Delivering core NHS and care services during the pandemic and beyond Contents

4Issues facing NHS and care staff: PPE and testing

69.NHS and social care staff have worked courageously and tirelessly to deliver for patients and care users throughout the course of the pandemic, and a number have sadly lost their lives to COVID-19. There have been consistent calls, from across all core health and care services, for the Government and NHS England & Improvement to take all necessary action to protect these essential front-line NHS and care workers. We have heard that some NHS and care staff were frustrated by a lack of, or in some cases perceived lack of, access to appropriate personal protective equipment (PPE) during the early stages of the pandemic. Some members of staff have also expressed a desire to be routinely tested for COVID-19. Without adequate access to PPE and a sensible testing regime, there is a significant risk that core NHS and care services cannot be provided safely and effectively during the next phase of the pandemic.

70.We also heard about problems relating to the fatigue and “burnout” of the NHS and care workforce with some members of staff expressing concern that more support may be required. Recent events in this country and elsewhere have, of course, also placed a spotlight on problems facing Black and Ethnic Minority (BAME) individuals. We have consequently reviewed some of the important issues relating to discrimination and racism within the NHS. We have also launched a separate inquiry into Workforce burnout and resilience in the NHS and social care to ensure that these issues are voiced and addressed in more detail than has been possible in this report.138

Personal protective equipment (PPE)

71.There is a clear imperative to protect NHS and care staff who are dutifully providing treatments to patients and are by definition putting themselves at risk of catching COVID-19. As Claire Murdoch (National Mental Health Director, NHSE/I) told us on 1 May 2020:

[NHS staff] are heroes; they are courageous because they are coming to work when they are frightened. […] One of the best things we [NHSE/I] can do […] is to have our staff going home from work saying that they felt well supported, they had good access to things like PPE and they felt safe and listened to. That is incredibly important.139

72.Reliable access to appropriately fitting PPE is critical for NHS and care staff and therefore to the resumption of healthcare services. As Dr Katherine Henderson (President, Royal College of Emergency Medicine) put it: “We know PPE works”.140 However, during the early stages of the pandemic, there were numerous reports of significant problems in the Government’s and NHSE/I’s attempts to procure and supply PPE. These problems have been documented in the work of the Science and Technology Select Committee, the Committee of Public Accounts and the National Audit Office, as well as through our own inquiry into Management of the Coronavirus Outbreak.141

73.Difficulty in accessing sufficient levels of appropriately fitting PPE has left a significant minority of NHS and care staff feeling unprepared and anxious as they were put at unnecessary risk of catching COVID-19. On 1 May 2020, three months after the first case of COVID-19 was identified in the UK, and five weeks after lockdown, Gill Walton (Chief Executive, Royal College of Midwives) raised concerns around PPE provision, particularly in a community setting.142 Two weeks later, Nigel Edwards (Chief Executive, Nuffield Trust), Dr Jennifer Dixon (Chief Executive, The Health Foundation) Richard Murray (Chief Executive, The King’s Fund) each told us that PPE was still not being provided to adequate levels.143

74.On 14 May 2020, Chris Hopson (Chief Executive, NHS Providers) also explained that “If everything [PPE] had arrived that had been ordered, and if everything had arrived on time and to quality, we would not have the problems that we have”,144 adding that there has not been a “sufficiently reliable and consistent flow” of PPE for NHS staff.145 He referred to a NHS Trust Chief Executive telling him: “’I can’t really restart services until I have more than two days’ supply of PPE [...]. I am not there yet.’”146 These concerns were recently reiterated by a survey conducted by NHS Providers of its membership at the end of June 2020, which reported that 53% of respondents said that “PPE remains a concern”.147 The Royal College of Surgeons of England and Royal College of Emergency Medicine have stated that “The NHS workforce has responded brilliantly to the crisis, but morale has been damaged by the system failure on PPE.”148

Staff access to the most appropriate type of PPE

75.During the start of the pandemic, concerns were also raised about staff access to the right type and quality of PPE. For example, Chris Hopson explained that an inconsistent supply of the same type of PPE has reduced productivity for NHS Trusts, with Trusts forced to restart the “fit-testing process” for staff which “can take up to 30 or 40 minutes per person per mask”.149 Mr Hopson explained that:

There were six different mask types sitting in that stock reserve, and NHS Trusts found that one day they were getting one type of mask delivered, the next day another type of mask and the next day another type of mask. […] each different mask required a different fit test. There were other problems along the line—for example, insufficient fit-testing liquid.

