The task of preparing to treat those seriously ill with COVID-19 was an unprecedented challenge for the NHS. But the task of re-starting the full range of NHS services whilst managing the threat from coronavirus will be greater still.

The latest report from NHS Providers - Towards a new normal: Balancing COVID-19 and other healthcare needs - discusses the huge challenges for the NHS in reaching 'a new normal' that successfully balances COVID-19 with other healthcare needs over the next six months.

Over the past ten weeks, the NHS has successfully created the extra capacity needed to treat COVID-19 patients to avoid the overwhelm of health services seen in other countries. Whilst the NHS also continued to successfully provide care to the most urgent patients, the necessary focus on navigating the first peak of coronavirus has had a real, concerning, impact on care for other patients.

Over the past ten weeks, the NHS has successfully created the extra capacity needed to treat COVID-19 patients to avoid the overwhelm of health services seen in other countries.

   

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Trusts are clear that they must now restart all NHS services as quickly as possible. But they will have to do so whilst still treating COVID-19 patients and keeping sufficient surge capacity to avoid being overwhelmed in a second, and any subsequent, virus spike.

Trusts also have new challenges:

• dealing with the backlogs that have built up, for example in elective surgery
• significant new demand for mental health services from those affected by the social, economic and loss of life consequences of COVID-19, and from frontline staff who have had to provide care in highly pressured 'once in a career' circumstances
• meeting the complex needs of two million new shielded patients with tight constraints on how the NHS can interact with these patients
• treating those who have delayed seeking care over the last ten weeks, whose needs will now be more complex and advanced than they would otherwise have been
• the need for the NHS to support a social care system in full crisis.

The NHS' capacity to meet these new, extra challenges is severely constrained. After the deepest and longest financial squeeze in NHS history, the service went into the pandemic with 100,000 staff vacancies and insufficient capacity.

On top of this, NHS trusts now face a range of new barriers to responding effectively to restarting services and addressing the new demands they are already experiencing:

• ongoing concerns over frontline access to personal protective equipment such as sterile gowns, which are key to restarting surgery
• an unreliable and incomplete testing regime which cannot currently guarantee the timely access to staff and patient tests needed to safely restart a range of NHS services 
• shortages of key drugs and equipment including the most modern anaesthetic drugs and kidney dialysis machines
• a real risk of staff burnout, particularly following a relentless winter, combined with significant amounts of deferred leave and staff absence due to COVID-19. 

Trusts will do all they can to care for all patients and service users who need treatment, but the public needs to be aware that the NHS simply can't do everything that is currently expected of it over the next six months. We will therefore need to have a difficult, and important, debate on priorities.

Trusts will do all they can to care for all patients and service users who need treatment, but the public needs to be aware that the NHS simply can't do everything that is currently expected of it over the next six months. We will therefore need to have a difficult, and important, debate on priorities.

Chris Hopson    Chief executive

The chief executive of NHS Providers, Chris Hopson, who will today give evidence to the Health and Social Care Select Committee inquiry on delivering core NHS and care services during the pandemic and beyond, said: 

"The NHS has performed extremely well through the first peak of the virus, but that's just the first few laps of what we know will be a marathon.

"Only now is the scale of the challenge for the rest of the race coming into view.

"Trusts will do all they can to restart services as quickly as possible. They'll seek to solve every problem they encounter as they've consistently done so far. They will build on the innovations they've developed over the last two months, like the 6,000 patient consultations a day now being delivered online, compared to 200 before the crisis.

Trusts will do all they can to restart services as quickly as possible. They'll seek to solve every problem they encounter as they've consistently done so far. They will build on the innovations they've developed over the last two months, like the 6,000 patient consultations a day now being delivered online, compared to 200 before the crisis.

Chris Hopson    Chief Executive

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"But one key lesson from the pandemic so far is not to over promise. We must recognise that the NHS cannot deliver all that is now being asked of it. Expectations are already way ahead of reality. We need an honest and open debate on priorities and how quickly we can restart all NHS services."

Expectations are already way ahead of reality. We need an honest and open debate on priorities and how quickly we can restart all NHS services.

Chris Hopson    Chief executive