Covid-19: Tough decisions for NHS will mean the public accepting previously unpalatable rationing of care

The public will have to accept a reduced level of service from the NHS in a way that would have been deemed unpalatable just months ago as the service adjusts to a new way of working alongside Covid-19.

A discussion paper by the chief executive of the Nuffield Trust think tank warns that readjusting services to cope with the ever-present threat of infection will mean hospitals reducing the treatment they can provide due to added pressure on beds and staff, unless a fast and effective Covid test is rolled out.

Health care leaders will have to weigh up incredibly difficult choices that will leave people waiting longer and some services unavailable.

Here to stay? How the NHS will have to learn to live with coronavirus identifies several obstacles, which will slow down hospitals as they focus on restarting routine business alongside Covid-19 procedures.

• The English NHS has a lot of older hospital buildings, which include shared accommodation, and narrow corridors, which will make segregating Covid and non-Covid patients very difficult. Many hospitals do not have waiting areas that allow for social distancing. Additional capital investment will be needed to address these issues.
• Patients requiring planned surgery will need to be swabbed and required to self-isolate before planned investigation or treatment with a further test immediately before. The NHS will also require a larger amount of PPE and reliable supplies as it begins to take on more work.
• Services such as dentistry, general practice and others where physical contact between patient and professional is often essential, will face severe constraints in delivering care. Dental practices will face severe financial pressures from the need to clean rooms between patients and invest in full PPE, and despite the go-ahead to reopen services on 8 June, some may be unviable in the short term.
• The NHS will have a mountain to climb to address the waiting list, both in dealing with the backlog that predated pre-Covid and the consequences of postponing thousands of planned procedures. Some prioritisation of planned hospital work will inevitably happen, and some may not be able to be provided at all for some time. The NHS will have to continue to rely on the independent sector to support these efforts but even then, waiting lists will grow, possibly doubling within six months.  

A number of developments, which are outside of the health service’s control, could improve this situation such as the development and rollout of an effective Covid-19 vaccine, or the introduction of fast and reliable testing for infection.

Nuffield Trust Chief Executive Nigel Edwards said:

“The implications of living with the virus are profound and will dramatically change the relationship between the public and the NHS.

“Hospitals will need to remain in a state of readiness for a potential second spike in Covid-19 cases – which means there will be no return to business as usual as the service gears up now to begin to restart routine work and address a growing backlog of unmet need.

“Even before the pandemic, the NHS already had many outdated hospital buildings, extremely high bed occupancy, serious workforce problems, overcrowded A&Es and rising waiting lists. These problems, coupled with the challenge of containing infection and tackling the ongoing coronavirus crisis, will mean a profound change in the way we deliver services for the foreseeable."