Tag: COVID-19 Inquiry

Emergency Care crisis threatens UK’s ability to withstand next pandemic, RCEM warns

Efforts to ensure the UK healthcare system is resilient against future pandemics will be undermined if the capacity issues in emergency care systems that are already ‘struggling to cope year-round’ are not addressed, according to the Royal College of Emergency Medicine. 

The warning comes following the publication of the UK Covid Inquiry’s third report on the pandemic, titled the ‘Impact of Covid-19 pandemic on healthcare systems in the 4 nations of the UK (Module 3)’. 

The Chair of the inquiry, Baroness Heather Hallett, investigated the impact of Covid-19 on healthcare systems across the four nations, including government response, how society responded, capacity of health care systems, and the impact on patients and healthcare workers.  

Yesterday’s report concludes that healthcare systems “came close to collapse” and that ultimately, they “coped, but only just.” 

The inquiry has made 10 recommendations, including the need to increase capacity in urgent and emergency care and ensure hospitals have the ability to implement surge capacity.  

Dr Ian Higginson, President of the Royal College of Emergency Medicine said: “We welcome this thorough investigation by Baroness Heather Hallett and her team which has made a damning but honest assessment of how health systems around the UK coped with Covid-19. 

“For our members and their colleagues, this report will make for sobering reading – it reflects the reality they lived through during the pandemic. They showed up when they were needed, and in many cases worked beyond their limits. They remain exhausted and burnt out because of a system that continues to run red hot.  

“Covid-19 landed on an already fragile system. Our EDs were already experiencing overcrowding and long waits, which have only got worse since. 

It’s really frustrating that the obvious lessons around investing in emergency care haven’t been learned, and that it is necessary for a public enquiry into COVID to point out what everyone who works in emergency care already knew, still knows, and have been loudly saying.  

“Our EDs are struggling to cope year-round. There are doubts as to how well many would cope with a local major incident. How can they be regarded as prepared for the next pandemic or other potential crises?  

“Last year, 1,688,555 people waited 12 hours or more to be admitted, discharged, or transferred from a major ED in England. Compare that to 2019, when 487,729 people endured this wait.  

“We have patients receiving care on trolleys in corridors, on chairs in other non-clinical areas, waiting for an inpatient bed to become available for them to move into.  

“As the report recommended, there need to be plans for surge capacity in urgent and emergency care during a pandemic. This is true and we whole heartedly agree. But we need capacity all year round.  

“While we do have institutional knowledge of what a pandemic could bring, and the ability to isolate some patients with infectious illnesses due to infrastructural improvements, I haven’t seen anything to suggest that our emergency care systems are better prepared now than we were then.” 

“The failure to prepare, which is an ongoing theme of the enquiry modules, put front line workers at risk due to inadequate PPE and outdated facilities compared to other countries that have chosen to invest in their emergency care systems and their ability to manage infectious disease outbreaks. Our patients and colleagues paid the price of this failure. 

“This report is more evidence of the need to tackle systemic issues in urgent and emergency care. RCEM is pleased to have contributed to this important inquiry, and we will work with governments, across all four nations, to restore Emergency Departments to a state where they are fit for purpose and prepared for anything.” 

The Royal College of Emergency Medicine provided evidence to the inquiry. 

A witness statement was submitted by former President, Dr Katherine Henderson MBE, who held the post between October 2019 and October 2022. 

Former RCEM President, Dr Katherine Henderson MBE said: “The Covid-19 pandemic was unprecedented.   

“For our members and their colleagues working in Emergency Medicine, it was a time few of us have faced before and our health care system was Nnot adequately prepared for a pandemic to hit, and to hit with such force.   

“Emergency care is a core service for the public that they should be able to trust can deliver the care they need. It must be adequately resourced to be able to respond.  

“In the pandemic staff lacked appropriate personnel protective equipment (PPE). And we struggled to isolate people who had COVID-19 to minimise the risk and prevent transmission of the virus. And there were concerns over ventilators and oxygen supplies. 

 “Emergency medicine staff are incredibly pragmatic and resilient, but the toll this has taken on the workforce cannot be understated. And the goodwill of those who are working in Emergency Departments can’t be the sole reason to prop up the system that isn’t working as it should. 

