The Inquiry called for clean air in healthcare. Six months on, where is it?

Opinion | 20th September 2026

By Lara Wong, Founder and CEO, Clinically Vulnerable Families

Chapter one of the Module 3 report, paragraph 1.105. Baroness Hallett writes that new hospitals should be designed to maximise effective ventilation, and that in the short term, the use of HEPA filters should be prioritised within healthcare across the UK.

Not "might be considered". Not "the NHS may want to discuss". Should be prioritised... across the UK.

A giant air filter on a hospital ward in Winchester hospital (photo taken October 2023)

On 14th September the government published its response to the UK Covid-19 Inquiry's Module 3 report. But paragraph 1.105 is not mentioned in it. Neither is anything else about ventilation or cleaning the air.

I want to explain how that happened, because it is not a simple story of the government ignoring an Inquiry.

How can a finding just disappear?

Baroness Hallett made ten brief numbered recommendations, but paragraph 1.105 was part of the full report. You can find it in chapter one, in the section on ventilation, after several pages in which the report finds that the guidance should have emphasised ventilation far earlier than June 2021, and that the reason it is likely to have been because the IPC Cell’s incorrect belief that Covid was not primarily spread by aerosols. The Inquiry's own expert, Professor Clive Beggs, described portable HEPA filters as "cheap" and easy to install and that they can improve air quality in a similar way to ventilation.

However, the government’s response is focused only on recommendations. Everything else in the report “has been shared with policy teams for consideration”.

And that is a serious problem. Whilst it isn’t a clear “no”, it leaves the issue hanging with no clear route to addressing it. Over 400 detailed pages were carefully drafted, yet only ten recommendations have commitments attached, and so the key finding about indoor air quality in hospitals was lumped into a sentence about sharing things with policy teams. No department has to address it, and there is no date attached to an outcome. So there is nothing on paragraph 1.105 for the UK Covid-19 Inquiry implementation dashboard to track, because the dashboard only tracks commitments made in response to the recommendations at the end of the report. Yet paragraph 1.105 is exactly what we urgently need to be addressed right now.

Covid Inquiry dashboard

The word ventilation does appear once. Recommendation 6 asks trusts to keep records of the technical systems needed to expand critical care: power, ventilation, oxygen, waste management. But the government's response to Recommendation 6 talks about CRITCON scores, bed capacity, staff redeployment and the design of estates, and does not consider room ventilation at all. So ventilation may have been interpreted in the response as only referring to machinery for extra ICU beds, and has been ignored for people across healthcare who continue to be exposed to infections from that person coughing two seats away.

What CVF actually asked for, and why

Our statement to Module 3 was very specific, we asked for improved indoor air quality in healthcare using mechanical ventilation and HEPA. We wanted CO₂ monitoring in healthcare settings, with the readings made available to patients and their families so that people could make their own decisions. More generally, we have asked for national clean air standards for public buildings, workplaces and education settings. We also explained that this wasn't just about Covid, because better ventilation and air cleaning reduce the risk from airborne infection generally. Especially when it comes to Clinically Vulnerable people the risk has never been about just one single virus. Clean air is different from almost everything else we have asked for because it protects not only immunocompromised patients, asthmatic children, and older people whose immune systems are less effective. It helps everyone in a quiet way that most people won't even notice.

 "Illustration of the effects of poor and good ventilation on a room containing infectious respiratory aerosols, immediately after the infectious person has exited the space at 2:30 pm. The top panel shows the aerosol concentrations in the air at 2:30 pm and 3:30 pm, whereas the bottom panel shows the same scenario for a well ventilated room. (Illustration from CDC website (CDC 2023b))" Beggs' expert report

The Inquiry heard that poor air quality in high-risk healthcare environments became a barrier to Clinically Vulnerable people. A CVF member, Dr Adrian Warnock, was quoted in the opening pages of the report, describing how he played down his symptoms to his GP over the phone because he was so frightened of going into hospital, lying awake at night struggling to breathe and as he sat weighing his risks rather than going in to receive the care he so urgently needed. CVF's surveys found that high-risk people were cancelling appointments in high numbers.

I am not going to put a percentage on that because I don't have any up-to-date figures. What I will say is that the number was never small, it did not improve over the years the Inquiry looked at, and that your data was only included in the Inquiry's report because CVF collected it from you at a time when nobody else would.

Credit where it is due

Recommendation 1 is a real win, and it reflects arguments CVF has been making for years. The government has accepted that infection prevention and control guidance must reflect all plausible routes of transmission until evidence rules them out, and that the reasoning behind each precaution must be published. Also, a new expert advisory committee must include expert scientists on disease transmission and not just clinical medicine.

The report is blunt about the reasons why. For decades, guidance divided respiratory particles into droplets above five microns and considered they were aerosols below that point, and this had a knock-on to the precautions provided. Professor Beggs told the Inquiry that the five-micron threshold has no basis in physics and was arbitrary. The Chair therefore concluded that those cut-off points were incorrect and should no longer be relied on in healthcare guidance.

