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‘Second phase of NHS response to COVID-19’ letter

On 30 January 2020, the NHS in England declared that the outbreak of COVID-19, an infectious disease caused by a novel coronavirus, represented a level 4 (national) incident. On 17 March 2020, the NHS in England introduced a range of measures and changes to services aiming to increase capacity and limit the spread of the virus. This included pausing non-urgent elective care treatment.

Letter on second phase

On 29 April 2020, Simon Stevens, NHS Chief Executive, and Amanda Pritchard, NHS Chief Operating Officer, set out the ‘second phase of NHS response to COVID-19’ in a letter to health system leaders. 

The letter outlined that the NHS would be entering the second phase in its response to the pandemic due to a decrease in hospitalisations of COVID-19 patients. It asked NHS organisations to ‘fully step up non-COVID-19 urgent services as soon as possible’. It also asked local systems to ‘make judgements on whether you have further capacity for at least some routine non-urgent elective care’.

Other key measures outlined in the letter included:

  • increased capacity for testing of asymptomatic staff
  • continued support to high-risk patients
  • risk assessments for staff from BAME backgrounds
  • bringing forward the rollout of the Enhanced Health in Care Homes services in community and primary care, which aimed to provide support to care home residents with multidisciplinary teams
  • retaining providers’ ability to increase ‘surge capacity’.

The letter said that community, primary care and mental health would need to prepare for increased demand for their services, while the NHS would also continue to provide support to the social care sector.

Later developments

A letter on the ‘third phase of NHS response to COVID-19’ in July 2020 focused on ‘accelerating the return to near-normal levels of non-Covid health services’. It confirmed that the level of COVID-19 demand on the NHS meant that the NHS incident level would move from level 4 (national) to level 3 (regional) from August 2020. In November 2020, the NHS in England returned to incident level 4 which lasted until late March 2021, when the incident level was again reduced to level 3.

In December 2021, the NHS declared that the spread of the Omicron variant of the virus represented a level 4 national incident. Guidance for NHS leaders encouraged an acceleration of the COVID-19 vaccination programme and an increase in the availability of COVID-19 treatments and bed capacity. In May 2022, NHS England confirmed its decision to reclassify the incident as level 3.


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

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

NHS England.
Preparing the NHS for the potential impact of the Omicron variant and other winter pressures.
NHS England; 2021. 

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.