The UK is probably less well-equipped to cope with a pandemic than it was before Covid because of deteriorating health inequalities, the crisis in the NHS and pressures in care homes, leading experts have warned. The head of the British Medical Association (BMA) said that the overall situation meant the nation would be “still massively underprepared” when a new pandemic hit. The first report of the official Covid inquiry, published on Thursday, pointed to major failures in government planning and warned that more must be done to improve preparedness. Pat McFadden, the Cabinet Office minister, whose department heads up emergency planning, told the Commons on Friday that while there was more to be done, “progress had been made” under the Conservatives in improving pandemic measures. But a series of experts say this might be fruitless given the worsening situation in many other relevant areas, including declining public health and increasing inequalities, much of it a function of austerity policies. Sir Michael Marmot, professor of public health at University College London and author of a pair of landmark government-commissioned reports into health inequality, said the impact of Covid confirmed his predictions that such a pandemic “would expose the underlying inequalities in society and amplify them”. He said: “The lesson to me is that to prepare for the next pandemic, we need to prepare to improve the health of the population. But the health inequalities have got bigger. We’re in a worse state now.” Between 2010 and 2022, statistics for life expectancy in the UK were static, he said. “Over that 13 years, life expectancy did not improve at all. I don’t know another period in peacetime since 1900 where we’ve gone 13 years without an improvement in life expectancy.” The Association of Directors of Public Health, which represents local public health leaders, echoed Marmot’s words, saying that improvements in preventable illnesses such as heart disease and type 2 diabetes would help mitigate the impact of a new virus. “It is now well-evidenced that products like alcohol, unhealthy food, gambling products and fossil fuels are a strong contributory factor to these non-communicable diseases,” said Greg Fell, the association’s president. “Therefore, to become more resilient, we must invest in reducing the levels of consumption of these harmful products.” There was also a need to better invest in public health, Fell added, saying that now there were “simply not enough properly trained and resourced staff to carry out our role effectively”. Another major weakness raised was the state of the NHS, with Prof Philip Banfield, the chair of council at the BMA, saying the Covid report made it clear “that we are still massively underprepared for when – not if – the next pandemic hits”. He said: “We went into the pandemic with a sick population, with huge health inequalities, public health services stripped to the bone and the NHS and social care understaffed and under-resourced. “None of this has improved since and, in many cases, has got worse; this cannot all be blamed on the pandemic itself.” Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, said the impact of a new pandemic during an existing winter crisis would be “simply unimaginable”. He added: “The conclusion that we are less prepared for a pandemic as we stand today is indisputable. Acute hospital services are collapsing. “There is insufficient workforce and capacity to meet current demands which leads to patients suffering harm and appalling conditions on a daily basis. There are insufficient critical care beds.” The head of the Faculty of Intensive Care Medicine, Dr Daniele Bryden, warned that the UK still did not have capacity in hospital intensive care units to cope with a future pandemic, despite these having played a key role during Covid. This included an uneven distribution of beds and a lack of staff, she said. “Overall, intensive care capacity is not yet sufficiently robust to weather another challenge.” Martin McKee, professor of public health at the School of Hygiene and Tropical Medicine, said that while Covid had provided “a wealth of evidence” to assist in areas including airborne transmission and treatments, there was little evidence the UK was better prepared overall than in 2020. “NHS performance is demonstrably worse,” he said. “Child mortality, an indicator of social conditions, is worse than in 2020 and inequalities by level of deprivation and ethnicity have widened.” While Covid also highlighted ways to better protect people in care from a pandemic – a module of the inquiry on this will report later – people in the care sector warned that it was not necessarily any better able to cope. Jane Townson, chief executive of the Homecare Association, which represents domiciliary care providers, said: “Nothing has changed from before. In fact, arguably things are worse. The sector remains in a very weakened state. “UK workforce numbers have decreased by 70,000 over the last two years. The growth in workforce numbers has come solely from international recruitment.” Mike Padgham, chair of the Independent Care Group, a membership organisation for care home operators, said: “We are as vulnerable now as we were in 2019. Only this week we heard that social care is understaffed by some 131,000 and that an extra 540,000 social care staff will be needed by 2040 to cope with rising demand. “That doesn’t speak to me of a sector that is ready for anything the world can throw at it – it says exactly the opposite.”