The NHS will be inflicting pain, misery and risk of death on tens of thousands of patients if it again shuts down normal care when a second wave of Covid-19 hits, doctors’ and surgeons’ leaders are warning.

They are urging NHS bosses not to use the same sweeping closures of services that were introduced in March to help hospitals cope with the huge influx of patients seriously ill with Covid [1].

“The NHS must never again be a Covid-only service. There is a duty to the thousands of patients waiting in need and in pain to make sure they can be treated,” said Prof Neil Mortensen, president of the Royal College of Surgeons of England.

The leader of Britain’s doctors warned that hospitals should not leave patients “stranded” by again suspending a wide range of diagnostic and treatment services.

“We cannot have a situation in which patients are unable to access diagnostic tests, clinic appointments and treatment which they urgently need and are simply left stranded,” said Dr Chaand Nagpaul, chair of council at the British Medical Association (BMA).

“If someone needs care – for example for cancer, heart trouble, a breathing condition or a neurological problem – they must get it when they need it.”

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Their comments come amid growing fears about a second wave of infections and mounting concern that the widespread disruption to hospital care that began in March, and patients’ fears about going into hospital, led to thousands of patients dying avoidably of cancer and heart disease and will lead to further fatalities in the years ahead.

Over 1 million fewer patients underwent planned surgery in England in April, May and June [2], and 30,000 to 40,000 could not start cancer treatment as hospitals discharged thousands of patients and suspended many of their usual services to concentrate on treating those with Covid-19.

Unavailability of care, in tandem with patients’ reluctance to go into hospital, have been linked to the fact that in England 12,000 more peoplethan usual have died of illness not linked to Covid in recent months, such as heart attacks, according to the Office for National Statistics (ONS).

One cancer expert has estimated that anywhere between 7,000 and 35,000 patients could die over the next year as a direct result of missing out on NHS care in recent months.

“The NHS had to stop almost all planned surgery at the beginning of the Covid crisis, and we just cannot let that happen again. Things will need to be done differently in the face of any further spike,” Mortensen told the Guardian.

Nagpaul added: “While not publicised in the daily briefings, these [12,000] excess deaths are just as much a tragedy and loss to loved ones as those occurring from the virus.”

Mortensen and Nagpaul’s warnings to NHS bosses that they must find ways to maintain normal care in the event of a second wave comes amid mounting fears about the growing number of infections and the recent rise in the R rate in some regions of England and Scotland which has led to a number of local lockdowns being imposed on towns such as Leicester and Aberdeen.

“The NHS must never again be a Covid-only service. There is a duty to the thousands of patients waiting in need and pain”
Prof Neil Mortensen

Hospitals should set up more “Covid-lite” sites to enable surgeons to resume common operations such as hip and knee replacements and cataract removals, and make good use of the NHS’s £400m-a-month deal with private hospitals, Mortensen suggested. The NHS should also look at using the seven Nightingale hospitals it created early in the pandemic as extra capacity for non-Covid care, added Nagpaul [3].

The NHS is trying to arrange care for the large number of patients who missed out on care in recent months, many of whom are facing a long delay before they can get seen. But it could see its treatment waiting list soar if there is a repeat of the shutdown that NHS England chief executive Sir Simon Stevens ordered in March, the BMA boss said.

“Aside from the individual distress, pain and potentially life-threatening impact that delaying care would have on individuals, there’s a risk that increasing the backlog further would have a grave consequence for the NHS in the future.

“The knock-on of not addressing this now and delaying further care during a potential second wave could mean that we are constantly trying to catch up with the missed care,” said Nagpaul.

The NHS Confederation, which represents hospitals, has already acknowledged that the service’s unprecedented pausing of normal care involved “a terrible cost” for patients needing non-Covid care [4]. Niall Dickson, its chief executive, said: “The NHS can flex and will be there for patients again if there is a second wave. The challenge this time will be to run both Covid and non-Covid services in parallel as far as is possible.”

Hospitals are working hard to clear the backlog that built up. But they are hampered by social distancing limiting the number of patients they can have on site and staff having to wear personal protective equipment, reducing the number of operations that they can perform.

Newcastle upon Tyne Hospitals trust has begun running ophthalmology clinics at the weekend in a bid to tackle its backlog of patients with sight problems awaiting diagnostic tests. Ninety patients will attend on both Saturday and Sunday. Patients awaiting a CT or MRI scan, which play a key role in diagnosing cancer, are also being invited to attend new weekend radiology clinics.

The Academy of Medical Sciences last month estimated that as many as 120,000 people could die of Covid this winter and the NHS could be overwhelmed if a second wave arrives at the same time as hospitals are struggling to deal with the usual spike in flu and other seasonal breathing problems [5].

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The medical leaders’ intervention drew a sharp response from NHS England, which refused to rule out a second shutdown.

“Even at the height of coronavirus, for every one Covid patient in hospital, there were two other in-patients being treated for other conditions, so it is factually untrue to suggest the NHS was ever a ‘Covid-only service’,” said a spokesperson.

“More than five million urgent tests, checks and other treatments took place during the peak of the virus, including 65,000 patients getting vital cancer treatment. How the health service has to respond to any further Covid peak will partly depend on just how big it is.”

Stevens has told hospitals to get back to providing 80% of planned operations by September and 90% by October, in order to reduce the backlog as far as possible before a second wave hits.

Denis Campbell Health policy editor