Rob Harwood, an anaesthetist at a hospital in the East of England, laments that even the simplest medical procedures have become laborious in the age of Covid-19.
For example, “you can have fewer people in the waiting areas [for X-rays] because you have to be physically distanced, it takes longer to turn somebody over on the X-ray scanner because of all the cleaning that has to be done between cases”, said Dr Harwood, who represents senior doctors at the British Medical Association.
“Productivity is really impacted by the way we have to work [now],” he added.
At the height of the coronavirus pandemic, England’s NHS found beds for everyone who was admitted who needed them, defying grim predictions that a wave of Covid-19 patients would overwhelm its wards. But as clinicians and managers seek to return to a semblance of normality ahead of a possible winter surge in Covid cases, the price of this achievement is becoming increasingly apparent in a massive accumulation of cases that could undermine the NHS for years.
Health leaders’ decision to halt all non-emergency surgery from mid-April to free up beds for virus patients threatens to lengthen waiting lists to historic levels, with one estimate suggesting the number of people waiting for treatment in England could hit 10m by the end of the year.
Many people also held back from seeking medical help during the coronavirus lockdown — either because they wanted to ease the strain on staff, or because they were afraid of catching Covid-19 in a hospital or GP surgery.
The resulting backlog could have long-lasting consequences. Some experts believe the toll from delayed cancer diagnoses and treatment could yet exceed that of the virus itself.
Restoring normal working to a health service that for many years has suffered from a severe shortage of workforce and capital is a huge challenge. Last month, NHS chief operating officer Amanda Pritchard and Julian Kelly, the service’s chief financial officer, wrote to health trusts, setting out demanding targets and outlining financial consequences for those who miss them.
The letter, seen by the FT, refers to “our shared goals for accelerating the return to near-normal levels of non-Covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”.
It goes on to state that in September, the NHS will be expected to deliver at least 80 per cent of the volume of operations involving an overnight stay and of outpatient or day case procedures carried out last September. This will rise to 90 per cent in October.
These targets mean that systems need to “very swiftly return to at least 90 per cent of their last year’s levels of MRI/CT [screening] and endoscopy procedures, with the goal to reach 100 per cent by October”, wrote Ms Pritchard and Mr Kelly.
Trusts will be given a cash allocation for the rest of the financial year and an activity target calculated using their pre-Covid volumes. However, the letter makes clear that they will have between 20 and 25 per cent of the nationally set price deducted for each case they fail to treat, should they miss the targets. Trusts that exceed their targets, in contrast, will be given an additional incentive payment of 70 to 75 per cent of the nationally set price for each extra case they treat.
Chris Hopson, chief executive of NHS Providers, which represents leaders of hospital, ambulance, mental health and community services, said NHS bosses had made clear that whether or not the targets were met, hospitals would have their fixed costs covered.
But he added that a lack of clarity over cash allocations for the rest of the year had left his members fearing that they may not be reimbursed for any extra costs needed to hit the targets.
Mr Hopson also pointed out that trusts might fail to meet the targets for restoring services due to circumstances beyond their control — for example an older or awkwardly designed hospital where it was harder to separate Covid patients from others. “If they significantly undershoot [the target] for very good reasons . . . that could mean financial problems,” he warned.
“Everybody is moving as fast as they possibly can to increase activity levels but they are trying to overcome a very difficult set of constraints,” he added.
The NHS said that elective surgery “has already rebounded from around 30 per cent of its usual rate during the peak of Covid — when hospitals were looking after 108,000 coronavirus inpatients — to over 60 per cent [in August], and is steadily increasing in line with our ambition to get back to near-normal levels ahead of winter”.
But progress “will continue to depend largely on controlling the virus in the community, including the success of Test and Trace, rapid action to control local outbreaks, and of course continued public support for hand hygiene and social distancing measures”.
However, a recent report by the Nuffield Trust showed that while all health systems made choices about how to prioritise care, manage infection control and keep capacity in reserve in case of future outbreaks during the pandemic, the NHS was likely see a slower return to normality than others.
Sarah Reed, the report’s author, said this was because the service went into the pandemic with “higher occupancy rates and fewer doctors, nurses and capital assets than most other health systems, while also being more severely impacted by the virus than most”.
She warned: “It is this weaker starting position that now risks a slower and more fraught recovery for the NHS.”
For charities representing people whose treatment or diagnosis have been delayed by the pandemic, the need to return to the pre-Covid status quo is urgent.
Cancer Research UK, a charity, estimates that in the 18 weeks that followed the start of lockdown on March 23, 3m people did not receive screening tests, such as mammograms or cervical smears, that they otherwise would have got. Meanwhile the most recent data available shows that in June the number of urgent suspected cancer referrals was 21 per cent lower than a year earlier. Lung cancer referrals were especially hard-hit, with 41 per cent fewer referrals than in June 2019.
Michelle Mitchell, the charity’s chief executive, acknowledged the NHS had been working hard to set up “Covid-protected” spaces so that patients could get the care they needed in a safe environment. But “we’re worried the backlog of patients isn’t being cleared quickly enough”, she said.
Ms Mitchell added it was “more crucial than ever” that the government ensured the “already overstretched” NHS workforce received the investment it needed in the comprehensive spending review expected this year.
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