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Chief executives from across the NHS in England have become seriously concerned about their staff, with increased levels of anxiety and fatigue being reported during the pandemic. There is additional concern in NHS organisations with more black and minority ethnic (BME) staff. 

In a report published by the NHS Confederation, chief executives from NHS trusts across England also reveal concern about the impact of the pandemic on poorer communities and the fear among leaders that they could face another major surge in the virus. 

The report comes ahead of guidance expected later this week from NHS England and NHS Improvement which will outline the next phase of the NHS response to the pandemic. 

Several key themes emerged from the interviews with 13 NHS chief executives: 

• Resuming services: every chief executive is concerned about the challenge of protecting the safety of patients and staff as routine services are resumed alongside services for COVID-19 patients. And without exception they wanted to harness the positive changes made over the last few months and stress their determination to not go back to how things were done before. 

Fiona Noden, chief executive of Bolton NHS Foundation Trust, said: “I’ve been overwhelmed by the response from staff and the way they have transformed services.”

• Staff wellbeing: chief executives cited concerns about the long-term mental health impact on their staff and many had provided mental health support within their organisations. And everyone stressed how vital it was for front-line staff to have the support and resources they needed, including psychological support, personal protective equipment (PPE) and access to regular testing. 

Siobhan Harrington, chief executive of Whittington Health NHS Trust, said: “Dealing with the effects of COVID-19 has been a challenge for the NHS and its staff both physically and mentally. Staff have gone above and beyond, but this has left its mark, with increased levels of anxiety and fatigue. We are encouraging staff to take a break and care for themselves and each other, as well as availing themselves of local wellbeing support available internally and from other organisations across the system. As we face a potential second wave and another tough winter, I am concerned about the long-term impact on the health and wellbeing of our staff. We will continue to put measures in place to support staff. Looking after our people must remain a priority for all of us.”

• Health inequalities: The pandemic has hit the poorest hardest and all these chief executives were concerned about the continuing impact it will have on deprived  communities. They believe the NHS is more than ‘just’ a health care provider and has a key role in supporting their local communities. One chief executive described how her trust is working with the local council to support people experiencing homelessness in the area, as well as potentially setting up a food bank.

Brendan Brown, chief executive of Airedale NHS Foundation Trust, said: “Hospitals are anchor institutions for our communities. We have a bigger role to play in the future than just providing healthcare.”

• Innovation: the pandemic has enabled NHS leaders and their staff to introduce innovations at speed and scale, often achieving in weeks what might have taken years. Many organisations were planning more digital care and telemedicine, including virtual consultations, but the pandemic has accelerated this. The emergency has also led to new and more flexible ways of working and health leaders are exploring how best to embed these. 

Steve Russell, chief executive of Harrogate and District NHS Foundation Trust, said: “During COVID-19 many of the hoops we normally have to jump through have been removed and the focus has moved from transactional discussions to focusing on wellbeing, outcomes and inequalities.”

• Partnership working: chief executives welcomed the removal of funding barriers and other restrictions had made it much easier for health and care services to work together. And they argued that they needed to be sustained to deliver improved care for patients.  

Sam Higginson, chief executive of Norfolk and Norwich University Hospitals NHS Foundation Trust, said: “COVID-19 has reinforced the need to resolve the Integrated Care System legal position if we are to work in different ways going forward.” 

• Regulation: overall there was support for the role of NHS England and NHS Improvement since the pandemic hit, but there were concerns over the amount and type of information demanded from national bodies. The chief executives want to see changes from the Care Quality Commission and recommend that inspections do not return to their previous form.

Maz Fosh, chief executive of Lincolnshire Community Health Services NHS Trust, said: “Clinicians and senior leaders are not going to jeopardise the quality of care for patients – what we need to see now is lighter touch regulation and inspection.”

• Funding: the chief executives argued for new ways of funding the service. They called for a system that incentivises a shift towards  improving the health of the local population health rather than the current focus on individual organisations. The leaders welcomed the funding changes made during the pandemic  but remain concerned that these are short term and will not deal with the underlying financial challenges that the NHS faces.

Niall Dickson, chief executive of the NHS Confederation, which represents organisations across the healthcare sector, said: “The last five months have turned the NHS inside out. The extent of changes across the health service has been extraordinary and has been achieved by a Herculean effort from managers, clinicians and support staff. 

“This report provides insight into the experiences of NHS leaders who found themselves in charge of highly complex organisations at a time of an unprecedented national emergency, when all eyes were on them and their teams to prevent an even greater catastrophe. It highlights the many positive changes that have come about which need to be built upon as we step tentatively to a new normal. But it also reveals the huge strain that has been placed on staff and the challenge NHS leaders face in ensuring staff in their organisations get the right psychological and other support that they will need.” 

Notes to editors

1. Interviews with the chief executives took place in late May and early June 2020. 

2. The chief executives interviewed for the report are all part of an NHS Confederation programme which provides peer support for first-time provider trust chief executives. Almost 50 chief executives have benefited from the programme since its launch in 2016. 

3. The names of the chief executives interviewed for the report are: Brendan Brown, Airedale NHS Foundation Trust; James Devine, Medway NHS Foundation Trust; Maz Fosh, Lincolnshire Community Health Services NHS Trust; Dr Susan Gilby, the Countess of Chester NHS Foundation Trust; Siobhan Harrington, Whittington Health NHS Trust; Sam Higginson, Norfolk and Norwich University Hospitals NHS Foundation Trust; Janelle Holmes, Wirral University Teaching Hospital NHS Foundation Trust; Fiona Noden, Bolton NHS Foundation Trust; Steve Russell, Harrogate and District NHS Foundation Trust; Jonathan Warren, Norfolk and Suffolk NHS Foundation Trust; Angie Smithson, Chesterfield Royal Hospital NHS Foundation Trust; Sarah Tedford, Hillingdon Hospitals NHS Foundation Trust; and Simon Weldon, Kettering General Hospital NHS Foundation Trust.

4. NHS Reset is an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic. Recognising the sacrifices and achievements of the COVID-19 period, it brings together NHS Confederation members and partners to look at how we rebuild local systems and reset the way we plan, commission and deliver health and care. To find out more, please visit  www.nhsconfed.org/NHSReset and join the conversation #NHSReset 

5. The NHS Confederation is the membership body that brings together and speaks on behalf of organisations that plan, commission and provide NHS services in England, Northern Ireland and Wales. We represent hospitals, community and mental health providers, ambulance trusts, primary care networks, clinical commissioning groups and integrated care systems. To find out more, visit www.nhsconfed.org and follow us on Twitter @nhsconfed

The NHS after COVID-19: the views of provider trust chief executives