NHS capacity issues make pandemic planning ‘extremely difficult’, says ex-CMO

Capacity issues in Scotland’s NHS make it “extremely, extremely difficult” to plan for a future pandemic, the country’s former chief medical officer has said.

Dr Catherine Calderwood served in the post between 2015 and 2020, when she was forced to resign after she travelled to her holiday home in contravention of Covid regulations in the early days of the pandemic.

Appearing before the UK Covid-19 Inquiry on Wednesday, Dr Calderwood was asked how the health service can balance preparedness for a pandemic while continuing to operate on a day-to-day basis.

“I think that’s extremely, extremely difficult,” she said.

“Our NHS is at the moment working at or if not beyond full capacity at all times.

“If you take my own area – the labour ward – the babies keep coming day and night, and we don’t have the luxury of saying ‘there’s going to be an exercise where we’re going to send six of you for mask fitting’, for example.

“We haven’t got the luxury of being able to have six spare midwives who could then go off to do that exercise.”

She said that instead, exercises are run which are “relevant and pertinent to the emergencies that might happen on the labour ward”.

The former chief medical officer added it is “very difficult without increased capacity within the NHS to think how we could ever have exercises” for pandemic preparedness due to a lack of staff and the inability of those who do work in the health service to “leave work that is prescient”.

Both Government and the health service routinely ran exercises to plan for a future pandemic in the lead up to Covid-19, including a number of tabletop exercises organised by the Scottish Government.

One such exercise was code named Iris – and simulated an outbreak of Middle East Respiratory Syndrome – resulting in 13 recommendations for the NHS and Government.

Dr Calderwood said of those recommendations, a number – most notably around PPE – had not been actioned.

She said that, “ironically”, staff had to be moved away from the implementation of the recommendations to focus efforts on the Covid-19 outbreak.

Meanwhile, Professor Kevin Fenton, president of the UK Faculty of Public Health, told the inquiry that health and care organisations have a responsibility to “visibly act” to reduce health inequalities.

He said: “We know that for a number of the inequalities that we observed, the experience of our communities on poor trust, stigma, discrimination, including structural racism, has repeatedly come up as a huge issue that our communities need us to confront and address.

“And I believe that organisations working in health and care have a responsibility to visibly state and to visibly act on these inequalities in a much more comprehensive way.”

He said that future pandemic preparations should be planned though an “equity lens” adding: “If you plan for those that are farthest and hardest engaged, then automatically you have been able to design a system or programme that will engage everybody.”

Asked about the suggestion that planning around inequalities and vulnerabilities of the population can only be “taken so far until the precise nature of the emergency is known”, Prof Fenton added: “You won’t be able to do everything in planning to mitigate the impact of inequalities, but there’s still a lot that can be done.”

Later in the day, Mark Woolhouse – professor of infectious disease epidemiology at the University of Edinburgh – criticised the “extraordinarily onerous” procedures for gathering data for scientific research in Scotland.

He told the inquiry that difficulties in gathering this critical information “was a serious impediment to getting potentially life-saving research done”, adding the balance between privacy rights through data protection and medical research was “completely out of kilter”.

He said that during one of his research projects, accessing the relevant data took over a year and involved hundreds of person hours, despite “using anonymised data so there was no risk to patient confidentiality”.

He told Hugo Keith KC, counsel to the inquiry, that he wrote to Dr Calderwood stating he was “very concerned about the implications of having such an onerous data access system in the event of an emergency like an influenza pandemic”.

Prof Woolhouse also warned that a future pandemic is inevitable.

He said: “It may be the next time, and there will be a next time, … it is possible that we are dealing with a virus that is much more deadly and is also much more transmissible.”

He added: “I am not sitting here as a doom-monger saying this is going to happen and this is going to happen soon.

“But I am confident enough to tell (the) Government that this is something you should be concerned about, and you should be prepared for.

“The next pandemic could be far more difficult to handle and Covid-19 was.”