Last winter was widely regarded as the toughest for the NHS in recent times. There’s always concern at winter time about extra pressure, longer waits for patients and staff run ragged. But last winter was exceptional. And whilst we didn’t agree that there was a ‘humanitarian crisis’, we do know that frontline NHS services were put under intolerable pressure, with only the heroic efforts of staff keeping services upright.
At the height of this pressure, the NHS had to provide an additional 4,500 beds a day – more than eight extra hospitals. Despite these extra beds, hospital bed occupancy rates remained well above the recommended safe levels. Record numbers of patients faced long delays in A&E departments and in waiting ambulances. Too many people were kept in hospital for longer than they should have been due to a lack of available capacity in social care and other parts of the NHS.
This wasn’t just a problem for hospitals - community, mental health, and ambulance services were also stretched to breaking point. In too many places, local services were overwhelmed, with staff placed under an unacceptable amount of pressure and patient safety compromised. We must ensure this does not happen again.
In too many places, local services were overwhelmed, with staff placed under an unacceptable amount of pressure and patient safety compromised. We must ensure this does not happen again.Chief executive
Fast forward six months and the NHS is deep into planning for what many worry will be an even tougher winter. NHS Providers has kept a close eye on these preparations, working with frontline NHS trusts to assess their state of readiness for the winter ahead.
The good news at the end of August is that national level planning is considerably more developed than last year. The local areas at most risk have been clearly identified and there are plans to move staff from better performing areas to help those in trouble if required. Emergency care performance has also been given greater priority.
But these improvements are being outweighed by a combination of increasing risks and NHS trusts are worried that they do not have enough staff, beds and other services to manage the risk to patient safety this winter.
They point to several factors: the relentless rises we are seeing in demand on A&E and other key services; growing staff shortages; and greater financial pressure which means trusts are less able to afford the extra capacity they urgently need.
The relentless rise in demand has also meant that some so-called ‘escalation’ beds – put in place as a winter contingency – are still in use even during the summer. Despite all the effort at local and national level, performance against the four hour A&E standard is no better at this point than it was last year. The reality at the frontline is that winter never really went away.
But, perhaps most importantly of all, the government’s plan that the NHS would consistently benefit from the £1 billion of extra support for social care – trying to get a double benefit from the same pot of money – has not worked. Trust leaders say that in about a third of systems this money will help the NHS, but, in the rest, it won’t. That’s not entirely surprising as councils have used the money on other social care priorities, as they are perfectly entitled to. As a result, the government’s target to reduce the number of people stuck in hospitals when they are medically fit to go home to 3.5% by September will be missed. And the NHS will be 2,000-3,000 beds short of its planned capacity.
Emergency winter cash injection
Trust leaders tell us that extra beds, staff and other services are urgently needed to fill this gap. We estimate this requires an immediate emergency winter cash injection of between £200 and £350 million. Failure to make this investment will almost certainly lead to lengthening waiting times for patients in A&E and other services, such as in mental health. It will also put the safety of more patients at risk.
Failure to make this investment will almost certainly lead to lengthening waiting times for patients in A&E and other services, such as in mental health. It will also put the safety of more patients at risk.Chief executive
The money can come as a repayable loan or an early draw down from the extra £8 billion promised for the NHS in the Conservative manifesto. Or we should find it from the existing NHS £109 billion budget. What’s important is that any extra investment must not be at the expense of existing expenditure on services that are key to winter performance such as primary care, community care and mental health care. And we can’t wait any longer – trusts need time to create the required capacity and every day of delay means more money spent on unnecessary, expensive, temporary staff fees.
It is not just about pumping in more money of course and the NHS is already improving the way it plans for winter and how it works with other local public services. But trust leaders are clearly saying that, without extra beds and staff now, local NHS services will not have the tools they need to manage patient safety risk this winter. We have been warned.
This article was first published in the Observer on 3 September 2017
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