There are many lessons to be learned from the experiences of the UK’s healthcare systems during the Covid-19 pandemic and many areas for improvement. The Inquiry has made 10 recommendations and considers them all to be necessary to prevent healthcare systems being overwhelmed in the next pandemic:

Recommendation 1: Ensure that decision-making on infection prevention and control is underpinned by clear structures and a cautious approach to transmission risk

The UK government must ensure that there is a body (equivalent to the UK Infection Prevention and Control Cell) in place ready to be convened at the outset of any future pandemic, to consider and draft infection prevention and control guidance for healthcare settings. This body must:

• have clear lines of responsibility and a clear, pre-defined role and remit during a pandemic
• have multidisciplinary membership, including experts in the science of viral transmission as well as those with clinical expertise
• ensure that its guidance accounts for the risk of all plausible routes of transmission until sufficient evidence emerges to rule out specific routes
• ensure that guidance clearly explains the underlying rationale for the precautions recommended.

Separately, the Department of Health and Social Care, NHS National Services Scotland, Public Health Wales and the Public Health Agency (Northern Ireland) should review the national infection prevention and control manuals and any future guidance to ensure that the approach to identifying risk of transmission is not confined solely to specific procedures. Emphasis should be placed on a combination of risk factors, such as rates of transmissibility, environment, setting and procedure.

Recommendation 2: Guidance for visiting restrictions

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should publish guidance for the implementation of visiting restrictions in hospitals in the event of a future pandemic. The guidance should identify the circumstances in which visiting restrictions should be introduced, escalated, decreased and removed alongside the measures and exemptions at each level. The guidance should be led by the following core principles:

1. Measures applied should be the least restrictive possible, both in terms of severity and the length of time for which they apply.
2. Restrictions should be decided upon and applied at the most local level possible.
3. Unless restrictions are applied at a specified level, trusts and health boards should take decisions on the severity of restrictions based on local risk assessments.
4. Communications with the public must clearly explain the measures in place and the reasons why restrictions apply.

The guidance should be reviewed every three years in line with the Inquiry’s Module 1 Report (Recommendation 4)

Recommendation 3: Better preparation for fit-testing

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with employers, including health boards and trusts, to review the availability of qualified fit testers and take steps to increase the number of fit testers accordingly. Availability should be reviewed every three years in line with the Inquiry’s Module 1 Report (Recommendation 4). The Health and Safety Executive and the Health and Safety Executive for Northern Ireland should update their guidance to employers to emphasise the need to ensure that sufficient fit-testing capacity is available. 

Recommendation 4: Improve data systems to identify individuals at high risk during a pandemic

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive must ensure that health data and digital systems have the capability to identify individuals at high risk of morbidity or mortality from a pandemic disease quickly and accurately in a future pandemic. This should include action to improve health data systems and patient record-keeping by:

• improving patient data by enabling more granular diagnostic coding
• ensuring that care records are compatible across primary and secondary care
• enabling secure data-sharing and linkage across multiple health datasets and systems for identifying individuals at high risk.

Recommendation 5: Prepare to scale up urgent and emergency care capacity

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, in conjunction with organisations responsible for delivering services, should plan for surge capacity in urgent and emergency care during a pandemic.

Plans must ensure that there is sufficient workforce capacity and the ability to surge, including the number and type of staff required, recruitment and training provision.

This should be completed as part of the whole-system civil emergency strategy recommended in the Inquiry’s Module 1 Report (Recommendation 4). Plans should be published and subject to review every three years.

Recommendation 6: Prepare for and test the ability to scale up hospital capacity

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with trusts and health boards to ensure that pandemic plans include practical steps to rapidly scale up hospital capacity to treat acutely unwell patients. This should include critical care services that can deliver multiple levels and types of organ support. It should also cover necessary equipment, supplies, space and staff, including redeployment and training.

All trusts and health boards must keep an easily accessible, up-to-date record of the information needed to implement these plans in the hospital sites they operate. This should include technical aspects of critical care expansion such as power, ventilation, oxygen and waste management systems.

