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When the Covid-19 pandemic arrived in the UK in March 2020, Professor Paul Elkington and a team at University Hospital Southampton NHS Foundation Trust (UHS) quickly developed a new form of respiratory protective equipment (RPE) called PeRSo (Personal Respirator Southampton) for hospital staff to use. PeRSo is a portable, wearable device which blows air through a HEPA filter into a hood, providing a high level of protection against respiratory infection. In this interview, Paul describes how, working with industry partners, his team was able to provide 3,500 members of staff at UHS with PeRSo during the pandemic. Describing the impact this had on staff morale and Covid infection rates, he explains why PeRSo is a preferable alternative to the FFP3 masks recommended by the Government during the pandemic. Paul outlines how, in the event of another pandemic, providing personal respirators would offer effective protection for healthcare workers and the wider population at relatively low cost. He also outlines what the Government needs to do to ensure the UK is prepared for future pandemics, including making changes to the regulatory framework and incentivising the development of personal respirators designed specifically for infection control. Further reading on the hub: A personal respirator to improve protection for healthcare workers treating Covid-19 (PeRSo) Powered respirators are effective, sustainable and cost-effective Personal Protective Equipment for SARS-CoV-2 Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn "Forgotten heroes" – the sequel: a blog and resources from David Osborn

In this blog, Laura Evans discusses the lack of protection against Covid-19 for vulnerable patients when going for a GP appointment or into hospital. She shares her personal experience of being dismissed when asking for basic patient safety measures to be put in place. Imagine you are in hospital waiting to be taken down for surgery. You are informed the surgeon does not like wearing gloves, mask or headwear and says it is their personal preference. You are also informed that the operating theatre has not been cleaned since the patient before you. What do you do? Do you say something, politely reminding people of your right to be kept safe in hospital? Or do you remain silent to avoid being ridiculed or made to feel like there is something wrong with you? Of course, this scenario would never happen. It would not be tolerated by society. There are safety regulations and protocols in place to prevent, as far as reasonably possible, spread of disease in healthcare settings. However, where spread of Covid-19 is concerned, this genuine fear is the lived reality for millions of people attending healthcare appointments where their vulnerability is neither checked nor proactively catered for. Many people do not have the confidence, in some cases the wherewithal, to ask people to be careful around them in healthcare settings. Those who do ask for their needs to be met, like myself, have been condescended to and, in some instances, shouted at when arranging appointments. The only exception being when arranging appointments on the cancer pathway, where there is an acceptance that the immune system may be compromised. It is astonishing. What is it about this particular C word? Covid-19 is responsible for the deaths of over a quarter of a million people in the UK and the mass disablement of millions lucky enough to survive it but who are now living with Long Covid. There are also over a million people who shielded during the pandemic restrictions, whose clinical vulnerability has not suddenly gone away. Even if the basic human response leaves a lot to be desired, it has become an economic imperative to prevent so many people being sick. The World Health Organization only declared the emergency phase of the pandemic over, the virus itself continues to devastate lives. The number of people unable to work full time, or even work at all, since the start of the pandemic is rising sharply.[1] The number of people moving to part time work or unemployment to care for someone has also risen in the last few years.[2] A BMJ study found people living with Long Covid have lower quality of life than stage 4 lung cancer patients.[3] Covid-19 has profoundly debilitating effects on aspects of normal life, such as walking, talking, cognitive function, bathing and dressing, personal relationships with friends and family, and employment. There is a lot of rhetoric about preventative medicine; why is more not being done to protect people from these devastating consequences? It is not just Covid-19 that spreads easily when basic protections are not proactively put in place. Patients are still swabbed for MRSA in pre-op checks despite the MRSA outbreak being two decades ago. Clearly proactive prevention works. Yet, there is no routine testing for Covid and a large proportion of positive cases are hospital acquired. My local NHS Trust, Mersey and West Lancashire Teaching Hospitals, has been exemplary across its Southport and Ormskirk hospital sites wherever patients request safety precautions. Nothing is too much trouble. However, interactions with other Trusts have resulted in an appalling lack of respect and dignity, and an