Lead counsel Jacqueline Carey KC made the comments on the first day of the public hearings covering the impact on healthcare yesterday.

Carey said ‘hugely difficult decisions' were ‘repeatedly made by healthcare workers which affected who was escalated for treatment and who was not'.

She added there was ‘undoubted indirect harm' caused to patients due to the need to focus on Covid, citing the suspension of elective care, such as hip and knee replacements, missed cancer diagnoses, people with heart problems staying away from hospital and dying in the community, and pregnant women delaying seeking help.

The lead counsel also highlighted that staffing capacity was a ‘matter of concern' with high vacancy rates across all sectors going into the pandemic.

‘Nursing levels were low and nursing vacancy rates were high,' Carey said. ‘And clearly Covid caused additional staffing pressures.'

She quoted BMA figures showing a record 30% of NHS absences were Covid related in April 2020.

Carey added: ‘If one stands back, it appears that the UK entered the pandemic with not enough staff, it was then compounded by staff absence through illness, staff being absent through shielding, staff lost because they had Long Covid, and that's before one even considers the long-term impact on the morale and wellbeing of healthcare workers who were simply burnt out.'

The lead counsel also highlighted the ‘stark deterioration' in the mental health of children and young people during the pandemic.

The inquiry continues.