The NHS entered the COVID-19 pandemic with 100,000 vacancies, A&E performance at an all-time low, growing waiting lists for elective care, and increasing demand for mental health, community and ambulance services. Primary care was under pressure and the social care system was fragile.
When the level-4 incident was declared in the NHS in March, trusts quickly stepped into gear to deliver the enormous task of reconfiguring services to ensure large numbers of COVID-19 patients coming through their doors were able to be cared for. Acute trusts scaled up critical care capacity, and community trusts implemented the 'discharge to assess' model, with mental health services launching 'mental health A&E's' to ensure people in need could safely receive support.
But this came at the cost of suspending some services to avoid the NHS being overwhelmed, and now, as the number of cases continues to decline, and the NHS moves towards its 'new normal', trusts are clear that the recovery from COVID-19 will be far from straightforward.
While trusts have continued throughout the pandemic to ensure people with and without COVID-19 receive the care they need, they are aware that ordinary healthcare needs did not simply vanish while the country deals with the virus. Our survey of trust leaders showed that the majority are expecting to see an increase in their caseloads as more people feel safe to come forward with their health problems. There was a 29% fall in the number of A&E attendances in March compared with the same time last year, and a national campaign, 'help us help you', was launched to encourage people with serious health concerns to seek help. As lockdown restrictions have eased, referrals and A&E attendances have begun to rise, and mental health services in particular have seen a surge in the number of people seeking support.
The process of restoring services as the outbreak retreats is a complex one, involving sophisticated modelling for demand arising from all sources, alongside a process of prioritising who will need care first. Trusts are keen to reassure patients who have concerns about coming to hospital for urgent treatment that they will be kept safe, with social distancing in place, dividing 'hot' and 'cold' areas which will need to be supported by a rigorous testing regime of staff and patients and an adequate supply of PPE.
The process of restoring services as the outbreak retreats is a complex one, involving sophisticated modelling for demand arising from all sources, alongside a process of prioritising who will need care first.
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All of this must take place in the context of considerable uncertainty about the future of the outbreak and when future waves could occur. Many thousands of people have been unwell enough to need hospital treatment for COVID-19 and will need ongoing support with the physical and mental health effects of the virus.
There is a desire in the sector to reap the benefits of the rapid innovation prompted by the outbreak, including the increased use of technology where appropriate, streamlining of discharge processes, and efficient models of care, but trusts are also very concerned about the toll the emergency has taken on their workforce and are cautious not to move too fast.
With social care in a fragile state, and pressures on primary care, any move to a 'new normal' will need to go at the pace of the most challenged sectors, so that no single part of the system becomes overwhelmed.
With social care in a fragile state, and pressures on primary care, any move to a 'new normal' will need to go at the pace of the most challenged sectors, so that no single part of the system becomes overwhelmed.
It's clear that far from being a return to the old ways of working, the next phase of trusts' response to the pandemic will look very different as they maintain readiness for future spikes of the virus alongside restarting many more services.
This was first published in the National Health Executive.