For most of the country, the Covid pandemic feels like a period we have put behind us. Restrictions are gone, vaccines are routine, and daily infection updates are no longer headline news. Yet for the NHS, the pandemic is not simply a chapter closed. Its consequences continue to shape the decisions made by leaders and policymakers across the health service.
One of the most pressing issues is the backlog in care. When hospitals were forced to prioritise Covid patients, millions of routine appointments, procedures, and screenings were postponed. The scale of the delay was unprecedented. Years later, the system is still working to recover lost ground. Every delayed operation or missed diagnostic appointment can lead to deteriorating health, more complex treatment needs, and increased pressure on emergency care. Tackling the backlog requires not just additional clinics and surgical sessions but also changes to how patients move through the system to avoid bottlenecks.
The workforce carries another part of the pandemic’s legacy. During the height of the crisis, NHS staff worked under extreme pressure, often for prolonged periods with little respite. The emotional toll of treating critically ill patients in large numbers, coupled with the constant threat of infection, has left lasting effects on morale. Burnout remains a real risk. Some staff have left the profession entirely, while others have reduced their hours. This compounds pre-existing shortages and puts more strain on those who remain. Recruitment efforts continue, but replacing experience and building resilience takes time.
Infrastructure challenges are also part of the Covid inheritance. The pandemic highlighted the limits of hospital capacity, particularly in critical care. Temporary facilities were set up in record time, but these were only ever a short-term fix. Many NHS buildings are outdated and in need of repair or redesign to meet modern standards of care. Strengthening the estate and improving capacity is essential for both everyday demand and future crisis readiness, but capital budgets are finite, and investment decisions are difficult in a system already stretched thin.
Public perception has shifted too. At the start of the pandemic, the NHS was the focus of extraordinary public goodwill, with support for staff visible in communities across the country. Over time, as the backlog persisted and delays in emergency response grew, frustration began to replace applause. Confidence is harder to sustain when patients and families are experiencing long waits, cancelled appointments, or difficulty accessing services. Managing expectations while striving to improve performance has become a delicate balance for health leaders.
For policymakers, these interconnected challenges demand more than short-term fixes. Efforts to reduce waiting times must be matched by plans to support the workforce, modernise infrastructure, and strengthen community services. Addressing one problem in isolation risks creating pressure elsewhere in the system. For example, expanding surgical activity without improving social care capacity can result in patients staying in hospital longer than necessary because they cannot be discharged safely.
Transparency will be critical to making progress. People are more likely to accept delays or changes in service if they understand the reasons and see a clear plan for improvement. Overstating successes or minimising ongoing problems risks damaging trust. This is particularly important when the health service faces both political scrutiny and the daily judgment of patients who rely on it.
The pandemic exposed vulnerabilities but also demonstrated what the NHS can achieve under extraordinary pressure. The rapid adoption of virtual consultations, the scale of the vaccination programme, and the flexibility shown by staff were significant achievements. The challenge now is to apply the same urgency and innovation to the slower-moving but equally important work of recovery and reform.
Covid may no longer dominate the headlines, but its effects remain woven into the daily reality of the NHS. Backlogs, workforce pressures, infrastructure gaps, and public expectations are all part of a legacy that will take years to address. Recognising these challenges honestly is the first step. Meeting them with sustained effort and clear priorities is the only way the health service can move from crisis response to long-term stability.
