“Superhuman” efforts by nursing staff, in the face of widespread shortages, prevented the entire health care system collapsing, according to the UK COVID-19 Inquiry’s new report.

The report examines the pandemic’s impact on health systems across the four UK nations, setting out how frontline services, patients and staff were affected.

As a core participant in this module, the RCN has used its platform to highlight the realities faced by nursing staff, from unsafe working conditions to the emotional toll of delivering care under unprecedented pressure. 

The report found:

• the UK entered the COVID-19 pandemic "ill-prepared", with health care systems overstretched and staff-to-patient ratios diluted, especially in critical care
• staff worked under "intolerable pressure", which has had a long-lasting impact on mental and physical health
• the pressures faced in hospitals highlighted the need to set out how beds, equipment and staffing capacity can be expanded
• there was confusion about how the virus was spreading, with a failure to consider airborne transmission
• there were many deaths of health care workers, including nursing staff, especially those from Black, Asian and minority ethnic backgrounds.

The report’s recommendations included calls for increased hospital and urgent and emergency care capacity, including beds and staff, to ensure hospitals have the ability to implement surge capacity; and UK-wide plans put in place to provide effective support for health care staff at the outset of any pandemic.

It also calls for a strengthening of the body responsible for infection prevention control, with a broader clinical membership, and the introduction of a new standardised method of reporting health care worker deaths during a pandemic.

Professor Nicola Ranger, RCN General Secretary and Chief Executive, said: “These findings must mark a moment in time – never again can nursing and the public be failed like this. Our profession was sent to fight a deadly virus short of tens of thousands of nurses, while inadequate protection and ineffectual guidance led to devastating outbreaks among staff.

“The governments have to grab these recommendations and apply them not only to the hypothetical next pandemic, but the crisis that still engulfs our health system. The shortage of beds and staff leaves people tonight lining corridors without treatment, too often dying there.

“It’s clear that all these failings caused services, such as critical care, to become quickly overwhelmed and unable to provide surge capacity. That significantly undermined the pandemic response and cost lives. This will live long in the memory of our profession.”

Over months of hearings, RCN representatives and members provided evidence on the profound strain placed on the workforce. Testimony focused on chronic staffing shortages, inconsistent and inadequate PPE provision, and the long-term consequences for staff wellbeing. The inquiry heard how unclear national guidance, rapidly changing protocols and a lack of preparedness left nursing staff exposed and unsupported at critical moments.

A key moment in the hearings came from the RCN’s Rose Gallagher MBE, who told the inquiry that repeated warnings from the nursing profession about airborne transmission were ignored for more than a year.

She described how infection prevention and control guidance remained rooted in droplet-based assumptions despite mounting international evidence, and how the RCN’s letters, emails and calls went unanswered. She warned that these failures “ultimately cost nursing professionals their lives,” leaving staff confused, fearful and lacking confidence in the protection they were given.

Nicola added: “Nursing staff were the constant presence in every setting during the pandemic and went through a level of trauma which isn’t captured by this report. They faced an unprecedented scale of death and saw their own colleagues die, some in the very same places they worked. Many isolated from their entire families to continue saving lives. Their contribution and sacrifice must never be forgotten.

“The report is right to call for better support for health care staff at the next pandemic, but we cannot forget those left behind from the last one. Today, ministers must agree to formally recognise long COVID as an industrial disease and deliver proper financial support to those who can no longer work.

“The most important legacy of this inquiry must be to ensure our health and care services are not devastated by the next national emergency. However, the sad reality is that it will be impossible to increase capacity in hospitals while the nursing workforce remains so severely depleted. It should cause great alarm that this report finds the NHS workforce is in such a state that it may not be able to work under the conditions of another pandemic. The time to invest in and listen to nursing is now, if we are to save lives in the future.”

The inquiry’s Module 10 hearings recently concluded, which examined the pandemic’s wider impact on society, including the experiences of key workers, vulnerable groups and the bereaved. The inquiry heard of severe pressures on mental health services, staff redeployment, and high levels of burnout among health care workers.