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The NHS “teetered on the brink of collapse” during the Covid pandemic, and only just coped thanks to the “superhuman” efforts of healthcare workers, an official inquiry has concluded.
In a damning assessment of how the UK’s healthcare systems coped with the pandemic, the Covid-19 inquiry chair, Heather Hallett, said the impact was “devastating” due to the NHS being in a “parlous state” before the outbreak of the virus.
She said Covid patients did not always receive the care they needed, with some diagnoses and treatments coming too late to save lives. “Healthcare systems coped with the pandemic, but only just,” said Lady Hallett, a former court of appeal judge. “On a number of occasions, they teetered on the brink of collapse and only coped thanks to the almost superhuman efforts of healthcare workers and all the staff who support them.
“Workers carried the burden of caring for the sick in unprecedented numbers. They were obliged to work under intolerable pressure for months on end.”
She said politicians, including the former health secretary Matt Hancock, refused to admit the NHS was “overwhelmed” during the pandemic, as they believed this to mean total collapse.
“There was clearly overwhelm,” she said. “Patients could not be admitted to hospital and, in particular, into intensive care units. The pressure was, at times, intolerable. This continued for wave after wave of the virus.”
Other findings of the report included:
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The NHS entered the pandemic with low bed numbers, high numbers of staff vacancies and high bed occupancy, meaning it was already in a “precarious position” and ill-prepared to deal with a pandemic.
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There was not enough PPE at the start of the pandemic, meaning healthcare workers had to put themselves and their families at risk to care for patients.
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Infection control in the early stages of the pandemic was flawed as it assumed Covid-19 was spread by physical contact, rather than being airborne.
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The “stay home, protect the NHS, save lives” public message may have inadvertently led to a decline in hospital attendance of life-threatening emergencies such as heart attacks.
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80% of healthcare professionals said they acted in a way that conflicted with their values during the pandemic, with some saying they felt they were “playing God” as they were unable to give everyone the treatment they needed.
The report is the third of 10 due to be published as part of the official Covid-19 inquiry, which finished taking evidence earlier this month, almost three years after hearings began. It has become the most expensive inquiry in history, with total costs standing at £204m.
Looking specifically at healthcare, this report was based on 300 written statements and 300,000 pages of evidence, along with the testimony of 93 witnesses who gave evidence in a 10-week hearing in 2024.
Hancock and Prof Chris Whitty, the chief medical officer for England, were among those who gave evidence. It included harrowing testimony from healthcare workers describing scenes in hospitals during the height of the pandemic, which some described as being similar to a terrorist attack or war zone.
Prof Kevin Fong, the national clinical adviser in emergency preparedness, resilience and response, said: “We had nurses talking about patients raining from the sky. Sometimes they were so overwhelmed they were putting patients in body bags, putting them on the floor, and putting another patient in their bed straight away.”
Others said they were traumatised by watching patients die alone, and they were “haunted by the cries” of family members they were unable to comfort.
Fong said: “Exactly at a time when you would recuse yourself to give the patient and their family some dignity, you are actually holding a phone or an iPad up, showing them the monitor, showing the family the patient, listening to families imploring the patient not to die and then the howling down the phone, and with nothing else that you can do other than to stay there.”
Staff said they resorted to sleeping on hospital floors, or in sleeping bags and camp beds, to get rest while on long shifts.
Hallett also highlighted the disproportionate impact on minority ethnic staff, who were more vulnerable to the virus, and the lack of data collection and risk assessments risked staff feeling “expendable and not valued”.
Hallett’s recommendations included increasing capacity in emergency care, strengthening the body responsible for infection control guidance and increasing support for healthcare workers. “When the next pandemic strikes, there may not be a workforce able or willing to work under the conditions that arose during the Covid-19 pandemic,” she said.
