Now is the time to act, urge health leaders following the government’s announcement of its Covid-19 autumn and winter plans for England on 14 September.
Hospital patients suffering from coronavirus are now at their highest level since March. The government introduced restrictions last October when there were more than 1,000 daily Covid-19 hospital admissions. Now, there are more than 8,000 people hospitalised with Covid-19, and 50 per cent more patients in intensive care than last October.
The NHS is under further strain from the 5.6 million backlog of people waiting for treatment that has built up over the course of the pandemic – with a flood of patients coming forward for life-saving treatment who are very sick or in need of time-sensitive surgery.
Add to that the unusual rise of hospitalisations from other viruses after over a year of avoiding germs – as the New Statesman reports here – and what is expected to be a tougher winter flu season because of lower immunity levels, and the winter looks bleak.
As Dr Dale Gardiner, the intensive care doctor and spokesperson for the Faculty of Intensive Care Medicine, told BBC Radio 4’s Today programme on 15 September, patients are suffering their emergencies “in slow motion” because of the pressures on the NHS tackling “sickness levels like never before”.
He described the NHS as a “building that has survived an earthquake and yet is still standing”, looking normal from the outside but full of cracks within.
On 14 September, Health Secretary Sajid Javid and Prime Minister Boris Johnson announced they would be sticking with “Plan A” to prevent the NHS being overwhelmed. This includes: vaccines for 12-15-year-olds; a booster programme for priority groups; encouraging the unvaccinated to get jabbed.
They also outlined that they would fall back on “Plan B” if the NHS comes under unsustainable pressure. This would mean: reintroducing mask mandates; urging caution; vaccine passports; guidance to work from home.
Yet some on the NHS front line fear it’s already time for plan B, which in itself doesn’t go far enough – warning that ministers must keep the prospect of a lockdown on the table.
“We saw how overwhelmed the UK was last winter and the government must be prepared to take swift action should the admissions figures rise – including further firebreak lockdowns if needed,” says a spokesperson for Doctors’ Association UK, a grassroots organisation working with thousands of doctors.
“Plan A would be a workable approach if the NHS was not already overwhelmed from 18 months of this crisis,” they added, warning that all sectors of the health service are struggling, and ambulance and emergency department services “may cease to function if inundated with large numbers of sick people”.
The group argues that social distancing and mask-wearing should be “standard as part of plan A”. It warns that backlogs in hospital waiting times, blood test bottle shortages and delays to mental health services will “only worsen as winter approaches”.
Pat Cullen, chief executive and general secretary of the Royal College of Nursing – which represents 465,000 nurses, student nurses, midwives and nursing support workers – describes the NHS as heading towards a “knife-edge winter we all fear”.
She criticises the government for failing to factor nursing workforce shortages into its autumn and winter plans. “Neglecting to mention these issues does not mean they will go away.”
With nursing vacancies nearly at a record high, Cullen says “health and care staff are not an inexhaustible resource. The last year has shown that, without adequate support and protection, more staff are becoming ill and unable to work”.
Doctors argue that the government must “act now and introduce other measures” to its official plan, in order to “keep the health service afloat this winter”, says Dr Chaand Nagpaul, council chair of the British Medical Association, which represents and negotiates on behalf of all doctors and medical students in the UK.
He argues that the government should make outdoor meeting where possible and mask-wearing in crowded indoor spaces a requirement rather than simply advice. “We’ve had this kind of doublespeak before, which has resulted in action not being taken until it is too late.”
Warning that if extra preventative measures are not put in place now, then England could see a situation where the NHS is “dangerously overwhelmed” and “ambulances were queuing round corners and hospitals had no choice but to pause all elective care”.
“While ministers speak of a ‘Plan B’ – although on what basis is unclear – they should open their eyes and realise that now is the time to act,” Nagpaul adds.
Matthew Taylor, chief executive of the NHS Confederation, which represents a wide range of health organisations, says the “government must not hesitate to act decisively if more drastic action is needed” over autumn and winter, revealing that “already, its [the NHS’s] services are facing impossible pressure and front-line staff are worried about what lies ahead”. He is cautious about the current plans, saying “time will tell whether these measures will be enough”.
Saffron Cordery, deputy chief executive of NHS Providers, which represents NHS trusts, describes the situation in the NHS as “far from ‘normal’”, and expects the next few months to be “busier than ever” for the health service.
While she says trust leaders “broadly welcome” the government’s plans, they are “already grappling with record waiting lists, lower bed capacity due to infection control measures, and rising demand for urgent and emergency care”, and are encountering “more people severely ill requiring complex care”.
A “critical concern” among some hospital trusts, she adds, is short staffing and levels of “burn out” after a gruelling 18 months.
The chief scientific adviser Patrick Vallance has advised Boris Johnson to “go hard and go early” with coronavirus restrictions this winter. Yet the Prime Minister will currently only consider vaccine passports, mandatory masks and home-working guidance as a plan B.
That said, the legislation that would allow the government to impose future local or national lockdowns has not been repealed, suggesting an as-of-yet non-existent “Plan C” could look very different, depending on how – or whether – our embattled health service copes.