You asked, “What would be the answer?” The answer would be to get to a stable distribution system in which there was sufficient stock of all the different types of masks, so that Trusts could say, “Okay, I just want to have type A because that is what we are used to using, and that is what all our staff have been fit-tested in.” […] we are reliant either on what sits in the pandemic stock reserve or on what we can bring in from abroad. It is an imperfect situation.150

76.Dr Katherine Henderson (President, Royal College of Emergency Medicine) told us that some types of PPE had caused problems for staff productivity across emergency services. Dr Henderson said that “The productivity of everything drops in this situation. Putting on and taking off PPE takes time. It adds time to every single encounter.”151 Dr Henderson also highlighted the problems that PPE can have for staff, telling us: “Wearing a face mask all day is tiring. It dehydrates you. You feel tired by the end of the day. People get skin problems from wearing a mask. It is very uncomfortable. All of that adds up to a productivity issue, so the workforce are a real concern.”152

77.Dr Henderson further explained that PPE can also cause “problems with communication” between staff and patients.153 She explained that the Royal College of Emergency Medicine conducted a survey of its members and fellows and “97% of [respondents] said that it is more difficult to communicate wearing PPE. Even doing simple things like having a conversation takes longer when you are wearing PPE.”154

78.The need for a consistent supply of the correct type of PPE has been a particularly pronounced challenge for dentistry services because most dental operations involve aerosol generating procedures which are considered to be an infection risk and therefore require dental staff to wear particular types of PPE. Mick Armstrong (Chair, British Dental Association) told us that the dentistry industry is “still bedevilled by having the correct PPE consistently and widely available”.155 The Local Dental Committees Federation, the Association of Dentists Groups and British Dental Association have all said that the lack of adequate PPE has significantly limited the number of patients that can be seen.156

79.In response to these concerns, Amanda Pritchard (Chief Operating Officer, NHSE/I) explained that “We [NHSE/I] are conscious that both the demand for PPE and the price of PPE has risen, so we are very keen to continue working with the BDA [British Dental Association] to make sure that we support NHS dentists through that”.157

PPE and BAME NHS staff

80.We were told that problems with the supply of PPE to NHS staff, as outlined above, have been especially severe for Black, Asian and Minority Ethnic (BAME) staff. In the context of the heightened risk that COVID-19 poses to people from BAME communities, the need for BAME staff to have appropriately fitting PPE has been consistently raised with us. Chris Hopson told us that:

[O]ne of the consistent issues that is raised with our Trust Chief Executives is that some of the different types of mask do not fit particular types of face. You are right to identify that that has been raised as an issue particularly for certain groups of Black and ethnic minority staff. I had heard that east Asian nurses in particular were finding that some brands of mask did not fit in the right way. I have heard variants of your anecdote about some of it being built for 6-foot-3 rugby players.158

81.Richard Murray (Chief Executive, The King’s Fund) noted the disproportionate impact COVID-19 is having on BAME staff and told us that this “ratchets up the requirement for PPE” for BAME staff.159 The Royal College of Nursing has similarly called for “A comprehensive and continuous equality impact assessment on staffing issues relating to COVID-19, including reviewing […] access to PPE and to fit testing for BAME workers to be carried out across all settings.”160

82.Professor Steve Powis told us that: “It is absolutely the case that faces are different and not every single type of mask fits as perfectly as we would like on to every individual face” and it is “absolutely critical” that NHSE/I supports “staff who are at greater risk of COVID-19, [including] our BAME colleagues [who] are a particular risk group”.161

Response from the Government and NHSE/I

83.On 3 June 2020, we heard from Lord (Paul) Deighton (Adviser on PPE to the Secretary of State for Health and Social Care), who outlined the challenges to procuring and supplying of PPE to NHS and care staff, and the steps that were being taken to improve it. Lord Deighton emphasised the importance of building resilience into the PPE supply chain by diversifying where PPE is procured from. He also highlighted his and the Government’s ambition and plan to ensure that a range of PPE is made available to meet the needs of all healthcare staff.162

84.On 30 June 2020, we questioned NHSE/I leaders on the security of the PPE supply chain particularly as winter approaches and the possibility of a second wave of coronavirus remains present. Professor Steve Powis (National Medical Director, NHSE/I) said “It is absolutely the case that the supply lines are more secure now and the distribution network […] is in a much more secure and robust place”.163 He explained that:

We are doing work with Government and colleagues in NHSE to ensure, now that supply is much more stable, that organisations get a range of different masks in different sizes and of different makes where they need them, so that there is more flexibility in ensuring that individuals have a choice of the masks that fit best. [This is] a very important point, and it is work that we are doing as we speak.164

85.Sir Simon Stevens added:

