The United Kingdom’s recently concluded COVID-19 inquiry into the National Health Service (NHS) paints a stark picture of a public health system already stretched to its breaking point, sustained during the pandemic by healthcare workers described as performing “almost superhuman” efforts. The findings, detailed in a lengthy report, raise critical questions about preparedness for future health crises – questions that resonate deeply across the Channel in France, where similar strains are increasingly evident in the public hospital system.
The inquiry, led by Baroness Heather Hallett, spent ten weeks hearing testimony and cost approximately £204 million (roughly €238 million) to complete. It reveals a system plagued by pre-existing vulnerabilities – insufficient beds, consistently high occupancy rates, and chronic staffing shortages – that were dramatically exacerbated by the COVID-19 pandemic. The report underscores that the NHS “faced the pandemic, but by the skin of its teeth,” repeatedly teetering on the brink of collapse and surviving only through the extraordinary dedication of its staff. This investigation into the NHS’s response to the pandemic is prompting a critical re-evaluation of healthcare resilience, not just in the UK, but across Europe.
A Fragile System Before the Storm
Even before the arrival of SARS-CoV-2, the NHS was described as being in a “precarious state.” The inquiry detailed a chronic lack of capacity, with hospitals routinely operating at or near full occupancy. Thousands of positions remained unfilled, creating a persistent strain on existing staff. “Health systems faced the pandemic, but just about,” Hallett wrote, as reported by Top Santé. “Time and again they teetered on the brink of collapse and were held together only by the almost superhuman efforts of healthcare workers and all those who supported them.”
The reality on the ground was often brutal. Professor Kevin Fong recounted scenes from Birmingham hospitals where nurses were overwhelmed, resorting to placing patients in body bags on the floor temporarily while awaiting available beds. This desperate measure, he said, illustrated the impossible choices healthcare professionals were forced to make. The inquiry found that four out of five healthcare workers felt compelled to act in ways that conflicted with their professional values, with some describing the experience as “playing God.”
The Burden on Migrant Workers
A significant portion of these “superhuman” healthcare workers are migrants. Approximately 16% of the health and social care workforce in the UK were born outside of the country, a number that has increased by 116% in five years, with projections estimating 1.8 million foreign-born workers by 2028. The report highlighted the precarious situation of some of these workers, including those without legal status who earn as little as £4 per hour (approximately €4.50) for 14-hour shifts.
This workforce has borne a disproportionate share of the burden. Hallett warned that “when the next pandemic strikes, there may not be a workforce willing or able to work in the conditions that existed during the Covid-19 pandemic.” New rules set to take effect in April 2025 aim to ease the process for visa holders to change employers, a measure championed by the UNISON union. UNISON argues this is crucial to retaining staff. France, too, is increasingly reliant on foreign healthcare professionals to address staffing shortages and budgetary constraints within its public hospitals.
Long COVID and Moral Injury: A Looming Threat
Beyond the immediate crisis, the NHS COVID inquiry reveals a deeper, more insidious fatigue. The NHS CHECK project, which followed 5,248 English healthcare workers for 32 months, found that 33.6% continue to experience symptoms of Long COVID, yet only 7.4% have received an official diagnosis, according to researcher Danielle Lamb. This represents a significant risk to an already fragile sector.
In France, there is currently no equivalent cohort study tracking healthcare workers for Long COVID, leaving authorities unprepared to assess the extent of the problem and its potential impact on the workforce. This lack of data is particularly concerning as France prepares for future health challenges. The inquiry similarly highlighted the prevalence of “moral injury” among healthcare staff – the psychological distress resulting from actions taken or witnessed that violate deeply held moral beliefs.
Lessons for France and Beyond
The findings of the NHS COVID inquiry serve as a critical wake-up call for healthcare systems worldwide, including France. The report underscores the importance of investing in robust public health infrastructure, addressing chronic staffing shortages, and providing adequate support for healthcare workers – both during and after a crisis. The reliance on migrant workers, while essential, must be accompanied by fair wages and working conditions to ensure a sustainable and ethical workforce.
The French healthcare system, like the NHS, faces significant challenges, including budgetary constraints, hospital closures, and an aging population. The inquiry’s emphasis on preparedness, resilience, and the well-being of healthcare workers is particularly relevant as France navigates these challenges and prepares for future health emergencies. The question now is whether lessons learned from the UK’s experience will translate into concrete action to strengthen healthcare systems across Europe.
The next key step in the UK inquiry will be the publication of the final report, expected in the coming months, which will include specific recommendations for improving pandemic preparedness. The French government is currently reviewing its own pandemic response and is expected to announce new measures to strengthen the healthcare system in the coming year.
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