Overlooked, but not overcome: smaller hospitals and the staff response to the Covid-19 pandemic

How have smaller hospitals fared over the pandemic, and how did it feel from the perspective of those responding during the first years of the biggest health care emergency of our times? We interviewed staff in smaller hospitals around the country during 2021 to understand their key concerns from the perspective of institutions that are sometimes overlooked when system planning gets done. We also make a set of recommendations for future crisis planning and response.


Published: 09/12/2022

Read the report [PDF 180KB]

Although the burden placed on people by Covid-19 and its fallout is well documented, the health care system and society more generally have been affected to such an extent that assessments of the pandemic, particularly the initial waves and their response, will likely gather pace in coming years rather than abating. 

Health care professionals throughout the country underwent huge levels of stress, and while large urban hospitals, particularly those in London, were initially hit by the largest volumes of Covid cases, most smaller hospitals elsewhere were struggling with a lack of staff and resources long before the first news of trouble in Wuhan. Right from the start of the pandemic, there were concerns that smaller hospitals, which tend to care for older and more vulnerable populations, might find it more difficult to cope, with the potential for an over-stretched system to fail to provide adequate care.

So how did smaller hospitals fare during the pandemic? This report focuses on the operational responses and management approaches taken by staff from 10 smaller hospitals over the course of the first and second waves of the pandemic. It is intended to tell the story from the perspective of those working in small hospitals in order to understand what happened to acute and emergency care in these institutions as the country was gripped by the biggest health crisis in generations.

Suggested citation

Vaughan L and Leone C (2022) Overlooked, but not overcome: smaller hospitals and the staff response to the Covid-19 pandemic. Briefing, Nuffield Trust.