The first official report by the UK Covid inquiry is set to expose a catalogue of failures by the last Conservative government and health officials in the run-up to the pandemic. Lady Heather Hallett, the inquiry’s chair, will issue the report on Thursday and make recommendations to ensure that the UK is better prepared for any future outbreak. The British Medical Association (BMA), the doctors’ union, has urged Hallett in her initial findings to reflect the “appalling failure” to supply doctors and other health workers with the required PPE. The inquiry has been told of a catalogue of failings in preparing for a pandemic during years of austerity under the Tories and the Tory-Liberal Democrat coalition. Former health secretaries Matt Hancock and Jeremy Hunt, as well as former prime minister David Cameron, were among those who gave evidence at the inquiry. An expert report for the UK Covid inquiry by the medical historian Claas Kirchhelle found decisions were taken to reduce the “UK preparedness stockpiles” from 2012 onwards. This included surgical masks and FFP3 respirators, which provide maximum protection from airborne infection. Kirchhelle said the government cuts costs by opting to buy some respirators within weeks of a pandemic being declared, rather than hold them in stockpiles. This procurement was known as “just in time”. “Relying on [just in time] provision of critical PPE would result in substantial savings,” states Kirchhelle’s report. “However the approach also created greater vulnerability should supply chains be disrupted.” According to evidence submitted to Hallett’s inquiry, the minutes of a pandemic flu clinical counter-measures meeting in October 2017 recorded: “The respirator stockpile will need to be replenished in FY [financial year] 2019/20. Suppliers have been engaged to explore options to further prolong the life of the stockpile and minimize re-procurement.” The challenges in urgently securing supplies of PPE during the Covid-19 pandemic were compounded by failures to deliver the equipment that was expected as part of the “just in time” contracts. By January 2022, the Department of Health and Social Care had spent £12.6bn on PPE, including contracts with companies referred into a “VIP lane” by Tory ministers and officials. The BMA’s submission to the inquiry stated: “There is no doubt that the provision of PPE to healthcare workers during the pandemic was hopelessly inadequate, and that the task for the inquiry is to determine why this occurred, to ensure that it does not happen again.” The inquiry is also investigating procurement and is likely to make findings on the responsibility and reasons for these diminished PPE stockpiles. Hallett will examine whether the risk of a pandemic with the features of Covid-19 could have been foreseen and planned for. Lawyers representing bereaved families said there was evidence that a “high-impact newly-emergent” disease could have been predicted. Instead, the UK pandemic preparation focused on an influenza-style pandemic. There were nearly 220,000 deaths involving Covid-19 from March 2020 to March 2023. The bereaved families say that the policy of austerity undermined health services and made it more likely that “even a moderate pandemic would overrun the system”. They say civil contingency structures were not fit for purpose, and that they were lacking in policy, leadership and oversight. The Department of Health and Social Care has accepted that PPE was in short supply during the pandemic, but asserts that the UK never ran out nationally. In a submission to the inquiry, it stated: “Covid-19 was a huge shock to the entire world. Our resilience as a society was tested … The department is committed to learning lessons and implementing change where necessary.” The Covid inquiry is split into different investigations. A second report into “decision-making and political governance” is expected later this year. The inquiry is due to hear evidence from September on the effect of the pandemic on healthcare systems. Susie Flintham, on behalf of the Covid 19 Bereaved Families for Justice UK, said: ‘We have submitted 71 proposed recommendations which we hope to see included in the inquiry’s report. Bereaved families like mine, who fought to bring about this inquiry, know that the value of the inquiry depends on the strength of the recommendations. The years leading up to this moment have been emotionally draining for everyone whose loved ones were tragically let down by an underprepared government, but we know that the inquiry’s recommendations have the potential to save lives in the future, if lessons have been learned from our experiences.”