The NHS went into the COVID-19 pandemic on the back of a long, difficult winter, with over 100,000 vacancies, rising waiting lists, and key performance indicators at an all-time low. The health service is always under pressure in January and February, but there was no respite for staff as COVID-19 took hold in March. The service was placed on a ‘level 4 incident’ – the highest level of alert.
This set in train a series of rapid actions. Trusts suspended routine services and operations. Critical care capacity was quickly scaled up with wards, theatres, and recovery areas converted into intensive care units. Mental health trusts created ‘mental health A&Es’ to safely help people in crisis as well as access to 24/7 crisis support. Community services also played a key role in looking after patients who were well enough to be discharged from hospital.
These achievements were significant and prevented the NHS from being overwhelmed. But they had a big impact on the normal range of services the health service provides. The NHS is now working to get these up and running while continuing to treat smaller numbers of COVID-19 patients, and staying prepared for a potential second surge of cases.
How will that happen? At the request of MPs on the health and social care select committee, NHS Providers has carried out the first major survey of trust leaders across England since the start of the pandemic to gauge progress and identify the challenges ahead.
At the request of MPs on the health and social care select committee, NHS Providers has carried out the first major survey of trust leaders across England since the start of the pandemic to gauge progress and identify the challenges ahead.Chief Executive
The responses highlight some of huge strides taken by trusts in adapting to COVID-19, but also the scale of the difficulties they face. They are almost unanimous in reporting rapid innovation in how they deliver services, and are keen to keep what has worked well, but only just over half are confident about getting back to meeting the needs of all patients who need care.
The survey reveals trust leaders’ concerns about being able to scale up services. They reported that they were running at just over 50% capacity for non COVID patients. They expected that to rise to 70% in three months and just over 80% within a year, as services gradually come back on stream. Hospital trusts were typically less ready to return to full capacity. But ambulance trusts are already nearly there.
One important constraint is space. More than 90% of trust leaders agreed that physical distancing required for infection control reduced their available capacity. A similar proportion expected to see an increased backlog of people waiting for care, with a knock-on effect on their ability to return to a normal level of service.
A further challenge is a likely spike in demand for non-COVID-19 treatment. Trust leaders are expecting a steep rise in the numbers of people needing care over the coming months. As fears about coronavirus ease, more people are beginning to come forward, often with more advanced and severe problems because they have been reported late.
The conversation about the next phase of the COVID-19 pandemic needs realism about how quickly the NHS will be able to recover from the height of the pandemic and achieve a ‘new normal’ way of working.Chief Executive
Trust leaders are worried about the impact of the pandemic on staff. More than 90% expressed concern about staff wellbeing, stress, and burnout. Many were redeployed to new roles to deal with the initial surge in COVID-19 cases. Restoring normal services will mean bringing them back, but trusts will also need to retain capacity for a second surge. More than 50% of trust leaders felt there was insufficient testing capacity to safely resume all services. There were similar levels of concern about supplies of personal protective equipment.
This means the conversation about the next phase of the COVID-19 pandemic needs realism about how quickly the NHS will be able to recover from the height of the pandemic and achieve a ‘new normal’ way of working. While the public should have full confidence that the NHS is there to treat and care for them when they need it, we also need a much more open conversation about the differences we will all see in how that care is delivered for some time to come.
This was also published in the Times Red Box.