Leading experts warn the UK is likely to be less equipped to deal with a pandemic than it was before Covid due to growing health inequalities, the crisis in the NHS and pressure on care homes.
The head of the British Medical Association (BMA) said the overall situation meant the country was “still hugely unprepared” if another pandemic broke out.
The first report of the official Covid inquiry, published on Thursday, pointed to major shortcomings in government planning and warned that more needs to be done to improve preparedness.
Pat McFadden, the Cabinet Office minister, whose department is in charge of contingency planning, told the House of Commons on Friday that while more needed to be done, “progress had been made” under the Conservatives in improving pandemic measures.
But some experts say this may be futile given the deteriorating situation in many other relevant areas, including declining public health and rising inequality, which are largely due to austerity policies.
Sir Michael Marmot, professor of public health at University College London and author of a number of groundbreaking government-commissioned reports on health inequalities, said the impact of Covid confirmed his predictions that such a pandemic would “expose and exacerbate underlying inequalities in society”.
He said: “The lesson for me is that we need to prepare for the next pandemic, to prepare to improve the health of the population. But health disparities have widened. We are now in a worse state.”
Between 2010 and 2022, UK life expectancy statistics were static, he said.
“During those 13 years, life expectancy has not improved at all. I know of no other peacetime period since 1900 where we have had no improvement in life expectancy for 13 years.”
The Association of Directors of Public Health, which represents local public health leaders, echoed Marmot’s comments, saying improvements in preventable diseases such as heart disease and type 2 diabetes would help limit the impact of a new virus.
“It is now clearly established that products such as alcohol, unhealthy foods, gambling products and fossil fuels are strong contributors to these non-communicable diseases,” said Greg Fell, the association’s president.
“To become more resilient, we must therefore invest in reducing the consumption of these harmful products.”
There was also a need for better investment in public health, Fell added, saying there was now “simply not enough well-trained and equipped staff to do our role effectively”.
Another major weakness highlighted was the state of the NHS. Prof Philip Banfield, chairman of the BMA board, said the Covid report made clear “that we remain massively underprepared for when – not if – the next pandemic hits”.
He said: “We went into the pandemic with a sick population, with huge health inequalities, public health services stripped to the bone and the NHS and social care understaffed and underfunded.
“Since then, nothing has improved and in many cases it has even gotten worse. Not all of that can be attributed to 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 as we are now facing it is indisputable. Acute hospital services are collapsing.
“There is insufficient staff and capacity to meet current demand, resulting in patients experiencing harm and appalling conditions on a daily basis. There are not enough intensive care beds.”
The head of the Faculty of Intensive Care Medicine, Dr Daniele Bryden, warned that UK hospitals still do not have sufficient intensive care unit capacity to cope with a future pandemic, despite the fact that they played a major role during Covid.
She said this was partly due to an unequal distribution of beds and a shortage of staff.
“Overall, intensive care capacity is not yet robust enough to cope with a new 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 support areas such as airborne transmission and treatments, there was little evidence that the UK was better prepared overall than in 2020.
“The performance of the NHS is demonstrably worse,” he said. “Infant mortality, an indicator of social conditions, is worse than in 2020 and inequalities based on levels of deprivation and ethnicity have increased.”
While Covid also showed how people in care can be better protected from a pandemic – a module of the research on this will be reported later – people in care warned that they are not necessarily better able to cope.
Jane Townson, chief executive of the Homecare Association, which represents home care providers, said: “Nothing has changed from what it was before. In fact, things may have gotten worse. The sector is still in a very weakened state.
“The number of UK employees has fallen by 70,000 in the last two years. The growth in the number of employees has come entirely from international recruitment.”
Mike Padgham, Chairman of the Independent Care Group, a membership organisation for care home operators, said: “We are as vulnerable now as we were in 2019. Only this week did we hear that social care is facing a staff shortage of around 131,000 and that an extra 540,000 staff will be needed by 2040 to meet rising demand.
“That doesn’t tell me that the sector is ready for anything the world can throw at it – it says quite the opposite.”