Precisely how prepared is the NHS for what comes next?

Stay Home. Protect the NHS. Save Lives. The slogan was emblazoned on the Prime Minister’s lectern for the first time three days before the country entered total lockdown.

In Government circles, the mantra was seen as one of the most successful in modern political history, driving compliance with the most draconian of instructions. But senior figures in the health service had misgivings. There were fears about the “weaponisation” of the NHS to support a strategy that might later prove divisive. And there was concern that the public’s desire to “do right” by the health service could backfire, if those in need of medical help were deterred from seeking it. Both were to come to pass. Britain now faces a second wave of Covid, but the slogan has not been dusted off. So, is the NHS prepared for what the coming months will bring?

Yesterday, the health service launched a new campaign – Help Us To Help You – reminding patients they are not “a burden” and urging those in need of help to get it. While it has a mammoth backlog of cases delayed by the pandemic, including a 100-fold rise in those waiting a year for surgery, it is “open for business”, it insists.

With the first coronavirus wave came the diktat from NHS England that hospitals should empty a third of their beds to avoid overwhelming hospitals, a situation that had occurred in Italy.

A&E attendance dropped sharply, and deaths from heart attacks soared. Arrivals at A&E are still a fifth down on normal levels.

This time, no such instructions have been issued. Health officials say the NHS is better prepared. Much was learnt in the first few months of the crisis; partly about how to treat the most severe cases and the circumstances in which ventilators might need to be used.

The nature of the spread of the virus, and its concentration in some parts of the country, notably the North West, means instead of a blanket national response the regions are expected to make their own arrangements.

Health officials say trusts should work within a system of “mutual aid”, with hospitals asked to assist each other, so services for non-covid patients can run for as long as possible. But some hospital managers in the worst-hit areas say they are under pressure to hold the line and avoid cancellations for surgery, to help demonstrate that the NHS is working, when they think such measures are necessary.

All NHS trusts have been told to draw up worst-case scenario contingency plans, where a third of beds are devoted to coronavirus patients.

Nightingale hospitals are unlikely to be stepped up until other hospitals reach capacity, with the private sector enlisted to help with the backlog of non-covid work. Senior managers say the buildings – seen by some critics as “white elephants” during the pandemic – are more likely to be used for those recovering from Covid treatment, meaning that they would be deployed at a later stage in the second wave.

Many fear lessons have not been learnt; chief among them: how to stop hospitals fuelling the spread of disease.

Papers from Sage, the Scientific Advisory Group for Emergencies, suggest that at the peak of the pandemic, transmission within hospitals caused up to 22 per cent of hospitalised cases.

Scientists and the influential Commons health committee have repeatedly called for weekly testing of all staff, to prevent such outbreaks and keep staff at work.

Yet only this week, senior figures at NHS England could only say they were on “standby” and would introduce such tests if advised by the chief medical officer. No such advice has yet been issued.

The implosion of NHS test and trace, even before 16,000 positive cases were “lost” in the system, allowing the virus to spread unchecked, and the lack of spare testing capacity have left little hope this will soon be introduced.

Research this week shows that

18 per cent of recently hospitalised Covid patients are likely to have caught it there, rising to 24 per cent in the North West.

Meanwhile, strident messages about the NHS are emanating from political circles. “We must do all we can to prevent our NHS from becoming overwhelmed,” tweeted Nadine Dorries, the health minister, on Thursday.

Hours later, the Health Secretary said he was “very worried” about the trends. Matt Hancock told the NHS Providers conference: “We know from bitter experience that the more coronavirus spreads, the harder it is to do all the other vital work of the NHS.

“Our strategy is simple – suppress the virus and support the economy, education and the NHS until a vaccine can make us safe.”