What do trusts need now?
Taking all of the above into account, what do trusts need right now as the NHS approaches and surmounts the coming initial peak of coronavirus related demand?
They need a consistent supply of PPE to ensure that their staff have the equipment they require when they need it. They would also like greater visibility of future stock levels and delivery timelines so they can manage any supply risk. They need staff testing increased as quickly as possible with a clearer ‘best estimate’ trajectory of how and when this will happen in practice. They also want to understand what role the different types of testing laboratory, including the NHS laboratories they are responsible for, will play. They need as many extra ventilators as possible as quickly as possible, with greater visibility of when they will arrive.
Trusts would like more clarity on how and when the new extra surge capacity Nightingale hospitals will be used. They also want to ensure that this 'urban' model of surge capacity is appropriately reinforced by appropriate surge capacity availability in more isolated rural locations. There is a strong link between scale of challenge for a hospital trust and its geographic location, with many of the most challenged trusts being in more isolated rural locations. It is the hospitals in these areas that may be the least resilient but also the furthest away from surge capacity like the Nightingale hospitals in urban areas.
Trusts want more help and best practice sharing on the best way to use the extra capacity that the private sector can bring. There are a number of different models for using this capacity in the current context and trusts would like to better understand the benefits and disadvantages of these different approaches. They also want to be assured that they and their staff will be backed if they make sensible, difficult, prioritisation decisions in the heat of the moment that others might seek to challenge later with the benefit of hindsight.
Trusts would like more clarity on how and when the new extra surge capacity Nightingale hospitals will be used. They also want to ensure that this 'urban' model of surge capacity is appropriately reinforced by appropriate surge capacity availability in more isolated rural locations.
Looking just beyond the initial peak
Overall, the NHS has understandably focused on navigating this initial peak. As the service reaches the crest of the peak over the next fortnight, trust leaders will also want support in thinking through what the next phase will look like – how the service can get to ‘the end of this crisis’ in the best possible way.
Much of this will depend on the strategy adopted to exit the current period of social distancing and how coronavirus related demand is spread going forward. Trust leaders hope that the government will take full account of the NHS’ needs as it formulates this exit strategy and ongoing approach. Obvious factors to consider include the need, if at all possible, to avoid a spike of coronavirus demand coinciding with the ‘traditional’ NHS winter January to March peak and how to get the best match between demand shape and maintaining the resilience of staff.
There will also be new pressures for the NHS to manage that will require rapid decisions and reconfiguration to meet these new demands.
How to manage the balance between coronavirus related demand, which may persist for some time, and ‘ordinary’ healthcare demand in a way that maximises overall patient benefit and minimises the risk of patient harm identified above. How to meet the likely significant increase in demand for mental health services given the economic impact of coronavirus, the need to come to terms with loss of life and the social and psychological impact of a prolonged period of social distancing and lockdown. How to meet the pent up demand from those who are not currently accessing NHS services but who will need to do so in future, particularly if these problems have become more acute in the meantime. How to ensure that community services can cope with the needs of the higher, more complex need, patients hospitals have had to discharge, including identifying who should be readmitted if capacity becomes available.
How to provide ongoing healthcare services to a highly vulnerable group that is likely to have complex healthcare need but will require shielding from the risk of COVID-19 for an extended period. How to support a mass testing regime that can test millions of citizens and mobilise at the highest possible speed should those tests identify a further outbreak of coronavirus. Longer term, the potential need for a mass vaccination programme against coronavirus. These are all requirements that the NHS has not had to meet before but will now need to meet.
And what of the longer term future?