The NHS entered the COVID-19 pandemic with 100,000 vacancies (NHS Digital, 2020), A&E performance at an all-time low (NHS England, 2020a), a growing waiting list for elective care (NHS England, 2020b), increasing demand for mental health, community and ambulance services, and a social care system in a fragile state. This makes the achievements trusts, and their local system partners, have delivered to transform care within the first weeks of the coronavirus outbreak all the more remarkable. From creating sufficient critical care capacity to avoid the service being overwhelmed, to implementing community ‘discharge to assess’ models, accelerating the use of digital technology and creating 'mental health A&Es' to support those in need, their achievements are significant.
However, we all recognise that the priority to protect the public from COVID-19 came at the cost of suspending some services in the early weeks of the outbreak and delivering others in a different way. Trusts are now seeking to restart more services and exploring how they will balance the competing demands of retaining capacity to treat COVID-19 patients, cater for unknown future waves of the outbreak, and restart services in a way which keeps both their staff and patients safe.
This briefing shares the results of the first NHS Providers survey carried out with the chairs and chief executives of trusts since the COVID-19 pandemic began. It offers a snapshot view of the sector’s position as trusts emerge from the first peak of the outbreak, and move towards a ‘new normal’. It shares the different approaches trusts have put in place to continue caring for non-COVID patients, highlights the work they are doing to return to a sustainable level of services, and demonstrates the complexity of calculating what a sustainable level of service provision should be.
About this survey
On 14 May, NHS Providers published a briefing Spotlight on... The new normal (NHS Providers, 2020) and submitted evidence to the health and social care select committee session on the same day. During the session, Rt Hon Jeremy Hunt MP, chair of the committee, asked us to survey trusts to help gain a greater insight into the challenges around balancing COVID-19 and non-COVID care, particularly as the NHS works towards restoring services that had been paused as part of the rapid operational response to the outbreak.
The outbreak of COVID-19, and the task of treating those seriously ill with the virus, presented an unprecedented challenge for trusts and the wider health and care system. Prior to the pandemic, NHS trusts were already grappling with rapidly growing demand for healthcare. The NHS was facing its longest and deepest financial squeeze in NHS history with over 100,000 workforce vacancies in the trust sector alone and staff exhausted after coping with year-round levels of ‘winter’ demand. Despite treating record numbers of patients, acute trusts were recording their lowest results against performance standards in elective surgery and emergency care in over a decade. Community, mental health and ambulance services were under similar pressure.
NHS Providers conducted a short snapshot survey of chairs and chief executives between the 21 - 31 May. The survey aims to capture the views of the sector on:
- current demand
- capacity and workforce challenges
- the readiness of the NHS to reopen
- the barriers to returning to a level of service where trusts can meet the needs of all patients and service users who require care.
The survey received 158 responses representing 126 trusts, or 58% of the provider sector, with all regions and trust types represented in the data.