A survey by NHS Providers sets out in stark detail how NHS leaders are grappling with challenges on multiple fronts as they seek to meet rising demand for health services alongside a rapidly growing waiting list and a worrying surge of COVID-19.

The health service is coming under concerted pressure with recent figures revealing a record 5.1 million people on waiting lists, over 2 million A&E attendances in the last month and a steep increase in demand for mental health services.

Trusts and frontline staff are working at full pelt to clear the backlog of care that has built up during the pandemic, with 90% of pre-pandemic levels of operations now being carried out and a small, but welcome fall in the number of people now waiting over 52 weeks for treatment to begin.

But our survey reveals widespread concerns amongst trust leaders that winter pressures and further surges of COVID-19 will derail plans to deal with the backlog of care and undermine hard-won progress.

These findings come just days after the chief medical officer warned of a further wave of COVID-19 this winter and the prime minister was forced to delay plans to further ease restrictions following a sharp rise in infections and hospital admissions because of the Delta variant.

The survey responses reveal:

• A large majority of leaders (88%) said it was likely that another surge in COVID-19 cases would place additional pressures on their services.
• 89% said they were worried these additional pressures would come during the challenging winter months.
• Almost three quarters (73%) of respondents raised concerns that plans to clear the backlog of care over winter risked being disrupted because of the need to prioritise demand for urgent and emergency care.
• Almost half (48%) of respondents said they have seen evidence of staff leaving their organisation due to early retirement, COVID-19 burnout, or other effects from working in the pandemic. Respondents are concerned that juggling winter, flu, COVID-19 and ambitious recovery plans will once again put pressure on the workforce.

Commenting on the survey results, the deputy chief executive of NHS Providers, Saffron Cordery said:

"Our survey reveals the sheer scale of the challenge facing trusts right now. They are battling on multiple fronts as they try to recover care backlogs, deal with increased demand for emergency care and treat patients with COVID-19.

"This is difficult at the best of times but as we saw last year, could become even more challenging during the hard winter months, particularly with the expectation that flu will return and there will be increased respiratory viruses among children.

"Trusts are committed to clearing the backlog of care that built up during the pandemic. We are confident vaccines are breaking the chain between infections and hospital admissions, but the reality on the frontline is that even a small increase in COVID-19 admissions or emergency care pressures could affect our ability to deliver non-COVID services.

"Trust leaders are doing all they can, but there are three steps the government can take immediately to ease the current pressure trusts are facing.

The government must provide much needed short-term capital funding so trusts can direct it to the services that need it most.

Saffron Cordery    Interim Chief Executive

"First, the government must provide much needed short-term capital funding so trusts can direct it to the services that need it most. Trusts tell us they need capital quickly to expand intensive care units, to invest in digital to transform pathways to see patients more quickly, and to adapt estates to create more capacity.

"Second, trusts need to maintain patient flow and maximise their capacity. We're urging the government to commit to permanent, dedicated funding for the discharge to assess programme, which ensures patients who are ready to leave hospital are placed in a more appropriate setting freeing up hospital beds.

"Third, we need national bodies to work with NHS leaders to get the planning for winter pressures right to help manage the risk ahead. We know the NHS faces a perfect storm of COVID-19, flu and other respiratory illnesses as well as a growing backlog of care. We must act now."