HSJ’s daily update of what our sources are telling us about the progress of the pandemic

With many parts of the NHS facing a period of the most extreme operational pressure they have ever known, Daily Insight will bring you an update on the latest developments and concerns from those leading the efforts.

Yesterday saw another marathon session by Sir Simon Stevens before a committee of MPs answering questions on covid. Two weeks ago he was on a large panel talking about the vaccine programme; this time it was just him talking about the NHS performance in the pandemic.

The questions were far-reaching over the course of two hours but an important theme emerged around the importance of resilience in the future, post-pandemic NHS – most notably in future-proofing the workforce.

Sir Simon managed to crystallise this in a soundbite in an answer to one of the final questions, telling science and technology committee chair Greg Clark that “resilience requires buffer and buffer can look wasteful until the moment that it isn’t”.

He said one of the big lessons from the pandemic is that resilience should be built into public services rather than running everything to optimum, just-in-time efficiency.

The key lack of buffer over the past year has been, clearly, the straitened state of the NHS clinical and medical workforce. Primary, secondary, tertiary and community care providers have repurposed themselves to deal with the onslaught of the pandemic but the key question mark in the NHS response to covid has been over staff headcounts, not the number of physical beds on wards.

This has been no more evident than in the effort to juggle the covid response with the need to provide non-covid care. Taking elective and cancer surgery, a crucial rate-limiting step – to use the modern parlance – has been the availability of anaesthetists. It is impossible to do surgery if the gasman cannot come calling because they’re busy staffing an ICU full of covid patients.

Unfortunately for the NHS, Sir Simon pointed out there is a paradox in that it has robust medium-term outlook on its revenue – its day to day funding – but shorter term outlook on things like capital investment into infrastructure and workforce training, both of which require much longer term perspectives.

Jeremy Hunt, health and social care committee chair, suggested an independent body could publish annual estimates of how many people would be needed to go into training for roles in the NHS. Sir Simon welcomed anything that brings predictability.

The importance of figuring out the needs over the medium term and longer term will become much more pertinent into the spring and summer when the NHS has a better understanding of just how big its elective backlog will be, as well as the additional demands put on it by effects of the pandemic, such as long-covid and additional mental health issues.

Sir Simon picked up on the proliferation of mental health issues more than once through his evidence. He cited the surge in urgent referrals for young people into eating disorder services as a particular source of concern. He added that it would likely be one of the services at the front of the queue for some of the £500m set aside by the Treasury for the NHS to address mental health issues in the coming year.

However, he said, addressing these new and expanding challenges from the pandemic will require an expansion in the mental health workforce. Without more psychiatrists, therapists, mental health nurses and alike, “of the rest will be for the birds”.

Also speaking at the regular 10 Downing Street press conference on Tuesday evening, Sir Simon reiterated that the NHS wanted to know it “will get the staffing support it needs in the years to come”.