Plans for expanding capacity should be published, subject to review every three years and tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6).

Recommendation 7: A framework to guide the allocation of intensive care resources in the extreme event of saturation

The UK government and devolved administrations should publish a UK-wide framework setting out ethical and operational principles to guide the allocation of adult intensive care resources in the extreme event that they are saturated during a pandemic. That framework must:

• be informed by comprehensive engagement with the public and developed in conjunction with professionals across healthcare, law and ethics, as well as with regulators of healthcare professionals
• set out clearly established triggers for its use, based at least in part on a UK-wide system that measures critical care capacity strain and facilitates mutual aid (such as the CRITCON tool used in England)
• establish clinicians’ legal and professional duties in applying the framework, which should be clearly explained to clinicians through guidance
• be regularly reviewed with reference to contemporary patient data during a pandemic, and any future use of it must be evaluated and reported on publicly.

A plan and timeline for completing this work should be published within six months of this Report. Application of the framework should be tested as part of the pandemic response exercises recommended in the Inquiry’s Module 1 Report (Recommendation 6).

Recommendation 8: Systematically recording and publishing healthcare worker deaths

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with their respective public health agencies and healthcare employers to develop nation-specific mechanisms to collect, analyse and publish data systematically on the deaths of healthcare workers in the event of a pandemic outbreak. The UK Statistics Authority should work with data providers to ensure that the data are comparable across the four nations of the UK.

Recommendation 9: A standardised process for advance care planning across the UK

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with trusts and health boards, should establish and promote one standardised process across the UK (such as ReSPECT, the Recommended Summary Plan for Emergency Care and Treatment) for clinicians to ascertain and record their patients’ wishes and preferences for future care and treatment in order to inform individualised decision-making, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices.

Recommendation 10: Psychological and emotional support for healthcare workers

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with healthcare employers and professional bodies, should put in place plans to deliver effective support for healthcare workers at scale from the outset of a pandemic. Plans should cover the nature and level of support that will be provided during and after a pandemic. All four governments should develop a programme of peer support visits that can, from the outset of a pandemic, be targeted towards areas of acute hospitals under considerable strain. The purpose of the visits should be to support front-line staff, collect insights on the pressures that healthcare workers are facing and understand what further support they might need.

See also:

• UK Covid-19 Inquiry Module 1: The resilience and preparedness of the United Kingdom
• Covid-19 Inquiry: Module 2, 2A, 2B, 2C Report – Core decision-making and political governance

2026-03-13 SHBN Meeting.pdf

CATA has released copies of their reports into the public domain although, due to Inquiry confidentiality rules, some material has had to be redacted.

Links to CATA’s two reports:

• Changes in the Management of COVID-19 (March 2020)
• Independent Investigation into the conduct of the IPC Cell

David reminded the Network that Baroness Hallett, in her module 1 report (July 2024), had already confirmed that the primary routes of transmission for coronaviruses (including SARS-CoV-2) are “airborne and respiratory”. This was based on expert evidence presented to the Inquiry. David felt it was discourteous to Baroness Hallett for anybody to claim that COVID-19 is not an airborne disease, yet that is exactly what ministers (Andrew Gwynne and his successor Ashley Dalton) have been repeatedly saying in their correspondence with CATA.

In her module 2 report, Baroness Hallett mentioned that “policy makers paid insufficient attention to … airborne transmission”. She went on to commend Professor Cath Noakes for the evidence she provided, praising her for raising her concerns and highlighted a comment that there could have been “significant public concern” (i.e. panic) if the disease was declared to be airborne.

David shared evidence of this in the form of a WhatsApp message from Matt Hancock sharing concerns that if mainstream media published stories about the advisability of wearing masks, there would be a “loo roll type rush” on them.

The Inquiry report had included comments that Professor Sir Jonathan Van Tam had made to the Inquiry during his oral evidence that “If we knew then what we know now, there may have been less emphasis on contact transmission and more emphasis on airborne transmission and ventilation”. David rejected this statement outright, maintaining that, right from the start of the pandemic, it was known to be airborne. He presented proof of this via a statement by the the Health and Safety Executive (HSE) to its inspectors in April 2020 confirming that the risk of aerosol transmission was at its greatest within a metre of the infectious person—exactly the setting where most care is given to patients.