The Department of Health team have increasing confidence that supply will be available on a predictable forward basis rather than some of the more just-in-time approaches that were in place while there was a huge worldwide crunch on PPE supply and a massive spike in worldwide demand.165

86.We recognise the unprecedented scale of the challenge facing the Government and NHSE/I to keep NHS and care staff safe during the pandemic. As in other countries facing the pandemic there were, however, persistent failures with the procurement and supply of appropriate personal protective equipment (PPE) to some NHS and care staff, particularly during the early stages of the pandemic. It is important to recognise that different staff will require different types of PPE and there is a need to make sure that the PPE available is suitable for a diverse work force. We welcome the appointment of Lord Deighton as adviser on PPE to the Secretary of State for Health and Social Care. Lord Deighton’s evidence gave us confidence that the issues relating to PPE which have been raised with us will be prioritised and addressed.

87.We request an update from the Department of Health & Social Care by the end of November 2020 on what steps are being taken to ensure that there is a consistent and reliable supply of appropriately fitting PPE to all NHS staff in advance of the onset of winter and a potential second wave.

Routine testing of all NHS and care staff

88.All front-line NHS and care staff are placing themselves at a heightened risk of catching COVID-19. But despite repeated public and private pleas from NHS and care staff and representative organisations, from eminent scientists such as Professor Sir John Bell, Professor Sir Paul Nurse, and Professor Sir Jeremy Farrar, and from other House of Commons select committees,166 the Government and NHSE/I have not yet introduced routine asymptomatic testing for all NHS staff. Around 70% of COVID-19 carriers are asymptomatic,167 and only the routine testing all healthcare staff will ensure core health and care services are returned to normal levels.

89.Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, announced the Government’s plans for testing NHS staff to the House of Commons on 24 June 2020. He promised:

[…] to prioritise testing of all NHS staff with symptoms, asymptomatic regular testing of staff in situations where there is an incident, outbreak or high prevalence and regular surveillance testing across all staff.168

90.Throughout our inquiry, we have heard that the Government’s and NHSE/I’s testing strategy has arguably moved too slowly and put patients, care home residents, and NHS and care staff at avoidable risk. We have also heard that, in the early stages of the pandemic, where testing was on offer to staff, access was limited, turnaround time for results were too often long and staff morale and confidence were consequently damaged.169 We are also aware that there are some limitations to testing for COVID-19, including results which provide “false positives”.

Testing and social care

91.From as early as March 2020, we have raised the matter of regular testing for all health and care staff throughout this inquiry and our other work on the Government’s response to the pandemic.170 For example, on 26 March 2020, we asked Professor Yvonne Doyle (Director for Health Protection and Medical Director at Public Health England) whether social care workers would be treated as a priority for testing. In response, Professor Doyle told us “Yes […] [individuals who are] dealing with people in the community and in hospital, are very much part of the worker priority [for testing]”.171

92.On 19 May 2020, Vic Rayner (Executive Director, National Care Forum) told us that it is “absolutely critical” that all social care workers (including agency staff or those directly employed by care homes) are regularly tested for coronavirus and that results are received in a timely fashion. Ms Rayner added that this will be crucial to ensuring that “care homes can make proper decisions” about who can be in care settings and what further support is required.172 Ms Rayner stressed to us that, if this does not happen, then:

We [will] end up in a position where staff who have done a most extraordinary and incredible job of supporting people in this very difficult climate end up feeling like they are the people who are responsible for the spread [of COVID-19], which is the last possible thing they would want to do, whether they are agency or employed.173

93.However, subsequently, we have heard about the inequitable treatment of the social care sector which has inevitably affected care workers and patients.174 For example, the announcement made by NHSE/I on 17 March 2020, stated that there would be an «Urgent discharge of all hospital inpatients who are medically fit to leave” without these patients or care staff being tested at all175 and subsequent announcements, have failed to ensure the necessary safety of patients and care staff. Commenting on this announcement, Sir Robert Francis (Chair, Healthwatch England) told us that:

When I first saw the initial guidance that patients were to be discharged within two hours of being declared medically fit, I wondered how that could possibly happen safely. We heard stories that rather confirmed that, sadly.176

The idea that people might be discharged into that care home without anyone knowing whether they have COVID-19 or not seems very concerning. […] It is very important that there are properly run facilities, with the ability and capacity to look after people well and safely.177

94.During our inquiry, Richard Murray (Chief Executive, The King’s Fund) similarly questioned the Government’s and NHSE/I’s handling of the spread of coronavirus in care settings. Mr Murray told us:

Despite the fact that we saw evidence in Italy, Spain, France and others that social care was going to be the second problem for coronavirus after the hits on intensive care, we did not seem to take that on board. […] There is a question about how we were so slow given that we had seen what happened in Europe.178

