The NHS is already strained – the coronavirus outbreak may push it to breaking point

Maintaining already depleted staff morale with no clear end in sight will be extremely challenging

The coronavirus action plan published by the government on Tuesday contained reassuring statements about “plans in place to ensure people receive the essential care and support services they need”. But what does that mean in practice, and what are the particular challenges posed by Covid-19?

First of all, it means that every NHS organisation is required to have a “business continuity plan”. That sets out how that organisation will keep essential services going at times of disruption, whether that’s an IT failure or an epidemic. Those plans are kept under review, and regular test exercises take place so staff know what to do in an emergency. The detail varies from organisation to organisation, but the principles are the same: services are categorised on a scale of 1-4, from low priority to essential service, enabling local leaders to be clear which services can be stood down, if necessary, to enable others to continue.

Plans are agreed across a local area, so that every part of the NHS and social care understands what they can expect of every other part of the health service, as well as of agencies such as the police and fire services.

But that doesn’t mean there won’t be challenges if coronavirus worsens. Dealing with a major incident that affects a particular area for a short spell of time is quite different from something that affects a large part of the country for a long period.

There can be knock-on consequences for hospitals if services like GPs and social care fail. One reason we have relatively few hospital beds in this country is that we put a lot of emphasis on looking after people in their own homes. So local planners will be pulling out all the stops to ensure that social care teams can continue to function, indeed can up their capacity.

One of my biggest worries is the ability of social care providers to keep their services going. Because of the well-documented squeeze on social care funding, those who do receive care tend to have the most serious health problems. If Covid-19 puts further pressure on social care, many people receiving care will end up hospitalised, putting further pressure on their services.

It’s already been made clear that some services, such as planned surgeries, could stop for a period of time. That frees up hospital beds for people who need them urgently. For some patients, perhaps those who need a hip replacement, cancelling surgery would mean they have a prolonged but not life-threatening period of pain. But some planned surgery is needed by, for example, cancer or heart patients, for whom delay could impact their prognosis. So hospitals will be giving careful thought on how to maintain services for such patients in the context of a long-term impact on hospitals.

A key tenet of emergency planning is “mutual aid” – organisations helping each other out. That works very well when one particular area is under pressure – ambulances can be asked to take people to different hospitals, or staff can be brought in from elsewhere. But in the event that large parts of the NHS are under strain, the ability to do that would be reduced. These are difficult scenarios, but they are predictable ones and will be covered by local plans.

Perhaps the most challenging aspect of the coronavirus outbreak is that we do not know how long it will last. The NHS has been under pressure for years – maintaining already depleted morale with no clear end in sight will be extremely challenging. Our NHS and social care staff have repeatedly shown their willingness to go beyond the call of duty at times of crisis – yet they cannot do so indefinitely.

Helen Buckingham is director of strategy and operations at health think tank the Nuffield Trust