• Exclusive HSJ survey lays bare trust chiefs’ concerns over covid-19
  • Three biggest concerns are lack of staff testing, staff and PPE
  • “We will run out of ICU capacity next week,” warn 13 trusts
  • Hospital chief: “We are preserving ventilation capacity by ensuring that only those who may survive are considered”

Lack of staff testing, workforce shortages and running out of personal protective equipment are the three biggest concerns for trusts fighting the coronavirus outbreak, according to an HSJ chief executive survey conducted over the last 36 hours.

Thirteen of the 34 trust chief executives who responded to the snap survey, who were from trusts across England, also warned they would run out of intensive care capacity by next week as the number of coronavirus cases continue to rise.

The survey also revealed some trusts were already being forced to dilute safe staffing ratios and ration facilities. One chief warned: “We are preserving ventilation capacity by ensuring that only those who may survive are considered.”

However, the majority of respondents were supportive of system leaders’ guidance so far. Several respondents praised the “impressive pace and detail of the advice” (See: Majority of trust chiefs surveyed ‘satisfied’ with centre’s covid-19 action).

The three biggest areas of concern raised by the chiefs surveyed were:

  • Lack of staff testing, raised by 26 of the 34 respondents (77 per cent);
  • Staff shortages, raised by 26 of the 34 respondents (77 per cent); and
  • PPE shortages, raised by 23 of the 34 respondents (68 per cent).

One acute trust chief from the Midlands revealed they had faced “a near revolt amongst my clinical staff [because of PPE shortages and also] about the national guidance on use of surgical masks for non-aerosol generating work”.

The senior figure added: “They see hazmat suits and FFP3 [masks] being deployed in all scenarios in western Europe and want to know why we aren’t doing the same. Staff testing… would provide a huge psychological boost and help us get staff back to work.”

Out of ICU capacity ‘by end of the week’

The responses also underlined intensive care capacity is running out fast in a significant number of trusts.

Eight out of the 22 chiefs who answered this question said they would run out of capacity this week and a further five by next week. Trusts running out of capacity were not confined to hotspots identified so far in London and the Black Country.

One acute trust chief in the South East said: “Modelling suggests we won’t have enough capacity of any sort, including ICU. Staffing during the peak will suffer through illness and we won’t have enough staff to meet the additional capacity even if we didn’t have sickness.”

PPE shortages continue

The chiefs said the PPE they were most in need of were FFP3 masks — cited by 24 of the 32 respondents to this question — and visors — cited by 21 of the respondents. But equally sought after were sanitiser and cleaning products, cited by 21 of the respondents.


An acute chief from the North East and Yorkshire region added: “Lack of clarity in PPE guidance is exacerbating the PPE shortages. Staff testing is essential to keep staff numbers up (getting those who are isolating back to work if safe to do so).

“PPE guidance has not always been clear or consistent and is undermined by messages from some other national bodies.”

The continuing concerns about PPE shortages come despite assurances from NHS England leaders last week there was no national shortage and the problems were related to distribution issues. The army’s logistics team was drafted in to support efforts over the weekend. 

‘Have moved heaven and earth’

However, chair of the Commons health committee and former health secretary Jeremy Hunt praised the central efforts to address the PPE crisis in recent weeks. He said: “[NHS England and the Department of Health and Social Care] have moved heaven and earth to sort out PPE problems over the last week.”

But he added: “I urge the government to order much more of the high specification kit, including FFP3 masks and full length gowns.”

Mr Hunt also criticised the government for moving too slowly on staff testing

“I think we need to move much faster,” he said. ”We should introduce weekly testing for all NHS staff to ensure they are not going to be infecting vulnerable patients. This has to be the number one priority (for the government) to sort out.

“We need to massively ramp up the community testing if we’re going to supress the virus properly. We’ve got very welcome ambitions from the government but that’s not the same as a national plan.”

HSJ put the survey’s findings to NHSE and the DHSC.

The DHSC referred HSJ to yesterday’s announcement that it had “ramped up the delivery of protective kit”

An NHSE&I spokesman said: “These results show the vast majority of trust leaders are clearly concentrating on playing their part in preparing the NHS for this unprecedented challenge – and doing so admirably – rather than completing surveys.

“NHS staff at all levels are working around the clock to get services ready, including rapidly ramping up treatment capacity within hospitals, and we are supporting them nationally including striking a landmark deal with private care providers, calling up student and recently-retired clinicians to bolster the front line, and supporting the Department of Health as they procure for us the PHE-recommended protective equipment.”


HSJ sent the survey to trust chief executives on Sunday evening. Thirty-four chief executives filled in the survey, representing around 15 per cent of NHS trust chief executives in England. The survey was closed on Tuesday lunchtime. Some respondents, however, failed to fill in every question. This explains the variation in response numbers for different questions. 

 Updated 24 March 1.40pm: Minor error in ICU response figures corrected. 

Exclusive: Staff in ‘near revolt’ over protective gear crisis