95.There have been frequent and long-standing calls for more investment and support to be provided to the social care sector during the pandemic and beyond. Richard Murray emphasised the long-term need to support the care sector, telling us that “The social care workforce needs just as much attention as the health workforce”.179 This was reiterated by Dr Jennifer Dixon (Chief Executive, The Health Foundation) who told us that the Government should focus on supporting the care sector “without delay”.180 Nigel Edwards (Chief Executive, The Nuffield Trust) similarly echoed these comments when he told us that “Jennifer’s point, and indeed everyone else’s, about where we should put our effort is that getting the social care problem sorted out, which has been festering for a couple of decades, is absolutely the key priority”.181

96.In his oral evidence to us, Sir Simon Stevens acknowledged that “There is a general point, which is that the coronavirus pandemic has shone a very sharp spotlight on some longstanding weaknesses and lack of investment and resilience in the social care sector.”182

97.We questioned Professor Steve Powis (National Medical Director, NHSE/I) about what has been learnt since NHSE/I’s communication from the start of March 2020. In particular, we asked Professor Powis whether, knowing what he does now, he would change the guidance set out in the announcement issued on 17 March 2020 to ensure patients are tested or quarantined for 14 days prior to being discharged into care settings. We also questioned Professor Powis about subsequent delays in amending critical infection control and prevention guidance for healthcare settings. For example, we sought clarification as to why updates to the guidance (such as that relating to the 2-metre socially distancing measure) were introduced towards the end of May 2020, despite SAGE minutes from April 2020 showing that nosocomial infections (infections originating in hospitals) had been rising significantly.183

98.In response, Professor Powis acknowledged that:

It is always difficult going back in hindsight to a particular point in time, but clearly in April we moved to testing people coming out of care homes. As our knowledge of the virus has changed over the months, so the various guidance and advice has changed.184

However, he defended the NHSE/I’s early approach to the discharge of patients to care homes and its approach to updating infection prevention and control guidance for healthcare settings. Professor Powis told us:

No, I would not accept that we have taken our eye off infection prevention and control [in care homes]. I think people have been focused on it throughout.185

99.Professor Powis also drew specific attention to the matter of testing capacity. He explained that “testing capacity was very constrained at that time in early March. There were many fewer daily tests available than there are now.”186 Following consistent calls for routine testing of all healthcare staff including during our oral evidence sessions, on 3 July 2020, the Government announced a commitment to weekly tests for care home staff and monthly tests for residents in care homes in England.187 This routine testing has taken longer than was originally planned but appears now to be in place, although issues remain around the time taken to receive results.

Testing and NHS staff

The benefits of routinely testing NHS staff

100.Regular testing of NHS staff will also help to reassure the public that NHS services are safe to use. The Royal College of Nursing has stated that the lack of testing is a “key barrier” to providing “effective and safe care” and that there should be a “rapid expansion” and “a sustained rise in the number of tests being conducted.”188 The Royal College of Surgeons of England has similarly called for the Government to “ensure that the rollout of asymptomatic testing is swift”.189 In their joint submission, the Royal College of Surgeons of England and the Royal College of Emergency Medicine have stated that the “weekly testing of staff will help lower the risk of nosocomial infections [that is, infections originating in hospitals]”.190

101.The question of routine testing for NHS staff has been raised throughout our inquiry. On 14 May Nigel Edwards (Chief Executive, The Nuffield Trust) told us that “We are way behind where we need to be” in terms of testing191 and Chris Hopson (Chief Executive, NHS Providers) told us that regular testing of NHS staff was “something we know we need to do”192 and an “obvious next step”.193 The importance of routinely testing NHS staff was further emphasised to by Chris Hopson when he came before us again on 30 June 2020. Mr Hopson told us:

Our Trusts are telling us at the moment that they cannot guarantee sufficient reliable and consistent access in a timely way to the tests that they need. If, for example, you want to restart emergency services, you absolutely need to know that all the staff involved in that process will be able to get a test, and have it done and turned around sufficiently quickly to guarantee restarting services. What actually counts on testing is whether everybody who needs access to a test can get it reliably and consistently.