“The lessons contained in this report must bring about the urgent changes we need to futureproof our service – for both staff, and our patients.”

Covid-19 Inquiry: NHS ‘coped – but only just’

Inquiry publishes third report and 10 recommendations, examining ‘The impact of Covid-19 on healthcare systems’

The Chair of the UK Covid-19 Inquiry, Baroness Heather Hallett, has today published her third report which concludes that the UK’s healthcare systems “came close to collapse”. Ultimately it “coped, but only just”.

Module 3, the third of the Inquiry’s 10 investigations, has examined the impact of Covid-19 on healthcare systems across the four nations. It investigated how governments and society responded to the pandemic, the capacity of healthcare systems to adapt and the impact on patients, their loved ones and healthcare workers.

Today’s new report, ‘The impact of the Covid-19 pandemic on healthcare systems of the United Kingdom’ (Module 3), finds that the UK entered the pandemic ill-prepared. Healthcare systems were already overstretched and in a precarious state. This fragility had profound consequences once the crisis hit, especially when the numbers of people seeking treatment for Covid-19 started to increase dramatically.

Healthcare systems were overwhelmed and came close to collapse. Despite the best efforts of healthcare workers, many Covid patients did not receive the care they would otherwise receive and non Covid patients had their diagnoses and treatment delayed. For some this meant their condition became inoperable. Healthcare workers put their lives at risk and the pandemic had a significant and long-lasting impact on their mental health and wellbeing. 

In hospitals, visiting restrictions meant some vulnerable patients were left without vital support. Some people died alone. This continues to have a devastating impact on the bereaved.

Baroness Hallett calls for the prompt and thorough implementation of 10 key recommendations. These are necessary to prevent healthcare systems being overwhelmed in the next pandemic.

“This third UK Covid-19 Inquiry report concerns the impact of the pandemic on the UK’s healthcare systems. I can summarise that impact as: we coped, but only just.

“The healthcare systems came close to collapse. Healthcare workers carried the burden of caring for the sick in unprecedented numbers. It came at a huge cost to them, their families, their patients and the loved ones of patients. Collapse was only narrowly avoided thanks to the extraordinary efforts of all those working in healthcare across the UK.

“Despite those efforts, some patients did not get the level of care they would usually receive. The enormous strain placed upon the healthcare systems was unprecedented. Those working within it were obliged to work under intolerable pressure for months on end.

“We cannot know when, but there will be another pandemic. My recommendations, taken as a whole, should mean that the UK is better prepared for that pandemic. In doing so, we shall avoid some of the terrible human cost of Covid-19.

“I urge governments across the UK to work individually and collectively to implement these recommendations, in full and in a timely manner.”

A four-page brief summary of the report can be found on the Inquiry’s website and is available in a variety of languages and accessible formats.

In total, 95 witnesses gave oral evidence during Module 3 public hearings held in London in autumn 2024. The Inquiry heard from healthcare professionals, policy-makers, relevant experts, groups representing those most at risk from contracting Covid-19 and those who developed Long Covid as a result of catching the virus.

The Inquiry also heard from serving and former senior politicians, leading scientists, key medical professionals and civil servants.

Some of Baroness Hallett’s  conclusions are as follows:

  • While health ministers maintained that the UK never reached a state of overwhelm, “there was clearly overwhelm”. Lower levels of care were provided to patients and patients did not always get the care they needed, notwithstanding the efforts of healthcare workers.
  • The pressure was, at times, intolerable and this continued for wave after wave of the virus. Healthcare systems entered the pandemic with low numbers of hospital beds, high bed occupancy, high numbers of staff vacancies and of sickness absences, meaning systems were in a precarious position from the outset.
  • Initial infection prevention and control guidance was flawed because it assumed that Covid-19 was spread by contact transmission and failed to consider the extent to which the virus was also spread by aerosol transmission.
  • Supplies of Personal Protective Equipment (PPE) were particularly constrained at the start of the pandemic, causing healthcare workers sometimes to work in inadequate and unsuitable PPE and put themselves and their families at risk to care for patients.
  • 111 services were not able to cope with the level of demand. Call demand for advice and information about Covid-19 increased dramatically, particularly in the early stages of the pandemic.
  • Waiting times for emergency ambulances grew. Waiting times for even the most life-threatening calls grew, with some ambulance services resorting to military aid to ensure there was not a significant risk to life.
  • Visiting restrictions meant that many patients died without the comfort of being surrounded by their loved ones, while vulnerable patients such as those with dementia or a learning disability and children in mental health inpatient units, as well as women accessing maternity services  were left without vital support.
  • The public messaging “Stay Home, Protect the NHS, Save Lives” may have, inadvertently, sent the message that healthcare was closed, contributing to a decline in attendances even for life-threatening emergencies such as heart attacks.
  • The mental health of healthcare staff was severely impacted, with many exhibiting signs of post-traumatic stress disorder, while burn-out was common.

