Michael Mansfield QC began the fifth session of the People’s Covid Inquiry by pointing out that the Archbishop of Canterbury had now added his voice to the many organisations and individuals calling for a judicial inquiry into the pandemic. However, there was still no sign of the government setting one up. He reminded people that even if the government did start the process, it could dictate its own terms of reference which meant that it could choose not to examine certain areas such as the awarding of contracts during the pandemic.

The first witness was Unjum Mirza, a train driver on the London Underground and BAME representative for ASLEF (the train drivers’ union) on the Victoria line.

Mirza said that London Underground staff had felt that the government’s response to the pandemic was very slow and that when measures were finally put in place they were “incoherent and not fit for purpose.” For instance, the first thing London Underground did was to close 40 stations which encouraged passenger congestion in other stations. The relevant trade unions eventually took charge, which was possible as the Underground had largely resisted privatisation.

However, Mirza said things had been different on London’s buses, where 10 private companies compete with each other to run the different routes.

“Bus drivers told me they were just totally abandoned. The lack of any safety measures to protect the drivers was quite astonishing…the horrific death toll of London bus drivers was tragic.”

Individual bus drivers themselves took safety measures such as erecting plastic screens and closing access via the front doors of buses. One employer apparently sent out a notice saying these measures had not been agreed and threatened disciplinary action if they continued.

When asked about risk assessment for workers, Mirza said that London Underground/Transport for London (TfL) said they were “following the advice of the government and Public Health England.” There was no offer of risk assessment for ethnic minority workers until 5 June 2020, and then it was just a tick box questionnaire.

“They’re going to try and run this on a wing and a prayer, where we do the praying, and they do the winging. And, frankly speaking, the risk assessments were appalling.”

He described how he and fellow workers had to fight for fundamental protections such as masks and hand gel, and to get their cabs cleaned properly. Finally they had to threaten that they would not take the trains out if they weren’t supported in these basic public health measures.

Mirza felt that the government’s messaging around travel was unclear, and that it was obvious that those on zero hours had no choice but to go to work, especially when there was no financial support to self-isolate. He felt that the pandemic had shown up who the real key workers were, the ones who are absolutely vital to keeping society running, such as NHS staff, refuse workers, transport staff, and that everything would have “fallen apart” without them.  

“One thing that we have learned from this pandemic is that those who were worst hit were those in the poorest BAME communities and most deprived areas. Covid has really shown us the full spectrum of what’s wrong in society. The issues of racism, poverty, inequality, of low pay, deprivation, (poor) housing, all of these issues are what have been exposed by covid.”

The second witness was Raymond Agius, previously professor of occupational and environmental medicine at the University of Manchester. He had formed part of a covid control measures working group. In response to employers struggling with risk assessments, they had published “The covid risk control matrix,” with advice about what measures employers might take to control the risk to their employees. The group’s advice was not always ‘congruent’ with that of Public Health England.

Agius was asked why he thought healthcare workers had a seven-fold increase in their risk of getting covid. He pointed out that the principal determinant of dying from the disease was catching it, and therefore depended on exposure to the virus. Lesser risk factors included gender, age, comorbidity, obesity, and ethnicity. These risk factors were further influenced by socioeconomic risks such as crowded accommodation, poverty, and blue collar jobs.

Agius was also asked about RIDDOR; the law that requires employers to report and keep records of certain work-related incidents, including diseases contracted at work. Covid contracted by healthcare workers as a result of occupational exposure falls into this category. He said there had been problems with reporting as relevant guidance from the Health and Safety Executive (HSE) had been poor. For instance, if health workers had been following PHE guidance then contracting the disease needn’t be reported, but many experts felt that PHE guidance was not providing adequate protection.

As a result, many cases of covid contracted through occupational exposure were not reported to HSE, so that not only were numbers of health workers with covid underreported, but a vital opportunity to investigate such cases had been missed. Even so, HSE had received about 25,000 reports, the vast majority of which hadn’t been investigated.

“These statistics underestimate how bad the problem is. The investigations weren’t done, the lessons weren’t learned and all these people suffered illness and died.”

Agius and other experts believed that the airborne transmission of the virus had been grossly underestimated. The evidence was there from previous pandemics such as SARS and MERS, and research by HSE showed FFP3 masks were needed for healthcare workers rather than basic surgical masks. He believes the government “rationalised the rationing,” trying to find reasons to limit the quality and amount of PPE that was needed. Agius acknowledged that many countries were unprepared in terms of stocks of PPE in the first wave, but felt that in the second wave there should have been a much wider distribution, for instance, to bus drivers, instead of which billions of pounds worth of PPE were “sitting in thousands of containers in Felixstowe docks.”