[...] we are still a long way from where we need to be to have a testing regime that is reliable and consistent, which enables us to restart services in the way we need to.194

102.This concern has been particularly stressed to us by results from a recent survey conducted by NHS Providers of its membership. The survey showed that 57% of respondents agree or strongly agree with the statement: “There is insufficient testing capacity to safely resume all services”.195 On 30 June 2020, despite announcements from NHSE/I on 29 April196 and 24 June,197 Chris Hopson told us that “Trusts felt that two months ago there was a commitment that we would get to regular staff testing as quickly as possible, but two months later we still do not have a clear plan for doing that”.198

103.We have also heard that routine testing of NHS staff will be key to restoring public confidence that NHS services are safe to use. Professor Derek Alderson told us that routine testing of staff will be “absolutely essential to regaining public confidence” that medical services are safe to use.199 Similarly, Dr Katherine Henderson (President, Royal College of Emergency Medicine) told us:

We cannot build confidence for patients coming into hospitals if we cannot be sure that we can protect everybody. We must make sure [through regular testing] that staff are not carrying the virus, because asymptomatic spread is a worry, and staff-on-staff infection is a worry.200

104.Concern about asymptomatic transmission has also been raised by others. For example, Professor Sir Paul Nurse (Chief Executive and Director of the Francis Crick Institute, whose work has been at the forefront of the efforts to understand and tackle COVID-19) told us that research conducted by the Francis Crick Institute and others during March and April 2020 showed that, at the height of the pandemic, 40% of healthcare workers were infected and asymptomatic carriers of COVID-19.201 SAGE minutes from mid-April 2020 suggested that up to 20% of coronavirus patients may have been infected in hospitals.202 Whilst more recent estimates of nosocomial infections suggest that the actual figure was probably closer to 15%,203 that still remains a significant figure and the fact that SAGE saw those figures in mid-April makes it even more regrettable that faster progress has not been made on asymptomatic testing.

The importance of routinely testing all NHS staff

105.It is of course not just clinical staff who need testing. Professor Sir Paul Nurse told us that “regular, systematic testing of all healthcare workers, including not only frontline doctors and nurses but support staff, ambulance drivers, and other healthcare providers such as care homes, GP surgeries, community nurses and the like” is essential.204 Sir Paul explained that testing all NHS staff routinely:

[…] is important because it protects our healthcare workers. They deserve to work in a safe environment. Some of them are dying because of what they do. Frankly, they deserve better. They need to be protected and we need testing.205

106.Richard Murray (Chief Executive, The King’s Fund) similarly told us that routine testing should be expanded beyond clinical staff to, for example, porters and cleaners because they “move in and around wards” and into “people’s homes”.206 Mr Murray explained that: “You cannot run a hospital without them. […] they are providing essential services. They are at risk and, equally, they can transfer the virus themselves”.207

Response from the Government and NHSE/I

107.We have questioned Rt Hon Matt Hancock, Professor Chris Whitty and Sir Simon Stevens on the progress being made to test all NHS staff. We were told that decisions relating to how NHS staff should be tested and at what frequency has been medically led. We also heard that capacity constraints continue to influence those decisions.208

108.On 30 June 2020, Sir Simon told us that capacity to conduct routine testing remains a problem. Sir Simon explained that this was not, however, “the end of the story” and that NHSE/I “want to see a significant further increase in testing capacity”.209 Sir Simon further explained:

The aim, clearly, by the end of September or October [2020] is to have significant extra lab capacity so that, were the Chief Medical Officer then to recommend a change in the asymptomatic staff testing policy, that would be something that could be delivered.210

109.During our session on 21 July 2020, Professor Chris Whitty (Chief Medical Officer) similarly told us that from the start of the pandemic, the Government had been “starting from a standing start” as capacity for testing had not been sufficiently built up.211 Professor Whitty explained:

Initially, we did not have the capacity. Even now, we would be at the margins of capacity were we to do routine testing for all healthcare staff on a more than very occasional basis, but it is improving. The capacity constraints are being eased.212

110.We wrote to Rt Hon Matt Hancock and Sir Simon Stevens on 21 July 2020 to raise our concerns across three areas which required urgent action, including the matter of routine testing of all NHS staff.213 In his response, on 6 August 2020, Rt Hon Matt Hancock wrote:

We know that winter will bring new challenges, including a likely increase in cases of individuals showing symptoms that are consistent with those linked to COVID-19. So it is critical that we continue to scale up our testing programme. As the Prime Minister announced on 17 July, we will further increase our testing capacity to at least half a million antigen tests a day by the end of October.214

111.On 21 August 2020, Sir Simon wrote to us and set out his position on the future of testing all NHS staff. Sir Simon wrote:

I am […] pleased to confirm that NHS England and Improvement would be fully supportive of the introduction of regular asymptomatic NHS staff antigen testing in the Autumn (presuming of course that the chief medical officer/DHSC decide that it is scientifically and clinically appropriate, and the Test and Trace programme secures the requisite testing capacity as they are planning). To that end, my letter of 31 July asks frontline NHS organisations to gear up to be ready to do so.215

Testing and scientific advice

112.Despite being informed that capacity constraints have inhibited the routine testing of all NHS staff, we have also been told consistently that decisions about testing staff have been medically led and based on scientific research. Since the start of the pandemic, we have investigated what scientific research has been conducted, in the UK and internationally, on the role of testing in managing and preventing the further spread of COVID-19.

