hen coronavirus first entered the UK, the country was on the back foot and ill-prepared. The NHS was already facing record waiting times for operations, cancer treatments and GP appointments. Successive cuts to mental and social care, and severe workforce shortages, had left health services exposed and unable to properly function in normal times, let alone during a pandemic. As a result, the NHS was forced to cease routine services to treat the overwhelming surge of Covid-19 patients. Wards were repurposed for critical care and NHS staff were rapidly redeployed. There were around 2.5m fewer first outpatient appointments and 280,000 fewer urgent cancer referrals between April and June 2020 compared to the same period in 2019. Fewer than half the expected number of operations were completed, creating a backlog of care and a current record-high waiting list of 4.6 million, with more than 220,000 patients now waiting more than a year for non-Covid treatments. While daily government press briefings have focused on the alarming mortality numbers from Covid-19, we shouldn’t overlook the wider toll on our population. An estimated 12,000 excess deaths occurred as a result of non-Covid conditions during the first wave. Understanding the wider effects of Covid-19 on the population is exactly why we need a public inquiry into the management of the pandemic. This would help us to understand what went wrong during the UK’s Covid crisis, and show us what needs to happen to prepare for future public health emergencies. We must learn from the past year. Never again can we find ourselves with the worst mortality rate in Europe. One of the key findings of a public inquiry would doubtless be the government’s lack of preparedness. Ministers have a duty to protect frontline healthcare staff with proper and adequate PPE. They repeatedly assured the public that the UK had sufficient stockpiles, at first blaming the lack of PPE on delivery issues. But it soon became glaringly apparent that there had not been an adequate stockpile in the first place. Care staff were denied vital PPE during the early days of the pandemic, contributing to the spread of Covid-19 in care homes and the tragic loss of an estimated 30,000 lives. As a result, the government scrabbled desperately for PPE supplies, striking ad hoc deals at eye-watering sums with private suppliers – many with no prior experience of supplying such materials. It also resorted to ordering emergency supplies from abroad – such as the long-sleeved gowns in an 84-tonne shipment from Turkey last April, which were not just delayed but turned out to be unusable after they failed quality tests. We know that some NHS staff – many already at higher risk from Covid-19 – did not have adequate PPE and yet felt pressured to continue to work and treat their patients. Last April, just 12% of doctors said they felt fully protected from the virus at work, and an estimated 900 health and social care workers had tragically died from Covid-19 by the end of last year. Huge sums of public money were also squandered on the private sector. The public accounts committee reports on PPE procurement and England’s test and trace system shows the scale of this failure. The government budgeted £37bn for a test and trace system that wasn’t up to scratch (by comparison, the entire budget of Public Health England is only £300m). Local public health teams were able to contact trace 97% of people compared to just over 60% from national outsourced sites last November. The remarkable achievement of the vaccination programme reinforces the effectiveness of the NHS, which has delivered a programme at a fraction of the cost of the private sector. The recent public administration committee report shows there has been a lack of transparency around the information that informed ministers’ decisions throughout the pandemic. While the government repeatedly told the public that it was being “led by the science”, its policies have frequently seemed more influenced by political concerns. From delaying lockdown and allowing overseas visitors to freely enter the country without any checks, to deciding to suspend testing last March, the government’s failures are manifold. This disregard for scientific advice became clear last September, when ministers failed to make public and act on Sage’s advice to implement a circuit breaker lockdown, and then announced a relaxation of rules at Christmas as infection and hospitalisation rates surged. Ministers have also consistently been slow and indecisive in issuing policies. The BMA advocated the public wearing of face masks as a precautionary approach in April, when this was already the norm in most European nations. Yet the government equivocated for two months before requiring masks to be worn. Initially, these were only mandated on public transport, before they were finally implemented more widely in July. Of the many mistakes that a public inquiry would expose, one of the most longstanding problems has been the failure to address Britain’s many structural inequalities. Around a third of patients in intensive care beds have been identified as Black, Asian or minority ethnic, and in May it was reported that six in 10 health workers who had died from Covid came from BAME backgrounds. Ethnic minority populations have been up to four times as likely to die from the virus, while people living in the most deprived areas of England and Wales have been around twice as likely to die from Covid-19. A public inquiry would shine a light on this devastating picture. It would show that the health service is currently running on empty and urgently needs investment in its workforce, hospital beds and community facilities if it is to meet surges in demand without shutting off routine services. An inquiry would also expose the inequalities that have penalised the most vulnerable and poorest people during the pandemic. It’s only by reflecting on and learning from the mistakes of the past 12 months that we’ll ensure Britain is prepared for future public health crises. Chaand Nagpaul is chair of the British Medical Association council