NHS Providers says NHS trusts have done all they can to prepare for extra winter pressures. Local and national planning for winter is more extensive and meticulous than ever before. But the health service may be sorely tested in the coming months as it is already at or close to full stretch. Trusts are working hard to minimise the risks for patients.

Our new briefing, Ready and resilient? How NHS trusts have prepared for winter, outlines in detail what has been done locally and nationally to ensure safe, high quality care for patients.

Specific actions by trusts include:

• steps to ensure the seamless flow of patients through to discharge
• local resilience plans with partner organisations such as social care services
• support to ensure people with mental health needs are treated in the right place
• initiatives that make it easier for staff to do the right thing, for example through the use of checklists to standardise and improve the delivery of basic care
• communications to complement the “Stay well this winter” national campaign

Significant steps taken at a national level to improve NHS resilience include:

• a more joined-up approach, including the appointment of Pauline Philip as national director responsible for winter planning
• contingency plans to support trusts at greatest risk of having difficulties this winter
• extension of primary care streaming in emergency departments to ensure patients are treated in the right setting
• an extra £335 million in the 2017 Budget to help the NHS cope with winter

While preparations for winter have never been more meticulous and thorough, the report highlights continuing difficulties and pressures that could jeopardise trusts’ ability to cope. They include:

• Lack of beds – the NHS is already running at 87 per cent bed occupancy, which means there is very little give in the system. Too many patients still face delays in being discharged after they are ready to move on.
• Shortages of key staff groups including paramedics, GPs and A&E consultants and nurses.
• Funding pressures – the additional NHS funding for winter in the Budget was welcome but has come very late to be used to maximum effect.
• Flu – this year’s strain is potentially the worst we have seen in two decades, having already placed health systems in Australia and New Zealand under severe pressure earlier this year.

Describing some of the measures put in place for winter, the chief executive of South Warwickshire NHS Foundation Trust and Wye Valley NHS Trust, Glen Burley, said:

We’ve been looking at staffing out of hours and at night time particularly to ensure that we’ve got the right staffing to meet demand.

“In South Warwickshire we redesigned our emergency assessment unit to take account of changes that we’ve made over the last few years. That opens in two weeks time. In Wye Valley we’ve been looking at staffing out of hours and at night time particularly to ensure that we’ve got the right staffing to meet demand, and at both trusts we’ve been really focussed on staff flu vaccination. We’ve really high levels.”

Dr Navina Evans, who is the chief executive of East London NHS Foundation Trust, which provides mental health and community services, said:

“For our mental health patients and service users it is about making sure their care plans and treatment are fit for purpose to see them through the winter: for our acute services making sure that our liaison mental health services support them properly to manage their demand, and that our community services do the same by making sure that we prevent unnecessary admissions and facilitate quick discharge.”

The chief executive of West Midlands Ambulance Service NHS Foundation Trust, Anthony Marsh, said:

We have been putting extra paramedics, nurses and GPs into our call centres to be able to deal with more patients over the telephone, thus reducing the number of patients being conveyed to hospital.

“We have been putting extra paramedics, nurses and GPs into our call centres to be able to deal with more patients over the telephone, thus reducing the number of patients being conveyed to hospital: but also for those patients that do require to be taken to hospital, by supporting the handover process with our acute colleagues, enabling us to free up our ambulances more promptly to respond to further emergency cases in the community.”

The chief executive of Lancashire Teaching Hospitals NHS Foundation Trust, Karen Partington, emphasised the importance of support for nurses:

“We’ve created something called a ward liaison officer role and those are people who work on each of the wards to support the nursing staff. It takes away some of the administrative roles, chasing up scans, making sure we’ve got the pharmacy in place, and that means the nurses are then free to look after the patients on the wards.”

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

“Winter always presents a big challenge to the NHS.

“Last year the pressures were intolerable. Services were stretched up to, and in some places beyond, breaking point.

“This time preparations have never been more thorough.

“Our briefing highlights the range of measures trusts have put in place to improve resilience and provide safe, timely care for patients.

We can not say with certainty how tough this winter will be, but the likelihood is that services will be sorely tested.

“It also shows what national bodies are doing to support this work.

“But we have to recognise we are not where we would want to be as we head into winter.

“The NHS is already under severe pressure, and while the additional funding in the recent Budget is welcome, it has come very late to be used to maximum effect.

“We can not say with certainty how tough this winter will be, but the likelihood is that services will be sorely tested.

“We must hope the considerable efforts to curb the impact of flu are successful.

“What we can say with confidence is that NHS trusts have prepared for the challenge and will do all they can to provide high quality care for every patient, whatever the pressure.”