unnecessary battle for safe practices and care pathways. There is a worrying ‘survival of the fittest’ narrative pervading this matter, harking back to times when sick and disabled people were treated as socially embarrassing and a burden, to be hidden away and kept quiet. Anyone with the privilege of a robust immune system should ask if you would allow a medical practitioner to treat your open wound without gloves if you knew they were carrying a bloodborne infection? Any reasonable person would doubt such lapses in judgement. So why is Covid-19 different? Why should a vulnerable person be expected to tolerate lack of protections against Covid-19 and why is the NHS not compelled to put basic patient safety measures in place as they are expected to prevent spread of disease? It makes no sense. References House of Commons Library. Research Briefing. Labour Market Statistics. UK Government, 18 February 2025. Office for National Statistics. Employment in the UK: February 2025. Estimates of employment, unemployment and economic inactivity for the UK. 18 February 2025. Walker S, Goodfellow H, Pookarnjanamorakot P, et al. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study. BMJ Open, 2023. We would like to hear your experiences Are you a vulnerable patient? What is your Trust or GP doing to make you feel safe? You can share your experience by posting in the Comments below or join our conversation in the Community area of the hub. Related reading on the hub: “A perfect storm”: The global impact of the pandemic on patient safety Promises of Long Covid support have not materialised (a blog by Clare Rayner) Covid-19 : A risk assessment too far? A blog by David Osborn - Questions around Government governance Exploring the barriers that impact access to NHS care for people with ME and Long Covid Patient safety concerns for Long COVID patients

This is the recording of a webinar hosted by the Safety for All Campaign discussing the latest advancements in personal protective equipment (PPE) standards within surgical settings. The session featured presentations by Dr Ali Mehdi and Edward Curtin, who provided in-depth analyses of current PPE protocols and their implications for perioperative safety. Their insights sparked a dynamic discussion among participants, addressing topics such as the integration of innovative PPE technologies, adherence to evolving safety regulations, and strategies for mitigating risks to both healthcare professionals and patients.

In this interview, David Osborn, chartered occupational safety and health practitioner and member of the Covid-19 Airborne Transmission Alliance (CATA), speaks to Lotty Tizzard, Digital Content Manager at Patient Safety Learning, about how CATA was established during the pandemic to advocate for adequate respiratory protection for NHS employees.  David explains how CATA advocated for the government and heath service to recognise that Covid-19 is passed on by aerosol transmission (through microscopic particles in the air). He also outlines why surgical masks do not adequately protect people against catching airborne viruses and describes how inadequate respiratory protective equipment (RPE) contributed to thousands of NHS staff catching Covid-19 at work. As a result, many healthcare workers died and a large number still live with the ongoing symptoms of Long Covid. David describes CATA's involvement as a Core Participant in the Covid-19 Inquiry and outlines what he hopes will be done to ensure the UK is better prepared for future pandemics. Patient Safety Learning is also a member of CATA. 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 [email protected]

My last blog, "Forgotten heroes" – the sequel, built upon a very moving BBC Panorama programme Forgotten heroes of the Covid front line. The BBC documentary told the sad story of healthcare workers (HCWs) who had bravely and knowingly put themselves in harm's way to care for their patients during the darkest days of the pandemic. Many lost their lives, while many more were rendered so severely injured by the disease (Long Covid) that they were (and remain) unable to work and have been unceremoniously sacked by their NHS Health Trusts/Boards. The way that an organisation manages its activities is known as 'governance'. Good governance will lead to high standards of ethics, morality, care and compassion for the people who work within it and those who may be affected by its acts and omissions. Hence, when applied to a whole country, it is known as 'Government', its departments and agencies. In this blog, I propose a possible hypothetical scenario that may have led to the tragic situation revealed by the BBC documentary. I hope this will lead you to consider the standards of 'governance' that apply to the 'duty of care' which a Government owes to its HCWs during a pandemic and what, morally and ethically, should be done to support those "forgotten heroes" if the Government’s governance should be found to be severely lacking. But is the scenario I am asking you to imagine hypothetical or is it real? I shall leave that to your judgement – and that of the Covid-19 Public Inquiry.  