• Broadening participation in SAGE (the Scientific Advisory Group for Emergencies), through open recruitment of experts and representation of devolved administrations.
• Reforming and clarifying the structures for decision-making during emergencies within each nation. Improving consideration of the impact that decisions might have on those most at risk in an emergency: changes should aim to identify any risks to vulnerable groups, in both the planning for and response to emergencies.
• Ensuring that decisions and their implications are clearly communicated to the public. Laws and guidance should be easily understood and available in accessible formats.
• Enabling greater parliamentary scrutiny of the use of emergency powers through safeguards such as time limits and regular reporting on how powers have been used.
• Establishing structures to improve the communication between the four nations during an emergency to ensure better alignment of policies where desirable and to provide a clear rationale for differences in approach where necessary.

See also:

• UK Covid-19 Inquiry Module 1: The resilience and preparedness of the United Kingdom
• Covid-19 Inquiry: Module 3 Report – The impact of the Covid-19 pandemic on the healthcare systems of the United Kingdom
• Questions around Government governance

The new guidance, prepared by the British Occupational Hygiene Society (BOHS), the Chartered Society for Worker Health Protection and the UK’s leading authority on respiratory protection, has the added credentials of meeting the approval of the HSE, the British Standards Institution, RCN, BMA and others.

A key element of the guidance is that it makes it absolutely clear that it is illegal to refer to surgical masks as 'personal protective equipment'. The term 'PPE' has a very precise interpretation in terms of UK safety legislation.

The use of this misleading term for surgical masks has become widespread in NHS documentation. It demonstrates that the authors either don’t properly understand health and safety legislation and/or do not respect the authority of the regulatory body the HSE, its guidance and approved codes of practice. Incorrectly describing surgical masks as PPE lulls workers into a false sense of security. BOHS acknowledge the helpful input of Professor Andrew Curran (HSE’s Chief Scientific Advisor) in finalising this authoritative guidance and the legal clarifications that it contains.

The section of David’s presentation intriguingly entitled 'Size does matter!' explains the fundamental misunderstanding of IPC authors that 'airborne transmission' via aerosols only relates to droplets and particles that are deemed 'respirable' and are so small that they can pass deep down into the lungs (i.e. 5 microns or less). This fundamental flaw in IPC thinking was plainly evident in guidance produced by the 4-nations IPC Cell during the height of the pandemic and continues to this day, leaving healthcare workers endangered by believing they are protected by surgical masks against airborne diseases when in fact they are not.

David also explains how organisations such as CATA are now reaching out to international partners in Canada and elsewhere, with a common purpose of ensuring that IPC guidance across the world is founded on credible scientific principles, which, at present, it is not.

This has been in two parts:

• His first presentation was delivered on 3 December 2024, just as the public hearings for module 3 (impact of the pandemic on healthcare systems) were drawing to a close.
• In this second presentation (28 March 2025) David updates the group on CATA's current position and summarises their final submissions to Baroness Hallett.

The detail in CATA’s closing submissions to the Inquiry may be found in its written statement at this link.

Links are provided in the last two slides of the attached PDF file to CATA’s letters to the Chief Nursing Officers and Ministers.

2025-03-28 SHBN Presentation.pdf

It should be noted that, as at 19 May 2025:

• No reply has been received from the Chief Nursing Officers to CATA’s letter of 4 March.
• No reply has been received from the Minister (Rt Hon Ashley Dalton MP) to CATA’s letter of 18 March.

CATA has therefore written again to the Rt Hon Ashley Dalton MP. The letter is attached below:

cata-letter-to-ashley-dalton-mp-1-may-25 (1).pdf

Related reading on the hub:

• Update on CATA's ongoing campaign around the current IPC guidelines for healthcare (11 February 2025)

CATA Exec Letter to Members Final.pdf

Meanwhile they will seek resolution to 'unfinished business', such as pressing for a response to their letter to the Chief Nursing Officers which has not elicited even an acknowledgement of receipt, let alone a substantive reply to the points raised. 

