Covid inquiry: Scottish nurses faced ‘death and devastation’

Professor Fiona McQueen said the pandemic was “relentless” for nursing staff, but that she remained hopeful that the workforce would be stronger because of it.

“I’m confident and hopeful that the nursing workforce will move on and be stronger as a consequence of this”

Fiona McQueen

Her comments came as part module 3 of the UK Covid Inquiry, which is looking at the impact that the pandemic had on healthcare systems, patients and healthcare workers.

Professor McQueen, who was Scotland’s CNO from November 2014 to February 2021, was questioned this week by lead counsel to the inquiry, Jacqueline Carey KC.

Prior to the pandemic hitting Scotland, Professor McQueen noted that the country had been “strengthening the nursing workforce”.

“We had been increasing the nursing workforce, we had been increasing undergraduate nurse places, we had been investing in [the] GP nursing workforce [and had] over 200 additional school nurses,” she explained.

In addition, she said the country had just developed a “statutory footing for the number of nurses in a ward or department”.

This refers to the Health and Care (Staffing) (Scotland) Act 2019, which requires health and care providers, including NHS boards and care services, to ensure safe staffing levels. However, the Act did not come into force until April this year.

Professor McQueen was asked to describe the impact that the pandemic had on nurses at the time, and in the years that have followed.

“The pandemic was relentless. It’s affected probably every single person in society but I think that [for] the nursing workforce – and I’m incredibly grateful to them all who stepped forwards – [it] has had a real impact,” she said.

“Some have been exhausted, others have been rejuvenated and found new areas that they want to work in.”

Professor McQueen noted that her daughter was one of the student nurses who was deployed to the frontline during the pandemic.

She added: “I was well aware of the impact that [the pandemic] had on the whole workforce.

“I had briefings every day of what was happening and the devastation it had caused, the death that they saw that they should never have seen, and the work that people have done.

“But I’m confident and hopeful that the nursing workforce will move on and be stronger as a consequence of this.”

Professor McQueen was also asked at the inquiry to reflect on the impact that the temporary register had in Scotland.

The temporary Covid-19 register was set up by the Nursing and Midwifery Council in March 2020 and let former nurses and some internationally qualified nurses work in health and care services across the UK.

By 21 April 2020 there were 1,272 nurses and midwives on the temporary register in Scotland.

However, Professor McQueen said that she had heard anecdotally that “not that many” were deployed to the frontline – something that was echoed by England’s former CNO, Dame Ruth May, and Wales’s former CNO, Professor Jean White, in their respective countries.

“People may not have wanted to go to the frontline,” explained Professor McQueen.

“I think there was something about need and demand, so whether or not NHS boards actually needed the additional staff, and in many cases they didn’t, and then whether the additional staff wanted to do frontline work or whether there was work that they could do.”

Professor McQueen said there were ways that Scottish healthcare services could have better utilised temporary registrants.

“I think we probably could have done more to help the temporary registrants into perhaps social care or some other place that was struggling,” she added.

In addition, she noted that the ‘retire and return’ policy, which allows retired nurses to return to work, may not be as effective in a future pandemic, due to the rise in the pension age.

“When we had that [policy] within the pandemic, the normal pension age was 60 and nurses could retire at 55 without actuarial reduction.

“The next pandemic, the normal pension age is going to be at least 65, so we will not be able to, I don’t think, rely on nurses in the same way we did this time.

“I think that’s where a lot of our additional workforce came from, rather than the temporary register.”

Much like the other UK CNOs who gave evidence this week, Professor McQueen argued that increased Covid-19 testing for healthcare workers “would have been enormously beneficial”.

In the first few months of the pandemic in Scotland, it was only healthcare workers who were symptomatic who were tested for Covid-19, lawyer Ms Carey noted.

However, in May 2020, Scotland’s Covid-19 Nosocomial Review Group (CNRG), which was set up to temporarily monitor the evolving situation in the country, requested “additional targeted healthcare worker testing” to protect highly vulnerable patients in hospital.

Professor McQueen said this included staff working with oncology patients, elderly and frail patients and long-term mental health patients.

“We thought – or the advice from the CNRG was – this was a group who were particularly vulnerable and therefore we would look at testing staff on a weekly basis,” she explained.

Ms Carey probed Professor McQueen as to why Scotland did not just roll out blanket asymptomatic testing for healthcare staff in all settings, instead of doing targeted testing like this.

Professor McQueen suggested that it was an evidence-based decision to not do a wider rollout.

She noted that Imperial College London had presented a paper that “talked about the value of asymptomatic testing” but, at the time, the CNRG thought it was more of a “theoretical or abstract piece”.

The CNRG determined that “good infection prevention and control measures would actually be more effective because it would reduce nosocomial infection by 80%, and their advice at that time was not to blanket test asymptomatic workers”, said Professor McQueen.