The hypothetical scenario In the wake of the SARS outbreak (Severe Acute Respiratory Syndrome) in 2003, an enlightened Chief Scientific Advisor set a plan in motion to prepare the country for a major pandemic. All epidemiologists worth their salt knew that this was inevitable and would happen one day. Thoughts began to turn towards how HCWs should be protected while caring for infected patients. After all, if large numbers of them became infected then who would look after the rest of us? The health service would most likely be overwhelmed and the country would be thrown into chaos and civil disorder. So a laboratory run by scientists from the country’s foremost health and safety regulatory body undertook some research to discover how well the standard surgical masks (‘medical masks’) would fare in a pandemic. The results were unambiguous – “badly”! The scientists found live viruses behind every surgical mask tested, including fluid resistant surgical masks (FRSMs), when presented with an artificially generated sneeze or cough. The scientists were quite clear in recommending that HCWs should wear respiratory protective equipment (RPE) in order to be properly protected against inhalation of harmful (pathogenic) viruses in the event of a pandemic. There are several types of RPE, the disposable respirator known as FFP3 (filtering facepiece) and some other reusable types as well, which give good protection. Not long afterwards, the 'Swine flu' pandemic raced across the world. This triggered the Government to invest in a massive stockpile of RPE. As the years rolled by, this equipment reached its expiry date but, instead of renewing them, stickers were over the expiry dates extending their life after what were called ‘stringent tests’. One has to question how ‘stringent’, when it is known that some of the materials from which they are made degrade over time and this impairs their efficiency. Tests (even ‘stringent’ ones) can only show how a mask performs at the time of the test and not predict how it will perform in a few years’ time. Manufacturers assign an ‘expiry date’ for a very good reason – when used beyond that date they may fail in such a way that the wearer is unwittingly inhaling the hazardous airborne materials, such as dusts or virus-laden aerosols from which they thought they were being protected. Or, also dangerous, bits of the degrading mask may be inhaled by the wearer presenting a choking hazard. Around that same time. some of the health department’s experts that concluded that SARS coronaviruses were transmitted by droplets and the airborne route via aerosols and tiny particles known as 'droplet nuclei'. They recommended that RPE such as FFP3 respirators should be used when providing routine care to infectious patients. The years passed by and the stockpile came up for review again. Experts from the Government’s health department met to decide what to do. After all, there would be a significant cost to the country in renewing the stockpile, most of which was well out of date. The experts came up with a bright idea –- why not implement a process called 'stock rotation' where PPE would be withdrawn from the stockpile in good time before its expiry date and sent for use in the NHS, replacing it with new PPE. One might question why this simple process wasn't thought of back when the stockpile was first established – after all, it is a fairly commonplace practice in warehousing perishable goods with a shelf-life. This group was fortunate in that it included one of the experts who had authored the above-mentioned paper. Curiously though, they decided that all general ward, community, ambulance and social care staff would only be equipped with FRSMs who they considered need not be protected with proper RPE. Perhaps their attention had wandered away from SARS and were focused on other respiratory diseases like flu (notwithstanding the massive loss of life these caused during the last century). Roll forward a few more years and a SARS pandemic starts to spread out from a place called Wuhan in China with a virus that was 80% similar to its predecessor from 2003, which had been proven to spread by airborne/aerosol transmission.. The new disease was classified as an airborne HCID (high consequence infectious disease) for which the country’s health and safety rules required that HCWs be equipped with RPE (not surgical masks). The Director-General of the World Health Organization (WHO) announces to the world that the disease was airborne (although apparently ‘not in a military sense’ which is a little difficult to understand). A senior medical officer tells a committee of politicians that the disease approaching the country had a very strong force of transmission and is airborne. Then the pandemic arrived in the country, after having wreaked havoc with health services elsewhere in Europe. However, what the pandemic planners did not seem to have taken into account was that the health and safety rules associated with HCIDs required that RPE must be worn by healthcare workers when caring for infectious patients and now the stockpile of respirators was far too low. With not enough respirators to go round, what on earth was to be done? A Government Committee met to consider this dilemma. Two of the experts were present who had authored the paper mentioned above which had explicitly stated that RPE should be worn for SARS coronaviruses, and one of these experts had made the fateful recommendations about