“The issue with personal protective equipment (PPE) was so appalling, they (ITU) were receiving second hand PPE, some of which had blood on it” – Michael Rosen, author and patron of Keep Our NHS Public.

The first witness in the seventh session of the People’s Covid Inquiry was David McCoy, public health doctor, academic at Queen Mary University London and trustee of the Centre for Health and the Public Interest (CHPI).

McCoy was asked about research done by CHPI on a government contract with 26 private health companies to block book the entire capacity of their hospitals, ostensibly to help the NHS deal with the pandemic. The NHS needed extra beds because at the start of the pandemic it had “one of the lowest beds-to-patient population ratios in Europe.” He felt the historic low bed numbers were part of a strategy to create opportunities for the private sector to develop in the UK hospital sector. The contract meant that approximately 8000 private sector beds would be available to the NHS.

Unfortunately there was “a real problem of transparency” around how much the government paid for this contract and how much of the capacity was used. CHPI has estimated that on average there was one covid patient per day in the private sector beds, with a maximum of 67 per day. At the same time the government was paying the full running costs of these hospitals. The amount paid by the government is estimated at between £170 million and £400 million a month, in other words at least £2 billion over the course of the year. 

“The amount of healthcare that was actually delivered (under the contract) was quite minimal, less than during the same period in 2019.”

At the same time the private hospitals were allowed to continue to treat private patients, and any income was paid back to the government. McCoy felt that the deal had not been good value for money, but had helped the private hospitals to survive the effects of the pandemic. Importantly the government will continue to set aside money to pay for NHS patients to be seen in the private sector to the tune of £2.5 billion a year for the next four years, double the amount provided in 2018 and 2019.

Thus not only was there a continuous stream of public funding going into the private hospital sector during the pandemic, but the sector is now in a good position to deal with the backlog, both via NHS and private demand.

“What we’ve seen is a subsidy going into the private hospital sector to help it survive the initial effects of the pandemic, and now, potentially, to help it thrive as a result of the increased demand for healthcare.”

McCoy felt that the resulting growth of the private hospital sector was a mistake, but was the result of “very active lobbying” by the private sector for many years.

“We are seeing the growth of publicly-funded private hospital care as a result of this new framework. And we’re likely to see a rise in private financing within the health system. All of this will essentially erode some of the fundamental principles of the NHS, which is a publicly funded and publicly provided service across the board. Without question we are going down the route of a flawed health care policy.”

The next witness was David Wrigley, an NHS GP and deputy chair of the British Medical Association.

Wrigley was first asked what the BMA felt about the outsourcing of the test and trace programme and about how the government had contracted with the private sector to get personal protective equipment (PPE). He said the BMA was opposed to privatisation of the NHS, which included outsourcing of NHS services to the private sector.

With regard to test and trace he said the government for some reason had chosen to bypass 44 NHS laboratories and instead employed private sector firms to set up a parallel system of testing sites. Companies were brought in who had no experience of how to run these services. For example, the staff on covid phone lines had little or no medical training, although the public seeking advice believed they were speaking to medically trained staff. 

“The government completely ignored the expertise that was there in the Public Health system, which they could have built upon. But (public health) was just completely bypassed, and the private sector moved in.”

The BMA had “significant concerns” about the substandard performance of the largely outsourced test and trace programme. There were major problems, including patients being told to travel hundreds of miles for their tests, and delays in delivering test results to GPs. It had cost a total thus far of £35 billion—”unimaginable costs” according to the Public Accounts Committee. The Department of Health had justified the scale of the investment on the basis that an effective system would avoid a second lockdown, but there had been two more lockdowns since, so clearly it hadn’t worked. Wrigley believed that, if given appropriate support, the test and trace programme could have been run by Public Health England, local public health structures, and the NHS.

Wrigley contrasted the problems of the contracted out test and trace programme with the success of the vaccination programme, which had been administered via the NHS.

With regard to PPE, Wrigley said the BMA had been contacted daily by members about lack of supplies and the poor quality of what they did receive. The government had a “just in time” business model and had delegated much of the procurement process to a “complex web of external companies” which meant that the system was slow to respond.

“The government had allowed the private sector to take over.”

In addition the BMA was very concerned that the government had not followed the usual rules applying to NHS procurement. He said that over 70 companies had contacted the BMA to say they could supply high quality PPE, but had received no response from the government. The BMA had forwarded these offers to the Department of Health, but had had no reply.

“They opened up high priority lanes that led to fast-track contracts. It wasn’t what you knew but who you knew in government…contracts were handed out to firms that had no history of making PPE or medical grade equipment.”

The next witness was Rosa Curling, a lawyer, and co-founder and director of Foxglove, a non-profit organisation which uses a mixture of investigation, litigation, and campaigning to ensure that “technology is fair for everyone.”

