It’s still winter in the NHS

Adam Brimelow profile picture

13 June 2019

Adam Brimelow
Director of Communications


The NHS is about to get its monthly report card, reflecting performance on many of the priorities that make a big difference for patients. These include waiting times in A&E, and for cancer treatment and routine operations. As we head into summer, with fewer of the health problems associated with cold weather, you might expect pressures to ease. You would be wrong. Against nearly all the main treatment access targets, we are heading in the wrong direction.

As we head into summer, with fewer of the health problems associated with cold weather, you might expect pressures to ease. You would be wrong. Against nearly all the main treatment access targets, we are heading in the wrong direction.

Adam Brimelow    Director of Communications

For many people, this has been happening under the radar. Our national preoccupation with Brexit has diverted a lot of attention away from other key challenges, not least those we face in the health service. So, despite huge and growing pressures, there was little sign in January of the “NHS winter crisis” story that usually grips large sections of the media from new year into March. But we should not draw false comfort.

Yes, it was encouraging to see evidence of different parts of the health and care system – hospitals, community, mental health and ambulance services, along with GPs, local authorities, charities and voluntary partners – coming together in some places as never before to reduce recovery times and help patients home more quickly.

Yes, it was encouraging to see evidence of different parts of the health and care system – hospitals, community, mental health and ambulance services, along with GPs, local authorities, charities and voluntary partners – coming together in some places as never before to reduce recovery times and help patients home more quickly.

Adam Brimelow    Director of Communications

And yes, NHS staff once again showed remarkable resilience and commitment through the winter months in keeping services going, treating more patients than ever, and ensuring that the overwhelming majority received good care, often in the face of intolerable pressures. But month after month the performance figures confirmed the widening gap between the growing demand for care, and the capacity – in terms of staff and other resources – to deal with it.

And this has continued through the spring. The most recent figures (for April), showed attendances at major (type one) emergency departments were up nearly seven per cent on the previous year. Set against the official target to see and treat or discharge 95 per cent of patients within four hours, performance in these EDs was almost 20 per cent adrift, and deteriorating rapidly.

Similarly, the number of patients breaching the 18 week threshold for routine surgery rose, while the waiting list continued to climb to nearly 4.25 million. Delays for diagnostic tests including scans and biopsies also increased, and there was further slippage against key cancer treatment targets. What we are seeing is pressure on A&E having a knock on impact on wider health and care services. Trusts are in the impossible position of having to prioritise those who are most sick, and are seeking to manage the wider impact this has on cancer and planned procedures.

What we are seeing is pressure on A&E having a knock on impact on wider health and care services. Trusts are in the impossible position of having to prioritise those who are most sick, and are seeking to manage the wider impact this has on cancer and planned procedures.

Adam Brimelow    Director of Communications

The latest findings from the British Social Attitudes Survey suggest these difficulties are starting to make their mark. Public satisfaction with the NHS has fallen to its lowest level in more than a decade, with concerns over waiting times, staff shortages and funding at the top of the list.

Don’t get me wrong. This isn’t another harangue for more money for the NHS. We welcomed the extra funding announced for the health service announced last summer to see it through the next five years (though it still fell well short of the levels independent experts said would be needed to recover performance and adapt services to future needs, following the longest and deepest financial squeeze in the history of the NHS).

There is a real concern though about expectations. Trusts are working flat out to provide the safe, high quality care for patients enshrined in the NHS constitution. But the monthly figures confirm that against those high standards, they are falling short. Now, with a funding settlement in place, together with more than 300 new commitments set out in the long term plan, there is a real risk of expectations running still further ahead of what the NHS can realistically deliver.

Trusts are working flat out to provide the safe, high quality care for patients enshrined in the NHS constitution. But the monthly figures confirm that against those high standards, they are falling short.

Adam Brimelow    Director of Communications

Faced with these pressures, it is vital that the NHS works towards agreed standards that command the confidence of patients and the public, of frontline clinical staff, and of trust leaders who will be held to account to deliver them.

So of course it is right to review the targets, as is now happening, to ensure they reflect evolving clinical practice and changing patient needs. But this challenge – tricky at the best of times – is doubly difficult when performance is slipping against existing goals. To guard against any suspicion of shifting the targets to make them easier or cheaper, the process must be transparent, rigorous and inclusive. The outcome must not be pre-ordained. And we should not discard old benchmarks until the new ones are ready.

Today’s figures will show it’s still winter in the NHS. But the health service has weathered worse before. Overcoming these challenges won’t be quick or easy – people need to know that. It is vital their trust and support is not taken for granted. But overcome them we will.

About the author

Adam Brimelow profile picture

Adam Brimelow
Director of Communications
@adambrimelow

Adam Brimelow is NHS Providers’ director of communications. Prior to joining as head of news in 2016 he was a BBC health correspondent for 14 years, working across a range of outlets including Today and World at One on radio 4, TV news bulletins and online. Previously Adam also worked for BBC World Service and in local radio, based in Birmingham and Manchester. Read more

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