ow could a public inquiry help us prepare for the next pandemic? The mistakes made during the UK’s Covid crisis – from a lack of personal protective equipment (PPE) for health and social care workers, to an inadequate test, trace and isolate system – have been well documented. It is crucial that an inquiry into the UK’s Covid crisis goes beyond listing these problems and leads to action and meaningful change. For it to have a real impact, there are some longstanding issues that need to be addressed. The best time to repair the roof, as John F Kennedy said in his 1962 State of the Union address, is “when the sun is shining”. The UK had many opportunities to ensure it was better prepared for the pandemic. Pandemic influenza and emerging infectious diseases featured in the government’s national risk register long before the arrival of Covid-19. Now is the time for us to fix the roof, so when the next public health crisis arrives there are fewer leaks. During the first months of the UK’s Covid crisis, there were many shortages of crucial equipment, such as PPE, mechanical ventilators and tracheostomy tubes. It has taken huge amounts of work and resources to rectify this, and we must ensure we don’t lose sight of this in the future. The UK needs both sufficient stock of PPE and medical equipment to deal with future emergencies, and an overhaul of NHS hospital infrastructures. It quickly became clear that the design and layout of many NHS hospitals were ill suited to caring for large numbers of patients with a highly contagious respiratory disease. To minimise the risk of infection spreading, hospitals need negative pressure rooms for single patients to stop contagious viruses from leaking out. Many hospitals and intensive care units aren’t designed to minimise transmission of a virus, and still use open bays with small bed footprints, designed and installed decades ago. In some cases, hospitals didn’t have enough equipment for delivering oxygen at the high flow rates needed for treating Covid-19 patients. Fixing this will require significant funding. It will also mean addressing the backlog in expenditure on the NHS hospital estate (there are many leaking roofs to fix), and building new facilities that are fit for delivering healthcare during a pandemic. The pandemic has also brought longstanding NHS staffing shortages into stark focus. As I’ve written previously, increasing the number of available intensive care beds depends on the availability of specialist staff, not on the availability of physical bed spaces. The Intensive Care Society has calculated that 2,251 extra ICU beds were needed in January 2021, compared to January 2020 – the equivalent of building an extra 141 intensive care units in the UK. But the number of specialist staff available did not increase over this time period, and was instead stretched even more thinly. Training specialist staff takes years, so the UK need to start doing so now. The number of training places for healthcare professionals is managed by the government, and we need an urgent review of whether the existing workforce plan is going to deliver what the health service actually requires. The impact of the pandemic on the psychological wellbeing of the health and social care workforce has been immense. In one study of intensive care staff undertaken in July 2020, almost half reported symptoms consistent with conditions such as depression, post-traumatic stress and anxiety. Around one in seven reported thoughts of self-harm or “being better off dead”. The winter of 2020-21 has been much harder than the spring of 2020. Alongside training more staff, we need to look after the ones we have far better. In pandemics, as in intensive care medicine, being prepared is everything. You don’t wait for a virus to spread – you move faster and further than the virus to stop it. On multiple occasions, the government wasn’t fast enough. The UK was too late in locking down and imposing travel restrictions. In the future, it must improve the agility, responsiveness and coordination of its decision-making processes. Talk of “following the science” did not ring true last autumn, when it transpired that Sage and many other scientists had recommended a lockdown far earlier than the government enacted one. While ministers established the Joint Biosecurity Centre and decided to reshape Public Health England as the National Institute for Health Protection in the midst of the pandemic, these are both unlikely to assist in the quest for informed, coordinated and agile decision-making. The UK needs qualified experts advising decision-makers in a timely manner, and it’s important to remember that not everyone who claims to be an expert on a subject actually is one. During the pandemic, many ill-founded viewpoints have gained traction. In the future, we must remember that spending time reviewing every alternative viewpoint on an issue may not be of much use. More than 450,000 patients have been admitted to hospital, and more than 125,000 people have died in the UK due to Covid-19 since the start of the pandemic. Admission to hospital and intensive care is frequently the end of a long journey into illness. For many, that journey starts with poverty and social deprivation. The burden of Covid-19 has fallen more heavily on some sections of society than others, exposing inequalities that were present long before the pandemic began. The UK now needs to confront what it has often ignored: that being poor kills. This problem won’t be answered with a single-minded focus on economic growth, but rather an understanding that health and wealth are intertwined, and that tackling poor and overcrowded housing, air pollution, unemployment and inadequate education are essential for promoting both economic prosperity and public health. As an intensive care physician, I work on the frontlines of the pandemic and have seen first-hand the devastation it has caused. I understand the calls for justice that a public inquiry would deliver. To prevent ongoing injustices, it’s vital that any inquiry is given the teeth to examine these problems, and most importantly, that it’s followed with urgent, meaningful change. Dr Charlotte Summers is a lecturer in intensive care medicine at the University of Cambridge