- 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.
- The NHS entered the pandemic at a time of considerable challenge, with over 100,000 vacancies, rising demand for all services and key performance indicators at an all-time low. Similar pressures were evident in primary care and the fragility of the social care system has made it vulnerable in the pandemic.
- Despite this challenging context, the vast majority of trusts were positive about the transformation they and their staff had delivered during the pandemic in support of patients and service users:
- almost all (99%) of trusts agreed that they had seen rapid innovation in how they deliver services
- almost 9 in 10 trusts (86%) have increased capacity for remote services (video and telephone appointments), and all plan to continue providing some care remotely to reduce the impact of social distancing on capacity in hospitals.
- The impact of the COVID-19 pandemic on staff has been significant and trusts are committed to supporting their workforce as part of the return to a 'new normal':
- 92% of trusts said they have concerns about stress and burnout among their staff. High levels of staff absence and significant workforce reconfiguration during the COVID-19 response means that the return to providing normal services must take into account the needs of staff who are tired and recovering from an extremely challenging period in their career.
- 92% of trusts said they have concerns about stress and burnout among their staff. High levels of staff absence and significant workforce reconfiguration during the COVID-19 response means that the return to providing normal services must take into account the needs of staff who are tired and recovering from an extremely challenging period in their career.
- Trusts and their staff are also concerned about patients who, for a variety of reasons, have not accessed care during the lockdown period. They are confident that they can meet the needs of all patients who have urgent requirements but conscious they face ongoing constraints because of the need to sustain infection prevention and control (IPC) measures such as physical distancing and the use of personal protective equipment (PPE):
- the majority (80%) of trust leaders overall agreed with the statement "fewer non-COVID-19 patients have sought care in the last month" but report an increase in the numbers of people now seeking more urgent help
- however, the impact on those seeking help for physical ill health has been very different to the impact on those needing support for mental health issues - mental health trusts report a much smaller drop in demand during the crisis and an increase in the number of people needing urgent help in crisis
- the majority (89%) of trusts expect to see an increased backlog of people waiting for care, with a knock on effect on their ability to return to a normal level of service
- only half (55%) of trusts are confident that they are ready to return to meeting the needs of all patients. This varies by sector, with community and mental health trusts reporting more readiness to return to full capacity.
- The impact of the pandemic has been different across different trust types - trusts report that demand for physical health services dropped far more significantly than for mental health services during the pandemic:
- while 37% of acute trusts, 28% of community trusts and 25% of ambulance trusts strongly agreed that fewer non-COVID-19 patients had sought care in the last month, only 8% of mental health trusts strongly agreed.
- while 37% of acute trusts, 28% of community trusts and 25% of ambulance trusts strongly agreed that fewer non-COVID-19 patients had sought care in the last month, only 8% of mental health trusts strongly agreed.
- A small number of trusts (12%) said that they would not be able to return to their previous level of service but the response varied considerably by sector:
- a quarter of specialist trusts and a fifth of acute trusts said they would not be able to return to their previous level of service, but none of the community, mental health or combined community and mental health trusts responding felt this would be the case for their services.
- a quarter of specialist trusts and a fifth of acute trusts said they would not be able to return to their previous level of service, but none of the community, mental health or combined community and mental health trusts responding felt this would be the case for their services.
- Trusts emphasise the complexity of the modelling required to project the capacity needed to meet demand from new and existing patients over the coming months.Trusts describe three sources of demand anticipated to arise over the course of the coming months:
- those who have waited longer for care due to the pause in services
- those who have delayed seeking help leading to the drop in referrals for services and A&E attendances
- a level of new demand, particularly for mental health services, created by the lockdown itself.
- In summary, this survey highlights the significant achievements of trusts and their partners during the pandemic. However, it also reinforces the need for realism and prioritisation from government and national policy makers as the NHS recovers and returns to a ‘new normal’. This must be underpinned by a meaningful public conversation about our expectations of what NHS trusts can deliver, and by when.