England's chief medical officer has said the UK entered the Covid pandemic with significantly less intensive-care unit capacity than other wealthy nations – and that the situation was a "political choice".
Prof Sir Chris Whitty's comments came in evidence to the latest module of the Covid Inquiry, which is looking at the impact of the virus on the healthcare systems of the UK's four nations.
He was asked by counsel to the inquiry Jacqueline Carey KC how the UK could better respond to a future pandemic. The chief medical officer said that, in terms of capacity for looking after the sickest patients, the nation had been behind comparator states.
"Taking ICU in particular, the UK has a very low ICU capacity compared to most of our peer nations in high-income countries," he said. "That's a choice. That's a political choice. It's a system configuration choice, but it is a choice. But, therefore, you have less reserve when a major emergency happens, even if it's short of something of the scale of Covid."
Whitty said the then-government's decision to deliver increased bed capacity – demonstrated by the rapid construction of "Nightingale hospitals" in early 2020 – had shown that physical infrastructure was only part of the solution to stepping up capacity.
"The key thing, which is the very limiting thing for scale-up, is people. Trained people," he said. "So you can buy beds. You can buy space. You can even put in oxygen and things. And I think we learned some lessons from, for example, trying to set up the Nightingale hospitals, about the difficulties of doing that.
"But, fundamentally, the limit to that system... is trained people, and there is no way you can train someone in six weeks to have the experience of an experienced ICU nurse or an experienced ICU doctor. It is simply not possible."
He added: "So if you don't have it going into the emergency, if it's an emergency of this speed of onset, you don't have any illusions you're going to have it as you hit the peak."
Carey asked Whitty if there was an argument that the UK should have greater ICU capacity, and in particular more skilled-up nurses to staff the additional units.
Whitty said there was a good case to be made for boosting NHS capacity, but suggested that readiness to deal with extremely rare health crises should not be the principal driver.
"There are strong arguments for [having more skilled-up ICU nurses] in between emergencies," he said. "The argument for having them in the hope that we can be better off for a one-in-100 year event, I think, is less strong than some of the other arguments for having more ICU capacity."
Messaging worries
Yesterday's session also saw Whitty quizzed on whether he felt the government got its public messaging on the level of threat Covid posed to individuals – and the extent to which they should be concerned about it – right.
Whitty acknowledged that he had worried about the question at the time and still worried about it in retrospect.
"Did we get the level of concern right? Were we either over-pitching it, so that people were incredibly afraid of something when in fact their actuarial risk was low, or were we not pitching it enough and therefore people didn't realise the risk they were walking into?" he asked.
"I think that balance is really hard and arguably some people would say, if anything, we overdid it rather than underdid it at the beginning. I'm just saying that there... certainly there is a range of opinions on that."
Later, the chief medical officer was asked specifically about the government's "Stay at Home; Protect the NHS; Save Lives" messaging, and the impact on people who may have genuinely needed NHS services.
Whitty said that although he and other government officials had repeatedly used their TV briefings to underscore that the NHS was open for people in need of urgent care, it appeared that some people who should have sought treatment did not do so.
"There is reasonable evidence in my view, for example, that the number of people who came into hospital with heart attacks was lower than you'd predict," he said. "I don't anticipate there's any reason there'd have been fewer, so some of these people were staying at home who otherwise would not have done, and they would have had remediable conditions."
He added: "Did we get the message across that people should still go to hospital? I think we didn't get it across well enough. We tried."
The inquiry continues.