Who we are, the basis on which this briefing is written and what it covers

On 30 January 2020, national NHS leaders internally declared coronavirus a serious, level 4, incident. Over the last ten weeks, England’s 217 acute hospital, ambulance, community and mental health trusts have been at the forefront of the NHS response to coronavirus. These trusts employ 800,000 of the NHS’s 1.2 million staff and treat a million patients every 36 hours, so their performance is key to how the NHS copes with this new virus.

NHS Providers is the membership organisation for these trusts, with all 217 trusts in voluntary membership. We are not the government and we are not NHS England, but we do act as a two-way communications channel between trusts and the national leaders co-ordinating the NHS’ coronavirus response. So, we understand both the local trust and the NHS national leadership perspectives.

Most of the current media coverage of the NHS response to coronavirus is split between testimony from individual frontline staff and what is said at the daily Downing Street press conferences. NHS Providers seeks to fill the gap in the middle, explaining what trusts are doing to meet the unprecedented challenge they face. The full basis on which we make our public comment on coronavirus can be found here.

This long-read draws extensively on the real time electronic communications channels and other communications we have had with our trust chief executives and chairs over the last ten weeks. It is structured in five sections.

In the first section, it looks back a little and sets out how NHS trusts have prepared. This is the work trust leaders believe will enable the NHS, in this first immediate demand spike, to avoid the sudden ‘overwhelm’ experienced in Northern Italy.

In the second section, it sets out how NHS trusts are currently dealing with coronavirus as we reach the first peak of extra demand. It looks at how trusts are actually experiencing that extra demand, how they are adapting to cope as demand rises, the impact on frontline trust staff and what trust leaders feel has worked well.

In the third section, it looks at the pinch points that have emerged – personal protection equipment (PPE), testing, ventilators and oxygen system delivery capacity. It also sets out two other current concerns - striking the right balance between coronavirus and the NHS’ ‘normal work’ and that current circumstances inevitably mean trusts can’t consistently provide the quality of care they would normally provide.

In the fourth section, it begins to look forward at an immediate wish list of what trust leaders feel they need at this point and the questions their current experience throws up, to help frame the developing NHS response to coronavirus over the next month or so.

In the fifth section, it takes a brief and tentative early look at the new, post coronavirus, NHS that trust leaders are determined should emerge from this crisis, ensuring some of the temporary coronavirus related changes the NHS is making become permanent.

By necessity, this is reportage at pace, not a meticulous research paper. It’s our impression of how the situation feels to NHS trust leaders in mid-April 2020. Understanding of COVID-19, and how the NHS should organise to meet it, is constantly developing so some of what is written here will be quickly overtaken by new insights and learning.

This briefing has been written by Chris Hopson, NHS Providers chief executive, with input from the wider NHS Providers team.