Curling was asked about her written evidence which addressed “an unprecedented collection of NHS data,” collated nationally and held in a single place, called the Covid-19 Data Store. This store was set up by the NHS in March 2020 through a series of contracts with US tech giants such as Amazon, Microsoft, and Google—companies that exist to aggregate and monetise data. The move had been announced “very quietly” via an NHS blog, and the normal rules around procurement and data protection were cast aside. The government has released no details about the deals, nor about what types of data are involved, but Curling understood that all GP records would be forwarded to the store unless patients opted out. There had been very little publicity and no public consultation.

“When this was attempted in 2014, every patient was written to and their consent was requested. That hasn’t happened this time, there’s been a website, a few tweets, which basically say unless you opt out, there’s an assumption that you’ve consented.”

Curling said that the NHS is unique in holding the largest set of machine-readable data in the world, with an estimated value of £10 million a year, which makes it very valuable to technical corporations. 

“NHS data is incredibly valuable to private corporations. They know the NHS, with its highly centralised system, and its unique mass of health data, provides extraordinary opportunities from which to profit.”

Reports at the time suggested that the companies intended these contracts to extend beyond the pandemic and to involve non-covid related data. Questions immediately arose about the sensitivity of confidential medical information, what security was in place to protect it, who would have access and for what purpose, and whether the public could prevent their data being used for private profit. 

Curling said the NHS needs the public’s trust in order to be effective and to operate well—for instance to persuade people to be vaccinated or to share their health information. The only way to retain the public trust on which our public health depends was via meaningful consultation, which hadn’t taken place. Moreover trust is undermined when the public see that contracts are being awarded for reasons other than the public good.

She said that what had been seen as emergency arrangements were being pushed through in a very quiet way and should not become “business as usual.” Going forward Curling said she wanted “a massive step back and a full consultation process.”

“The data protection laws require your explicit consent to what happens with your data. The obligation is on the Secretary of State and NHS digital to seek your consent and to notify you about this proposal. Currently their notification is simply a web page, and a link to how you can opt out.”

The fourth witness was Michelle Dawson, a consultant anaesthetist working in critical care and a trustee of the Healthcare Workers Foundation, a charity set up as a result of the pandemic. Prior to the pandemic, Dawson had experience working in NHS procurement. 

Dawson said she and others had understood from the beginning that the pandemic was going to cross continents and impact every country.

“We thought—this is major, and waited for something to happen in the UK. We saw only absolute inaction.”

The government’s pandemic stock was massively run down and while the government was doing nothing doctors were being forced to see covid patients without PPE. At that time of acute shortage Dawson started to look for PPE and quickly managed to find 50 million FFP3 masks via the Chinese government.

“We spoke directly to the Cabinet Office. We sent them the correct paperwork. And I followed it up a week later, and nothing had happened. Those masks could not be held and so they were sold to Germany, because they were fit for purpose. Then we got 30 million masks a month, from the same supplier that was still willing to prioritise the UK, and we sent all of the paperwork. And that wasn’t followed up on either. I wasn’t a VIP, I didn’t have access to the VIP lane. And it wasn’t followed up.”

At that point she set up a charity to obtain PPE not only for the NHS, but for care homes and hospices, most of whom aren’t in the NHS supply chain. Hospices were going to have to close and send dying people home because they had no PPE. The charity received huge amounts of PPE from companies and contractors and raised over a million pounds. They distributed desperately needed PPE via a fleet of privately owned vans.

“I can’t describe how desperate it was. Porters, who are usually on zero hours contracts, were still having to move infected bodies, with no body bag, no mask, and no gown. Every single day, there was an NHS worker in tears in the changing room. We saw colleagues dying. And we were terrified we would be the next one. And you just have to keep going, keep working.”

Dawson was asked about the shortage of ventilators, and the fact that Dyson was given a contract to make 10,000 from scratch. She said there had been no need to reinvent ventilators, the government had just needed to buy the ones that had already been designed and quality assessed. In the end Dyson did not supply any ventilators to the NHS.

Finally Dawson was asked about how the government had punished hospitals who had been forced to look outside the NHS supply chain to find PPE. Many had had to resort to novel routes such as local companies, who just charged for raw materials, and to sourcing from abroad. She said the government had found time to audit where hospitals had obtained their PPE, and that they were refusing to pay for every single purchase made outside the official channels. She thought this would amount to “tens of millions per hospital.”

The themes to emerge from this session were familiar. The government had reacted late to the pandemic and had lost opportunities to prepare despite the fact that it was apparent from events abroad that a major crisis was brewing. When they finally decided to act they repeatedly bypassed the NHS and public health structures in favour of giving contracts to the private sector, who often had no relevant experience. Normal rules around contracting had been ignored and there was a lack of transparency about how contracts had been awarded, to whom, and at what cost.

The government had wasted millions of pounds on private sector beds, which were underused, and has committed money on private sector activity going forward which should have been invested in the NHS. Finally, under the cover of the pandemic, there has been an audacious move to centralise and pass on patient data to large corporations with no public consultation and no clarity on how and by whom that data will be used, and who will be able to profit from it.

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

Competing interests: none declared.