the PPE stockpile. This must have all been terribly embarrassing. Anyway they came up with a pragmatic answer to the problem. Solution: Declassify the disease so it isn’t an HCID any more. Done with a phone call to the right person and a quick confirmatory letter back from them. The disease was no longer ‘high consequence’ (just two days after a global pandemic had been declared by the WHO and the worldwide death toll was on a sharp upward trajectory). But oh dear! There is still a problem. Regardless of any HCID rules, the country’s health and safety laws say that if a hazard is airborne then RPE is required (which, as we know, does not include these paper surgical masks). The emergency pandemic legislation brought in by the country’s government had not repealed, revoked or suspended any of the health and safety laws and so they were still in force. This, being 'criminal law' was something that people could be jailed for breaching. Solution: Despite existing evidence that SARS coronaviruses (and other respiratory infectious diseases, such as tuberculosis) are transmissible via the airborne route, the health department pronounces that the virus causing the current pandemic is actually no longer airborne. They say that it is only transmissible via droplets that quickly fall to the ground or onto surfaces. They say that they will only cause infection if they land on someone’s mouth, nose or eyes or a person touches those surfaces and then touches their mouth, nose or eyes. So the country’s response strategy centres around keeping people 2 metres apart and handwashing. The airborne route is largely ignored except for some HCWs who don’t believe them and buy their own RPE – only to be instructed by the hospital authorities to take them off (on pain of disciplinary) and put on surgical masks instead. After all, if they wore these respirators it might scare the patients. But there is yet another problem. When any pathogenic viruses are ‘on the loose’ then the country’s health and safety law says that approved PPE must be worn to protect the wearer if no other, more effective risk control measures can be implemented. For administering close-quarter care to infectious patients no other risk control measures are practical other than PPE. The problem is that surgical masks are not approved 'PPE'. They are designated as ‘medical devices’ which are intended to protect the patient from drops of mucus or saliva that may come out of a HCW’s nose or mouth and may infect the patient. Furthermore the European standard for surgical masks says that they are not intended for protection of the wearer. Solution: We’ll call surgical masks 'PPE' anyway – after all the middle 'P' (protective) has a nice ring to it and should lead HCWs to believe they’re being protected (despite the underlying risk that they may be lulled into a false security and actually become more vulnerable as a result). The health and safety regulator appears somewhat concerned by this turn of events and makes representations to the other Government departments and the NHS that they should refer to RPE (such as FFP3s) as 'respirators' not 'masks' in order to ensure that the distinction is properly understood. However, this is ignored and FFP3s continue to be referred to as 'masks. So you now have 'FFP3 masks' and 'surgical masks'. After all, one mask sounds much the same as another doesn’t it? After all, if you were to refer to one as a 'respirator' (which sounds much better and more efficient) and the other as a 'mask' (which doesn’t) then workers might begin to question why they are not being given the best protection. Furthermore, all politicians, media and just about everyone else in the country started referring to surgical masks as PPE despite the fact that they are not. When concerns are raised with the safety regulator about this, their response is that, whilst they agree surgical masks are not PPE, the term PPE has now entered common parlance and it would be difficult, if not impossible, to reverse this. And so the myth that surgical masks are personal protective equipment persists to this day. A few days after the ‘downgrade’ from RPE to surgical masks, with the first wave now really taking hold, a doctor in Accident and Emergency at one hospital describes their situation to a politician as carnage and chaos. They were distraught as they didn’t have any proper PPE and needed FFP3s. The doctor felt as though they were being thrown to the wolves. They thought it likely that some of them were going to die as a result. Of course, sadly, that doctor was not wrong. Many did die. Many, many more became very ill with very serious and long-lasting health effects. But where, one might ask, is that regulatory body that is supposed to ensure that workers are kept healthy, safe and properly protected against the hazards they’re working with? Well, they say that decisions about respirators and masks in healthcare sector have nothing whatsoever to do with them. They say that it is the country’s health department and the public health people who issue the guidance about mask-wearing in the healthcare sector. It is they who are responsible for these decisions. Then another problem arises. Oh dear, don't health and safety laws just keep getting in the way when you’re trying to manage a