Going forward, Agius wanted to see better working conditions for high risk staff, better ventilation in work places such as hospitals, schools, and public transport, a much bigger emphasis on employers being told they have a legal responsibility to protect their workers, and priority vaccinations for at risk groups like teachers, ahead of the elderly.

“The employer has an obligation to take steps to protect their workers. People who are taking this burden (of covid exposure) by virtue of their work on behalf of society, deserve that level of protection as a precondition and the right levels of personal protection, as well as the vaccine, as a fundamental right.”

The next witness was Kirsty Brewerton, a clinical sister in the NHS, and CEO of a community organisation in Coventry involved in mental health. Brewerton had been qualified for seven years and during that time she had seen a gradual decline in NHS services, including a heavier workload and fewer staff, and felt that no effort had been made to improve things. She described the moral injury experienced by staff when put into situations where they could not do their work to the level to which they had been trained.

“You care about your job, you want to do it well, you don’t go into nursing to potentially harm people, but that’s how it feels sometimes. You’re put into situations where you can’t do a decent job and it isn’t safe.”

Brewerton said that staffing during the last wave of the pandemic was “the worst I’ve ever seen it,” with instances of one nurse to 21 patients, compounded by limited access to testing. Guidance had changed frequently, which had been difficult to explain to patients and relatives. Despite this there had been no routine risk assessment for mental health problems among staff and no minimum support for staff who needed it.

Looking ahead she hoped the NHS would take on the problem of moral injury, in particular through initiatives like minimum staffing levels.

“I do think there is a duty of care for the NHS to recognise that we (NHS staff) are at risk, we were at risk well before this, I’m proof of that. This has been a problem for a long, long time. It’s a stressful job, and it’s getting increasingly more stressful.”

The last witness was Chidi Ejimofo, a consultant in emergency medicine for 11 years. Asked about the experience of front line staff in the first wave he said that there had been initial enthusiasm to tackle the pandemic, followed by frustration when it became apparent that they had insufficient resources for what they were being asked to do, and inadequate direction at a national level.

“We were having to create our own guidance, we weren’t getting anything nationally.”

Ejimofo’s department had to source their own masks for their staff, paid for by the consultant body. Staff were falling sick, causing day to day strain due to the shortages, and there was an underlying fear as many staff came from ethnic minorities. They had to completely rearrange their department to cope with covid and non-covid patients, yet again with no guidance. 

Staff, already exhausted, predicted the second wave, despite reassurances from those in government. By then the workforce had “been in the trenches” for nine months, and had seen colleagues severely ill from covid, as well as deaths in the trust. Risk assessments only came about because there was a groundswell of protests, and even then they were just a “three part tick box.” Some staff would not accept the dangerous working conditions.

“They would take one look at the inadequate PPE and say no, and they’d walk off the job. I think that those experiences at the very beginning, may well have led to a lot of the mistrust that is now being labelled vaccine hesitancy.”

Ejimofo felt that the final insult was the non-existent pay offer, especially for the most junior staff.

Asked about Nightingale hospitals, he said they were “a waste of time” as there weren’t any specialist staff available for them. He wished someone had consulted front line staff, who could have pointed out that a hospital is not just a building and ventilators.

Going forward Ejimofo wants plans in place for future pandemics, and investment in the NHS including staffing and infrastructure.

“We weren’t prepared. We didn’t have the PPE, we didn’t have the protocols, we didn’t have the kind of rapid response systems, we didn’t have the infrastructure. I think that the NHS in a large way has been starved of funds for the last 12 years.”

There were a number of recurring themes in this session. Key workers, i.e. those who society relies on in a time of crisis, are often very poorly paid and live in conditions of deprivation. They couldn’t afford to self-isolate, especially when there was no financial support to do so. Their safety needs were ignored and many had to obtain their own PPE and find other solutions to stay safe. And in the case of some transport workers, they were threatened with disciplinary action when they took measures to protect themselves.

There was little or no attempt to provide meaningful risk assessments, nor any support for mental health problems among staff, especially juniors, who were being exposed to things “they should never have had to see or deal with.” Employers were confused about reporting covid contracted as a result of work exposure, which meant that the infection numbers are unknown.

Witnesses felt the NHS was unprepared for a pandemic, and that the government’s response had been slow and incoherent. Some noted that the pandemic had exposed and increased the inequalities that already existed in society.

Jacky Davis, consultant radiologist, founder member of Keep our NHS Public, panel member of the People’s Covid inquiry.

Competing interests: none declared.