The winter of 2017/18 was a watershed moment for the NHS. Most parts of the health service were under intense and sustained pressure, staff were unable to deliver the standard of care they would like and patient care in too many instances was compromised. This brought in to sharp focus that the NHS is currently unable to deliver the level of care, as laid out in the NHS constitution.
A range of indicators across the health and care system showed an overwhelming lack of capacity across the country. There were 1.3 million ambulance arrivals; the equivalent of an ambulance arriving every 15 minutes, 24-hours a day at all 137 trusts with major A&E departments all winter. Delays in handing over patients to hospitals were widespread, with two thirds of trusts experiencing handover delays of more than an hour each week.
Demand for services this winter substantially exceeded the previous winter. The number of attendances grew by 5% compared to last year meaning the NHS saw an additional 261,000 people, roughly equivalent to the population of a city the size of Plymouth. There were also an additional 85,000 emergency admissions to hospital compared to last winter.
This winter has highlighted a fundamental mismatch between demand and capacity across all parts of the NHS. In hospitals, the NHS had to open more temporary beds than last winter - reaching a peak of 4,700 in the first week of January. The severe flu outbreak and cases of norovirus also compromised some inpatient capacity across the system with 813 beds closed on average each week. Across community, mental health services, primary care and social care, demand for services was substantial over the period.
Despite seeing more patients in winter, the NHS still managed to treat, admit or discharge more patients than ever before within four hours. Despite A&E performance currently sitting at the worst level since data collection began in 2010, the NHS saw an additional 160,000 people within 4 hours compared to last winter – equivalent to the population of a city the size of Oxford.
Action must be taken to break out of this perpetual winter crisis the NHS faces each year and better support trusts and staff on the frontline. Next steps must include a meaningful national review of winter 2017/18, a new national planning framework that is realistic about demand projections and a full review of capacity across the health and care system.
NHS Providers’ Winter watch tracked NHS performance week-by-week over 14 weeks from December 2017 to the beginning of March 2018. We used a combination of the winter situation reports (NHS England, 2018) and insight from NHS trusts to report how the frontline responded to this year’s winter.
In the final overview for this series, we set out the story of the past winter, looking at the areas most under pressure and revisit the stories from our members. Finally, we set out some next steps aimed at improving the winter planning framework in future and helping ensure that trusts are better supported to manage through winter pressures.