A new report by NHS Providers, based on the first full survey of NHS trust leaders since COVID-19 started, highlights the scale of the challenge ahead as the NHS recovers from the first peak of the virus.

The report, Recovery position: What next for the NHS?, sets out the scale of increased demand and the dramatic loss of capacity many trusts are now facing as the NHS juggles treating COVID-19 patients with restarting the full range of services. The report shows that, whilst trusts are restoring services as fast as they can, some trusts, particularly acute hospitals, believe this restoration will take more than six months.

Whilst trusts are restoring services as fast as they can, some trusts, particularly acute hospitals, believe this restoration will take more than six months.

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The report is based on a survey of 158 trust chairs and chief executives, commissioned by the House of Commons health and social care select committee, with nearly 60% of all ambulance, community, hospital and mental health trusts responding. It highlights four key findings:

1. Trusts are facing significantly increased demand
   
   54% of trust leaders report increased demand for more urgent or crisis care and/or severe and late presentations/contacts from patients. This is exacerbated by patients not seeking treatment in a timely way – 80% report fewer non COVID patients sought care in the previous month [survey conducted 21 May – 31 May]. 89% believe there is now an increased backlog of people waiting for care.
   
   
2. Trusts are facing major capacity constraints and uncertainties in trying to restart services
   
   92% of leaders believe physical and social distancing, required for effective infection control, reduces available capacity. 92% are concerned about staff wellbeing, stress and burnout following the pandemic. 80% believe there is an unpredictable level of COVID-19 demand. 57% believe there is insufficient testing capacity and 53% believe there is insufficient PPE supply to fully restart services. When looking at their current level of capacity, trusts estimated on average that they are currently running at just over 50% capacity for non-COVID services. On average, they anticipate that their capacity will rise to 70% within three months, and over 80% in six to 12 months.
   
   
3. Trusts are doing all they can to restart services as quickly as possible
   
   86% of trusts have increased capacity for remote services like video consultations. 78% have reconfigured their workforce to speed up the resumption of services. 57% are using independent sector capacity to increase the flow of patient treatment. 46% have formed new partnerships with other trusts to maximise available treatment capacity.
   
   
4. However, the combination of significantly increased demand and significantly reduced capacity means services will take significant time to resume, particularly in acute hospitals
   
   Only 7% of trusts say they are immediately ready to meet the needs of all patients and service users. 22% say it will take them three to six months to be ready; 14% say it will take them six to 12 months. There is a clear difference between mental health (82%), ambulance (80%) and community (67%) trusts’ readiness to resume services within six months compared to hospital trusts (39%).
   

The chief executive of NHS Providers, Chris Hopson said:

"Trusts have achieved a great deal over the past four months. They expanded critical care capacity, accelerated the safe discharge of patients, moved thousands of outpatient appointments online and created mental health A&Es to support those in crisis. They also kept critical services going.

"But, to avoid overwhelm in the first COVID-19 peak, the NHS had to suspend some services. The challenge is to now restart those services. Trust leaders are deeply aware of their responsibility to do this as quickly and safely as possible.

"This report clearly shows that the NHS faces a really difficult problem. Some trusts will be losing as much as 40% of their capacity for as long as COVID-19 is with us. There are also many more patients to now treat.

"Trust leaders are as frustrated as patients and service users that they can’t go faster. But it’s not just a case of flicking the light switch back on. COVID-19 brings a whole new set of demands and the overwhelming priority must be to provide safe care.

"Our survey shows that the NHS will simply not be able to do all that is currently required of it. We must have an honest and difficult debate about priorities.

Our survey shows that the NHS will simply not be able to do all that is currently required of it. We must have an honest and difficult debate about priorities.

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"Berating trusts for not going faster won’t help. Trust leaders and frontline staff will bring the same commitment, pace and problem-solving ingenuity to this task that they demonstrated when creating 33,000 beds in less than a month to treat COVID-19 patients in the first peak.

"The Government must also recognise that the NHS needs more capacity to offset what has been lost as a result of COVID-19. There is now a key decision to make on whether to keep independent sector beds and the Nightingale hospitals and to fund the extra capacity needed in community, mental health, general and acute beds and emergency departments. Without that capacity the NHS task would simply be impossible."

About the survey:

• The survey was conducted online between 21 May – 31 May 2020.
• On 14 May, NHS Providers published a briefing Spotlight on... The new normal 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.
• We surveyed the chairs and chief executives of all trusts. It received 158 responses representing 126 trusts, or 58% of the provider sector, with all regions and trust types represented in the data.