I have been reading the testimonies submitted to the Covid inquiry with rising anger this week. I think back to the meetings we had in our hospital as the pandemic approached in early 2020.
We had never experienced this before – nobody had. We were terrified. And yet, as I recall, we calmly and methodically tried to anticipate how we could best use what we had to meet the incoming tide.
We set up daily meetings, formed working groups, reached out to others in our local networks. We didn’t know whether we were doing the right things, but at least we were trying to plan logically and work together to keep our patients safe.
But we are just one tiny cog in a massive machine. I assumed at the time that our processes would be mirrored at the highest levels, only better. Those in government would have more information and better people than us. There would be at least some high-quality leadership to plan and direct the national response. How could there not be?
How wrong I was. It appears that planning at the highest level was utterly shambolic, driven by hubris, ego and idiocy in equal measure.
To read about the petty preoccupations consuming our leaders – when it was already clear that Covid would be the biggest medical disaster of modern times, and when from dawn to dusk I was thinking about almost nothing other than planning for it – fills me with a dull fury I find hard to put into words. They couldn’t even be bothered to follow their own rules. It is beyond shameful.
And yet, after all that has already emerged, evidence of chaos in Downing Street isn’t that shocking any more. What really struck me was what seemed to be a throwaway comment by Simon Stevens, the head of NHS England at the start of the pandemic. While discussing Matt Hancock taking decisions over who should live or die if hospitals were to become overwhelmed, Lord Stevens mentioned that “fortunately this horrible dilemma never crystallised”.
I don’t know whether he really believes that hospitals were not overwhelmed. We may not have been inundated to the point of complete collapse. Maybe we were able to keep up the appearance of safety. But do not be mistaken: we were forced to take decisions that will have affected who lived and who died.
Even now, the denial continues that this happened. It did. Our resources were so short that we were forced to choose which patients we were able to treat in all sorts of ways.
We rationed oxygen, intensive care beds, non-invasive ventilation, even Covid tests early on. We did this with eyes open, in the full knowledge that we were treating patients differently to how we would if we had our usual resources available. If that isn’t rationing of healthcare, making choices for patients based on what we had available, then I would like to know what is.
We tried to make ourselves believe at the time that this was justifiable clinically. Lower oxygen levels were still safe, we said. Shuttling critically ill patients between hospitals on portable ventilators wouldn’t be too risky. Patients would be safe to go back to their care homes, and we needed the beds, so that was all right too.
Maybe these things were true. But the fact is that we had to make choices based on the resources we had at the time.
To my knowledge, at no time has anyone publicly put their hand up to say that yes, we had to ration resources, the NHS failed patients and the public on a systematic basis but that we did our best with what we had.
To say to all of us – doctors, nurses, the thousands of healthcare professionals who worked to breaking point but were still unable to offer the standard of care that we hold ourselves to – that it was not your fault. I cannot overstate how important that small piece of recognition would be. It would help to mitigate some of the moral harm we have all suffered by doing the things we did.
I still come back to these decisions in my darker moments. So, please, be honest with us. These life-or-death decisions did happen, and we on the frontline still hold the responsibility for them without acknowledgment or support.
After everything we have all been through, some honesty is the least we deserve.
