How is the NHS frontline coping? We’re in constant dialogue with the 218 frontline NHS trusts that we represent. There is a strong sense that, thanks to the extraordinary effort of our staff, the NHS is currently coping pretty well, perhaps even a little better than expected in some places. But we know that the real test will come over the next fortnight as the NHS experiences the initial peak of demand in terms of coronavirus patients needing critical care.
All trust chairs and chief executives point to the precious last four weeks the NHS has had to prepare, and during this time we have witnessed a truly extraordinary transformation, which might not be visible to those outside the NHS.
Reconfiguring the service in less than a month to create 33,000 beds to deal with critically ill coronavirus patients is unprecedented in NHS history. To put that in some context that’s like creating an extra 50 district general hospitals. Critical care has been expanded, and medically fit patients discharged more quickly thanks to good co-ordination and a step change in how we use community services. We've seen staff rapidly re-trained to treat Covid-19 patients and thousands of appointments redirected online and to the private sector. All at the drop of a hat.
Trust leaders report an amazing response from frontline staff. They’ve been willing to move to new areas they’ve never worked in before, adopt different shift patterns and work in brand new teams.
Deputy Chief Executive
London has been the early focus/test of how well these preparations will work as they have been first in line to cope with a rapid rise in Covid-19 patients. But it's clear from our most recent conversations that patient numbers are also rising in the west midlands and north east.
Trust leaders report an amazing response from frontline staff. They've been willing to move to new areas they've never worked in before, adopt different shift patterns and work in brand new teams. Twitter and online testimony shows how hard and challenging the work is. Established norms like one nurse to one patient in critical care have had to give way to one in four, as trusts adapt to provide the best possible care with the resources they have available. It's a relentless pace currently with no respite.
Clearly the number one priority for NHS leaders is to support their staff. And while media coverage has focussed on hospitals, the reality is that ambulance, community and mental health trusts are also playing a vital role alongside their colleagues in primary and social care. One chief executive talks about the herculean effort in just one town to keep things running – 4900 home visits, 10,000 video or phone consultations and staff being redeployed wherever they are needed.
That’s why staff testing is so important – trusts are desperate to ramp up this testing as quickly as possible to enable staff who can return to work to come back as quickly as possible.
Deputy Chief Executive
There are obvious pressure points. The biggest is the current staff absence rate – trusts are trying to deal with an unprecedented increase in patient numbers needing critical care with the highest staff absence rates they've ever seen. On average, we believe around one in six NHS staff are off work at the moment with many self isolating or having caught the virus, although there are no definitive figures at the moment.
That's why staff testing is so important – trusts are desperate to ramp up this testing as quickly as possible to enable staff who can return to work to come back as quickly as possible. The health secretary's commitment is helpful but needs to be backed up with action in terms of raw materials. Of course it would have been helpful if this was up and running sooner, but for now we should focus on the immediate needs. Testing capacity has started to increase but we need a clear public plan setting out how the NHS can rapidly increase the volume of testing as other countries have successfully done.
Personal Protection Equipment (PPE) has also been a major problem. Nothing could be more important than front line staff having the right equipment when they need it. Supply lines were initially overwhelmed as every health and care provider wanted huge amounts of equipment delivered immediately – in fact we saw demand go up by 500% in just 72 hours.
The emergency response has been impressive but it's obviously taken time to catch up. While the level of concern from trust leaders is dropping, we know that challenges remain. This isn't just for hospitals, it's for every part of the health and care system, including GPs, care homes and hospices where we're still seeing severe shortages. It's clear we're all going to need to help each other out until their supply chain is also sorted out. Mutual aid is the name of the game.
It’s clear we’re all going to need to help each other out until their supply chain is also sorted out. Mutual aid is the name of the game.
Deputy Chief Executive
There's also been a problem of frontline staff confidence in the guidance for what equipment to wear and when. The understandable response has been to default to the highest levels of protection equipment, but as other countries have found, that quickly becomes unsustainable. The updated guidance, published last week, is clearer, and has been endorsed by the World Health Organisation. It's vital that the NHS re-establishes frontline confidence in the guidance to safeguard future supply.
Experience from other countries also shows that ventilator capacity is key. While there is great work going on to source as many extra ventilators as possible, the reality is that these won't be in place for the immediate peak over the next few weeks. Much will depend on how big that peak will be. That's why trust chief executives were pleased to hear that social isolation is starting to have an impact. Here's hoping that’s the case.
A chink of light – much of this swift and targeted preparation has been working. The NHS front line is holding out, thanks to the calm dedication and professionalism of its staff. But we know the next fortnight is key to tackling the virus.
What's the one thing we can all do?
Stay at home, keep our distance and stop the NHS being overloaded.
This article was also published in the Independent.
About the author
