The BMA review of the Government’s handling of the pandemic and the impact on the NHS. What are the implications?

The BMA in May 2022 have released the first 2 of 5 reports on the government’s handling of the pandemic and its impact on the NHS.  The reports are based on the results of a survey of doctors carried out in late 2021 and a series of surveys carried out by the BMA during the pandemic.  They address questions the BMA consider need investigating by the UK Covid-19 Inquiry, together with recommendations for the governments across the UK. We look at the key findings, recommendations and the report’s implications.

Key findings: The first review

The first review looked at how well protected the medical profession was from Covid 19. This concludes that the UK was not adequately prepared for the pandemic. The UK government was slow to implement public health and occupational hygiene measures. Key lessons from pandemic planning exercises conducted prior to the pandemic, including the need to stockpile adequate PPE, were ignored.

Protection was lacking during the pandemic, with 81% of survey respondents feeling only partly protected during the first wave. The review concludes that infection control was also inadequate. Infection Prevention Control guidance was poorly communicated and difficult to implement.

Testing capacity was also insufficient at the beginning of the pandemic. The BMA conclude that the UK government drastically overestimated the UK’s capacity to perform Covid 19 tests at the pace and in the volumes required. The lack of capacity was one reason the UK government abandoned contact tracing and set up Test and Trace.  The review concludes Test and Trace failed to provide an adequate service for large parts of the pandemic and failed to meet its targets.

The BMA conclude that PPE supplies were insufficient and processes for training and ensuring safe fit were inadequate. As a result many medical professionals worked without adequate protection. Many survey respondents felt pressured to work without adequate protection.

The BMA concluded that risk assessments required by UK health and safety law were not consistently carried out or implemented. Many doctors were not risk assessed leaving them unjustifiably exposed. By May 2020 64% of respondents had not been assessed for their risk of contact with Covid 19. The review queries whether some medical professionals deaths could have been prevented with more prompt risk assessments.

The review also concluded that ventilation of NHS buildings was often not good enough, which meant that it was often not possible to properly implement infection control procedures.

Key findings: The second review

The second review assessed the impact of the pandemic on the medical profession.

The review concludes that the pandemic seriously impacted the physical health of medical professionals. Unsurprisingly, the BMA conclude that healthcare workers suffered higher infection rates and many more than in the general population were now dealing with the effects of long Covid.  Ethnic minority doctors and disabled doctors were among those whose physical health was more negatively impacted. 95% of doctors and dentists who died from coronavirus were from ethnic minority backgrounds, even though this group only makes up 44% of NHS medical staff.

The review concludes that the mental health of medical professionals suffered considerably. By November 2021 64% of health professionals who responded to the survey said they were suffering from a work or study related mental health condition. Between February 2021 and January 2022, the BMA counselling service saw a 173% increase in calls compared to the same period the previous year. Burnout and overwork were common, with 60% of respondents to an April 2021 survey reporting higher than average levels of fatigue. Reported incidents of abuse of healthcare professionals rose from 10% in August 2020 to 48% barely a year later.

The review concludes that NHS occupational health services were not adequately resourced to deal with the pandemic, noting that there was a 40% fall in the number of occupational health Consultants between September 2009 and December 2021.

Positive findings

The reviews were not uniformly critical of the Government. It was concluded that the vaccine programme was a success overall and should be used as a model for how to effectively fund scientific research in a fast moving situation. Remote working was also better facilitated for some doctors.

Recommendations

The reviews made a large number of recommendations, including the following:

• Government should continue to carry out pandemic preparedness exercises for the most likely types of infections and act on the lessons learned from the pandemic.
• Public health systems should be resourced and funded to have adequate contact tracing capacity and be able to rapidly scale up testing for future variants or pandemics.
• The UK government need to maintain an adequate stockpile of suitable PPE.
• Accessible occupational health assessments and support to access psychological support services should be available to staff at all levels.
• There was a need for continuous assessment of workplace shortages and future staffing requirements.
• There was a need to improve capital investment, modernise physical infrastructure and improve ventilation of NHS property.

Implications

Some of the issues highlighted by the BMA will be reflected in employer’s liability claims from staff who contracted Covid in the workplace or who have experienced workplace stress, particularly from healthcare professionals in vulnerable categories. These were extraordinary times and it remains to be seen what attitude the courts will take to claims when considering the duty of care and health and safety regulation. What we can be sure of is that as the Inquiry develops the evidence base will build and these issues will be revisited many times.

If you would like to discuss this topic in more detail, please contact Ben Lambert, Senior Associate.