pandemic! For instance, there’s one which says that when a worker contracts a serious disease through their work (or dies of it), then it must be reported to that health and safety regulator as 'occupational exposure'. However, it wouldn’t be good for morale amongst healthcare workers if the true impact the disease was having upon them became widely known. Neither would it be good for those people in the health department who had been responsible (and accountable) for decisions they made about the stockpile the instruction they had given to downgrade from respirators to surgical masks. Solution: Discourage such reporting – ideally stop it altogether! Perhaps, when employers do make such reports, the safety regulator should reject them on the grounds that the healthcare workers probably didn’t catch their disease from the infectious patients they were working with (coughing their germs into the air around them) but more likely ‘out in the community’. So these unfortunate healthcare workers have no official record made of their 'occupational exposure' to the disease and any such suggestion is vigorously denied by their employers. This has the potential to severely hamper those workers when, after a year of sick pay, they are unceremoniously sacked and may need evidence that their disablement was caused through their work. Well, that brings us to the end of our hypothetical scenario. What do you think? Truth or fiction? Related reading: Since the publication of this blog, A Byline Times' investigative journalist has delved deeper into the story and his findings, published here, provide more detail.

As reported recently, the Scottish Healthcare Workers Coalition called upon the Scottish Government to reinstate 'universal masking' in health and social care settings.  In this statement written in support of their campaign, an occupational safety and health practitioner, David Osborn, explains the legal requirements for risk assessments that the Government ought to have undertaken before reaching such a decision that exposes healthcare staff to the life-changing consequences associated with repeat Covid-19 infections.  He also explains the legal duty of the Government to consult with workers before implementing changes that may affect their health and safety. Neither duty (risk assessment nor prior consultation with workers) appears to have been well met, putting the Scottish Government and Health Boards in breach of UK-wide health and safety law.  The decision by the Scottish Government to withdraw the coronavirus guidance for extended use of facemasks across health and social care is clearly a matter that has significant implications for the safety of health and social care workers. It is a legal requirement under the Health and Safety at Work Act etc 1974 that employers (including Governments and their Health Boards) must do at least two things before implementing a change that may materially and substantially impact workers’ health and safety at work: They must conduct a suitable and sufficient risk assessment of the proposed actions; and They must consult with all employees or their elected representatives concerning the proposed change. 1. Risk assessment To be “suitable and sufficient” the risk assessment for the abandonment of universal masking should have considered several factors such as: The fact that variants of the SARS-CoV-2 virus continue to evolve which are becoming more immune resistant and subject to vaccine escape. The opportunity for viruses to mutate in this way depends upon the sheer number of viruses in circulation within the population. The greater the number, then statistically the more likely it is that a variant could evolve with potential to partially or wholly defeat our current vaccines and greatly impair the nation’s recovery from the pandemic. It just takes for one single virus to mutate in a certain catastrophic way for this to happen – as will have been the case in Wuhan in 2019. Any responsible Government and Health Board should take all reasonably practicable steps to reduce the number of viruses circulating in the population, particularly in health and social care premises. The Scottish Government appears blind to this simple but important duty that it owes to the Scottish people and its healthcare workers in particular. Evidence is emerging that cases of SARS-CoV-2 reinfection and associated hospitalisations and deaths have increased in relative frequency as new Omicron lineages have emerged with enhanced transmissibility or immune escape characteristics. The evidence also suggests that the time interval between repeat infections is decreasing, particularly (and rather peculiarly) amongst individuals who have previously been infected with the Alpha (‘Kent’) variant which arose during the second wave (winter 2020-21). Many healthcare workers will have been infected during that period. The consequence is that these workers are (a) that these infections may recur more frequently and (b) are at greater risk from these repeat infections. It has long been established that each time a person is infected or reinfected with the SARS-CoV-2 virus they have a risk of developing Long Covid, which can have severe detrimental effect on their health and quality of life – sometimes causing debilitating, irreversible, long-term