Coronavirus: Restarting NHS services will be a major challenge, warn experts

‘We need an honest and open debate on priorities and how quickly we can restart all NHS services,’ says a health service chief

Medical staff in full PPE at Southampton General (Getty)

Restarting NHS services will be an even greater challenge than coping with the first coronavirus infections, health think tanks and hospital chiefs have warned.

Since March, the NHS has freed up more than 33,000 beds to prepare for an influx of Covid-19 patients needing intensive care. But since the peak of infection, health chiefs have worried that delays to care were harming patients.

Around 46,000 so-called excess deaths have been recorded during the pandemic, as compared against a five-year average. Around a quarter of these are believed to be unrelated to Covid-19.

Hospitals now face restarting as many normal services as they can while continuing to cope with coronavirus – with the threat of a second wave remaining very real.

In a joint statement, the Health Foundation, Nuffield Trust and King’s Fund think tanks have said it could take months before the NHS and social care are able to fully restart.

All three bodies will be giving evidence to the Commons health committee on Thursday, where they will warn about the impact on the health service’s “exhausted staff” and demand action to help care homes – which are now at the frontline in the fight against coronavirus.

The experts will stress the need for the NHS to begin planning for a second peak of infections, especially if it comes in winter – when the service is usually overwhelmed by seasonal flu.

They will warn about concerns over how the NHS manages the risk of infection, with the need for more protective equipment, social distancing and increased testing. This will “severely limit capacity for many months”, they said.

Jennifer Dixon, chief executive of the Health Foundation, said: “Getting services back up and running, taking account of likely future pressures from Covid-19, winter, and the backlog of ill health from delayed care will be a steep climb.”

Separately, NHS Providers, which represents hospitals, warned trusts face huge backlogs in delayed surgeries as well as new demand for mental health services as a result of the pandemic.

NHS Providers chief executive Chris Hopson, said there needed to be a debate about priorities. He said: “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.”

Richard Murray, chief executive of The King’s Fund, said: “The health and care system is a complex web of inter-related services: when one part fails, patients and service users can easily fall between the gaps. All aspects of the health and care system will need to be back up and running if services are to return to any semblance of normality. In the case of social care, normality should not be the aim: the sector needs increased funding and fundamental reform.”

Nigel Edwards, chief executive of the Nuffield Trust, said patients would be forced to wait longer and some services would have to be put on hold.

He added: “Hospitals and a whole range of services provided in the community will have to be remodelled to control infection and keep people safe, by separating out coronavirus patients and testing constantly and quickly at every level. We must be honest that this will slow things down.”

One intensive care consultant from the Midlands told The Independent that restarting some surgery while maintaining the extra intensive care beds for current and future coronavirus patients was not sustainable. He feared the relaxed lockdown measures from this week would see an increase in Covid-19 admissions.

He said: “If we go back to normal levels, we are going to have to keep some of that surge capacity open and if we see an increase in coronavirus cases we need to think how we manage those dual demands.

“It’s an impossible conundrum. We can’t not do cancer surgery for six months. The mortality from that would be huge.”

He added beds alone were not the key issue and staffing those beds with enough nurses and doctors was key, saying: “I don’t really feel as if the staffing issues have been considered. The risk of fatigue and burnout is ever-present in intensive [care units] and much more so now.”