The Chair considers that all Module 3 recommendations should be implemented in full and in a timely manner.

The Inquiry will monitor the implementation of the recommendations during its lifetime. In summary, the Inquiry recommends:

  • increasing capacity in urgent and emergency care and ensuring that hospitals have the ability to implement surge capacity;
  • strengthening the body responsible for infection prevention and control guidance, broadening its membership to enhance its decision-making and improving the guidance itself;
  • improving data collection, enabling individuals at highest risk of harm from infection to be more easily identified and recording deaths of healthcare workers more accurately;
  • promoting a standardised process and documentation for advance care planning, recording patients’ preferences for future care and treatment;
  • increasing support for healthcare workers, improving retention and increasing resilience; and
  • publishing guidance to assist decision-makers, providing clear criteria for clinical decisions if critical care resources become completely exhausted.

A full list of the Inquiry’s recommendations can be found in the full report. 

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The Inquiry has published recommendations for Module 1 and Module 2. Baroness Hallett welcomes the action taken by the four governments of the UK to date and trusts that all remaining recommendations will be implemented promptly and in full. Progress on the implementation of recommendations can be tracked on the Monitoring of Inquiry Recommendations page on the Inquiry’s website. The Inquiry expects to receive the next progress update in May 2026.

Module 3 was the first to publish a record of the Inquiry’s listening exercise, Every Story Matters, which brought together the contributions of more than 32,000 people. The Healthcare Record sets out the personal impact of the pandemic in stark and often distressing terms.

The Inquiry’s next report – focusing on the development of Covid-19 vaccines and the implementation of the vaccine rollout programme (Module 4) will be published next month, 16th April 2026. A further four reports will follow covering Modules 5 to 9, with the final report, Module 10, scheduled to be published no later than Summer 2027.

Read the full Module 3 report, the In Brief summary  and other accessible formats on our website.

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Hourglass: Abuse of older people doubled during pandemic

“Older victims of abuse were locked in and left behind” – that’s the stark warning from Richard Robinson, Chief Executive of Hourglass, the only UK-wide charity dedicated to ending the abuse of older people, as he spoke to the Domestic Abuse Support and Safeguarding roundtable today.
 
Attending the Inquiry’s final investigation into the societal consequences of the COVID-19 pandemic, Richard Robinson is highlighting the often-overlooked impact of the pandemic and government restrictions on older victims of domestic abuse—many of whom were trapped with their abusers, cut off from support, left out of crisis planning, and their needs ignored in pandemic guidance and restrictions.

Calling for dramatic change, he is urging policymakers to ensure older people are no longer an afterthought at times of national emergency.
 
The roundtable session, part of the Inquiry’s final investigation (Module 10), took place today, bringing together leading voices from across the domestic abuse and safeguarding sectors to examine the societal consequences of the pandemic, with a specific focus on vulnerable populations.

Speaking ahead of his attendance, Mr Robinson said: “We must be clear: the pandemic intensified existing inequalities, isolating older people and placing many in harm’s way. At Hourglass, we saw a sharp rise in abuse cases as victims were locked in with perpetrators and cut off from help.
 
Older people in general were left behind – not just in policy, but in protection – and older victim-survivors of domestic abuse were almost entirely ignored. That must never happen again.”
 
