It's time to transform the NHS – the pressures of COVID-19 have left no doubt

Record numbers of Omicron-driven infections are turning into rapidly rising numbers of COVID-19 patients in hospital. Staff absences, which have now reached 80,000 a day, are severely hampering the response. All on top of very high demand for non-COVID care during the most pressured four weeks in the NHS calendar.

There is good news. The vaccines are working. The surge of seriously ill older people the NHS saw last January, and feared so much this time, has not yet materialised. London, the original UK epicentre of Omicron, looks like it is now stabilising. But after a decade of the deepest financial squeeze in NHS history, the health and care frontline is going to be stretched perilously thin in places over the next three weeks, as evidenced by the 25 trusts who have needed to declare a critical incident in the last week.

Trust leaders tell us that, due to the dedication, professionalism and flexibility of NHS staff and managers, the line should just about hold.

Trust leaders tell us that, due to the dedication, professionalism and flexibility of NHS staff and managers, the line should just about hold. As we have demonstrated over the last 18 months, thanks to our national structure, the NHS can deliver in ways many other national health systems can't. We can booster-vaccinate a higher proportion of our vulnerable population more quickly and administer a higher number of new, life-saving, antiviral drugs than any other nation in Europe. As we saw on 18 January 2021, when the NHS coped with 40,000 COVID-19 patients in hospital on the same day, trusts can rally around to help neighbours when they hit serious trouble. We can create "insurance policy" super-surge capacity across the country at incredible pace, with the first eight hubs now in place. We can create virtual wards, using new technology to monitor less seriously ill patients remotely, only bringing them into hospital when needed.

These are the advantages of a single, taxpayer-funded, national system. A system with a proper national and regional infrastructure to support local trusts to work together to meet collective patient need, free from the requirement to maximise individual organisational profit. But we must be open and honest about the impact this degree of pressure is having on patients and staff. And we need to recognise the pressure extends well beyond hospitals. Ambulances, mental health and community services, GPs and social care face unprecedented challenges too.

Despite that extraordinary effort from the NHS frontline, thousands of patients are having to wait longer than the NHS would want for urgent care. For 999 calls to be answered. For ambulances to hand over patients to hospitals. For patients to be seen promptly in accident and emergency departments and discharged back home or to the care sector. And, despite trusts working incredibly hard to avoid this, they are now having to delay planned care again, adding further to the growing care backlog. There is a clear, regrettable, impact on quality of care and, in the most pressured parts of the system, a worrying increase in patient safety risk.

The impact on frontline staff is also significant given that we are asking them, once again, to make an extraordinary effort.

The impact on frontline staff is also significant given that we are asking them, once again, to make an extraordinary effort. While some may live with the pressure, after two years of being on a "war footing", others are now burning out. Trust leaders are doing all they can to support their staff as effectively as possible, while managing the personal impact on their own lives. But there are some serious frustrations that still need to be addressed nationally, such as consistent and timely access to lateral flow and PCR tests when needed.

COVID-19 is, hopefully, a once-in-a-generation challenge. But when any system comes under pressure, its weakest links are revealed. It is now very clear that the NHS and our social care system do not have sufficient capacity. That asking staff to work harder and harder to address that gap is simply not sustainable. That we need a long-term, fully funded, workforce plan to attract and retain the extra 1 million health and care staff the Health Foundation estimates will be needed by 2031. And that we need a national transformation programme that embeds modern technology, 21st century medicine, integrated care closer to home and much greater emphasis on prevention at the heart of our health and care system.

These are the longer-term issues we will need to address once this immediate challenge has been met.

This blog was first published by the Observer.

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