NHS will take months to return to normal in England, says hospitals boss

The NHS in England will take “months” to return to normal service after the Covid crisis is finally over, because its workforce is “exhausted and traumatised”, according to a senior hospital trusts boss, who says many staff may quit altogether.

Hundreds of staff members are being denied the chance to decompress after working intensely and seeing huge numbers of patients dying during the brutal second wave, and as a result “very large numbers” will go on long-term sick leave or leave their jobs, said Chris Hopson, the chief executive of NHS Providers.

MPs or patients should neither expect nor pressurise the NHS to immediately resume speedy diagnostic and treatment services because that is “not possible”, he told the Guardian. Cancelled surgeries, thousands of which have been repeatedly postponed since March 2020 for ailments such as cancer, will also take time to return to normal.

Almost 4.5 million people in England are waiting for hospital care – the highest number on record – and in theory should be treated within 18 weeks. But the widespread disruption to non-Covid care wreaked by the pandemic means waiting times have plummeted and the number of people forced to wait more than a year for sometimes urgent care has soared from 1,398 to 192,169 in just a year.

“There’s potentially quite a tension between giving staff who are completely exhausted the space and support they need to recover, and at the same time the NHS recovering the backlogs of care that have built up, particularly in the hospital sector,” said Hopson, whose organisation represents England’s 240 NHS trusts.

“What [hospital] chief executives worry about is that the focus is just going to be on the service delivery, about ‘quickly, quickly, quickly, catch up on all of this’. Of course that’s really, really important. How do we balance that with the need to give our staff space to recover and decompress? That’s a really tricky and difficult issue. These could potentially be conflicting demands for a lot of people [in the NHS]”.

Ministers need to explain to the public that hospitals will not be able to tackle the huge backlog of cancelled care until frontline personnel have taken a rest, Hopson said. Many of them will need lengthy spells away from their jobs to recover physically and mentally once the current peak of Covid-19 has passed, probably in about a month, he added.

“We cannot expect the NHS to carry on at the intensity we’ve been running at. We’ve completely run the tank dry and need to give people the chance to recover.” His views reflect a belief among hospital bosses that if staff are not given proper time off, some may “break”.

Hopson urged politicians to come up with “a clear set of expectations about what the public can expect over the next few months, as we go through this period of enabling our staff to just recover from what we’ve asked and expected them to do. It’s striking how many NHS staff on TV recently have said things like ‘I feel broken’ or ‘I feel burned out.’”

A delay before the NHS gets back to normal is “a difficult concept, because some people might say: ‘Oh look, why are these people not doing what they should be doing?’ It’s just not possible to carry on asking staff to do that for a further number of weeks and months. That would be unreasonable.”

The different NHS bodies and what they cover

NHS trusts

There are 216 in England, which provide acute, specialist, ambulance, community and mental health care. They are each responsible for giving patients care and treatment, within specified waiting-times, sticking to their budgets and hiring staff. Trusts have worked together as never before during the pandemic, for example by accepting critically-ill Covid patients from nearby areas.

NHS England

A body quasi-independent from the Department of Health and Social Care that oversees the running of the NHS in England, distributes its budget and sets its priorities. Its chief executive, Sir Simon Stevens, has known Boris Johnson since they were at Oxford University together in the 1980s. He regularly gives evidence to parliamentary committees and has appeared at several No 10 Covid briefings.

NHS Providers

Represent England’s NHS trusts. Its chief executive, Chris Hopson, a regular interviewee on broadcast outlets, has a long track record of highlighting issues of concern to hospital bosses, for example the inadequate supply of personal protective equipment for NHS staff last spring, the shambles of the government’s Test and Trace programme and demand for tougher restrictions on personal freedoms in order to drive down coronavirus infections. Canny and a highly effective communicator, he is also well-connected in Whitehall and is taken seriously by ministers and Stevens as is the public face of the people running NHS hospitals.

NHS Confederation

It performs a similar role to NHS Providers, with two differences. It represents NHS bodies in Wales as well as England, and it also represents England’s 1,260 primary care networks – local groupings of GP surgeries – so speaks for GPs who send patients for care, not just the trusts that provide it. The confederation’s link with family doctors mean it has been much more closely involved in the ongoing rollout of the Covid vaccines than NHS Providers.

British Medical Association

It is the main trade union representing about 70% of the UK’s 240,000 doctors. As such ministers have to heed its views, not least because it negotiates doctors’ pay. But it is also a professional body which produces guidance to improve care both with specific conditions and across health more generally. Its chair of council (leader), Dr Chaand Nagpaul – a London GP – is probably the country’s most high-profile doctor, and offers his views daily on the latest developments with the pandemic.

The Hospital Consultants and Specialists Association

A smaller medical trade union than the BMA, set up a few years ago. Its president, anaesthetist Dr Claudia Paoloni, is also often quoted in the media.

Doctors Association UK

A campaigning network of grassroots medics across the UK which was only formed a few years ago. It uses insights and testimonies from frontline medics to expose what it sees as failings in government or NHS policy, such as bullying or difficulties obtaining a visa to work in the NHS. Its main public face is Dr Samantha Batt-Rawden, an intensive care doctor. She is an articulate and accomplished media performer and regularly uses Twitter to highlight issues.

Everydoctor

Similar in make-up and purpose to the DAUK, highlighting frontline doctors’ experiences. Its founder, Dr Julia Patterson, who trained as a psychiatrist, has recently become its chief executive as part of its plans to become more professional and less ad-hoc in a bid to expand its role, reach and influence. It is holding the first of what it intends to be regular press conferences this week.

Nigel Edwards, chief executive of the Nuffield Trust health thinktank, said ministers and the public would have to accept that longer waiting times for months ahead are inevitable. NHS staff sickness, holes in the workforce and the need to recover from the pandemic mean “there will be trade-offs, and the government will need to be frank about how slowly health services will realistically recover, and in turn what the public can reasonably expect from their NHS”.

A survey of 7,000 doctors across the UK in December undertaken by the British Medical Association found that as a result of the intense pressures of working during Covid, 28% are more likely to retire early, 21% are more likely to leave the NHS for another career and 47% are more likely to work fewer hours.

Prof Neil Mortensen, the president of the Royal College of Surgeons of England, backed Hopson’s request for MPs to be patient with the NHS’s reopening of services while its workforce recovers. “There is no point politicians talking about 24/7 operating when many anaesthetists, theatre staff and surgeons will need time to recuperate”, he said.

He said that it took the NHS in England until the autumn to resume doing 60-80% of its usual amount of surgery after the first peak of Covid in the spring, but added that long waits for care should be avoided because they can cause patients to become depressed or worsen physically.

NHS England did not respond directly to Hopson’s remarks. An NHS spokesperson said only that: “Pressures on NHS staff through the pandemic have been both intense and unrelenting, and the welfare of our workforce is critical to ongoing patient care.

“During the first wave of the pandemic, more than 400,000 NHS workers accessed the NHS’s staff health and wellbeing programme, and clearly this support needs to continue and to expand.”