RCoA calls for greater government investment in resources, facilities and staff to deliver COVID-19 care

Published: 22/07/2020

Doctors not confident their hospitals would cope with a second COVID-19 surge

More anaesthetists are suffering mental distress than ever before as morale drops

In a survey of members of the Royal College of Anaesthetists (RCoA), which represents the largest group of hospital doctors, 44% of respondents were not confident their hospitals would be able to provide safe COVID and non-COVID services should there be a second surge of infections.

Over one-third (38%) of respondents also cited low or non-existent rapid testing for staff at their hospitals and one-in-five (20%) said there are currently insufficient infection prevention and control measures to prevent staff from infecting surgical patients with COVID-19.

Results also highlighted the increasing trend in mental distress amongst anaesthetists and the disruption to the training opportunities for anaesthetists in training:

  • nearly two-thirds of respondents (64%) have, to some extent during the past month, suffered mental distress due to the pressures faced during the COVID-19 pandemic
  • over one-third of respondents (34%) reported a low or very low level of team morale, compared with nearly one-in-five (21%) in May
  • nearly nine-in-ten trainees (89%) strongly agree that the pandemic is affecting their training opportunities, career and professional development.

The RCoA has been calling for an increase in sustainable government investment for resources, facilities and staff to support a return to non-COVID-19 activity. While the Government has now announced £3 billion of additional funding for the NHS, more detail is needed as to how this will be spent and whether this will be enough to support the service and its staff through what is expected to be one of the most difficult winters in a very long time. The RCoA is also seeking rapid development of cross-speciality ‘reservist’ health and care teams for deployment in the event of a surge in COVID-19 patients.

Responding to the findings of the survey, Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:

“As the NHS begins to return to a new ‘normal’ service, the findings of our survey clearly emphasise the reality facing anaesthetists working in the NHS across the United Kingdom. Worsening staff morale is certainly a concern.

“We saw the NHS deliver outstanding care for COVID-19 patients at the start of the pandemic, however this involved cancelling thousands of planned surgeries. In the event of a potential second surge of infections, it is imperative that the NHS does not again return to a COVID-only health service.

“If we are to maintain a high level of elective surgeries through any subsequent surge, Government and other stakeholders need to provide more detail on their commitment to increase capacity. Whilst we welcome the recent announcement of £3 billion of additional funding to help the NHS prepare for winter through investment in the Nightingale hospitals and the private sector, discharge policies and testing, the health service is only as good as its staff. We need to see guarantees of funding for reservist and assurances that there will be sufficient numbers of anaesthetic, theatre, perioperative care and ward staff available to return to their routine work activities. Without this it is difficult to see how the NHS will sustain current elective surgery capacity.  

"One immediate concern is how the COVID-19 pandemic has impacted the mental health and wellbeing of our members. Expecting healthcare workers to instantly bounce back after the first surge is unrealistic at best, harmful at worst – this pandemic has taken its toll and morale is falling. The Government needs to release the promised NHS People Plan as soon as possible. It is critical that staff have a chance to rebuild, can take the leave so badly needed to rest and recuperate, and are properly remunerated for their work over the past few months. Patient safety depends on staff wellbeing. Without mentally and physically healthy and motivated staff, a second surge could be disastrous for patients and the NHS. 

“We must also look further into the future – with waiting lists at record highs, the NHS will be under stress for many years. It is key for anaesthetists in training not to be disadvantaged by the pandemic and that a transparent and flexible approach to re-scheduling assessments, teaching and training is implemented.

“Over the next few months the College will continue to work with the Government and other stakeholders such as the Academy of Medical Royal Colleges which has called for the implementation of a wide range of measures1 to help ensure the NHS is prepared to meet any future challenges.”

Key survey findings:

  1. 44% of respondents are not confident in their hospital's ability to provide planned surgery safely while managing COVID-19 demand during future surges.
  2. Nearly two-thirds of respondents (64%) have, to some extent during the last month, suffered mental distress due to COVID-19.
  3. Nearly nine in ten trainees (89%) strongly agree that the pandemic is affecting their training opportunities, career and professional development.

Key recommendations:

  1. NHS Improvement should publish a new People Plan, with the investment and teeth needed to support staff welfare and wellbeing, build resilience and address inequality.
  2. NHS Improvement should identify, train and maintain the skills of cross-specialty ‘reservists’ who can support COVID-19 surges, with the support of the Medical Royal Colleges.
  3. The Government should make a commitment to additional, and sustainable, investment in the resources, facilities and staff needed to support a return to pre-COVID-19 activity.
  4. Hospitals and trusts may need to cohort specialist surgery on a regional basis; and there is merit in a ‘clean hospital’ approach. Other locations for managing planned surgery or COVID-19 care should be considered, with sufficient resources made available, separate from the NHS.
  5. Efforts should be made to support hospitals in ensuring that sufficient numbers of anaesthetic, theatre, perioperative care and ward staff are free to return to their routine work activities.
  6. A transparent, flexible, approach to re-scheduling assessments and teaching should be developed, with clear guidance on how missed learning opportunities will be delivered.


The Royal College of Anaesthetists ran this survey of its combined membership of 23,000 fellows and members from 30 June and 5 July to develop a View from the frontline of anaesthesia during COVID-19. 334 members of multiple grades and sub-specialties responded to the survey.


  1. Preparing for COVID-19 surges and winter bit.ly/AoMRCAction