The UK government ‘failed in its duty of care’ to doctors and the healthcare workforce in its handling of the Covid-19 pandemic, says the BMA (British Medical Association).
A major review into the UK government’s handling of the pandemic and its impact on the NHS, the health of the population, and doctors, has been undertaken by the BMA.
The first two reports conclude that the UK government failed in its duty of care to protect doctors and the wider healthcare workforce from avoidable harm and suffering in its management of the Covid-19 pandemic.
This failure is evidenced in detail and published today, Thursday 19th May, by the BMA.
The reports, part of a series of five, are the most comprehensive accounts of the lived experiences of doctors throughout the pandemic, collated from thousands of doctors across the UK, including those who were on the frontline during Covid-19.
They also draw upon real-time surveys over the past two years, as well as formal testimonies, data and evidence sessions from stakeholders.
Page after page details the devastating impact of the pandemic on medical professionals as individuals, and on the NHS, showing mistake after mistake – errors of judgement and policy made by the UK government – which amount to a failure of a duty of care to the workforce.
In what is believed to be the first documented account of its kind, doctors from across the UK have spoken out about their own experiences during the pandemic, recounting their fears and anxieties as well as laying bare the shortages of PPE, a lack of timely and adequate risk assessments, and the huge impact on their mental and physical health.
The reports, which will also form part of the BMA’s submission to the UK Covid-19 Public Inquiry, make a series of recommendations about lessons which must be learned as well as presenting evidence of where things went wrong.
Dr Chaand Nagpaul, BMA chair of council, said: ‘A moral duty of government is to protect its own healthcare workers from harm in the course of duty, as they serve and protect the nation’s health.
‘Yet, in reality, doctors were desperately let down by the UK government’s failure to adequately prepare for the pandemic, and their subsequent flawed decision-making, with tragic consequences.
‘Many doctors were left unprotected due to critical shortages of PPE as coronavirus hit our shores, resulting in healthcare professionals becoming infected at a higher rate than the rest of the population.
‘Hundreds of healthcare workers lost their lives after contracting Covid-19.
‘95% of doctors who died in April 2020 were from an ethnic minority, a figure which demands that the UK government addresses the deep race inequalities afflicting our NHS workforce.
‘With no respite, doctors worked on the frontline exposed to the virus – while the majority of the public stayed at home during the lockdowns.
‘They saw levels of illness and death they were never trained for.
‘With the dystopian reality of no hospital visitors, doctors had to hold phones in front of dying patients so they could say goodbye to loved ones.
‘Doctors’ health suffered as a result, with significant numbers still experiencing mental and physical exhaustion as they face the gargantuan task of the greatest backlog the NHS has ever faced.
‘Sadly, many continue to experience the debilitating symptoms of long Covid, preventing them from returning to work and affecting their lives daily.
‘These reports add clear evidence of why the UK government’s response to Covid-19 has been described as “one of the most important public health failures the United Kingdom has ever experienced”.
‘The evidence presented in our reports also demonstrates, unequivocally, that the UK government failed in its duty of care to the medical profession.
‘The lessons from this review need to be learned and acted on now – given that new variants, new viruses or future surges of demand can happen swiftly.
‘We must never see a repeat of doctors and healthcare workers left exposed and vulnerable, and we can never afford to see another disaster on this scale ever again.’
Key recommendations for governments from the reports include:
1. UK and devolved governments should continue to carry out pandemic preparedness exercises for the most likely types of infections and must act on the lessons learned from these exercises and the Covid-19 pandemic, identifying key themes such as PPE stockpiling, testing, and public health capacity.
2. 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.
3. The UK government needs to maintain an adequate rotating stockpile of suitable PPE and have plans to quickly scale up procurement and manufacturing if required.
4. General wellbeing support including timely and accessible occupational health assessments and support to access psychological support services must be made available for staff at all levels across all health services, with specific support also offered to ensure staff can recover from the pressure of delivering care during a pandemic.
5. The need for a continuous and transparent assessment of workforce shortages and future staffing requirement to ensure health services and public health systems are better prepared to deal with crises.
6. Improve capital investment, modernise physical infrastructure and improve ventilation of the NHS estate.
7. To mitigate inequity in the future, mechanisms must be introduced to make the experience of working in the NHS less variable by background or protected characteristic.
Today’s reports also contain new qualitative and quantitative research conducted by the BMA asking doctors about their experiences in several areas.