As David Osborn, one of the Exec Team observes:

"This is, in itself, a clear indication of the high-handed, dismissive attitudes with which the Alliance and other stakeholders have been treated by State bodies since 13th March 2020. You will recall that was the day when the majority of healthcare workers were denied the Respiratory Protective Equipment so badly needed to protect them from becoming infected by the patients in their care. That was truly a day that will live in infamy in the history of the NHS."

CATA also awaits with interest to see whether the new Health Minister, Ashley Dalton, will pick up her predecessor's 'in-tray' and respond to CATA's letter to Andrew Gwynne (attached below).

2025_01_22_CATA_Letter_to_A_Gwynne.pdf .pdf

Related reading on the hub:

• Update on CATA's ongoing campaign around the current IPC guidelines for healthcare
• The Covid-19 Airborne Transmission Alliance (CATA) and the Covid-19 Inquiry: Interview with David Osborn
• Covid-19 : A risk assessment too far? A blog by David Osborn

In our closing statement for Module 3, we included a demand for an interim recommendation from the inquiry in support of our position, supported by a number of other core participant groups. To this end, we wrote with the BMA, Long Covid and bereaved family groups to Baroness Hallett, Chair of the inquiry, to explain why an interim statement is so important, especially as we now know that the definitive module 3 report will not be published until spring 2026.

We have received a strong rebuttal from the inquiry stating that there will be no interim statement this year. CATA felt that the inquiry’s letter required a response questioning some of the reasoning but this led to an immediate further rebuttal. The inquiry will therefore not consider our request.

Meanwhile, IPC guidance continues to be predicated on a droplet paradigm of transmission with surgical masks for almost all clinical interactions except those deemed to be aerosol generating procedures (AGPs) – none of which is based on current scientific evidence. You can see the three letters attached.

Clarification

David wishes to clarify a point raised in the interview: 

"When talking about the “IPC Cell” I said that they 'didn’t produce minutes'. In fact, notes or minutes were taken at all IPC Cell meetings. The point I was making is that they were not published ('produced' in the sense of being released into the public domain), when the minutes of most other groups such as SAGE and NERVTAG were published.

The few IPC Cell minutes that have trickled into the public domain have mostly been as a result of Freedom of Information requests by a colleague and a few that I have managed to obtain myself. In some cases, public authorities have taken around 18 months to disclose documents, and it has required the intervention of the Information Commissioner's Office. I anticipate that more minutes will be disclosed for public scrutiny as time goes on."

You can read more about CATA and the Covid-19 Inquiry in David's blogs and presentations on the hub:

• Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn
• Healthcare workers with Long Covid: Group litigation – a blog from David Osborn
• Covid-19 : A risk assessment too far? A blog by David Osborn
• CATA and the UK Covid-19 Public Inquiry: Presentation from David Osborn

Join the conversation

Were you working in health and social care during the pandemic? We'd like to hear about your experience of health and safety at work.

• Were you provided with adequate PPE to carry out your job safely?
• Did you catch Covid-19 while at work?

You can join the conversation by commenting below (you'll need to sign up first) or get in touch with us directly by emailing content@pslhub.org

Presentation slides:

2024-11-22 SHBN Presentation.pdf

Read some of the blogs David has written for the hub:

