When Boris Johnson announced on Saturday that he was imposing the national lockdown measures he had long striven to avoid, he was clear about the reason — and the purpose.
Standing at the Number 10 podium on Saturday, the prime minister warned the NHS risked being overwhelmed and repeated the message that had done so much to motivate Britons to obey the initial countrywide lockdown in March: “stay at home, protect the NHS, save lives”.
Ministers had hoped that a combination of meticulously-observed social distancing, the Test and Trace programme and targeted local restrictions would curb the spread of the disease and keep the pressure on the country’s taxpayer-funded health service at manageable levels.
Instead, according to senior NHS officials, in parts of the country Covid-19 admissions were two to four times greater than the reasonable worst-case scenario for which the NHS had been asked to plan by the government.
Over the past week, the NHS had treated 2,800 additional Covid-19 inpatients — the equivalent of five hospitals worth, they pointed out.
Alison Pittard, dean of the Faculty of Intensive Care Medicine, said the government’s focus on imposing measures in particular virus hotspots had initially led to “a general feeling that things were being contained and therefore manageable. The number (of infections) in those areas were slowly increasing, but not dramatically as they did at the beginning of the year”.
But in the past few weeks the numbers in apparently less-affected areas had started to escalate “and in the hotspot areas the numbers had escalated more quickly than they expected”, added Dr Pittard.
As staff gear up for the second wave, the challenge they face is even more daunting than in March. Eight months ago other strains on the health service were relieved by a decision to cancel all non-urgent surgery and discharge thousands of patients in order to clear 33,000 beds for prospective Covid-19 patients.
The result, however, has been ballooning waiting lists for other forms of treatment, which health leaders and ministers alike are determined must now be tackled alongside the virus.
“I think that is what triggered the response from government because what we don’t want to do is go back to spring where we struggled to do very much normal activity and so it’s really important this time round we are able to manage both,” added Dr Pittard.
Chris Hopson, chief executive of NHS Providers, which represents leaders across the health service, said that, alongside the need to keep other treatments going, the NHS would soon be coping with winter when a surge in seasonal respiratory conditions leaves the service severely overstretched even at the best of times.
An additional complication was the need to put in place stringent infection control measures and to keep Covid-19 and non-Covid-19 patients apart, which had reduced hospital capacity by between 10 and 30 per cent, he said. Staff were also “really tired” after the effort of fighting the first wave.
Virtually every single trust chief executive he had spoken to had said their task now was “much, much more difficult” than it had been in March. “It is much more complicated in terms of the need to juggle both demand pressures and also capacity pressures”, Mr Hopson added.
Amid fears that the treatment backlog will grow still further, Ian Higginson, vice-president of the Royal College of Emergency Medicine, appealed to Britons to come to hospital if they felt ill, rather than believing they would not be safe or they should not add to the burdens on staff.
But Dr Higginson made clear that the strains on emergency departments and the wider NHS had long predated the coronavirus outbreak — storing up problems that were now being felt.
“Before the pandemic was even a thing our Royal College was saying acute care was really struggling, our emergency departments were under-resourced and overcrowded and often outdated in terms of their facilities and equipment,” he said.
Rapid changes had been made in emergency departments as a result of the first wave of the pandemic, to reorganise how things were done, “but of course we haven’t changed the whole NHS in the six months since this all started. Its underlying conditions are still present without the pandemic being layered on top of it,” he warned.
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