A new report by the House of Commons Health and Social Care Committee, a cross-party group of MPs, has outlined key issues that arose for medical professionals and patients during the pandemic. And it called on the Department of Health and Social Care to learn lessons from organisational structural failures in the NHS; both in terms of the first wave of Covid-19 and from often related oversights in professional equality of NHS staff.
MPs where told by Chris Hopson, Chief Executive of NHS Providers, that during the first stages of the pandemic NHS trusts were being given six different types of masks from the national stock reserve. He said that “trusts found that one day they were getting one type of mask delivered, the next day another type of mask and the next day another type of mask”.
He explained that for staff this was a waste of time as for each individual type of mask, a fit test was required that could take up to 30 to 45 minutes for each individual staff member. Also, they found that these masks were not one-size-fits-all as “different types of masks do not fit … certain groups of Black and Ethnic Minority (BAME) staff” and with one in particular being described as “being built for 6-foot-3 rugby players”.
Inside the wards in times of Covid-19
Staff fatigue, and routine testing for NHS staff were also a recurring theme within the report. The inquiry heard that routine testing of all staff should be introduced, even for those who are currently asymptomatic, as to further reduce risk to both staff and patients. As well as advocating for staff wellbeing, and keeping in mind targets for recruitment and retention, that more needs to be done to support NHS staff.
Long-standing issues of racial disparity between NHS staff and senior management was also vocalised, with a continuing underrepresentation of staff from the BAME community. Richard Murray, Chief Executive of The King’s Fund, said: “If there are no BAME staff on appointment panels it is much more likely that BAME staff will not get through”.
Also the differing workplace experience of BAME staff was referenced by a study by The King’s Fund, which found that BAME staff members were twice as likely than their white counterparts to experience workplace discrimination, more likely to have experienced recent abuse from staff, and where substantially under-represented on NHS trust boards.
With Sarah Owen, Labour MP for Luton North, voicing the grievance of one nurse who said, during the start of the pandemic, that “all BAME nurses [were] allocated to red wards and my white colleagues [were] constantly in green wards".
Sir Simon Stevens, Chief Executive Officer of NHS England, said regarding these challenges of equality that “I think there are systemic features to discrimination and racism, the NHS is both part of the problem and part of the solution” and said that the NHS was already attempting to address those issues through the Workplace Race Equality Standard.
MPs also heard that deaths in the hospital wards and their tragic racial and class asymmetry have made stark inequalities in society unmissable, with Jennifer Dixon, Chief Executive Officer of Health Foundation, telling the inquiry that “now it is the time for an inequalities strategy, off the back of Covid, to try to address some of those issues more purposefully than we have been able to do over the last 10 years”.
Responding to this report Susan Masters, RCN Director of Nursing, Policy and Public Affairs, said: “Employers must determine how things like the allocation of shifts, or the fit testing of, and access to, PPE affects BAME health and care workers. However, the surest way to address the underlying issues of racial discrimination in our profession is through a fully funded, cross-governmental health and race inequalities strategy which is acted upon properly.”
Challenges of patient care during lockdown
Questioning the quality of communication for patients to access critical health services, the inquiry heard that appointments for treatment for life threatening conditions, such as cancer, had been unclear during lockdown.
With one NHS patient saying that “I fell into a hole where I was absolutely in limbo. I did not know, and I had no communication about, when the chemotherapy might start. For most of the lockdown I have been sitting here at home knowing that all the cancers are growing”.
Referrals and treatment for cancer had come under extreme pressure, with chemotherapy appointments, and operations experiencing substantial disruption - with Dame Cally, National Cancer Director for NHS England, saying that chemotherapy appointments had been “running at about 70% of normal levels” during lockdown. But this decline throughout the NHS during lockdown, combined with new diagnoses also being down, concerns were raised that an increase in missed diagnoses and a backlog in appointments will lead to an increase in future waiting times for treatments.
Dr Charlotte Augst, Chief Executive of National Voices, also highlighted that the non-communicative limbo created by the GP referral process was part of a wider problem of communication, that also existed pre-lockdown, explaining that “the anxiety of not knowing whether you are actually on a waiting list… adds a whole layer of distress to what is an already distressing situation”.
Also outline within the report were concerns dealing with the backlog of delayed elective operations, that are essential to prevent more serious conditions, would become a long-term project for the NHS, with Derek Alderson, President of the Royal College of Surgeons of England, telling the inquiry that “it may take us years to catch up”.
Responding to this report Dr Chaand Nagpaul, BMA council chair, said “the NHS is now facing a triple whammy – the mounting risk of a second spike, winter pressures and the need to address the huge backlog of non-Covid care which has accumulated over the last six months. We now need a full and comprehensive plan, backed by appropriate funding, to ensure that we can provide much-needed care to the millions of patients.”