UK COVID-19 Inquiry

The UK government must ensure that there is a body (equivalent to the UK Infection Prevention and Control Cell) in place ready to be convened at the outset of any future pandemic, to consider and draft infection prevention and control guidance for healthcare settings. This body must: have clear lines of responsibility and a clear, pre-defined role and remit during a pandemic; have multidisciplinary membership, including experts in the science of viral transmission as well as those with clinical expertise; ensure that its guidance accounts for the risk of all plausible routes of transmission until sufficient evidence emerges to rule out specific routes; and ensure that guidance clearly explains the underlying rationale for the precautions recommended. Separately, the Department of Health and Social Care, NHS National Services Scotland, Public Health Wales and the Public Health Agency (Northern Ireland) should review the national infection prevention and control manuals and any future guidance to ensure that the approach to identifying risk of transmission is not confined solely to specific procedures. Emphasis should be placed on a combination of risk factors, such as rates of transmissibility, environment, setting and procedure.

The UK government (Department of Health and Social Care) accepted the recommendation in September 2026, agreeing that clear, accountable structures must support infection prevention and control decision-making during a pandemic (Department of Health and Social Care and Cabinet Office response, Sep 2026). In the same month, the Scottish Government stated that although the recommendation was not directed at it, joint work was underway on pandemic preparedness proposals and updated guidance had been published (Scottish Government response, Sep 2026). The Welsh Government confirmed in September 2026 that it is participating in a UK-wide review of advisory arrangements and will require health boards to appoint infection prevention and control directors by summer 2027 (Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should publish guidance for the implementation of visiting restrictions in hospitals in the event of a future pandemic. The guidance should identify the circumstances in which visiting restrictions should be introduced, escalated, decreased and removed alongside the measures and exemptions at each level. The guidance should be led by the following core principles: 1. Measures applied should be the least restrictive possible, both in terms of severity and the length of time for which they apply. 2. Restrictions should be decided upon and applied at the most local level possible. 3. Unless restrictions are applied at a specified level, trusts and health boards should take decisions on the severity of restrictions based on local risk assessments. 4. Communications with the public must clearly explain the measures in place and the reasons why restrictions apply. The guidance should be reviewed every three years in line with the Inquiry's Module 1 Report (Recommendation 4).

In September 2026, the UK government (Department of Health and Social Care) accepted the recommendation, agreeing to publish additional guidance on visiting restrictions to support decision-making in the event of a future pandemic (Department of Health and Social Care and Cabinet Office response, Sep 2026). The Scottish Government also accepted the recommendation in September 2026, committing to review and strengthen its guidance, while the Welsh Government noted it and committed to developing a clearer national approach (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with employers, including health boards and trusts, to review the availability of qualified fit testers and take steps to increase the number of fit testers accordingly. Availability should be reviewed every three years in line with the Inquiry's Module 1 Report (Recommendation 4). The Health and Safety Executive and the Health and Safety Executive for Northern Ireland should update their guidance to employers to emphasise the need to ensure that sufficient fit-testing capacity is available.

In September 2026, the Department of Health and Social Care accepted the recommendation, stating that the Health and Safety Executive intends to update its pandemic preparedness guidance for employers by the end of 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026). In September 2026, the Scottish Government accepted reviewing qualified fit-tester availability while accepting in principle proposals to increase tester numbers, and the Welsh Government noted the recommendation while assessing capabilities across health and social care (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive must ensure that health data and digital systems have the capability to identify individuals at high risk of morbidity or mortality from a pandemic disease quickly and accurately in a future pandemic. This should include action to improve health data systems and patient record-keeping by: improving patient data by enabling more granular diagnostic coding; ensuring that care records are compatible across primary and secondary care; and enabling secure data-sharing and linkage across multiple health datasets and systems for identifying individuals at high risk.

In September 2026, the Department of Health and Social Care accepted the recommendation, stating that its 10 Year Health Plan and existing data policy work provide a strong foundation to achieve the required improvements to data systems (Department of Health and Social Care and Cabinet Office response, Sep 2026). The Scottish Government also accepted the recommendation in September 2026, noting that adopting ICD 11 standards will be examined next financial year, while the Welsh Government noted it and committed to provide a more detailed update in May 2027 (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, in conjunction with organisations responsible for delivering services, should plan for surge capacity in urgent and emergency care during a pandemic. Plans must ensure that there is sufficient workforce capacity and the ability to surge, including the number and type of staff required, recruitment and training provision. This should be completed as part of the whole-system civil emergency strategy recommended in the Inquiry's Module 1 Report (Recommendation 4). Plans should be published and subject to review every three years.

The UK government (Department of Health and Social Care) accepted the recommendation in principle in September 2026, stating that it agrees it is important to continue preparing to scale up urgent and emergency care capacity (Department of Health and Social Care and Cabinet Office response, Sep 2026). In the same month, the Scottish Government also accepted it in principle, commissioning NHS boards to review capacity and surge plans, while the Welsh Government noted the recommendation alongside its winter and year-round emergency planning (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with trusts and health boards to ensure that pandemic plans include practical steps to rapidly scale up hospital capacity to treat acutely unwell patients. This should include critical care services that can deliver multiple levels and types of organ support. It should also cover necessary equipment, supplies, space and staff, including redeployment and training. All trusts and health boards must keep an easily accessible, up-to-date record of the information needed to implement these plans in the hospital sites they operate. This should include technical aspects of critical care expansion such as power, ventilation, oxygen and waste management systems. Plans for expanding capacity should be published, subject to review every three years and tested as part of the pandemic response exercises recommended in the Inquiry's Module 1 Report (Recommendation 6).

