A shortage of beds for severely unwell eating-disorder patients has forced the NHS to send more than 100 women from England to hospitals in Scotland for treatment since 2017.

The cost of relocating patients, which included under-18s, was more than £10m, with one patient staying more than a year in hospital, costing close to £250,000.

The Guardian spoke to families who warned of the toll of travelling hundreds of miles to see unwell relatives. One mother said she had spent hundreds on petrol to visit her daughter and had slept on the hospital floor after being unable to get a hotel.

Experts say that not being close to family and friends can hinder the recovery of many people with mental health problems, as they are isolated from their support network.

Campaigners have warned of a crisis as demand for treatment among those experiencing anorexia and bulimia has “skyrocketed” since the start of the pandemic. Newly released data shows admissions up 84% in five years.

But living alongside Covid-19 for the foreseeable future will mean stark choices. Even if a second wave is prevented, resuming routine hospital, primary care and dental services with such an infectious virus still circulating is going to be all but impossible without a vaccine. 

A major problem will be the challenges of infection control: swabbing, testing and isolating patients before surgery, creating time for changing PPE between patients, allowing additional time between operations or treatments to deep clean or allow air changes in operating theatres or dentists’ consultation rooms. 

Even if a more rapid test can be developed, the impact on a system used to running with very little spare capacity will be formidable. Even before the crisis, the number of acute and intensive care beds per 1,000 population was lower than most OECD countries. There are also challenges of supplying and distributing PPE to the frontline. 

The NHS has large numbers of older hospital buildings, with shared accommodation and narrow corridors. Many hospitals and GP surgeries do not have waiting areas that allow for social distancing, and A&E departments before the pandemic were significantly overcrowded. Even if these difficulties can be overcome, the NHS will need to make sure it has enough beds and ventilators for a possible second wave. 

The staffing problems will be profound. Workers in high-risk categories may need to be removed from frontline duties, worsening longstanding staffing shortages. Staff who remain will have to make big changes to their day-to-day work, changing daily practices like ward rounds and creating time for testing and PPE. 

The combined effect: a reduction in the NHS’s ability to provide care. Waiting lists will lengthen, non-urgent procedures will be deprioritised, and patients will find it harder to get routine appointments. The big question facing politicians is how far the public will be prepared to accept such limitations on an NHS they have already sacrificed so much to protect.

Hospital performance in England is at its worst level on record, data shows.

Key targets for cancer, hospital care and A&E have been missed for over three years – with delays for hospital care and in A&E hitting their highest levels since both targets were introduced.

The monthly figures – the last before the election – prompted Labour and the Liberal Democrats to attack the Tories’ record on the NHS.

But Prime Minister Boris Johnson said “huge demand” was to blame.

He said only the Tories could be trusted to have a “strong, dynamic economy” to ensure the rises in the NHS budget being planned could be made.

“I’m afraid when I look at the rival proposals and the economic disaster that Jeremy Corbyn and the Labour Party would cause, that will make it impossible for us in the long term to fund the NHS.”

But Labour leader Mr Corbyn said the performance figures were “disgusting” and a lack of staff and funding was to blame.

And Liberal Democrat health spokeswoman Luciana Berger said the Tories had a “shameful” record.

The NHS could be short of almost 70,000 nurses within five years, according to a leaked copy of the government’s long-awaited plan to tackle the staffing crisis.

Blaming the government’s decision to abolish bursaries for nursing students, a draft of the NHS people plan says: “Our analysis shows a 40,000 (11%) shortfall [in the number of nurses needed in England] in 2018-19 which widens to 68,500 (16%) by 2023-24 without intervention, as demand for nurses grows faster than supply.”

That would mean that the NHS’s shortage of nurses increases from one in nine of the workforce to one in six, adding to the rising pressures on hospitals, GP surgeries and mental health care.

The report, seen by the Observer, makes clear that the shortage could be even higher than 68,500 because of “additional pressures” on GP surgeries, which are due to take on greater responsibilities for patient care over the next few years under the NHS long-term plan.

The document adds that even if its recommendations are implemented in full, the health service will still be short of 38,800 nurses by 2023-24, almost as many the current total of 40,000 vacancies. It says: “We believe we can reduce the gap between supply and demand to 38,800 (10%) in 2023-24, assuming that we are able to make progress on all of the interventions in this chapter.”

Dozens of A&E units, GP surgeries and walk-in centres have been earmarked for closure because of the NHS’s money problems, understaffing and modernisation plan, a new report reveals on Wednesday.

NHS bodies have decided in the last four months alone to shut or downgrade at least 70 services across England, the campaign group 38 Degrees has found.

They include maternity units and a raft of community hospitals. The latter are meant to take the pressure off acute hospitals, which often struggle under the weight of patient demand.