Since the pandemic hit the UK in March this year, measures to tackle coronavirus have been constantly changing. But the one constant has been the likelihoxod of a second surge of Covid-19. This September, the Prime Minister Boris Johnson announced the UK was “now seeing a second wave”, adding “It’s been inevitable we’d see it in this country.”

This second wave - a widespread transmission of the virus throughout communities across the whole UK - was predicted by the vast majority of doctors in England in September. A poll by the British Medical Association (BMA) showed that 86% of more than 8,000 doctors and medical students believed a second peak was ‘likely’ or ‘very likely’ in the next six months.

Since September, the number of Covid cases have been rising significantly on a daily basis, bringing new challenges and adding to existing pressures on an already stretched NHS, including healthcare professionals responsible for older people’s care.

Lessons learned from the pandemic

The possible challenges a second wave will mean for healthcare can be predicted based on initial experiences of the pandemic. Health and care leaders suggest we will be better prepared to cope with a second wave because of the lessons learned during the first one.

Nick Ville, policy director at the NHS Confederation, says that since the onset of the pandemic, “the NHS has learned a great deal and is in a better position to manage the virus than first time round, but that’s not to say the winter period won’t be extremely challenging.”

He says members are working hard to prepare for this alongside the resurgence of Covid. This includes sustaining current NHS staffing, beds and capacity and taking advantage of the additional £3bn of revenue funding for ongoing independent sector capacity, Nightingale hospitals and support to safely discharge patients from NHS hospitals. “Recovery plans are being prepared in every system,” he says.

However, he says that “realism is needed” in the face of a number of ongoing practical problems to the delivery of care, including the impact of infection control measures, staff shortages and burnout, physical space limitations and the problems with the test, track and trace system. The NHS is also anticipating a growth in demand particularly for mental health care.

“The NHS is ambitious in its aims to restore services for patients, but needs the practical support from politicians and public understanding as it grapples with these challenges,” Mr Ville says.

Rapid increase in activity in primary care

Dr Richard Vautrey, chair of the British Medical Association's General Practitioners Committee,  says the biggest challenge presented by this second wave is that “the public has already been through months of hard restrictions on their activities, and their willingness to continue to do that is understandably going to be more challenging in the coming months.

“Linked to that is trying to gain the support of the public and our patients. Without their support it’s going to be doubly hard to deliver what they expect,” he says.

He says primary care is seeing “a rapid increase in activity”, and that its workforce is feeling “stretched, tired, and not supported by senior NHS managers”. The emphasis on remote consultations in hospitals has also increased the workload burden for practices as they are having to deal with referrals and requests from secondary care, he says.

Added to the healthcare pressures of a second wave faced by already run down, worn out staff and patient populations, are the traditional winter health problems such as colds and flu. Jenny Aston, advanced nurse practitioner, Granta Medical Practices, Cambridge, says the already “enormous work” that goes into delivering a flu campaign has been even greater this year, with a much higher uptake and more people being vaccinated because of Covid fears.

Such is demand, she says that in some places “there isn’t enough vaccine to go round or staff to deliver it, so waiting lists have to be created, which increases workload and stress”.

This new surge of Covid in winter also raises concerns about people with respiratory conditions who are already vulnerable during this season.

Recruitment and retention problems in the NHS

In addition to the traditional winter challenges faced by the care home sector, Ms Vic Rayner, executive director, National Care Forum, says a second wave means there is also “a massive challenge around workforce”. A recent report by Skills for Care shows that there are still more than 100,000 vacancies within the sector. She says existing recruitment and retention problems in a low paid sector pre-Covid have been compounded by the pandemic, and that following the brief return to ‘normal’ life before the second wave, “we now have a mentally and physically exhausted workforce”.

Primary care staff limiting their visits to care homes will “continue to cause challenges for the sector”, she believes, adding, “We need to continue to give people within care homes the full access to the health services that every other citizen gets, however the second wave emerges.” 

NHS “As prepared as we can be” for second wave

Having faced the first wave of the virus, healthcare professionals “know the challenges, and we’re as prepared as we can be”, says Dr Vautrey. But he says healthcare teams are “stretched to breaking point” and that the pandemic has compounded problems, such as staff shortages, that “we have been warning about for many years”.

Ms Aston believes practices and hospitals are more prepared for this second wave in terms of PPE, how to monitor Covid symptoms, and conducting digital consultations. But difficult issues will still have to be faced, she says, such as whether to manage a patient with respiratory illnesses at home.

While better prepared for a second wave, Dr David Turner, GP partner, Chorley Wood Health Centre, Hertfordshire, predicts the same soaring waiting lists and cancelled operations and procedures as the first outbreak, and that clinicians “will bear the brunt”, of patients’ anger.

Ms Rayner says there have been “enormous changes” for the care sector since the outbreak, such as visiting restrictions, putting Covid testing of staff and PPE in place, and tablets to support virtual consultations.

While efforts have been made to increase take up of flu jab in recent years, it has not been common practice for care home staff and therefore, this year Public Health England has created a wide range of digital assets and resources reminding them of their responsibilities in ensuring staff are vaccinated.

A major change is that the restriction of staff movement in the care sector, recommended in the Government’s winter plan for adult social care, will now become enforced through regulation. “The suggested use of enforcement feels very harsh given the recruitment challenges facing the workforce,” says Ms Rayner.

Growing financial demands on NHS from Covid

Being prepared for the second wave comes at a cost – an already overstretched NHS requires more resources to cope with the growing demands resulting from Covid. But the Government’s Covid fund for general practice only lasted until 31 July this year. Dr Vautrey says the BMA has repeatedly called for this fund to be reinstated but has only received “vague promises, but nothing concrete”.

Ms Aston is concerned that there are assumptions that “we are better prepared than in reality – it’s going to be a very long, uphill struggle this winter,” she says.

Beyond Covid

Some medical experts are now talking of ‘Long Covid’, referring to ongoing lung health management post-infection, as well as post-Covid heart attacks and strokes because of clotting issues and ongoing chronic fatigue. And future spikes, and a third or more waves of the virus cannot be ruled out given the transmission trends seen so far.

Commenting on the longer-term prospects for healthcare in the wake of Covid-19, Dr Vautrey stresses, “the need to see investment, an increase in the number of people working in NHS and social care, and that they are valued”.

As for the care sector’s future, Ms Rayner points out that “we’ve got a Government that has prioritised the fundamental reform of social care – and if ever there was a time when we needed to get on with that reform agenda, this is it”.

And she sends a clear message to the Government that “we need to focus on the care sector beyond Covid, to make sure we do everything possible to support and enable those people receiving care now, and to make sure high quality care provision is available for people in the future, with a skilled workforce to deliver it. Because this pandemic could make a fragile sector slip over the edge.”

Despite the devastation caused the pandemic, Ms Rayner says it’s important not to forget the work healthcare professionals are doing to support older, vulnerable people. She praises “the fantastic support from geriatricians in terms of understanding how Covid manifests itself in older people, and also older, frail people living in congregate settings.”

Ms Rayner also hears of “wonderful stories about the work going on in care homes to support residents”, such as the home that organised a 'virtual' cruise activity to engage its residents.

She says: “Care home staff are having to rethink everything they would normally do to keep people entertained and connected, where normally care homes would have been massively integrated within local communities.

“We’ve got to respect and support these staff, and shout together to make sure they are properly rewarded.”

Kathy Oxtoby is a medical journalist.

For more news and articles on the pandemic go to our Covid-19 section.