Restarting health services will take many months

Three independent health and care charities have warned that it will take many more months before NHS and social care organisations are able to fully restart services following the coronavirus outbreak.

The Health Foundation, The King’s Fund and Nuffield Trust are cautioning that the government and health and care leaders should not underestimate the pandemic’s impact on already exhausted staff who need to be sure they can treat and care for people safely, or on public fears about seeking treatment.

They warn that immediate measures need to be taken to address the ongoing crisis in social care where death rates from coronavirus in care homes only just appear to be stabilising. Also, that plans to resume health and care services need to factor in the very real possibility of a second peak in coronavirus, as well as planning for winter pressures.

Ahead of the release of NHS England’s monthly performance figures - likely to show the scale of the virus’ impact on waiting lists - they identify five immediate challenges that government and the wider health and care system will face in resuming core services:

Managing infection control and impact on capacity – expanding health and care services in hospitals, general practice, social care and other settings will require an expansion of PPE, an expansion of testing and tracing, additional space for social distancing, additional staff and more time for cleaning equipment and facilities. This will severely limit capacity for many months until the infection has been brought under control in the community.

Understanding and addressing the full extent of unmet need - by focusing on protecting services for the most vulnerable, many other people’s needs may have gone unmet, and people’s conditions may have deteriorated while waiting for care. Meanwhile, people left with serious complications from coronavirus will require additional care.

Reassuring the public about using services – many sections of the public may still be very worried about easing the lockdown, particularly in areas badly hit by the virus, and may be reluctant to use NHS and social care services for fear of infection. Resuming care for ‘normal business’ is likely to need a significant public information campaign, and extensive work with staff, to reassure and protect them.

Jennifer Dixon, chief executive of the Health Foundation, said: “Covid-19 has wreaked significant harm on our society, with the toll felt most sharply by ethnic minority and socioeconomically deprived populations. Responding to the virus has exposed strengths and weaknesses in our health and social care system. Getting services back up and running, taking account of likely future pressures from COVID19, winter, and the backlog of ill health from delayed care will be a steep climb. But Covid-19 has also demonstrated how the health and care system can move fast, implement new technology and ways of working, and the deep commitment of NHS and care staff. All of these will be needed, with resources to match, to face the challenges ahead.”

Richard Murray, chief executive of The King’s Fund, said: “As well as the very real and visible challenges faced by NHS hospitals throughout this crisis, there have been multiple hidden frontlines in services such as social care, community health and mental health. 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 said, chief executive of Nuffield Trust, said: “With the virus still at large there is no easy route back to the way things were before in the NHS, and unfortunately that means people waiting much longer and some services being put on hold. 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.”