The involvement of nursing staff in coronavirus pandemic planning was “extremely limited”. despite their expertise from previous epidemics, the UK Covid Inquiry has heard.
Rosemary Gallagher, professional lead for infection prevention and control at the Royal College of Nursing (RCN), gave evidence today at the inquiry.
She highlighted how the lack of consultation with key stakeholders led to the UK government’s insufficient preparation for the coronavirus pandemic.
Her evidence forms part of the first module of the inquiry, which is looking at the UK’s resilience and preparedness for the coronavirus pandemic.
Ms Gallagher told the inquiry that the resilience of a health and care workforce was “absolutely essential” in order to deliver services that meets the public’s needs.
She said: “We know that we went into the pandemic with a significant shortage of about 50,000 nurses…and, therefore, that immediately put us at risk when we needed to surge capacity to support patients who were infected, either at home or in hospitals.”
The RCN had “complained and lobbied for many years” about unsafe nurse staffing levels, constantly participating in research and consultations that were “highlighting the importance of investment in the nursing workforce”, Ms Gallagher said.
In her witness statement, she added how the college had “highlighted the over-representation“ of Black and minority ethnic staff at bands 4-6, which represent those “professionals providing care on the frontline”.
However, in pandemic planning, the government did not mitigate the risk of the disproportionate impact that a pandemic could have on Black and minority ethnic staff, Ms Gallagher argued.
Meanwhile, she also noted that “historic underfunding” of public health had undermined the capacity of local public health teams to effectively improve health, reduce inequalities and respond to the coronavirus pandemic.
She said: “In terms of population health and having a population that is as well as it can be to not suffer unnecessarily from the impact of an infectious disease, population health is absolutely vital.”
“It’s absolutely vital that we are around the table to be able to identify opportunities or risks to that proposed guidance”
In Ms Gallagher’s written witness statement, she described how there had not been “a whole system approach to pandemic planning”.
She echoed this in front of the inquiry, explaining that some community staff were redeployed into the acute sector, without sufficient thought being given to the services needed to continue in the community.
In addition, Ms Gallagher said she could not recall “in depth discussions” taking place on what the real impact of moving nursing staff between these settings would mean.
She said: “Certainly, you would expect to need to move staff in the case of a national incident.
“The pandemic highlighted the impact of doing such actions, and there was real concern regarding how we would maintain care for patients in the community.
“The RCN has raised concerns over a number of years around the reduction in the community nursing workforce, and the implications for that not just in terms of community care, but the knock-on effect of care in hospitals.”
Similarly, Ms Gallagher told the inquiry that opportunities for nurses to be directly involved in pandemic planning, in the lead up to the coronavirus outbreak, were “extremely limited”, despite the expertise the college had gained from previous epidemics.
She said: “Nursing is the largest part of the healthcare workforce and, actually, we have a key role in implementing guidance and guidelines.
“It’s absolutely vital that we are around the table to be able to identify opportunities or risks to that proposed guidance.”
Ms Gallagher led the RCN response to the Ebola virus disease outbreak in west Africa between 2014-2016.
She told the inquiry that it was possible for lessons to be learnt by the UK government in pandemic planning from the RCN’s experience with Ebola.
“We were not preparing for a pandemic of Ebola, this was very much a local situation, but it highlighted significant lessons around how infection control policies were written,” said Ms Gallagher.
She added: “It identified lessons around not just what type of personal protective equipment (PPE) was needed, but how we support staff to be educated on how to put these on and take these off safely.
“And it also highlighted many lessons around confidence and communication and transparency that was needed by the health care workers,” she noted.
One such lesson occurred when a healthcare worker in Spain was infected with Ebola after indirectly caring for a patient in a hospital setting.
Ms Gallagher said she fed back this finding to the Department of Health and Social Care at the time but had “no knowledge of what happened with those recommendations and that report after it was delivered”.
Separately, Ms Gallagher assisted the World Health Organization on behalf of the RCN with the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia.
She told the UK Covid-19 Inquiry that, from this, lessons also should have been learnt around airborne viruses and the need to stockpile PPE and respiratory protective equipment (RPE).
Ms Gallagher argued in her witness statement that, during pandemic planning, there was “too much of a focus on an influenza pandemic”.
As such, she warned that not enough consideration was given to how plans for a flu pandemic would need to be adapted “to deal with a respiratory infection pandemic where the primary mode of transmission was not necessarily via traditional droplet transmission”.
Airborne transmissions should have been properly factored into infection prevention control guidance regarding “the level of PPE required for healthcare workers exposed to patients with Covid-19”, she said.
Ms Gallagher told the inquiry: “In my view, if you are planning for a pandemic, we need to consider all eventualities.
“There was inadequate consideration given to, not just the use have respiratory protective equipment for a prolonged period of time, but exactly which elements of the health and care system would need to use respiratory protective equipment if we had widespread infection.”
She added: “The failure to consider a pathogen that has pandemic potential that would require the extended use of respiratory protective equipment was not duly considered and it is my view that that had an effect on how large the stockpile was of respiratory protective equipment as opposed to, to face masks.”
The hearings for the UK Covid-19 Inquiry are ongoing, and are due to last three years, until summer 2026.