113.On 21 July 2020, we spoke to several eminent scientists who described the importance of routine testing of all NHS staff—especially for those that may be asymptomatic carriers of COVID-19. During this session, Professor Sir Jeremy Farrar (Director, Wellcome Trust) told us:

It has to be blanket testing. We know that a significant number of people are asymptomatic. Therefore, just testing those who are symptomatic will leave a whole pile of transmission going on that we will not get on top of. It needs to be random and frequent.216

114.Professor Devi Sridhar (Chair of Global Public Health, Edinburgh University) reiterated the concern that there was still no mass, routine testing of NHS staff when she told us “We knew about the issue of asymptomatic infections from the New England Journal in February 2020”.217 Professor Sir John Bell (Regius Chair of Medicine, University of Oxford), commenting on the lack of routine testing, similarly told us “It was not a novelty to think, “Oh gosh, we should test healthcare workers.” It was in fact something that we knew about from other places.”218

115.During our session on 21 July and also in further correspondence with us, Sir Paul Nurse (Chief Executive and Director, Francis Crick Institute) explained that, as part of the SAFER study, researchers at University College London Hospitals (UCLH) NHS Foundation Trust, in partnership with the Francis Crick Institute, have been collecting twice-weekly self-administered nose and throat swabs and monthly blood samples from 200 healthcare staff. These staff are caring for patients in a variety of roles within, for example A&E, intensive care, and COVID-19 wards at UCLH. Sir Paul concluded, from initial analysis of samples taken between 26 March and 8 April 2020, that all healthcare staff should be tested for COVID-19, including those who are not showing any symptoms of the virus. This is because there is a significant risk that coronavirus is being and will continue to be spread between staff, and between staff and patients, at a high rate.219 Sir Paul explained:

My colleagues at the Francis Crick Institute contacted Downing Street in March and wrote to Matt Hancock in April, emphasising[…] [that] at the height of the pandemic, our own research, which only backs up what has been done elsewhere, showed that up to 45% of healthcare workers were infected. They were infecting their colleagues and patients, yet they were not being tested systematically.

[…] it was quite clear that those without symptoms were likely to be transmitting the disease. Again, our own research has shown that nearly 40% of healthcare workers at that time were infected but had no symptoms. That was a major failure. In the healthcare environment, we were not providing proper protection.220

116.In contrast to the expert evidence we have received, on 21 July 2020, Professor Chris Whitty (Chief Medical Officer) told us that there is currently not a need to test all NHS staff on a routine basis. In later correspondence, Professor Whitty acknowledged that current research shows that “67% of UK infections are asymptomatic” but argued that “the percentage of people who are infected asymptomatic remains uncertain and is between 30–80%”.221 This uncertainty means, according to Professor Whitty, that the need to routinely test all NHS staff “is therefore not a settled question”.222 The Chief Medical Officer emphasised the importance of the on-going SIREN study which aims to provide clearer data on the “frequency and under what circumstances” the testing of all staff should take place.223

117.Public Health England, with advice from the Chief Medical Officer, is running the SIREN study, which is designed to monitor the prevalence of COVID-19 in NHS staff. The Secretary of State for Health and Social Care has told us that the study will help to determine where, and how frequently, wider asymptomatic staff testing is needed by identifying areas or settings in the NHS where there is a high prevalence of coronavirus.224 Professor Whitty explained that this study will “allow for systematic data capture, which tells us more than a large amount of unconnected data would”225 and that this will provide “a much better idea about the right way to do [testing]”.226

118.Although Professor Whitty has stressed that the Government’s attention should currently be on determining the frequency at which staff should be tested through the SIREN study, Professor Whitty has told us that, in the longer-term, he “does not disagree that asymptomatic testing is going to be needed”.227 During our session on 21 July 2020, Professor Whitty further explained:

If there is a surge in winter, which is a really serious concern looking forward—where I spend most of my thinking time—and is what I am really worried about, we certainly will need asymptomatic testing among healthcare staff.228

If there was a big surge I would be absolutely in favour of going for regular testing [of all NHS staff], even in advance of knowing the optimal frequency.229

119.During the same session, Professor Sir Paul Nurse emphasised to us that, throughout a pandemic “knowledge is uncertain, and we cannot always rely on clinical trials to come to decisions”. Sir Paul described this as being “uncomfortable for scientists because they are giving advice in an uncertain situation”, and suggested that the best way to deal with such situations is through transparency and openness.230

120.We are grateful to Professor Chris Whitty (Chief Medical Officer) and his expert colleagues for their continued and constructive engagement with our work. We also recognise that the Government, following the advice of the Chief Medical Officer and others, has taken a considered approach to implementing the SIREN study. We note that the Government aims to utilise the SIREN study to better inform the frequency at which, and under what circumstances, the testing of NHS staff for coronavirus ought to take place.

