Hospitals in England will miss target for restoring pre-Covid services

Most trusts in England ‘will fall short’ of official edict to return to 90% of elective surgery and outpatient procedures

NHS England has told trusts that outpatient procedures such as CT scans should be fully restored by October. Photograph: Neil Hall/AFP via Getty Images

Michael Savage Policy editor-Sun 6 Sep 2020

Most hospitals in England will fall short of official demands to increase their services back to almost pre-Covid levels next month as they continue to deal with the fallout from the pandemic, health service insiders have warned.

An official edict by NHS England called on trusts across the country to return a series of services back to 90% of activity levels seen before the crisis hit. However, insiders warned that the continued need for extra precautions to cope with Covid-19 meant some hospital trusts would still be 30% below their pre-crisis capacity.

The edict comes amid nervousness within the health service that it remains acutely vulnerable to rising infection rates and dependent on a test-and-trace system that some still regard as too unreliable.

A reduction in beds to improve social distancing, the cumbersome PPE that surgeons are having to wear and the loss of facilities such as waiting rooms are still hitting hospital capacity. Some insiders also warned that patients were still not returning in sufficient numbers in some areas.

A letter to NHS Trusts at the end of July, signed by the NHS England chief, Simon Stevens, stated they should return to 90% of their pre-Covid activity levels in overnight elective surgery and outpatient procedures. It stated that MRI and CT scans, as well as endoscopy procedures, should be back to 100% by next month.

Hospitals are somewhere between 15% to 30% [of] capacity down, just at the point where you’re wanting to recover all of the backlog of care that has built up

Chris Hopson, NHS Providers

Siva Anandaciva, chief analyst at the King’s Fund thinktank, said: “Ramping up activity to meet these new national targets was always going to be an incredibly tough ask for the NHS. Many frontline NHS staff are physically and emotionally exhausted by their experiences during the pandemic, new safety restrictions mean some NHS treatments and procedures now take more time to schedule and deliver, and there are indications that patients remain hesitant to use some face-to-face NHS services.

“Although the desire to restore NHS activity levels as soon as possible may be the right one, these new targets may prove to be more skewed towards ambition than realism.”

Chris Hopson, chief executive of NHS Providers, said it was right to set ambitious targets, but true that most trusts would struggle to meet them.

“There is a huge amount of good work going on at the NHS frontline to do that, most of it unreported,” he said. “As one trust leader said to me today, they are significantly exceeding their own expectations … of how fast they do this. The reality is that targets are very ambitious. We think a small number of trusts will exceed them and a minority will meet them.

“The majority, not for want of trying, will probably fall short. Everybody is doing their job as best they can, both in setting the ambitious targets and trusts doing everything they can to reach them. Hospital trusts are rightly adopting a very rigorous approach to infection control … so everywhere you look, you’re losing capacity.

“The general estimate is that hospitals are somewhere between 15% to 30% [of] capacity down, just at the point where you really need it, because you’re wanting to recover all of the backlog of care that has built up.”

The concerns about the service’s ability to return to full capacity, or even meet the targets already set out, come ahead of a looming battle over the health service’s funding.

Many in the service now believe a long-term financial settlement, agreed under Theresa May, will have to be completely overhauled in light of the pandemic and the backlogs it has generated.

Health chiefs predicted a huge battle as the government’s spending review approaches, planned for later this year. Some predictions suggest that the waiting list for hospital treatment could increase to almost 10 million people by Christmas.

An NHS spokesperson said: “Treating as many people needing non-urgent care as possible ahead of winter is the right priority, and thanks to the hard work of local teams, the number of operations has more than doubled since the peak of the virus.

“This continued success will, however, also depend on controlling the virus in the community, including through test and trace, rapid action to control local outbreaks, and of course continued public support for hand hygiene and social distancing measures.”