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‘Next steps on NHS response to COVID-19’ letter

On 30 January 2020, the NHS in England declared a level 4 (national) incident in response to the outbreak of COVID-19, an infectious disease caused by a novel coronavirus. This triggered what NHS England and Improvement later referred to as the ‘first phase of the NHS’s preparation and response’ to the pandemic. On 17 March 2020, Simon Stevens, NHS Chief Executive, and Amanda Pritchard, NHS Chief Operating Officer, wrote to health and care system leaders on ‘Next steps on NHS response to COVID-19’.

‘Next steps on NHS response to COVID-19’

The letter set out ‘important actions’ for NHS providers aiming to:

  • ‘free-up’ inpatient and critical care capacity, including by postponing all non-urgent elective operations for at least three months, discharging hospital inpatients who were medically fit to leave and freeing up community and immediate care beds
  • prepare for treating ‘large numbers of inpatients requiring respiratory support’
  • expand and support the NHS workforce, including by asking retired clinicians to return to work and deploying medical and nursing students
  • support wider government measures such as social distancing and ‘shielding’ of vulnerable people, including by implementing ‘remote consultations via telephone and video call’
  • undertake a ‘system-wide stress-testing exercise’ and set up teams in all organisations for sharing national guidance
  • remove ‘routine burdens’, including by cancelling routine regulatory inspections.

The letter stated that additional funding would be made available to cover the costs of responding to COVID-19. It also said that there was flexibility for organisations to act according to their own circumstances.

Later developments

On 29 April 2020, NHS England reported that it had provided hospital care for 19,000 confirmed COVID-19 patients and expanded its capacity through large numbers of returning health professionals or students starting their careers early.

A high court ruling later concluded that the policy of urgently discharging NHS patients into care homes ‘failed to take into account the […] risk to elderly and vulnerable residents from non-symptomatic transmission’. The Secretary of State for Health and Social Care Matt Hancock’s decision to make and maintain the discharge policy without advising isolation upon care home admission was ruled unlawful.

The NHS response to the virus evolved over time. In April 2020, NHS leaders set out guidance to begin to reopen elective care. Pausing elective treatment in March 2020 had long-term consequences, considerably increasing the waiting list for elective care.


NHS England.
Next steps on NHS response to COVID-19.
NHS England; 2020. 

NHS England.
Second phase of NHS response to COVID-19.
NHS England; 2020. 

Health and Social Care Committee.
Clearing the backlog caused by the pandemic.
House of Commons; 2021.  

Scientific  Advisory Group for Emergencies.
Consensus statement on the association between the discharge of patients from hospitals and COVID in care homes.
gov.uk; 2022. 

High Court judgment Gardner & Harris v Secretary of State for Health and Social Care & Ors [2022] EWHC 967 (Admin).

Health Foundation.
COVID-19 policy tracker 2020: a timeline of national policy and health system responses to COVID-19 in England in 2020 [webpage].
Health Foundation; 2020.