121.We accept the advice we have received from many eminent scientists that there is a significant risk that not testing NHS staff routinely could lead to higher levels of nosocomial infections in any second spike. We therefore urge the Government to set out clearly why it is yet to implement weekly testing of all NHS staff.

122.We note that Professor Chris Whitty has said that the testing of asymptomatic staff may be necessary in the future and that if there is a “surge in winter” of coronavirus cases then he would be likely to advise that routine testing of NHS staff should take place.231 However, we are concerned that contrary to this advice, routine testing of asymptomatic NHS staff appears not to have been introduced where the virus is already surging in the North East and the North West, perhaps due to capacity constraints.

123.We ask that Professor Whitty sets out to what extent testing capacity has impacted the advice he and his colleagues have provided to the Government on routine testing of NHS staff. We further ask Professor Whitty to clarify whether he has advised the Government to introduce routine testing of all NHS staff in the current virus hotspots and if not why.

124.We conclude that the case for routine testing of all NHS staff in all parts of the country (including clinical staff as well as cleaners, porters and so forth) is compelling and should be introduced as quickly as capacity allows and before the winter-flu season begins. Those whoeither directly or indirectlyprovide treatment to patients should not be put at any further unnecessary risk of catching or spreading COVID-19. We urge that steps be taken to expand capacity rapidly to make this possible.

125.We recommend that, by the end of October 2020, the Government and NHSE/I set out: i) what current capacity there is for testing all NHS staff, ii) what further capacity (if any) will be required and iii) how long it is likely to take to secure sufficient capacity to offer routine tests to all NHS staff.


138 Health & Social Care Committee, Workforce burnout and resilience in the NHS and social care inquiry, HC 320 [webpage]

141 Health & Social Care Committee, Managing the Coronavirus Outbreak inquiry, HC 36 [webpage]; Science & Technology Committee, UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks, HC 136 [webpage]; Public Accounts Committee, Readying the NHS and social care for the COVID-19 peak, HC 405; National Audit Office, Readying the NHS and adult social care in England for COVID-19, HC367, 12 June 2020.

143 Q72; Q98 and Q117. See, also: The Health Foundation, The King’s Fund and Nuffield Trust (DEL0292)

147 NHS Providers (DEL0318)

148 Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308)

152 Q140. See also: Jenny Priest (Director of Policy and Public Affairs at Royal College of Obstetricians and Gynaecologists) (DEL0199); Stuart Bonar (Public Affairs Advisor at Royal College of Midwives) (DEL0255); Knight-Yamamoto (Public Affairs Manager at Royal College of Nursing) (DEL0284) and Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308); Royal College of Physicians (DEL0319).

156 Dr Martin Skipper (Head of Policy at LDC Confederation) (DEL0248); Ms Penny Whitehead (Head of Policy and Research at British Dental Association) (DEL0252); and Lewis Robinson (Policy and Public Affairs Advisor at Association of Dental Groups) (DEL0276).

160 Knight-Yamamoto (Public Affairs Manager at Royal College of Nursing) (DEL0284)

162 See, for example: Qq553–562, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

166 See, for example: NHS Providers, Testing questions in testing times, 30 April 2020 [webpage]; Q568–571, Q586, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36; Public Accounts Committee, Readying the NHS and social care for the COVID-19 peak, HC 405, 29 July 2020 [report]