health conditions. The more times they become reinfected, the worse these conditions may be and the longer they may last. By law, the risk assessment must be recorded (on paper or electronically) and be made available to employees and their representatives immediately upon request. I therefore call upon the Scottish Government to confirm whether or not such a risk assessment was undertaken before the decision was taken to abandon universal masking. If one was done, then the Government and the Health Boards should publish it so that interested parties, such as the Coalition, can determine whether it has properly considered all relevant factors that have a direct bearing on the increased risk of healthcare worker infection and how they plan to mitigate that risk. If no such risk assessment was done, either by the Government centrally or by its Health Boards, then they have acted recklessly and unlawfully. 2. Consultation For clarity, the “consultation”, which is required by the Safety Representatives and Safety Committees Regulations 1977 and the Health and Safety (Consultation with Employees) Regulations 1996, has a very clear meaning. It means: a) providing employees, or their safety representatives, with all relevant information relating to any proposed change in health and safety arrangements (including giving them sight of any risk assessments) before that change is implemented; b) allowing the employees and their representatives sufficient time to discuss amongst themselves and seek any further advice they may need to inform an opinion about the change; c) the employer must then take account any the feedback that it receives. These are serious matters. The UK Government and the devolved administrations, through inept planning for pandemics and the issue of seriously flawed guidance, failed to provide health and social care workers with the necessary PPE to prevent them inhaling airborne virus whilst they cared for highly infectious patients. It is quite understandable that our brave healthcare workers are now so aggrieved by the Government’s decision. These are the same people for whom we, the public, stood and clapped so proudly at our doorsteps during those dark days. The chaotic state of the UK’s planning and preparedness for pandemics has been laid bare at the UK Covid-19 Public Inquiry. During future sessions, the Inquiry will receive evidence concerning the deception which was wrought upon healthcare workers that the flimsy paper masks they were given would keep them safe from the disease when health and safety law requires proper tested and certified respirators to be used (such as FFP3 and equivalent) when workers are exposed to dangerous microbiological hazards in their workplace. Current World Health Organization guidance still advocates that universal masking policies in health and social care premises do still have their place in Governments’ armoury of defence measures to keep healthcare workers safe. Given all that they have already been through, combined with the ongoing suffering that many of them are experiencing from the disease they have contracted whilst caring for us, surely it is now time for the Scottish Government to pay greater consideration and respect for their health and safety. Some commentators may view the abandonment of universal masking as the Government playing “Russian Roulette” with their health by "letting the virus rip" – as sadly it is likely to do as the autumn and winter seasons approach.

I guess that a common feature linking most visitors to Patient Safety Learning is that they have a profound interest in two things. First, recognising and applauding innovations and ‘best practice’ in healthcare. Second, recognising, exposing and denouncing bad practice. The thing they have in common is the desire to learn from the mistakes in the past to do better in the future. When it comes to ‘bad practice’ in healthcare it is usually in connection with some adverse and damaging impact on patients. Our thoughts turn perhaps to certain medical failures, such as the ‘Mid‑Staffs scandal’. Seldom do we find the need to consider the adverse and damaging impacts on the doctors, nurses and all the other staff who work in the health and social care sector. However, those of you who watched the recent BBC Panorama programme, 'Forgotten heroes of the Covid frontline' will have been appalled at the scandal that now confronts so many frontline staff for whom we stood outside our front doors and clapped for so enthusiastically back in those dark days at the height of the pandemic. This blog is dedicated to those 'forgotten heroes'. I hope that it demonstrates that they are not, in fact, forgotten I hope that the resources linked to this blog may be of help to them. The BBC Panorama programme, Forgotten heroes of the Covid front line, touched on a number of important issues, which I will briefly summarise. Transmission of the disease from person to person The Government (and World Health Organization) claimed that Covid-19 was spread by droplets from the nose and mouth of infectious patients, which would quickly fall to ground within 2 metres. Many eminent scientists across the world warned that the disease is also spread by a more insidious mechanism known as 'airborne transmission'. This refers to tiny