The NHS has too few staff to prepare for a pandemic surge, while its ageing buildings and social care’s weak ‘resilience and capacity’ would also undermine its response, NHS England has warned.
A new NHSE submission to the covid-19 public inquiry says funding pressure from 2010 has undermined the health service’s “resilience” and that “resilience and capacity issues in social care are national issues which must be addressed from the centre”.
The document was posted unnoticed on the inquiry website last month. No current or former NHSE leaders have so far given evidence to the inquiry. It is the first time NHSE has clearly set out that understaffing and underinvestment compromised the service’s readiness to deal with the pandemic.
Referring to the NHS’s ability to create “surge capacity [with] flexible staff and equipment which can be pivoted into different roles”, it goes on: “It is only possible to train staff to work more flexibly into different roles/environments if they can be freed up to attend training and refreshers.
“This requires ‘surplus’ staff numbers on rotas, which is not currently possible in relation to many staffing groups across the NHS.”
The submission, referring to “discussion of bed capacity and workforce” in inquiry hearings so far, adds: “The NHS needs staff. We now (in 2023) have a long-term workforce plan but there are ‘no quick fixes’.”
Referring to “NHS estate and capital spending”, it says the “age and design of the NHS estate means a lack of flexibility into surge response is ‘baked in’… 12 per cent of the estate pre-dates the founding of the NHS in 1948, around 17 per cent is over 60 years old and about 44 per cent is between 30 and 60 years.
“Furthermore, facilities that are needed go beyond infrastructure for oxygen, to flexible theatre/ICU space, spaces that can be segregated to enable good infection prevention control measures and adequate ventilation systems (as well as enabling digital healthcare).”
The statement, a closing submission for the inquiry’s first module, adds: “The age and configuration of the NHS estate caused multiple challenges during covid-19 such as infection prevention and control, patient segregation, and providing oxygen supply. It was a rate-limiting factor in the NHS’s ability to adapt and increase our capacity.”
NHS leaders, including at NHSE, have for several years been pressing for more investment in staff, buildings and social care.
A closing submission from the Department of Health and Social Care appears to agree “resilience” was poor when covid hit, stating: “As a society, there is a need to consider how levels of core capacity for day-to-day health and care services can remain resilient and be expanded to meet demand when faced with a health emergency.
“The department accepts that at the time the pandemic struck, the adult social care sector had structural challenges which damaged its resilience. It also notes that the NHS is run at capacity, and therefore has little spare flexibility in the system when shocks occur. It is also the case that public health funding, like most other forms of funding, was not protected in the same way as the NHS.”
But in a statement a spokesperson appeared to suggest things have since improved, saying: ”We’ve made significant progress in growing the workforce with record numbers of staff working in the NHS. We are also implementing the first ever NHS Long Term Workforce Plan, backed by over £2.4bn in government funding, which will deliver the biggest expansion of staff training in NHS history.” They also highlighted “work to upgrade and modernise NHS buildings”, and including the new hospital programme, and said it was ”investing £7.5bn to help put social care on a stronger financial footing”.
So far the covid inquiry has focused on pandemic preparations, though it has also touched on the NHS’s resilience and readiness. Senior current and former NHSE figures will give evidence to the inquiry in later hearings when it is due to examine the operational response more closely.
Testing and data
On the contentious subject of testing in a pandemic, in the same submission, NHSE pushes back on a suggestion it says was made to the inquiry by Duncan Selbie, the former Public Health England CEO, “that the plan was for NHS England to be responsible for mass testing in the event of an influenza pandemic”. Instead, it says, “we would respectfully note that testing for communicable diseases is and has traditionally been a public health function”; going on: “We mention this… not to side-step responsibilities, but to highlight the importance of being clear as to who is responsible for what.”
During the pandemic, DHSC led – and was often criticised over – the task of vastly expanding covid testing capacity, setting up the “NHS Test and Trace” unit.
The submission also comments on the readiness of NHS systems, early in the pandemic, to provide live operational data. It supports calls for “mapping” what data may be needed in future pandemics, but adds: “It does not necessarily follow that there could or should have been earlier commitment to building systems that would have enabled such data to be ‘switched on’… at least within the NHS.”
It says “data collection in the health system” is “an ongoing challenge and requires commitment, in terms of time and other resources, including the costs of information technology and systems. It cannot be divorced from the wider issues of system capacity, resilience and prioritisation.”
Updated at 3pm on 3 October when the DHSC provided a comment.