Huge backlog in operations building due to lack of PPE and staff testing

Denis Campbell Health policy editor
Photograph: Neil Hall/AFP via Getty Images

A lack of vital protective equipment and long waits for coronavirus test results are stopping hospitals from tackling a huge backlog in operations, a key NHS leader is warning.

Patients whose surgery has been postponed because of the pandemic face even longer delays because hospitals are having to wait for as long as 13 days for the outcome of tests, Chris Hopson told the Guardian.

In thinly veiled criticism of the health secretary, Matt Hancock, the chief executive of hospital group NHS Providers blamed ministers for repeated failures to ensure easy availability of fast-turnaround testing for NHS staff, whiletrusts have warned about the lack of adequate supplies of surgical gowns.

Both problems risked patients unwittingly becoming infected with Covid-19 in hospitals across England, which would not be able to get back to providing the range of treatment they had before the pandemic until those problems were solved, said Hopson.

That along with ongoing shortages of the sterile gowns that operating theatre teams needed to perform surgery safely remained “major obstacles” to the NHS’s reopening, added Hopson.

“We can’t restart NHS services as quickly as everyone would like because of the wide range of constraints trusts are facing, including shortages of personal protective equipment (PPE) and testing,” said Hopson, whose organisation represents all 217 NHS trusts in England.

“My concern about reopening the NHS is that people are massively underestimating how difficult and complex it’s going to be to restart the full range of services and levels of activity that are needed. People think it’s like flicking a light switch back on again but it absolutely isn’t.

“It’s fiendishly complicated and will take a lot longer than people think because there are a number of different problems that have to be sorted first. We need to ensure that hospitals are safe for people without coronavirus who need to be treated, including those who need elective surgery.”

Some 4.2 million people in England are waiting to have a non-urgent procedure such as a cataract removal, hernia repair or hip or knee replacement.

Hopson’s remarks are a blow to Hancock and Sir Simon Stevens, NHS England’s chief executive. They have told hospitals to resume as soon as possible the normal activities – operations and diagnostic tests – that have been largely suspended since March because of the pandemic.

Hospitals cannot do that until doctors and nurses can have regular tests for coronavirus and get the results back very quickly, to prevent asymptomatic staff – or patients arriving for an operation – inadvertently bringing the virus in with them, added Hopson.

In pointed criticism of ministers, he said: “The gap between the tone and content of the government’s statements on testing and the difficult reality on the ground is painfully wide and needs to be closed quickly. The reality is five- and even 13-day test turnaround times, which are effectively useless to the hospital.”

Hancock pledged on 10 April that “we have capacity for all key social care staff and NHS staff who need to be tested to get those tests”. But many health workers say it is still too difficult to get a test and that results can take many days to come back.

Shortages of full-length surgical gowns could mean that patients have their surgery cancelled at the last minute, Hopson added.

Although patients due to have surgery have been told to isolate for 14 days beforehand, trusts typically only have four or five days of supply in hand, so cannot guarantee that they will have enough PPE to undertake the surgery, added Hopson.

“It’s particularly unfair to ask a patient whose operation has already been delayed to start the difficult process of isolation without being certain that they can actually perform the surgery when the due date arrives.”

NHS England bosses are understood to be sympathetic to Hopson’s concerns and share what he called hospital bosses’ “deep frustration” at ministers’ failure to solve either problem.

Hopson also identified “absolute exhaustion” among staff and the need to retain around 25% of intensive care unit beds for people with Covid-19 as other constraints on the NHS’s ability to return to normal.

Public Health England research published on Tuesday found that up to a fifth of hospital inpatients with Coronavirus and nine out of 10 healthcare staff may have become infected in hospital.

Doctors’ leaders said Hopson was right to warn that safety had to have been assured before operations could restart.

“While the PPE situation is improving, we need a guarantee that there is adequate equipment to protect all staff before we recommence services. This includes equipment for those delivering non-Covid care in order to reduce the risk of transmission through health settings. Staff must have confidence that they will be properly protected from infection now and into the future,” said Dr Rob Harwood, chair of the British Medical Association’s consultants committee.

That, and routine testing of patients due to have routine surgery “are central to protecting both staff and patients, and are essential if we are to avoid a second spike in the virus”.

Dr Claudia Paoloni, the president of the Hospital Consultants and Specialists Association, said: “We are all keen to see hospitals to restart a wider range of NHS services, but not until this can be achieved safely and sustainably.

“It would be premature and inadvisable to attempt a return to ‘business as usual’ before the testing regime is operating effectively and accurately in all parts of the country and significantly increased supplies of PPE can be guaranteed to protect staff and patients.

“We cannot risk a further spike of infections among hospital patients, who are much more vulnerable to the illness because of other health conditions.”

The Guardian approached the department of health and social care for their response.