167 See, for example: Office for National Statistics, Coronavirus Infection Survey, 18 August 2020 [webpage]

169 See, for example: Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308); Mr Paul Alexander (Policy Manager at The Royal College of Radiologists and collaborator at The Society and College of Radiographers) (DEL0030); Sean O’Sullivan (Head of Health and Social Policy at Royal College of Midwives) (DEL0027); Mr Jonathan Blay (Public Affairs Manager at Royal College of Psychiatrists) (DEL0038); Mr Jordan Clark (Public Affairs Officer at Alzheimer’s Society ) (DEL0049); Head of Patient Advocacy Shelagh McKinlay (Myeloma UK) (DEL0060); Dr Katherine Henderson (President at Royal College of Emergency Medicine) (DEL0081); Mr Jonathan Blay (Public Affairs Manager at Royal College of Psychiatrists) (DEL0139); The Royal College of Pathologists Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists) (DEL0211); Stuart Bonar (Public Affairs Advisor at Royal College of Midwives) (DEL0255); Tamora Langley (Head of Policy Media and Public Affairs at Royal College of Surgeons of England) (DEL0258); Knight-Yamamoto (Public Affairs Manager at Royal College of Nursing) (DEL0284); Niall Dickson (Chief Executive at NHS Confederation) (DEL0198); and Ms Susan Bahl (Head of Policy and Public Affairs at NHS Providers) (DEL0137) and NHS Providers (DEL0318).

170 See, for example: Qq199–204; Q469, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

171 Q234, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

172 Q475, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36. See, also: Qq468–475.

173 Q475; Qq468–474, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36.

174 See, for example: Q78; Qq92–94; Q98; Qq102–103; Qq106–108; Qq117–118 and Qq165–167. Fazilet Hadi (Policy Manager at Disability Rights UK) (DEL0124); Mrs Anna Bailey-Bearfield (Policy and Public Affairs Manager at Care and Support Alliance ) (DEL0142); Mr Sam Dalton (Policy & External Affairs Executive at ARCO (Associated Retirement Community Operators)) (DEL0164); Knight-Yamamoto (Public Affairs Manager at Royal College of Nursing) (DEL0284); Mr Matthew Rose (Senior Parliamentary and Stakeholder Engagement Adviser at Care Quality Commission) (DEL0299); Erika Schmidt (Senior Associate at Equality and Human Rights Commission) (DEL0190) and Mr Joseph Brunwin (External Relations Officer at MS Society and N/A at MS Trust) (DEL0208).

175 Letter from Sir Simon Stevens (Chief Executive, NHSE/I) and Amanda Pritchard (Chief Operating Officer, NHSE/I), to Chief executive of all NHS trusts and foundation trusts et al., Important and Urgent Next Steps on NHS Response to COVID-19, 17 March 2020 [letter]

188 Knight-Yamamoto (Public Affairs Manager at Royal College of Nursing) (DEL0284)

189 Tamora Langley (Head of Policy Media and Public Affairs at Royal College of Surgeons of England) (DEL0258)

190 Royal College of Surgeons of England and Royal College of Emergency Medicine (DEL0308). See also: Mr Paul Alexander (Policy Manager at The Royal College of Radiologists and collaborator at The Society and College of Radiographers) (DEL0030); Dr Katherine Henderson (President at Royal College of Emergency Medicine) (DEL0081); Mr Jonathan Blay (Public Affairs Manager at Royal College of Psychiatrists) (DEL0139); The Royal College of Pathologists Janine Aldridge (Public Affairs Officer at The Royal College of Pathologists) (DEL0211); Stuart Bonar (Public Affairs Advisor at Royal College of Midwives) (DEL0255); Tamora Langley (Head of Policy Media and Public Affairs at Royal College of Surgeons of England) (DEL0258); Knight-Yamamoto (Public Affairs Manager at Royal College of Nursing) (DEL0284); Niall Dickson (Chief Executive at NHS Confederation) (DEL0198); and Ms Susan Bahl (Head of Policy and Public Affairs at NHS Providers) (DEL0137) and NHS Providers (DEL0318).

195 NHS Providers (DEL0318)

196 Letter from Sir Simon Stevens (Chief Executive, NHSEI) and Amanda Pritchard (Chief Operating Officer, NHSE/I), to Chief executives of all NHS trusts and foundation trusts et al, Second Phase of NHS Response to COVID19, 29 April 2020 [letter]

197 Letter from Ruth May (Chief Nursing Officer for England), Steve Powis (National Medical Director) et al, to Chief Executives, Chief Nurses and Medical Directors and HR Directors of all NHS Trusts and Foundation Trusts, Healthcare associated COVID-19 infections - further action, 24 June 2020 [letter]

201 Q569, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

202 Scientific Advisory Group for Emergencies, Social Distancing Review - Sage Advice, 14 April 2020 [report]

204 Q568, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

205 Q568, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

211 Q619, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

212 Q621, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

216 Q586; Q607, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

217 Q573, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

218 Q571, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

220 Q569, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

222 Ibid.

223 Q621, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

226 Q621, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

227 Q621, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

228 Q621, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

229 Q622, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

230 Q567, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36

231 Q622, Health & Social Care Committee, Management of the Coronavirus Outbreak, HC 36




Published: 1 October 2020