In September 2026, the Department of Health and Social Care accepted the recommendation in principle, agreeing that it is important to continue preparing to scale up hospital capacity and regularly test this ability during a pandemic (Department of Health and Social Care and Cabinet Office response, Sep 2026). That same month, the Scottish Government also accepted the recommendation in principle, commissioning health boards to review their surge arrangements, while the Welsh Government noted it and stated that its next phase of work will develop plans to increase general hospital capacity (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government and devolved administrations should publish a UK-wide framework setting out ethical and operational principles to guide the allocation of adult intensive care resources in the extreme event that they are saturated during a pandemic. That framework must: be informed by comprehensive engagement with the public and developed in conjunction with professionals across healthcare, law and ethics, as well as with regulators of healthcare professionals; set out clearly established triggers for its use, based at least in part on a UK-wide system that measures critical care capacity strain and facilitates mutual aid (such as the CRITCON tool used in England); establish clinicians' legal and professional duties in applying the framework, which should be clearly explained to clinicians through guidance; and be regularly reviewed with reference to contemporary patient data during a pandemic, and any future use of it must be evaluated and reported on publicly. A plan and timeline for completing this work should be published within six months of this Report. Application of the framework should be tested as part of the pandemic response exercises recommended in the Inquiry's Module 1 Report (Recommendation 6).

The Department of Health and Social Care stated in September 2026 that it will explore developing principles to guide adult intensive care allocation during pandemic saturation, but noted that formulating a plan and timeline will take longer than six months (Department of Health and Social Care and Cabinet Office response, Sep 2026). That month, the Scottish Government accepted the recommendation in principle and confirmed work with the other nations, while health advisers and ministers in Wales likewise committed to developing a UK-wide framework (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The department stated it will provide an update in May 2027 through the inquiry implementation dashboard, and the record holds no update since the Welsh Government's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026; Welsh Government response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive should work with their respective public health agencies and healthcare employers to develop nation-specific mechanisms to collect, analyse and publish data systematically on the deaths of healthcare workers in the event of a pandemic outbreak. The UK Statistics Authority should work with data providers to ensure that the data are comparable across the four nations of the UK.

In September 2026, the Department of Health and Social Care accepted the recommendation, stating that it will take a "proportionate, staged approach" to implementation (Department of Health and Social Care and Cabinet Office response, Sep 2026). The Scottish Government accepted the recommendation in principle in September 2026, proposing a phased approach to test data linkage while noting that differing data sources may prevent complete comparability across the UK (Scottish Government response, Sep 2026). The Welsh Government also agreed in September 2026 to adopt a staged approach, stating that practical, legal, and information governance issues must still be resolved before establishing a reporting mechanism (Welsh Government response, Sep 2026). The record holds no update since the department's response of September 2026 (Department of Health and Social Care and Cabinet Office response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with trusts and health boards, should establish and promote one standardised process across the UK (such as ReSPECT, the Recommended Summary Plan for Emergency Care and Treatment) for clinicians to ascertain and record their patients' wishes and preferences for future care and treatment in order to inform individualised decision-making, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices.

In September 2026, the UK government (Department of Health and Social Care) stated that it does not specifically intend to introduce a standard process across the UK and the devolved governments at this time (Department of Health and Social Care and Cabinet Office response, Sep 2026). In September 2026, the Scottish Government accepted the recommendation in principle, stating that while it does not support a mandatory UK-wide process, work is underway to develop a business case for a standardised digital future care plan in Scotland (Scottish Government response, Sep 2026). The Welsh Government also stated in September 2026 that it does not support a single UK-wide process, confirming that it will instead review and strengthen its existing Advance and Future Care Planning Framework (Welsh Government response, Sep 2026).

The UK government, Scottish Government, Welsh Government and Northern Ireland Executive, working with healthcare employers and professional bodies, should put in place plans to deliver effective support for healthcare workers at scale from the outset of a pandemic. Plans should cover the nature and level of support that will be provided during and after a pandemic. All four governments should develop a programme of peer support visits that can, from the outset of a pandemic, be targeted towards areas of acute hospitals under considerable strain. The purpose of the visits should be to support front-line staff, collect insights on the pressures that healthcare workers are facing and understand what further support they might need.

In September 2026, the UK government (Department of Health and Social Care) partially accepted the recommendation, stating that it will partner with healthcare employers and professional bodies to establish a scalable psychological support programme with clear triggers and a defined minimum offer (Department of Health and Social Care and Cabinet Office response, Sep 2026). In September 2026, the Scottish Government accepted the recommendation in principle, proposing to develop lists of trained peer supporters, while the Welsh Government noted the recommendation and highlighted its existing workforce wellbeing guidance (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026). The record holds no update since the Scottish and Welsh Governments' responses of September 2026 (Scottish Government response, Sep 2026; Welsh Government response, Sep 2026).