aerosols that hang in the air and can cause infection by inhalation. But these warning were ignored. Protection of healthcare workers It doesn’t take a rocket scientist or a competent epidemiologist to appreciate that these brave people were at considerable risk of catching Covid-19 themselves while caring for infectious patients in hospitals, residents in care homes, etc. We had all seen the news in February 2020 as the disease rampaged through Italy and noted, with considerable alarm, the number of healthcare workers who were dying from the disease. The UK Government and health authorities had plenty of time to ensure that our healthcare workers were properly protected with the best possible equipment. But they weren’t. Instead of being provided with proper respirator masks, such as those known as FFP3s (Filtering Face‑Pieces), they were provided with flimsy surgical masks which (a) do not filter out the virus‑laden aerosols, and (b) do not provide a tight seal to the face, meaning that the aerosols can get in via the gaps around the edge. Anyone who has ever worn that type of mask and also wears glasses will have evidence of how the exhaled aerosols escape from the mask and mist up their glasses. What goes out, can come in… To add insult to injury the authorities had the effrontery to refer to these masks as “personal protective equipment” (PPE), assuring workers that these would protect them from the disease. For the avoidance of doubt: they are not designated as PPE under UK legislation. They never have been PPE and they are not fit for that purpose. Surgical masks do not protect against airborne hazards such as infectious aerosols. Those who recommended them for this purpose either knew that or should have known that. The "unkindest cut of all” As healthcare workers became infected with the disease, many NHS health trusts and health boards robustly denied that there was any possibility whatsoever that their infections could possibly have been associated with their work. “Nothing to do with us” they said (or words to that effect). Then, once those who were so badly afflicted with the after effects of the disease (known as Long Covid) had been off work for a certain length of time, they were unceremoniously sacked. As the Panorama programme reveals, it is this “denial of occupational exposure” by the NHS which is the most hurtful and vile aspect of the treatment meted out to our “heroes of the Covid frontline”. It is nothing less than a national scandal. As a society, we surely owe it to our healthcare workers who have been harmed in this way to support them through the difficulties that lie ahead of them. In many cases they will have the after effects of Covid-19 for the rest of their lives. We should never forget that their grievous situation has arisen through no fault of their own, but is directly attributable to their selfless bravery back in the darkest days of the pandemic and the misinformation they were given about PPE. Help for health and social care workers Earlier, I mentioned resources that may be of help to those health and social care workers who wish to stand up for themselves and demand that their cases of Covid-19 be recognised as “occupational exposure” (as defined in UK law) and have their cases officially recorded and reported as required by health and safety legislation known as RIDDOR (The Reporting of Injuries Diseases and Dangerous Occurrences Regulations 2013). There are two important points to remember: You do not have to prove that the actual virus which triggered your disease entered your body at work rather than out in the community. It just has to be more likely than not (otherwise known as 'the balance of probabilities), which is easy to demonstrate, given the circumstances of the work at the time. The excuses given by health trusts and health boards for not RIDDOR-reporting generally centre around claims that they were “following Government guidance” and “issued PPE in accordance with that guidance”. However this has no legal validity whatsoever. Let’s take a look at what the RIDDOR actually require… If a disease was (a) diagnosed by a doctor based on symptoms alone or, in the case of Covid-19, by a positive test result (since it was not always possible to see a doctor); and (b) was more likely than not caught through your work, then it is reportable. Whether the employee was given no PPE, the wrong PPE or the very best PPE, it is still reportable. Whether the employer was or was not following official guidance, it is still reportable. There is nothing whatsoever in these regulations that exempts an employer from making the statutory report on these grounds. Four resources you may find useful 1. A letter sent to NHS Employers. This challenges the advice that NHS Employers issued in the form of a flow-diagram regarding RIDDOR-reporting and explains why it was flawed and bore little resemblance to the RIDDOR regulations. In fairness, upon receipt of this letter NHS Employers have replied confirming that they have removed the offending diagram and are now consulting with the Health and Safety Executive (HSE). https://www.tridenthse.co.uk/riddor/Letter_NHS_Employers_2023-03-20.pdf 2. A letter sent to HSE, which is overtly critical of the fact that they did not properly enforce RIDDOR reporting within