Over the past couple of months, in the face of the pandemic, the public have shown incredible solidarity with everyone in the NHS and beyond. We have seen the weekly 'clap for carers', countless volunteers looking after the vulnerable who are shielding, and numerous organisations and individuals rallying round to support staff with acts of generosity.
Getting this far has been a huge effort. However, now we are confronting a task of equal if not greater magnitude: the long and complicated process of restarting routine care whilst also managing the ongoing pandemic.
There is no denying that patients have been affected in the process of freeing up capacity to treat those seriously ill with COVID-19. Since March, waiting lists have significantly grown as routine operations came to a halt, and some priority services had to be paused if the risk of infection was too high. Trust leaders are also deeply aware that discharging patients early or delaying planned care comes with its own risks. Trusts continue to carefully mitigate these risks but it is almost impossible to always get this right.
Getting this far has been a huge effort. However, now we are confronting a task of equal if not greater magnitude: the long and complicated process of restarting routine care whilst also managing the ongoing pandemic.
Before the pandemic, NHS trusts were struggling: they faced staff shortages of 100,000, rapidly rising demand, had just come through a relentless winter, and were continuing to deal with the fall out from the longest and deepest financial squeeze in NHS history. Adding to this, last summer demand for services didn’t abate so the NHS didn't get its usual chance to 'catch up' on its elective care, and it was feeling the impact of an underfunded and neglected social care sector. In short we went into this pandemic already weakened.
So, the NHS has done extremely well to continue to treat non COVID-19 patients. Trusts have ensured that accident and emergency departments remained open, that crisis care for mental health patients has been dramatically expanded, that emergency cancer and other vital, time critical, care was continued, and stepped up treatment of patients in their own homes. Indeed, hospital trusts treated more patients without the virus than patients with COVID-19 during this first peak. But we cannot deny that the focus on coping with coronavirus has had an impact on the care the NHS has been able to provide to many of its patients.
Trusts are now facing extremely difficult and challenging demands. The backlog of those waiting for planned care has significantly grown. We are also facing additional demand for mental health services, from frontline staff who have worked under immense strain, from the public who have been affected by the economic, social and loss of life factors associated with COVID-19 and pent up demand from those who, for many reasons, could not access care during the crisis. The NHS will also need, as far as possible, to support a social care system which is now even deeper in crisis. And on top of all of that, NHS trusts will be required to play a key role in the test, track and trace regime.
The NHS will also need, as far as possible, to support a social care system which is now even deeper in crisis. And on top of all of that, NHS trusts will be required to play a key role in the test, track and trace regime.
Of course they want to meet these challenges and to provide the best possible care. We know this from the efforts they've already made. But the reality is they are severely constrained by factors outside of their control. How do they plan for future surges in COVID-19 when it is immensely difficult to forecast how the virus will behave? Given the global shortages, can they rely on a sustainable supply of personal protective equipment for all staff who need it? Will the government-led testing regime be able to test all symptomatic staff and patients quickly enough, or provide the reassurance of regular tests for those who have no symptoms but need to be at work? And how do trusts manage the workforce shortages and risk of burnout among staff which have never been more evident?
There are things that can help. Clear and consistent messaging from the government on how lockdown will be eased will go a long way in helping to avoid a second peak and overburdening the health service. A framework for providers to maintain the flexibility to make decisions which work for their local trust and their patients. The pandemic has affected different areas of the country in different ways, at different times: a one size fits all approach will not be suitable when it comes to resuming services. As trusts turn their thoughts to winter it will be vital to ensure the NHS is sufficiently prepared to manage pandemic related demand alongside typical winter pressures. And, linked to that, the NHS needs to understand how it can use the additional capacity that has been created beyond the end of June - particularly the Nightingale hospitals and contracts with the independent sector.
Given the scale of these challenges and constraints, it is already clear that NHS trusts will be operating in a new normal and will be unable to deliver all that is expected.
To politicians we ask that you don't overpromise - instead let us have an open and honest debate about priorities. To the public we ask you to not forget your heroes when things get even tougher. Remember the NHS' efforts, remember the hardships, and remember that staff worked tirelessly to keep you safe in these unprecedented times, and will continue to work as hard as possible to keep caring for you.
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