NHS Providers says the sustained physical, psychological and emotional pressure on health staff is threatening to push them beyond their limits.

The warning has been prompted by fresh evidence of trust leaders’ concerns over the toll of unrelenting pressure on the workforce, worries over the impact of winter, and frustration that trusts need more support from the government to deliver a sustainable service.

However most leaders say the quality of care being provided in their local area is high or very high, and they report that collaboration across different organisations in their communities to improve services for patients has increased during the pandemic.

However most leaders say the quality of care being provided in their local area is high or very high, and they report that collaboration across different organisations in their communities to improve services for patients has increased during the pandemic.

   

The findings, drawn from a survey of trust leaders, are contained in a new briefing from NHS Providers. This is being published as the NHS faces growing pressure from COVID-19, the need to restore services for patients which were disrupted by the pandemic, and the added activity for hospitals, mental health, community and ambulance services that comes with winter.

Leaders from 140 NHS trusts and foundation trusts – more than two thirds of the total – across England responded to the survey. Findings include:

• 99% were concerned about current levels of burnout across the workforce
• 94% were extremely or moderately concerned about the impact of seasonal pressures over winter
• 56% were worried that the government and its arms length bodies were not effectively supporting the delivery of a sustainable service
• 83% were worried that insufficient investment is being made in social care in their area
• 68% said the quality of healthcare being provided in their area was high or very high
• 92% said that collaboration and partnership working in local systems had accelerated during the pandemic.

The survey responses included some powerful commentary that underlined trust leaders’ concerns. A hospital trust chief executive based in the midlands said: “We have a perfect storm on the horizon; depleted staff, depleted capacity, increasing workload.”

We have a perfect storm on the horizon; depleted staff, depleted capacity, increasing workload.

   

A leader at a combined community/mental health trust – also in the midlands – warned: “Staff are tired and have been working at full pace since March. There is a huge amount of anxiety relating to COVID. In addition, we need more workforce to meet the targets and manage over winter who are simply not out there.”

But, noting the growing spirit of collaboration encouraged by COVID-19, the leader of another hospital trust based in the north west told us:

“There are so many things that I am proud of. The most powerful experience for me has been how NHS staff from all services and organisations have worked together do try and do their best for patients.”

Responding to the findings, the chief executive of NHS Providers, Chris Hopson, said:

“Month after month NHS staff have been going the extra mile to care for patients, often in intolerable conditions. But as this survey makes clear, they’re now running out of road.

“There’s been no let-up in the pressure.

“The pandemic came off the back of a really tough winter. And while the response to the spring surge in COVID-19 cases showed the NHS at its best, the pressures took their toll on staff who gave so much. Many are exhausted. Some are traumatised. A number lost colleagues to the virus.

“Everyone wants to get services back to normal and bear down on delays. We’ve seen remarkable progress on that in recent weeks, despite the limitations imposed – rightly – by tough infection controls.

Everyone wants to get services back to normal and bear down on delays. We’ve seen remarkable progress on that in recent weeks, despite the limitations imposed – rightly – by tough infection controls.

“But now with the new surge in COVID-19, looming winter pressures, and continuing severe staff shortages, it’s clear from our survey that trust leaders are deeply concerned for their workforce.

“The worry is that the sustained physical, psychological and emotional pressure on health staff is threatening to push them beyond their limits of endurance.

“It is also striking that more than six months into the pandemic, trust leaders feel the plans put forward by the government to deliver a sustainable service are not where it should be.

“It’s vital that we have a robust and effective test and trace regime in place in time for winter. Time’s running short and despite some progress, there’s a long way to go.

“Trust leaders are determined to ensure staff and patients are safe. That means securing a reliable supply of PPE. On this, the situation is much improved.

“But they also need to know that all extra costs arising from a second surge of COVID-19 will be covered. Some trusts already face significant gaps in this year’s finances, and it could get much worse.

“Against this backdrop it is remarkable to see trust leaders report the quality of healthcare being provided in their area remains high.

Against this backdrop it is remarkable to see trust leaders report the quality of healthcare being provided in their area remains high.

“And it’s particularly encouraging to see the way that the pandemic has galvanised local collaboration between different organisations to provide a better, more seamless service.

“Providers have been at the forefront of this work and it is clear they will have a leading role to play in consolidating and developing further the improvements we have seen in the way services are organised and delivered.

“This is a powerful – and much needed – signal of hope as services and their staff steel themselves for what promises to be a long, hard winter.”