The UK is likely to be less well equipped to deal with a pandemic than it was before Covid because of worsening health inequalities, the NHS crisis and pressures in care homes, leading experts have warned.
The head of the British Medical Association (BMA) said the overall situation meant the nation would be “still massively underprepared” when a new pandemic struck.
The first report from the official Covid inquiry, published on Thursday, highlighted major failings in government planning and warned that more needs to be done to improve preparedness.
Pat McFadden, the Cabinet Office minister whose department leads emergency planning, told the Commons on Friday that while much remained to be done, “progress had been made” under the Conservatives in improving measures to combat the pandemic.
But a number of experts say this may prove unnecessary given the deterioration in many other relevant areas, including worsening public health and rising inequality, largely due to austerity policies.
Sir Michael Marmot, professor of public health at University College London and author of two landmark government-commissioned reports on health inequalities, said the impact of Covid confirmed his predictions that such a pandemic would “expose the underlying inequalities in society and amplify them”.
“For me, the lesson is that to prepare for the next pandemic, we have to prepare to improve the health of the population. But health inequalities have widened. We are worse off today,” he said.
Between 2010 and 2022, UK life expectancy statistics remained static, he said.
“During those 13 years, life expectancy has not improved at all. I don’t know of any other period in peacetime since 1900 where life expectancy has not increased for 13 years.”
The Association of Public Health Directors, which represents local public health officials, echoed Marmot’s comments, saying improvements in preventable diseases such as heart disease and type 2 diabetes would help mitigate the impact of a new virus.
“There is now strong evidence that products such as alcohol, unhealthy foods, gambling products and fossil fuels are major contributors to these non-communicable diseases,” said Greg Fell, the association’s president.
“Therefore, to become more resilient, we must invest in reducing the levels of consumption of these harmful products.”
There is also a need for more investment in public health, Fell added, saying that at present “there are simply not enough properly trained and resourced staff to carry out our role effectively.”
Another major weakness highlighted was the state of the NHS, with Professor Philip Banfield, chairman of the BMA, saying the Covid report clearly showed “that we are still massively underprepared for when – not if – the next pandemic strikes”.
He said: “We entered the pandemic with a sick population, with huge health inequalities, dismantled public health services and an understaffed and under-resourced NHS and social care.
“None of this has improved since then, and in many cases it has even gotten worse. All of this cannot be blamed on the pandemic itself.”
Dr Tim Cooksley, former president of the Society for Acute Medicine, said the impact of a new pandemic during an existing winter crisis would be “simply unimaginable”.
He added: “The conclusion that we are less prepared for a pandemic in the current situation is indisputable. Acute care hospital services are collapsing.
“Staffing and capacity are insufficient to meet current demands, leading to suffering and appalling living conditions for patients on a daily basis. There are not enough intensive care beds.”
The head of the School of Intensive Care Medicine, Dr Daniele Bryden, has warned that the UK still does not have the hospital intensive care unit capacity to cope with a future pandemic, despite playing a key role during Covid.
This included uneven distribution of beds and a lack of staff, she said.
“Overall, intensive care capacity is not yet strong enough to cope with another challenge.”
Martin McKee, professor of public health at the School of Hygiene and Tropical Medicine, said that while Covid had provided “a wealth of evidence” to help in areas such as airborne transmission and treatments, there was little evidence that the UK was better prepared overall than in 2020.
“NHS performance is clearly worse,” he said. “Infant mortality, an indicator of social conditions, is worse than in 2020 and inequalities based on deprivation and ethnicity have widened.”
While Covid-19 has also highlighted ways in which people in care can be better protected from a pandemic – a module of the inquiry on this will be the subject of a later report – care workers have warned that it is not necessarily better equipped to cope.
Jane Townson, chief executive of the Homecare Association, which represents home care providers, said: “Nothing has changed compared to before. In fact, it is probably worse. The sector remains very weak.”
“The number of workers in the UK has fallen by 70,000 in the last two years. The growth in the number of workers is solely due to international recruitment.”
Mike Padgham, Chairman of Independent Care Group, a membership organisation for care home operators, said: “We are as vulnerable today as we were in 2019. Just this week we learned that social services are short-staffed by around 131,000 people and that an additional 540,000 social workers will be needed by 2040 to cope with growing demand.
“That doesn’t tell me that the industry is prepared to deal with whatever challenges the world might throw at it. It says exactly the opposite.”