the healthcare sector. Although this is a long letter, the intention was to set out an unassailable argument, based on the law, HSE guidance and the implementation of RIDDOR in other sectors of industry, as to why healthcare workers’ disease should be reported. The aim of this letter was not just to communicate these facts to the HSE (since they should already know them) but mainly to provide information and assistance to any affected healthcare workers who may wish to read them. HSE have replied to this letter, giving the following explanation: “RIDDOR was originally drafted to capture single one-off unexpected events (accidents and incidents). It was not intended to be used in a pandemic involving thousands of instances of infection, where an employer may be required to make a judgement as to whether a worker caught the infection as a result of a workplace exposure or in the wider community.” One would have hoped that the HSE would have a better understanding of the role of RIDDOR and its origins. The Regulations have never just been about 'accidents and incidents'. It has always been about diseases and long-term health issues – that is what the first 'D' in RIDDOR stands for. Neither has it been solely about 'capturing single one-off unexpected events', it has been about identifying trends that need further investigation. Dating back to HSE Guidance L.73 in 1995: “The [RIDDOR] reports alert the enforcing authorities to individual incidents. They also provide data which indicates how risks arise and show up trends.” Had RIDDOR-reporting been properly enforced trends would (or should) have been spotted in relation to overall infection-rates among healthcare workers. In any event, I am not persuaded that this is a valid reason for denying recognition and official recording of 'occupational exposure' to a lethal disease against which our healthcare workers so valiantly battled at extreme risk to their own health. It only takes a few minutes to tap the relevant details into the online RIDDOR system for each case. It is not a lot to ask. Interestingly, whereas my concern centres around under-reporting, HSE respond by saying that “they have found a significant amount of over-reporting”. I am lost for words! Please refer to the last page of my letter to them and make up your own minds. https://www.tridenthse.co.uk/riddor/Letter_HSE_2023-03-20.pdf 3. In response to the flawed flow-diagram produced by NHS Employers, I have prepared my own flow-diagram setting out the way in which RIDDOR should have been (and should continue to be) implemented in the healthcare sector during the pandemic. I must emphasise that this diagram represents my own personal and professional interpretation of the reporting mechanism and has no official status. HSE will undoubtedly push back on some aspects of this, particularly the aspects of worker-to-worker cross-infection within healthcare premises which their guidance states is non-reportable. I state that it is reportable and I give my reasons. I am pleased to note that in their letter of reply they do not contest this point. https://www.tridenthse.co.uk/riddor/Flow_Diagram_2023-03-20.pdf 4. For healthcare workers with Long Covid, I have produced a template letter which you are welcome to download and adapt according to your own particular circumstances, with a view to sending it to your health trust, health board or other employer, setting out your reasoning as to why your case is, even now (may be a year or two after their initial infection), RIDDOR-reportable. https://www.tridenthse.co.uk/riddor/HCW_RIDDOR_Template_Letter.doc I have also provided some guidance notes to assist you in using the template letter: https://www.tridenthse.co.uk/riddor/HCW_RIDDOR_Template_Letter_Notes.pdf. Even if this letter fails to persuade the more intransigent health trusts/boards to RIDDOR-report (and one can anticipate them being instructed by HSE not to), such a letter may be helpful in demonstrating 'occupational exposure' in the event that they eventually become eligible for some form of State support which they so richly deserve. Conclusions Healthcare workers have not been, and are still not, treated fairly or ethically by the Government, their Departments and Agencies or their own employers. Health and Safety legislation is not being applied equitably between the healthcare sector and other industry sectors. This applies both to the regulations known as COSHH (relating to safe working with hazardous substances, including pathogenic organisms), where the basic requirements for respiratory protection have not been met, and RIDDOR (as described above), where it is basically a postcode lottery as to whether healthcare workers’ COVID-19 infections are recognised and recorded as 'occupational exposure' or not. Going forward, to strike a more positive note, my greatest hope is that a just and fair arrangement is put in place to support those health and social care workers whose lives have been ruined through their selfless devotion to duty during the pandemic. It matters not whether this is achieved via the Industrial Injuries Disablement Benefit scheme or a bespoke scheme comparable with the Armed Forces Compensation Scheme for injured veterans. After all, throughout the pandemic we have referred to them as “frontline workers”.