The former chief nursing officer (CNO) for Northern Ireland has told the UK Covid-19 Inquiry there was a lack of nurses here to care for patients during the pandemic.
The latest sitting of the inquiry heard evidence from former NI CNO Professor Charlotte McArdle, who was questioned on control and communication between the Department of Health and local health trusts.
The third module of the inquiry is focusing on the impact of the pandemic on healthcare systems across the UK.
Professor McArdle was the head of the nursing and midwifery professions in NI during the pandemic. She left the position in October 2021.
One major problem she highlighted, when it came to caring for patients throughout that period, was a lack of nurses here.
“We didn’t have the capacity to do what we needed to do,” she said during Wednesday’s hearing.
In October 2020, Prof McArdle had asked chief nurses in the rest of the UK and Ireland if they could provide Northern Ireland with staff, but no one was able to help.
“At that time we had challenges, particularly in relation to intensive care,” she said.
In 2020, the Department of Health launched the HSC Workforce Appeal, which encouraged people from across all staff groups in healthcare, including retirees, to come forward in response to the outbreak of Covid-19 to manage the urgent recruitment of temporary staff across health and social care.
Prof McArdle said that not all of the applicants had the particular set of skills needed for frontline services, or had very rigid rotas that couldn’t be facilitated, whilst others wanted permanent roles that weren’t going to be provided through the HSC Workforce Appeal.
Counsel to the inquiry Nick Scott asked if anyone had made an application through the Workforce Appeal during the second wave of Covid: “Did you make available use of everybody who expressed an interest?”
Prof McArdle replied that the individual health trusts would be better placed to answer that, as she wasn’t “directly involved” in the appeal.
“Again, this is one thing that we hear frequently,” said Mr Scott.
“The trusts are better placed to answer that, in terms of management of the Nightingale, of the Workforce Appeal. Is there not a lack of control from the Department of Health, where these issues are then passed on to the trust?”
Prof McArdle responded: “I don’t believe so. I think the Department of Health has a very specific role in overseeing the health and social care system. During the pandemic, we became closer to that system. I was very involved operationally, but in terms of the response to the Workforce Appeal, it was managed by HR and the workforce policy director. What I’m saying is that I’m not close enough to know the details of that.”
A large part of Wednesday’s hearing also focused on visiting restrictions placed on hospitals across NI during the pandemic.
On March 26, 2020, all general hospital visits across Northern Ireland had stopped, with exception to critical care and pregnant women in labour.
On April 9, 2020, an update stated that, “with immediate effect, all intensive care and general hospital visiting across Northern Ireland has now stopped”.
Although palliative [end-of-life] care outside of intensive care was listed as an exception, there was no exception for those patients receiving end-of-life care within intensive care units.
Prof McArdle said: “I deeply regret that we had to make that decision, but we were in the peak of the first wave.”
She also noted that, at the time, the department thought the wave would only last for “a couple of weeks”.
“I felt, at the time, we were between a rock and a hard place. There was nowhere else to go with this.
“It wasn’t a decision that I either wanted to make or would have wanted anybody’s family to have to experience, but it was the balance of risk between protecting patients, staff and the public, and I really do understand the implementations of having to take that decision.
“I have my own personal experiences, having not been able to visit my own mother when she died in hospital, so I do understand.”
Prof McArdle said that, “even in extremist parts of the wave, if staff could have facilitated a visit [to end-of-life patients] in any way, they would have done so”.
Mr Scott said that reports show that only two out of Northern Ireland’s seven intensive care units facilitated end-of-life visits.
Prof McArdle said a number of circumstances had to be considered and that she is “absolutely certain that, where possible, staff would have tried to accommodate even a short visit where they knew a patient was at the end of life”.
She added that a small number of reports were received when nursing staff could not facilitate this, and that they documented reasons as to why guidance pertaining to specific exceptions was not followed in these cases.