Mass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care, doctors’ leaders have said. Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped. An influx of Covid-19 patients has led to planned operations being cancelled or postponed in at least seven hospital trusts. On Friday three hospital trusts in South Yorkshire postponed non-urgent surgery, a day after Nottingham University hospitals did the same. Sources said the hospitals in Rotherham, Doncaster and Barnsley were cancelling “small numbers” of elective operations and outpatient appointments involving non-urgent conditions. “Things are very, very difficult at the moment, very challenging at the moment. It feels like a juggling act every day,” said one official in the South Yorkshire NHS. “The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating.” In a memo to staff seen by the Guardian, Rotherham hospital’s chief operating officer, George Briggs, said: “We have taken the decision to cancel all electives apart from urgent and cancer cases.” He said staff sickness due to Covid-19 had “hit a record high over the last few days”. NHS national leaders have decreed that normal care should continue. There is growing evidence that widespread suspension of screening services, diagnostic testing and treatment in the spring left hundreds of thousands of patients unable to access care for cancer, heart disease and other serious illnesses. Knee and hip replacements, cataract surgery and other operations were cancelled. As a result, some experts have estimated that tens of thousands of people could die prematurely of cancer alone. In June the NHS waiting list was projected to hit 10 million by the end of the year. Three years ago, without a pandemic but faced with a winter health crisis including an intense strain of flu and bad weather, non-urgent surgery was postponed across the country. Over the past week, coronavirus has led to the hospitalisation of nearly 1,000 people a day on average across the UK. The number of Covid patients treated in hospital in Liverpool surpassed the peak of the first wave. The BMA, which represents about 70% of Britain’s 240,000 doctors, says hospitals have too few beds and staff to maintain surgery and diagnostic testing for non-Covid illness while the second wave is unfolding. “While trusts did their best to reintroduce elective care after this first wave, many have now been forced to return to limited services to keep their heads above water as we work through the second, even more demanding peak of cases,” said Dr Rob Harwood, the chair of the BMA’s hospital consultants committee. “As we approach winter, it’s likely that many trusts will have no choice but to continue to restrict their elective care services, which is incredibly worrying for both staff and patients, as backlogs increase and health conditions potentially worsen.” Addressing NHS plans to fine hospitals if they do not undertake this month at least 90% of the planned operations they performed in October last year, Harwood added: “It’s clear that with Covid cases rising rapidly across the country, this approach is not realistic and must be scrapped. Hospitals should not be penalised for having to make difficult decisions about cancelling elective procedures where they urgently need to divert resources to ensure Covid patients get the care they need.” Dr Nick Scriven, the immediate past president of the Society for Acute Medicine, said: “I think this [trusts cancelling operations] is going to be inevitable across large areas of the health service as the pandemic and winter coincide. We know bed numbers are low compared with other countries and with the necessary infection control processes the ‘functioning’ of what we have is slowed down across the board. “In a ‘normal’ winter, the NHS plans for less elective work, especially around Christmas and new year, and this is nothing like normal. If you add in the increasing difficulty of keeping ‘green’ areas [of hospitals] clear of Covid, having enough staff to cover the front door as well as elective areas and the ICU capacity issues, it will be extremely difficult to keep elective surgery running at anything above a low urgent/emergency procedures-only model.” Scriven added: “I feel it is unrealistic to expect trusts across the country to meet the set elective targets in the current climate, especially in those areas already hit hardest in the north-west of England, where even today we see hospitals with more Covid patients than in the spring.” Tracy Taylor, the chief executive of the Nottingham trust, said it had made the difficult decision to postpone some non-urgent surgery and appointments until 2 November following a dramatic increase in the number of patients with Covid-19. This week the trust has had more than 200 inpatients being treated for coronavirus. “This surge is now at levels similar to April and is combining with our normal winter emergency pressures. This is not a decision we have taken lightly, but we need to ensure we have the beds and staff available to care for those in urgent need during this surge of Covid-19,” Taylor said. Bradford teaching hospitals trust on Tuesday suspended some non-urgent surgery and outpatient appointments with consultants for two weeks to help it cope with an influx of Covid patients that took its total of such cases to 100. The trust is sending some patients needing surgery and investigations to private hospitals in Yorkshire to help ensure at least some of them get treated. The impact of Covid-19 on one of Northern Ireland’s largest hospitals led to warnings that trauma surgery may have to be rationed. Ronan McKeown, a Craigavon area hospital consultant who treats patients with injuries from road collisions and domestic accidents, urged people to try to reduce the risk of having accidents. In Wales, planned cardiac surgery remain suspended at Morriston hospital in Swansea following a Covid-19 outbreak, while in Lancashire and South Cumbria health authorities said on Friday that they were “increasingly concerned” about the significant increases in Covid admissions. An NHS spokesperson said: “Hospitals’ ability to provide non-urgent operations partly depends on not having to divert staff and beds to care for severely ill coronavirus patients, but in parts of the country including Liverpool, Lancashire and Nottingham they are now treating more Covid patients than at the peak of the pandemic in April.”