Five years on

Yesterday’s COVID-19 Day of Reflection marks five years since the pandemic first took a foothold on UK shores.

As BMA council chair at the time, representing our profession during the most harrowing chapter the NHS had faced since its inception will forever be indelibly imprinted in my memory.

This time five years ago, we were on the eve of a national lockdown to prevent spread of a deadly virus that went on to claim the lives of more than 200,000 citizens in the UK.

We faced a dystopian reality in which patients were admitted to hospital in solitude without the comfort of any visitors, with doctors and nurses being the conduit between patients and their loved ones by holding a mobile phone for video calls, often in their final days of life.

It was a time when the inadequacies in pandemic planning meant that the nation didn’t have enough stock of basic personal protective equipment to safeguard the health of its own NHS workforce, resulting in staff fearing for their lives as they looked after infected patients.

We saw how government ministers would on occasion veto official expert advice from SAGE, and how these politically influenced public health strategies led to inconsistent policies and confusion.

The initial rejection, for example, of the public wearing masks to prevent spread, was followed by masks later becoming mandatory in certain settings.
There was also the glaring incongruity of the WHO urging nations to ‘Test, Test, Test’ to control spread, while at the same time the UK abandoning testing altogether with a policy of self-isolation, leading to the virus spreading blindly throughout the nation.

We saw how a decade of disinvestment in public health infrastructure led to the government spending £37 billion on a privately run test and trace system which failed to deliver, and how a lack of testing capacity during the initial wave meant that some doctors had to travel 50 miles to check if they were infected.

This lack of testing contributed to the deaths of tens of thousands of frail elderly people in care homes due to the virus being transmitted from infected patients discharged from hospital.

Then there was the grim paradox of the government building Nightingale Hospital units in record time, only to find them unoccupied as white elephants since workforce shortages meant that they couldn’t be staffed.

I have flashbacks of doctors phoning me in panic, asking me whether they should walk into a ward without adequate PPE, caught between their duty to patients, and the need to protect their own health.

It is tragic that an estimated 1,000 healthcare workers died from COVID, many of whom may have been alive today had they been adequately protected.
Most poignant for me was COVID’s ugly exacerbation of racial inequalities in healthcare.

Nearly 90 per cent of the doctors who died during the first wave of the pandemic were form ethnic minority backgrounds, with many having come to the UK from overseas to serve our nation and, in doing so, paying the ultimate sacrifice.

Such a statistic defies statistical variability, and I’m proud that as BMA council chair I called this out for what it was - structural racism pervading our health service- and demanded action from government.

Our repeated warnings pre-COVID that a decade of austerity had left the NHS so bereft of workforce, beds and facilities resulted in the tragedy of the NHS having to abandon elective care altogether during the first wave.

This circumstance led directly to a backlog in unmet care totalling several million operations and outpatient appointments, a situation that we are still trying to recover from.

I am profoundly proud that the BMA more than rose to the challenge in representing the profession during this dark and desperate time.

The pandemic truly brought out the best in the association and its staff.
Our member services operated 24 hours a day during the first wave, supporting any doctor worried about working with inadequate protection or working conditions.

The BMA aided international medical graduates by successively lobbying to end health surcharge fees, and also indefinite leave to remain for families who had lost a healthcare worker from COVID.

We ran an unparalleled series of tracker surveys throughout the first year, giving us real time information which allowed us to campaign on the realities facing doctors.

The strength of being a professional association was evident as our medical academic, public health and occupational health committees pulled together to propose sensible measures to control viral spread and protect doctors from harm.

The BMA even developed a risk-assessment tool to protect our most vulnerable members, on the back of the government’s tardiness in taking action.

Perhaps most notably, the association negotiated an agreement relieving GP practices of their normal contractual duties so that they could help to deliver the largest scale vaccination programme in the entire history of the NHS.

As I look back at what was the most gruelling two years in my career, I am left with a clear conscience that we, as the BMA, said what needs to be said, and did what needed to be done.

We were the visible front face speaking on behalf of our profession our patients and the NHS – in the media from prime-time television to broadsheets, to parliamentary select committees, and directly to ministers.

But what matters more than ever now, is to have the assurance that there has been learning, and that should the nation suffer the misfortune of another pandemic, that we will be better and adequately prepared.

The truth is we don’t need to await the results of the COVID inquiry to know some basic hard truths.

We need an NHS with enough staff, beds and community facilities and the spare capacity to deal with surges in demand.

We need to have a public health infrastructure that can swiftly test, detect and limit viral spread.

Above all, we need an NHS delivering in the principles of equity and fairness to its workforce and population, so that no-one, whatever ever their background, should have to suffer disparities in access to care or outcomes in health.

We owe it to the over 200,000 people whose memories we are respecting on this Day of Reflection, to make sure the nation is best prepared to prevent such avoidable tragedies being repeated in the future.

Dr Chaand Nagpaul served as BMA council chair between 2017 and 2022

(Image credit: Matthew Saywell / BMA)