Former chief nursing officers (CNOs) from the UK’s four nations have been sharing their experiences and the major lessons learnt from the Covid-19 pandemic.
The former CNOs have been speaking in Module 3 of the UK Covid Inquiry, which is examining the ‘impact of the pandemic on healthcare across the UK’ and is currently in its second week of hearings.
Jean White: ‘Confusion added to a distrust of guidance’
Professor Jean White, former CNO for Wales, responded to questions on the guidance and provision of personal protective equipment (PPE).
Professor White served as CNO for Wales from 2010 before retiring in 2021.
Professor White’s statement to the inquiry described how issues surrounding the ‘fit and suitability’ of PPE was raised with her during meetings of nurse directors.
The inquiry heard examples of concerns that some of the face masks being used in critical care environments were not fully waterproof, with some staff resorting to ‘double masking’ to try and fix this, as per Professor White’s statement.
She also told the hearing how she had ‘made sure any issues I came aware of’ were reported to the infection prevention and control (IPC) cell, for action to be taken.
She explained that healthcare services in Wales ‘did not run out of stock’ but that PPE stock was ‘not necessarily in the right place’ when it was needed.
And she accepted there were times that staff and patients were ‘probably’ put at risk following confusion over PPE use, particularly as there was different messaging about mask wearing across four parts of the UK and advise on mask-wearing in clinical settings was still being refined
‘We tried to find a way with advice to mitigate the risk, but certainly having the confusion added to a distrust of guidance that was coming out and that was not helpful to anybody,’ she said.
Ms White made clear that she ‘wasn’t the policy lead’ on mask mandating and that she is not an expert on infection prevention and control measures.
‘I needed to follow the advice I was being given,’ she explained.
Fiona McQueen: ‘Lack of testing was a problem’
Scotland’s former CNO, Professor Fiona McQueen, was questioned on the roll-out of Covid-19 testing in Scotland, particularly at the start of the pandemic in 2020.
Professor McQueen became CNO for Scotland in 2015 and stepped down from the post in 2020.
She explained that testing was initially targeted in ‘unexpected clusters’ or ‘outbreaks’ of the virus, rather than via blanket asymptomatic testing being ‘implemented across the board’.
Professor McQueen said this decision was ‘evidence based’ and not ‘solely down to a lack of capacity’.
‘There’s no doubt at the early days of the pandemic, lack of testing capacity was a problem,’ she admitted.
Responding to questioning on the impact of the Covid-19 pandemic on black Asian and minority ethnic people in Scotland, Professor McQueen described a ‘real worry’ over how the pandemic would impact these groups.
‘We weren’t quite sure what was happening and was there a greater death rate or not, and in the early days of the pandemic, it was difficult to be definitive about it,’ she said.
Dame Ruth May: ‘Bring back the full educational package’
Responding to questions yesterday, the former CNO for England, Dame Ruth May, described the impact of the removal of the bursary for student nurses as a ‘catastrophic decision’ which undermined pre-pandemic preparations and had a lasting impact on the nursing workforce.
Dame Ruth served as CNO for England from 2019 before retiring earlier this year.
Dame Ruth suggested there were 5,000 fewer nurses and 700 fewer midwives at the beginning of the pandemic than there would have been if the nursing bursary – which helped with tuition fees and the costs of training – was not scrapped in 2015.
Stressing that the domestic supply of future nurses and midwives in England was ‘key to a future pandemic’.
Dame Ruth said this would have been equivalent to around 40 extra nurses working in every hospital during the pandemic.
The former CNO outlined the need to develop domestic workforce supply and ‘bring back the full educational package or write off debt’.
‘The domestic supply of future nurses and midwives in this country is key to a future pandemic,’ she said.
Charlotte McArdle: Northern Ireland ‘led the way’ in visitor restrictions
Speaking in this morning’s session, the former Northern Ireland CNO Professor Charlotte McArdle responded to questioning on the country’s hospital visiting restrictions, saying ‘Northern Ireland led the way in ensuring restrictions were applied in a person-centred way’.
Professor McArdle was CNO for Northern Ireland from 2013 to October 2021, and now serves as deputy CNO for NHS England.
She recalled how visiting was restricted at the start of the pandemic to try and stop the virus spreading.
Professor McArdle said: ‘We made that decision that we needed to restrict visiting to protect very vulnerable patients, to protect our healthcare staff and to protect the public.’
She added that ‘we didn’t at the time think the pandemic would be as long as it was’ when those earlier restrictions were introduced.
The former CNO described how she had worked with the Northern Ireland health minister to ‘try and provide a solution’ to the concerns being raised about visiting restrictions.
‘Which is probably why we had so many iterations of the guidance, because at every point possible we tried to be flexible, taking into account the feedback we were getting from families and service users,’ she said.
Professor McArdle was questioned on whether she was aware of any ‘complaints, comments, suggestions, [or] thoughts’ from family members who felt they were being illegally prevented from seeing their family and loved ones.
‘I am aware of a number of cases where people had travelled from other countries to come to visit, and when they arrived to see a dying relative, usually a parent, they were unable to visit,’ she said.
‘In those circumstances where that was known, a solution was found to accommodate.’
