Speaking as a manager in a small DGH, we were already in the process of sharing services/using hub and spoke models with larger trusts in our region as we simply cannot recruit the medics needed to provide the services. The hospital remain where it is as it serves such a huge population, but the individual trust I imagine will be taken over by one of the larger in time to come. And that was before covid.
Funny you mention Manchester as I worked there as wythenshawe and CMFT merged a couple of years ago. When I left, about 6m ago, they were merged by name and management only really, not many of the services had joined up completely though it was heading that way. It takes years to complete a merger like that. So yes I think in years to come we'll have less trusts and they'll all be super trusts, with hub and spoke models delivering more local care.
I think the advancement in technology for appointments is a brilliant thing to come out of covid. This development was already in the works but timetabled to be established in the next 2 years or so and was being met with great resistance from some doctors and nurses (not all) covid made people look at things differently. Telephone appointments mean people don't have to leave work for hours to travel, park and wait for their appointment, elderly or house bound don't have to leave or rely on family or PTS to take them. Same for video conferencing. And you can schedule more patients into the same time frame doing either of those solutions, therefore the waiting lists will go down quicker.
Face to face appointments will always be necessary for examinations and tests etc. But either the virus and any other outbreaks we get (even just basic flu and noro virus) the less people in the hospital the less risk to the patients and the staff, therefore staff sickness should decrease (in theory, unlikely in reality).
Our doctors have gone through all our waiting lists, reviewing hundreds of patients notes and most recent results to identify any risk in delaying them, anyone who could actually be simply discharged with a letter etc, which brings the wait times down for others and avoids unnecessary appointments.
The negative aspect that I hope is reversed ASAP is the reduction of provision in some areas. Speaking as a pregnant patient, I'm aware other pregnant people have had lots of the "standard" antenatal appointments cancelled or changed to telephone which isn't ideal (I personally haven't had any change to my care) and I hope those provisions are reinstated as they're so important. I presume maternity isn't the only place negatively affected.
Big changes are afoot I am certain, but I don't think it's necessarily a bad thing. Hopefully.
I'm ever the optimist though! And the NHS has been poorly managed by the big wigs and central government for years so I doubt that will change!