With lockdown restrictions gradually easing, wouldn't it be great to think the pandemic is sorted and we can all move on? But while there is much to celebrate, as the vaccination programme goes from strength to strength, we cannot lose sight of what the health service needs to ensure it can tackle the multiple challenges it faces. That includes a new worrying surge of COVID-19. We know that this is a real risk, given that current data shows a significant increase in hospital activity across the country.
Trust leaders have shared their concerns with us in a new survey, as they combat a daunting array of challenges – COVID-19 coming back centre stage while they are also seeking to meet rising demand for mental and physical health services, rapidly growing waiting lists for planned surgery which have now reached over 5 million, and significant pressure across the urgent and emergency care pathway.
Staff have done extremely well to get us to this point. Trusts are working rapidly to clear the backlog of care that built up during the pandemic. In national guidance, they were asked to work at 70% of pre-pandemic levels of operations from April 2021 with a 5% increase each month, given that some staff are still absent from work and infection prevention control measures restrict capacity. But trusts are cracking on and going faster, carrying out 90% of the activity against the 2019 baseline. That's resulted in 50,000 fewer people now waiting over 52 weeks for treatment to begin – certainly a step in the right direction.
Most trust leaders are concerned that winter pressures and further waves of COVID-19 will derail this progress in tackling recovery plans across all services
Interim Chief Executive
But most trust leaders are concerned that winter pressures and further waves of COVID-19 will derail this progress in tackling recovery plans across all services, including in mental health. Even a small spike in COVID admissions will mean re-prioritisation, with resources and focus moved away from non-urgent care once again. And with A&E admissions now rising, three quarters of the trust leaders surveyed are concerned that their work to address waiting lists will be disrupted by the need to prioritise urgent and emergency care, with many patients now presenting late or with more complex conditions.
Trust leaders are particularly worried about these additional pressures coming during the challenging winter months when trusts are already at their busiest with seasonal pressures. The chief medical officer Professor Chris Whitty last week warned of another future wave of COVID-19 this winter, and there is an expectation that with less social distancing flu will return and there will be increased respiratory viruses among children.
Half of trust leaders are also concerned about the levels of staff leaving their organisation due to early retirement, burnout, or the impact of working in a pandemic. In particular, trust leaders say people are retiring or those who delayed retirement are now putting those plans in place. Trusts are doing all they can to make sure that staff health and wellbeing is prioritised during this difficult time, such as through the creation of wellbeing hubs, innovative new ways of working, and better communications. But chronic staff shortages are leading to excessive workloads and stress at work, raising the risk of people deciding they have had enough, and want to move on. Without long term planning, there is a very real risk that continuing to juggle winter, flu, COVID-19 and ambitious recovery and NHS transformation plans will add additional pressure on existing staff.
There are three steps to help trusts address the challenges they face.
Interim Chief Executive
So what needs to be done? There are three steps to help trusts address the challenges they face. Firstly, the government should provide the short-term capital funding to trusts so that they can direct it to where its needed most. For many trusts, this will be to expand intensive care units where they treat those who are sickest with COVID-19. For others, this cash will be invested into digital innovations to transform how quickly patients are seen. For some, including particularly for mental health trusts, this will be used to adapt estates to create much needed extra capacity.
Next, the government should commit to permanent funding for the discharge to assess model. This programme ensures that patients who are ready to leave hospital are placed in a more appropriate setting, such as in their community. During the pandemic, this funding helped free up 30,000 beds and its withdrawal would mean increased length of stay for patients, delayed discharges and avoidable readmissions.
Lastly, national bodies should work closely with NHS leaders to appropriately plan to help manage the risk this winter. With COVID-19 on the rise, the threat of new variants and an expected spike in flu and other respiratory illnesses, alongside the growing waiting lists across services, the NHS is facing a perfect storm.
If these actions are not taken, and the concerns laid bare by trust leaders ignored, then it is likely that the quality of care will suffer, with more delays for patients, and still greater pressure on staff. So much has been achieved amid the tragedy of the pandemic, we must not throw away that progress now.
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