Hourglass data, which Mr Robinson presented to the Inquiry, includes: 

  • A 33% rise in calls to its helpline in 2020/21, with a further 22% increase the following year.
  • A surge in psychological and sexual abuse cases, and a doubling of reports involving abuse by neighbours.
  • Widespread concern about neglect and loneliness, with nearly half of the public believing older people became more vulnerable to abuse during lockdown.
  • Evidence that 43% of adult family homicide victims during the pandemic were aged 65 or over.

Mr Robinson is calling for urgent and lasting change, including a Violence Against Older People Strategy to sit alongside the existing VAWG framework; a comprehensive Safer Ageing Strategy to tackle abuse, ageism, and structural neglect; and ring-fenced, multi-year funding to expand the UK’s critically under-resourced support services for older victims.

He added: “The Covid-19 Inquiry as a whole is a vital opportunity to shine a light on what went wrong and why. But it’s also the moment to commit to doing better.

“Today’s roundtable should highlight that older people must no longer be an afterthought in crisis planning. Their safety, rights and dignity must be central to how we prepare for the future.”
 
The roundtable is chaired by Kate Eisenstein, Director of Policy, Research and Legal at the Inquiry, and includes representatives from national and specialist organisations across the domestic abuse, justice, and safeguarding sectors.
 
The charity is urging those keen to support the charity to donate by visiting www.wearehourglass.org.uk/donate or Text SAFER to 70460 to donate £10.

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From austerity to crisis: Covid-19 Inquiry highlights UK’s pre-pandemic weaknesses, says TUC

Just three days short of its second anniversary, the Covid-19 Public Inquiry published the report from the Module One investigation into the resilience and preparedness of the United Kingdom (writes TUC’s NATHAN OSWIN).

The report highlights the devastating consequences of austerity in the decade that preceded the pandemic and the risk of vulnerability in the UK population.

The Impact of austerity on public services

Inquiry Chair, Baroness Hallett, states plainly that, “In short, the UK entered the pandemic with its public services depleted, health improvement stalled, health inequalities increased, and health among the poorest people in a state of decline.” This blunt assessment underscores the critical condition of the nation’s public services as they faced the unprecedented challenges of the Covid-19 pandemic.

The role of the TUC and evidence from frontline workers

As Core Participants in the Inquiry, the TUC played an integral role in the process, working with our unions to provide the evidence that ten years of under-investment and real terms funding cuts to public service in the run up to the Inquiry left key services struggling to cope.

“Public services, particularly health and social care, were running close to, if not beyond, capacity in normal times” the report states, a statement that doctors, nurses, porters and social care workers have been telling us all. 

The Inquiry also heard that “there were severe staff shortages and that a significant amount of the hospital infrastructure was not fit for purpose. England’s social care sector faced similar issues. This combination of factors had a directly negative impact on infection control measures and on the ability of the NHS and the care sector to ‘surge up’ during a pandemic.”

A call to avoid past mistakes

The report is both a damning indictment and a call to never repeat the mistakes of that decade – a desperate reminder of the need to invest in our public services.

And while the report is not naive about the costs needed to make the UK more resilient ahead of the next pandemic – a matter of when not if – it reaches  the conclusion that “the massive financial, economic and human cost of the Covid-19 pandemic is proof that, in the area of preparedness and resilience, money spent on systems for our protection will be vastly outweighed by the cost of not doing so”.

Addressing health inequalities

What’s more, the Inquiry is crystal clear as to the price we pay for inequality across our communities. It notes that at the outset of the pandemic, the UK had “substantial systematic health inequalities by socio-economic status, ethnicity, area-level deprivation, region, social excluded minority groups and inclusion health groups”.

And Baroness Hallett’s report correctly states that these inequalities weakened the ability of the UK to cope, stating that “resilience depends on having a resilient population. The existence and persistence of vulnerability in the population is a long-term risk to the UK.’ 

Recommendations for the future

The recommendations themselves speak of the need to engage with wider society for planning on how we handle a crisis and to take into account the “capacity and capabilities of the UK”. 

No one knows the capacity and capabilities of our public services better than the staff that deliver them and the TUC and its affiliated unions stand ready to assist the government in this vital work.

Conclusion: Building a resilient future together

It is by working in partnership – with proper resources going into our public services – that we can truly learn the lessons this report sets out and secure the resilience and preparedness that the UK needs for a future full of challenges.