Understanding the continuing challenges

Saffron Cordery profile picture

16 September 2021

Saffron Cordery
Deputy Chief Executive
NHS Providers

During the pandemic NHS staff could not have worked any harder. They have always gone that extra mile for patients, but dealing with the pandemic has been, and remains, a marathon effort. Staff are still working flat out to tackle waiting lists and address the rising demand for urgent care. Recent NHS performance statistics shine a light on their efforts – and there are some fantastic achievements.

In June, for example, staff performed 84,000 more diagnostic tests than the previous month – that's the highest number for a year. They screened 230,000 people for cancer – that's the second highest figure on record. And, yet again, they managed to reduce the number of people waiting for surgery for more than a year by 32,000. However, with COVID-19 continuing to relentlessly pile on the pressure on the healthcare front line, and with thousands of new cases every day, there's no sign of any let up.

The COVID-19 case load is not the only pressure facing the workforce, as the latest NHS performance data reveal.

Saffron Cordery    Deputy Chief Executive

As if that wasn't hard enough, the COVID-19 case load is not the only pressure facing the workforce, as the latest NHS performance data reveal. These numbers show what trust leaders had already been telling us – that the NHS is the busiest it's ever been. In fact, pressure-wise, during the summer months the NHS climate has felt more like last winter. Despite the achievements working in the NHS can leave staff feeling like they're on a treadmill – constantly running, faster and faster, and yet still going nowhere in terms of making inroads into the demands or easing pressures. 

Trust leaders tell us that this is because they are dealing with a very difficult combination of six distinct pressures all at the same time. These pressures are causing them major operational problems and could make the coming winter even more challenging. First, trusts are going as fast as they can to recover care backlogs. But the pace at which new patients are being added to waiting lists is unfortunately, and inevitably putting more pressure on staff, beds, and equipment. 

Second, hospital trusts are working with much lower bed capacity. This is because of ongoing enhanced infection control measures to protect patients, families and visitors from COVID-19. And we're regularly losing around 7,500 of the NHS' pre-pandemic inpatient bed base. This is proving to be a major challenge given that there were insufficient beds even before the pandemic started. Third, trust leaders say they still have large numbers of staff self-isolating. The changes to the rules on self-isolation for double jabbed close contacts on 16 August were very welcome but should, in retrospect, have been introduced much earlier.

Fourth, trusts have been in peak summer leave period and more leave has been taken than normal, where possible, because of leave that couldn't be taken in earlier waves of COVID-19. This leave is absolutely crucial to safeguarding staff well being and helping to prevent burnout. Growing numbers of absences due to stress, anxiety and mental health issues are also an ongoing concern.

Fifth, demand for urgent and emergency care is escalating, and in many places, exceeding levels witnessed prior to the COVID-19 pandemic. In July alone, 2,215 patients waited over 12 hours to be seen in emergency departments. Demands on ambulance services are particularly concerning, with the most serious 999 calls requiring an ambulance reaching 82,000 in July – a 32% increase compared to two years ago, before the pandemic. We would normally expect these stark performance statistics during the winter peak, not during the summer months.

Finally, while the number of COVID-19 patients we've seen in hospital is lower than many were predicting, it's still a huge pressure and one that is mounting, particularly for hospitals with high bed occupancy for other reasons, such as the higher level of emergency admissions many trusts are experiencing, and the pressure on beds from backlog recovery.

None of these pressures are new to the NHS. But combine them, and add COVID-19 into the mix, and you have a picture of an NHS running at full pelt.

Saffron Cordery    Deputy Chief Executive

None of these pressures are new to the NHS. But combine them, and add COVID-19 into the mix, and you have a picture of an NHS running at full pelt, with a staff in danger of running out of steam. And that's before the usual winter pressures kick in, which could be compounded by even more cases of flu, RSV and COVID-19. To ensure the NHS doesn't end up running on empty we need long term solutions. This means proper funding, so that the NHS has sufficient capacity and can realistically meet demand. This means a fully funded workforce plan, so that trusts can plan ahead. And this means investing in new treatments, the latest technology, and modern estates.

Having to deal with the combination of COVID-19 and other pressures has been an uphill struggle for staff for far too long. Which is why when the government makes its decisions on how much money to give the NHS for the next three and a half years in the upcoming spending review, they need to properly recognise the marathon efforts of frontline teams by equipping them to deliver the quality of care patients expect, and rightly deserve. 

This blog was first published by the National Health Executive

About the author

Saffron Cordery profile picture

Saffron Cordery
Deputy Chief Executive

Saffron is NHS Providers deputy chief executive, part of the senior management team and sits on our board. She has extensive experience in policy development, influencing and communications and has worked in the healthcare sector since 2007. Before moving into healthcare, Saffron was head of public affairs at the Local Government Association, the voice of local councils in England. Her early career focused on influencing EU legislation and policy development, and she started working life in adult and community education.

She has a degree in Modern Languages from the University in Manchester, for ten years was a board member and then chair of a 16–19 college in Hampshire and is a trustee of GambleAware, a leading charity committed to minimising gambling-related harm. Read more