With all eyes focused on the extreme pressures facing the NHS right now, it's tempting to ignore the UK COVID-19 Inquiry. How can it possibly help fix the myriad problems that officials and trust leaders are currently grappling with?
But that is to ignore one of the Inquiry's primary tasks: to help the health and care sector learn and implement lessons throughout the life of the Inquiry.
To deliver this aim, the Inquiry will produce regular reports and recommendations based on research and hearings. These will be supplemented by information collected through its listening exercise, "Every Story Matters". This will give the Inquiry unique access to first hand accounts from NHS and care staff, as well the bereaved. It's vital therefore that this exercise is conducted to best effect.
The listening exercise
The listening exercise is the Inquiry's way of honouring the commitment in the terms of reference "to listen to and consider carefully the experiences of bereaved families and others who have suffered hardship or loss as a result of the pandemic". It is also designed to give individuals a chance to share their experiences outside the public hearings because the terms of reference made it clear that the Inquiry will not consider individual cases of harm or death in detail. Early indications suggest that there will be opportunities for NHS and care staff to contribute to the exercise in due course.
An evolving approach
Launched in November with an online portal inviting the public to share their experiences of the pandemic, the Inquiry plans to host targeted face-to-face sessions with specific groups in the coming months. It will also test different approaches with affected groups as it develops the exercise.
When running at full capacity, the exercise will run alongside the Inquiry's module investigations and the public hearings which are scheduled to commence in May 2023.
For now, the Inquiry is only planning on the listening exercise informing its work on module 3 – the one considering the impact of the pandemic on healthcare systems in England, Wales, Scotland, and Northern Ireland. But requests have been made to extend it to other modules as some issues will inevitably be cross cutting. It is true that many will have important insights into how prepared services were before the pandemic took hold, whether as patients, service users, carers and families, or staff.
Hearing and listening?
The accounts gathered through the exercise will support, but not be part of, the Inquiry's legal process. The individual experiences which people share will not be treated as evidence or individual testimony.
Not everyone is happy with this approach. In addition to reading reports, some people also want the chair to hear directly from the bereaved in the public hearings. Lawyers representing the bereaved families in particular continue to press the chair, Baroness Hallett, on this point.
Although Baroness Hallett, has promised to keep the issue under review, she has ruled that evidence of the circumstances of individual deaths and pen portrait material will not, as a general rule, be admitted.
Evidence of individual deaths may be considered relevant to the Inquiry, however, where it is indicative of possible systemic failings. This leaves the door ajar for individual testimony to be explored, but the chair insists that the focus will be on the themes and issues that arise, not detailed consideration of individual cases of harm or death.
It is difficult to see how this can be done without identifying providers in a public hearing, and we would expect the chair to want to hear from all those involved.
Which brings us to the question of balance.
Learning from all that happened – the good and the bad
In the online version of the exercise, respondents are asked to choose from a list of topics relating to their experience. There is only one option to share a positive experience.
Most would say that it would be naïve to expect otherwise.
But there is a key consideration here, which makes this inquiry stand apart. During the pandemic, NHS and care staff made extraordinary efforts to save lives and comfort the dying, many came to harm, and some paid the ultimate price. The successful vaccination rollout, which saved so many lives, and an accelerated movement towards mutual aid and collaboration between providers, also depended on thousands of staff putting their shoulder to the wheel. Trust leaders have told us repeatedly about how proud they are of their amazing staff and all they achieved. Beyond that, in policy terms, there are interesting lessons to learn from a period in which regulation became more flexible, and NHS bureaucracy was greatly reduced.
The public also understand the sacrifices staff made and showed their appreciation in many ways during the crisis. Who can forget the weekly round of applause for key workers – the Clap for Heroes?
For the Inquiry to identify the lessons that may be applicable now and to future civil emergencies, it must extend the listening exercise to all the modules. It must also facilitate the emergence of what will be a complex narrative, with multiple equally valid perspectives looking back on an extended period. The Inquiry needs to meet this challenge head on, seeking out and reflecting this complexity, encouraging all the players to give their accounts and share their insights. A failure to do so would leave us with an incomplete account of what happened and that could fatally undermine the UK's ability to plan and prepare for future pandemics.
This blog was first published by HSJ.