Some of the headline findings include:
- 81% of doctors did not feel fully protected during the first wave of the pandemic
‘Several of us were told not to wear facemasks on rehab wards for fear of frightening the patients. This was true in many hospitals, and I believe it was a top-down policy.’ (Consultant, England)
‘No PPE availability. Failure to acknowledge that speaking, singing, coughing etc (sic) are all aerosol generating procedures, that healthcare staff cannot assess patients without getting close. Therefore, ALL categories of staff should be provided with PPE.’ (GP trainee, England)
‘We made our own, and bought our own when we could find any, we depended on friends sourcing FFP3 masks, my son’s school 3D printing visors.’ (SAS doctor, England)
‘We were sent six pairs of gloves and six aprons in an envelope approximately three weeks after the start of lockdown.’ (GP contractor/principal, Northern Ireland)
- Some doctors felt that their own protection (PPE) was not taken seriously or adequately considered:
‘I was put under pressure to carry on regardless and “support my colleagues”.’ (Consultant, England)
‘Many of my senior doctors were not wearing PPE in meetings, I was clinically extremely vulnerable and had shielded and this made me very anxious. However, I was new and did not feel I could speak up.’ (Junior doctor, England)
‘Using FFP3 with black hair is easier with a hair cover. The elastic snags. PPE posters do not routinely show or normalise the reasonable adjustments necessary for non-religious and religious reasons for covered hair.’ (Consultant, Scotland, Black/Black British)
- 11% of doctors who had developed long Covid-19 had at some point been unable to work full-time or at all, and 51%, while still able to work, nevertheless saw a reduction in their quality of life.
‘I caught Covid-19 in March 2020 from a colleague at work. I have been mostly bedbound since. My life as I knew it had ended. These are supposed to be the best years of my life but I’m spending them alone, in bed, feeling like I’m dying almost all the time.’ (Junior doctor, Scotland)
‘I have long Covid and have been off work for 12 months, not well enough to fulfil my role as mother to my two young children.’ (Consultant, England)
‘My second Covid-19 infection (both infections occupationally acquired) has left me with damage to my spinal cord. I now walk with crutches and cannot walk more than about 200m without them. I also have bladder and bowel problems and have to intermittently catheterise. There is not a day that goes by where I don’t have some form of pain.’ (Medical academic trainee, England)
- 95% of doctors and dentists who died from coronavirus in April 2020 were from ethnic minority backgrounds, even though this group makes up 44% of NHS medical staff.
‘Risk assessment was not carried out. I think this was because high BAME staff numbers which would have led to more staff being off isolating. Option for working from home wasn’t explored so we still don’t know if this would be doable.’ (Salaried GP, England, African)
‘(Risk assessment) was just an arbitrary piece of paper to be filled in to make people feel they were doing something when in all honesty ethnic minorities were dying more. But if we told all ethnic minorities to shield there would not be many left to do the job in the NHS. So it was more “hey you are ethnic and at higher risk but carry on” (sic.)’ (Consultant, England, Arab)
‘Often the most vulnerable are at most risk of exposure due to economic and other pressures not allowing them the privilege of asking for protection. I am very aware of the large number of Filipino nursing staff who died from Covid-19 and there is anecdotal evidence that they did not feel they could say no to working in hazardous situations because of a lack of understanding of their employment rights and fears of their immigration status.’ (GP contractor/principal, England, Pakistani)
- Doctors with a disability felt less protected than other respondents (41% of those with a disability of long-term condition felt ‘not at all’ protected during the first wave, compared to 36% of those without a disability/long-term condition).
‘My line manager told me I had to work in the office even though I could do my job as effectively from home. This put my health at risk.’ (Public Health Consultant, Scotland, Has a disability/LTC)
‘(Risk assessment) was not automatically initiated, when pushed to get assessed, was initially taken as trying to get out of work. As an Indian doctor, aged over 45 with Asthma, I was expected to continue doing home visits.’ (Salaried GP, England, Has a Disability/LTC, Indian)
- Between February 2021 and January 2022, the BMA’s counselling service saw a 173% increase in calls compared to the period between February 2019 and January 2020, rising from an average of 200 a month to up to 800 a month at the peak of the pandemic.
‘Psychologically it was one of the worst periods of my life. I received private therapy throughout the pandemic and that helped tremendously but I have felt suicidal at times.’ (SAS doctor, England)
‘It has taken me basically 18 months to adapt to the “new normal” with a significant flare of chronic anxiety/depression symptoms the whole time.’ (Consultant, Scotland)
‘I found the experience to be most disturbing of my career because of the stress of the unknown, the frustration around slow national response, the overwhelming pressure we were under and the emotional toll on almost everyone I was working with. I didn’t sleep, often felt angry and suffered post-traumatic stress for a period.’ (Consultant, Scotland)
‘I had to stop working as my mental health was so impacted. I have now resigned and feel I am unlikely to return.’ (Salaried GP, Wales)
‘I’m used to seeing people die, I’m a palliative care doctor, but how do I talk about caring for people with Covid-19 who were watching patients in beds opposite them literally dying before their eyes from exactly the same thing as they had?’ (Consultant, England)
‘And we were expected to mentor, support and teach the junior doctors who were utterly unprepared for death and suffering on this scale. I was unprepared, never mind them.’ (Consultant, England).