• Questions around Government governance

Recommendations

1. Each government should create a single Cabinet-level or equivalent ministerial committee (including the senior minister responsible for health and social care) responsible for whole-system civil emergency preparedness and resilience, to be chaired by the leader or deputy leader of the relevant government. There should also be a single cross-departmental group of senior officials in each government to oversee and implement policy on civil emergency preparedness and resilience.
2. The lead government department model for whole-system civil emergency preparedness and resilience is not appropriate and should be abolished.
3. The UK government and devolved administrations should develop a new approach to risk assessment that moves away from reliance on reasonable worst-case scenarios towards an approach that assesses a wider range of scenarios representative of the different risks and the range of each kind of risk. It should also better reflect the circumstances and characteristics particular to England, Scotland, Wales, Northern Ireland and the UK as a whole.
4. A new UK-wide whole-system civil emergency strategy should be put in place and it should be subject to a substantive reassessment at least every three years to ensure that it is up to date and effective, and incorporates lessons learned from civil emergency exercises.
5. The UK government and devolved administrations should establish new mechanisms for the timely collection, analysis, secure sharing and use of reliable data for informing emergency responses, such as data systems to be tested in pandemic exercises. In addition, a wider range of ‘hibernated’ and other studies should be commissioned that are designed to be rapidly adapted to a new outbreak.
6. The UK government and devolved administrations should hold a UK-wide pandemic response exercise at least every three years.
7. Each government should publish a report within three months of the completion of each civil emergency exercise summarising the findings, lessons and recommendations, and should publish within six months of the exercise an action plan setting out the specific steps to be taken in response to the report’s findings. All exercise reports, action plans, emergency plans and guidance from across the UK should be kept in a single UK-wide online archive, accessible to all involved in emergency preparedness, resilience and response.
8. Each government should produce and publish a report to their respective legislatures on whole-system civil emergency preparedness and resilience at least every three years.
9. External ‘red teams’ should be regularly used in the Civil Service of the UK government and devolved administrations to scrutinise and challenge the principles, evidence, policies and advice relating to preparedness for and resilience to whole-system civil emergencies.
10. The UK government, in consultation with the devolved administrations, should create a UK-wide independent statutory body for whole-system civil emergency preparedness, resilience and response. The body should provide independent, strategic advice to the UK government and devolved administrations, consult with the voluntary, community and social enterprise sector at a national and local level.

See also:

• Covid-19 Inquiry: Module 2, 2A, 2B, 2C Report – Core decision-making and political governance
• Covid-19 Inquiry: Module 3 Report – The impact of the Covid-19 pandemic on the healthcare systems of the United Kingdom
• Questions around Government governance

Every Story Matters provide a toolkit that contains information and creative assets that can be used to encourage participation in Every Story Matters. Every Story Matters aims to provide inclusive methods for people to talk about their experience of the pandemic, so anyone that wants to share their story feels heard, valued, and can contribute to the Inquiry.

• tips on engaging people to take part in Every Story Matters
• print campaign assets to download
• online campaign assets to download
• information on how to use campaign assets
• information on accessible engagement options.

• Resilience and preparedness (Module 1)
• Core UK decision-making and political governance (Module 2)
• Impact of the Covid-19 pandemic on healthcare (Module 3) 
• Vaccines and therapeutics (Module 4) which started on 5 June 2023.

Structure of the Inquiry

January 2024 newsletter

Every Story Matters

Every Story Matters is an online form that asks you to choose from a list of topics and then tell us about what happened. By taking part, you help us to understand the effect of Covid-19, the response of the authorities, and any lessons that can be learned. Find out more and take part.

Module 2 will be split into parts and will examine core political and administrative governance and decision-making by the UK government. Modules 2A, 2B and 2C will address the same overarching and strategic issues from the perspective of Scotland, Wales and Northern Ireland, and hearings will take place in each nation.

Module 3 will investigate the impact of Covid, and governmental and societal responses to it, on healthcare systems, including on patients, hospital and other healthcare workers and staff.

Baroness Heather Hallett has also set out the timetable for the next 12 months. The Inquiry’s first procedural hearings will begin in September and October for Modules 1 and 2. Public hearings for Module 1 will begin in spring 2023 for Module 1 and summer for Module 2. More information on Module 3 timings will be available in the coming weeks. 

The Inquiry will announce further modules in 2023. These are expected to cover both ‘system’ and ‘impact’ issues including: vaccines, therapeutics and anti-viral treatment; the care sector; Government procurement and Personal Protective Equipment (PPE); testing and tracing; Government business and financial responses; health inequalities and the impact of Covid-19; education, children and young persons; and the impact of Covid-19 on public services and on other sectors. The Inquiry will be looking at the impact of the pandemic on inequalities at every stage of its investigations.