"Phases involved in transmission of respiratory viruses. Virus-laden aerosols (<100μm) are first generated by an infected individual through expiratory activities, through which they are exhaled and transported in the environment. They may be inhaled by a potential host to initiate a new infection, provided that they remain infectious. In contrast to larger droplets (>100 μm), aerosols can linger in air for hours and travel beyond 1 to 2 m from the infected individual who exhales them, causing new infections at both short and long ranges (Wang et al. 2021 a)." Beggs' expert report

So whilst the principle has been conceded, actions requiring improved air quality have not followed. If we recognise aerosol transmission, then it must be addressed in a packed outpatient department, with sick and vulnerable patients mixing in a building with closed windows. If the government has now agreed with us about the physics, it must follow through with the changes we need.

Elsewhere there is positive movement, and it is worth knowing about. Better identification of people at high risk, through the single patient record and a consultation this autumn on standardising NHS data about protected characteristics. Fit testing capacity is also being addressed, with updated Health and Safety Executive guidance promised by the end of this year, though the government admits it has not worked out who will pay. On advance care planning it supports the principles but has declined a single UK-wide process, which for members who found a DNACPR on their record years later is a significant concern.

There isn't a commitment anywhere in the response on patients wearing their own masks. Respiratory protection does appear but only regarding fit testing for staff. It was something we battled long and hard to get addressed in the Inquiry and it is really important. People who have no choice but to attend healthcare are on the whole those at higher risk in the first place. The Inquiry heard its expert Dr Ben Warne say there was no good reason to stop patients wearing high-grade face masks, and the Chair quoted him in her report with approval. But the government has not addressed the issue.

Scotland may not have addressed clean air but it did one thing better

Scotland published its response on the 17th September, and it is worth reading too. Interestingly, every recommendation ends with a named Accountable Officer and dated milestones. Health boards must send their returns by the end of this month, and there will be a national review by December 2026. Improvement work will be concluded by March 2027. For us, many of the dates still seem distant, but at least it is clear who is responsible for delivering them.

The UK response names neither an accountable officer nor a date for most of its promises, and it says openly that it cannot meet the Chair's six-month deadline to produce even a plan for Recommendation 7, and it plans to report in May 2027 instead.

Sadly, neither government has acted on paragraph 1.105. But I am pleased that one of them seems to be clear about what a commitment should look like, and that is the standard we should now hold all four nations to (NB/ Wales and Northern Ireland are still to come).

What you can do

The most useful thing any of us can do this month is to make paragraph 1.105 and patients’ right to mask impossible to ignore.

Write to your MP and quote it, then ask some questions that neither response has answered. Why doesn’t something so important appear in the government’s response? What guidance will protect a patient’s right to wear their own FFP3 mask in healthcare? It has already been raised in the House of Lords, but any requirements for action remain unclear.

Ask your trust or ICB about indoor air quality. What can they tell you about ventilation rates or air filtration in the waiting areas and consulting rooms I use? What is your pandemic plan? The government says that NHS England will explore whether local pandemic plans can be published. It is much easier for "exploration" to carry on indefinitely when nobody has to report back with an answer. Perhaps you could try sending them an FOI, and CVF can help to publish all of the plans.

Get your ‘reasonable adjustments’ on your record. From 30th September every publicly funded health and care provider in England must be able to record, share and view a patient’s reasonable adjustments through a national digital flag. CVF repeatedly asked the Inquiry for improvements to patient data. Contact your GP practice and be specific:

• Staff masking on request.

• Waiting outside or in a separate room.

• Remote consultation where appropriate.

Be warned, unfortunately the flag is currently built on the Equality Act definition of disability, which is a real problem - because an increased health risk, or a household risk, is not the same as having a physical or mental disability - so some Clinically Vulnerable may be turned away due to the same issue we have been raising for many years.

Watch for the data consultation. It is expected this autumn and we will do our best to let you know when it opens. Systems cannot protect people they cannot see.

And tell us what happens. Refused an adjustment, told to take off your FFP3, asked about the air and got a blank look? Our members' evidence has already reached the opening pages of a national inquiry report once. It can get attention again.

Three years ago we carried our own filters into the hearing room, and Adam Wagner KC held up a CO₂ monitor so that Baroness Hallett could see the air quality for herself. Thankfully she was incredibly interested and that opened a conversation with CVF, and the Inquiry bought air filters as a consequence. Subsequently, the 'Healthcare' report identified in paragraph 1.105 that "the use of HEPA filters should be prioritised within healthcare across the UK".

The government has now written to Parliament about learning the lessons of Module 3, and the word "ventilation" is even in there. But the commitment we need to protect patients and staff both now and in a future pandemic isn't.

We are not going to stop highlighting the importance of paragraph 1.105!

Clinically Vulnerable Families is run entirely on the generosity of our supporters. Please share this, or donate if you can.

Keep up to date with our work:

Sign up to our newsletter.

PLEASE Help us to keep going...

We are a small organisation and we rely on your help.

Support our work If you value our work and are able to, please know that Clinically Vulnerable Families is a small organisation run entirely on the generosity of our supporters. Please help by sharing this story, spreading the word, or by making a donation.

Donate Now

Even a small contribution - like the price of a coffee - does make a real difference. Thank you!