intensive care] ward, nurses were going bed to bed which is absolutely forbidden. You [are meant to] have one nurse per patient 24 hours a day.

“There weren’t enough nurses… [staff] were traumatised and there are people still recovering from this. I’ve spoken to nurses who have not been able to go back.”

The issue of patient-to-staff ratios in intensive care nursing is set to be a key part of the Module 3 hearings, with evidence due to be given by the chief nursing officers of the four nations of the UK.

Jacqueline Carey KC, senior lawyer and counsel to the inquiry, said evidence would also cover the “physical and mental toll” of the pandemic on the healthcare workforce, staff shortages, the suitability and reliability of personal protective equipment (PPE), how all of these impacted patient care and the thoughts and feelings of the bereaved.

“There is a further impact which deserves to be highlighted,” said Ms Carey, towards the end of her submission.

“Many of the witnesses who speak on behalf of those working in healthcare systems have attested in their statements to the gratitude to the staff who worked tirelessly to look after us all, often at the detriment of their own physical and mental health.

“I know that in previous modules you have heard and indeed condemned the abuse that public servants were subjected to for the decisions they made and sadly you may hear more of that within these hearings.

“It is nothing short of an outrage that there are some members of our society who think it’s appropriate to insult and in some instances physically threaten individuals and their families who were doing their jobs to try to protect us all.”

She acknowledged that there may end up being scrutiny of decisions made in healthcare, but added: “I am sure that [the inquiry chair] will want to denounce the increase in personal attacks and abuse that was meted out by those who are often ill-informed and may be ignorant to the additional harm they have caused.”

Core participants in the upcoming Module 3 hearings include representatives of the Royal College of Nursing (RCN), the office of the chief medical officer, other royal colleges, NHS organisations from across the UK and others.

The chief nursing officers of the UK are not listed as core participants, but are expected to give evidence.

Ms Carey finished her opening remarks by speaking about the lasting impact of the pandemic for the entire country.

“Although the public health emergency phase of the pandemic has ended, the myriad effects of the pandemic are still keenly felt by those providing healthcare and those receiving healthcare in the UK today,” she said.

“They are felt by those who are suffering long Covid, whose treatment was delayed, the many thousands of healthcare workers left feeling completely and utterly exhausted and burnt out by the work they undertook and the efforts they went to look after us.

“And by those who deeply miss and mourn the friends, family and colleagues who died.”

Ms Carey added, addressing Baroness Hallett directly: “And that, my lady, is why in my submission Module 3’s findings and recommendations are of such significance to each and every one of us who has the benefit of access to healthcare available to all, based on clinical need and not on individual ability to pay.”

On the same day the Module 3 hearings commenced, the Covid-19 inquiry published the first in a series of records detailing first-hand experiences during the pandemic.

Titled Every Story Matters, the series has received contributions from tens of thousands of people.

“I probably had on average about 20 different guidelines to read on a daily basis at work”

GP nurse

The first edition focuses on the country’s healthcare systems, to tie in with the evidence sessions of Module 3.

It heard testimonies from nurses who got ill, had friends and colleagues who died with Covid-19, and those who were worried about the strain the pandemic had on the workforce – alongside other issues.

One healthcare professional, whose occupation was not specified, described how one of their friends, who also worked in healthcare, died aged 29 after contracting Covid-19 during a training session.

Like the Module 3 hearings, the Every Story Matters report also covered the issue of PPE in hospitals.

One community nurse said she had friends “working in ICU wearing bin bags” due to poor availability or rules on PPE.

Another nurse, who worked in a hospital, noted how they had needed to adjust ill-fitting PPE.

“I used to roll it up to my waist, get an apron and use the apron as a belt, and then hang a pen off that as well,” they said.

“So, the sizing wasn’t great and then you’re bigger than you think you are and you crash into a lot of items because you’ve got more width on you.”

Every Story Matters also heard from people who worked, and were treated, in primary care.

One GP nurse, who was also quoted by Ms Carey in her opening remarks to the inquiry, spoke about being overwhelmed by not just the patient workload, but the constantly-changing guidelines and standards as more information emerged about the virus.

“I probably had on average about 20 different guidelines to read on a daily basis at work,” the nurse said.

“At the end of the day, we were focusing more on reading these guidelines than we were on actually actioning for our patients. It took away a lot of precious clinical time and patient experience.”

Another primary care nurse, speaking more positively about examples of good patient care despite the circumstances, said: “We did adapt, and I think we did change.

“I think we did what we had to do. It was dynamic the whole time really, wasn’t it?

“It was changing all the time, and we did our best, I think, to go and do what we had to do.”