• NHS Providers calls for an urgent review of managing winter pressures to be led by NHS Improvement and NHS England with input from trusts
• Review should investigate how effectively the NHS prepared for this winter looking at how funding for winter pressures is distributed and how services are supported by social care and GPs
• Since it is trusts who bear the burden of the current approach, they should have the chance to set out what has worked for them and what needs to change

New data from NHS England underlines the need for an urgent review, called for by NHS Providers, into the way the health service manages winter pressures.

The winter operational update from NHS England shows in the week ending 22 January demand remained at historically high levels.

Attendances at A&E and emergency admissions were up on the previous week. There was a fall in the figures for ambulance diverts and trusts reporting serious operational pressures, but bed occupancy rates remained well above recommended levels for patient safety.

The review should be led by NHS Improvement and NHE England with frontline trusts having the opportunity to contribute.

We call for the review to be conducted rapidly, finishing no later than the end of April 2017. Results of the review should be made public.  

Process

NHS Providers believes a review of how the NHS has handled winter pressures should include the following:

• The review should be led by NHS Improvement and NHS England
• Frontline trusts should have the opportunity to contribute to the review
• Expert organisations such as the Royal College of Emergency Medicine should also be consulted
• The review should be conducted rapidly, with a target finish date of end April 2017 at the latest
• The results of the review should be made public

Areas of investigation

NHS Providers believes that issues for the review  to consider include:

• How effectively the NHS prepared for this winter
• How effectively the new A&E delivery boards have worked
• Whether the NHS should revert to specific, dedicated, winter funding (many trusts believe that mainstreaming dedicated winter funding into the overall NHS budget has led to the loss of much needed extra winter capacity)
• How effectively the cancellation of elective operations worked, the knock-on impacts, and where this approach should be extended or reduced next year
• How primary care access, particularly to general practice, can be extended over the holiday period
• What can be done to consistently ensure social care fully supports the NHS
• How to rapidly and consistently implement the important new A&E performance work. NHS Improvement has signalled a more standardised approach to streaming patients, prioritising support for the sickest patients and ensuring there is a consistent and holistic view of providers’ performance on emergency care
• How to enhance the support providers receive from NHS Improvement and other NHS system leadership bodies
• What short term measures can be taken to close the current supply/demand gap before next year in key staff groups and areas such as the shortage of A&E consultants in many smaller, rural, hospitals
• What can be done to ensure NHS staff have a reasonable workload over the winter pressure period

Stakeholder response

Our calls for a review have been echoed by Dr Sarah Wollaston MP, chair of the health select committee. 

The chief executive of NHS Providers, Chris Hopson, said:

“The last few weeks have shown that the NHS needs a new approach to managing winter pressures. The current situation is unsustainable and the NHS has to do something different next year. The time to start planning for that new approach is now, with a formal review of what needs to change.

“This winter has seen some of the worst performance figures on record against the 4-hour target in A & E. Delayed discharges are worse than ever. Bed occupancy rates are consistently above recommended levels. Trusts are reporting unsustainable workloads on their staff. This has been widely reflected in recent media coverage.

The current situation is unsustainable and the NHS has to do something different next year. The time to start planning for that new approach is now

 “The message from frontline NHS trusts is clear. The NHS has, so far, just about managed this year’s winter pressures in the face of unprecedented demand without a crisis or meltdown. But it has been a close-run thing and some trusts have failed to cope for short periods of time.

 “We owe a huge debt of thanks to frontline staff who have responded way beyond the call of duty to ensure the NHS as a whole has just about kept its head above water. But we cannot carry on trying to manage well known winter pressures in this way. Trusts tell us their resilience and ability to cope with these pressures is diminishing year by year and that their ability to consistently provide the right quality of care, safely, is now being compromised.

“We must formally review what has happened this winter and what we will do differently next year. We also need to recognise that there are wider underlying issues that must be addressed, including sustainably funding the NHS to cope with rising demand and sustainably tackling the workforce shortages the NHS faces.

“As it is NHS trusts who bear the burden of the current approach, they should have the chance to set out in a review what has worked for them and what needs to change. The review should therefore include appropriate input from the NHS frontline and expert bodies such as the Royal College of Emergency Medicine.

“The results of the review should be made public so those who use and pay for the NHS can see that the service is seeking to learn from this year’s experience and is adopting a sustainable approach to managing winter pressures.”