Planning together for winter pressures

Professor Ted Baker profile picture

07 November 2018

Professor Ted Baker
Chief inspector of hospitals
Care Quality Commission


While NHS trusts are increasingly experiencing year-round, sustained pressure, we know that the health and care system sees surges in demand and increased challenges during winter – with emergency departments often bearing the brunt of this.

It is not just the number of people attending emergency departments that creates increased demand on the service, but the fact that those attending hospital often have more complex needs and require more medical attention.

Professor Ted Baker     Chief inspector of hospitals

However, it is not just the number of people attending emergency departments that creates increased demand on the service, but the fact that those attending hospital often have more complex needs and require more medical attention.

NHS Providers warned in its recent report that this coming winter is likely to be even more difficult than that last for trusts, staff and patients. Despite many local NHS leaders starting their winter planning back in May/June, they remain concerned about the impact of winter because of limited capacity across the health and social care system.

I share those concerns. I am sure that your staff will do all they can to provide safe care for patients despite the pressures, indeed it is their commitment and your leadership that will be key to maintaining the quality of care.

I am sure that your staff will do all they can to provide safe care for patients despite the pressures, indeed it is their commitment and your leadership that will be key to maintaining the quality of care.

Professor Ted Baker     Chief inspector of hospitals


Earlier this year, we published a report, Under pressure: safely managing increased demand in emergency departments, which presented the findings from our inspections of emergency departments over winter 2017/18 alongside the views of over 70 frontline clinicians who attended workshops aimed at understanding the issues facing staff and what needs to change.

The discussions with clinicians were structured around four key areas of clinical concern:

  1. Ambulance handover, crowding and safety in emergency departments
  2. Emergency department medical and nursing workforce
  3. Patient flow, escalation and winter planning
  4. Condition-related issues during winter: flu and respiratory illnesses; frailty; paediatrics and mental health


They generated a number of practical steps to help overcome barriers and support improvements in three key areas:

  • Demand – actions that can be taken outside of the hospital that have been found to reduce the number of attendances to emergency departments.
  • Capacity – actions that emergency departments and hospitals can take to improve patient flow through the hospital.
  • Output – actions that can be taken to help to get people home more quickly and avoid admission to hospital.


Their advice is laid out in the report, which I recommend to you. The actions do not present simple solutions to what we all recognise is a complex problem, but they do point to the essential steps hospitals and wider systems can take to ensure patient safety is protected under the continued pressure that services are experiencing.

Our inspections showed that many trusts had improved despite the pressures they are facing and we found committed staff working in difficult circumstances, often going above and beyond what could reasonably be expected of them. However, it is clear that some services are finding it increasingly difficult to manage the workload they face. This year’s State of Care report also highlighted urgent and emergency care services as an area of concern, with 7% of these services rated as inadequate and 41% rated as requires improvement overall.

Our inspections showed that many trusts had improved despite the pressures they are facing and we found committed staff working in difficult circumstances, often going above and beyond what could reasonably be expected of them.

Professor Ted Baker     Chief inspector of hospitals

Another important message that these reports carry is that hospitals cannot work alone to address this ever-increasing demand on services – transformation is needed across the health and care system as a whole. Looking beyond hospital emergency departments, the findings from our local system reviews show a variation in the way that local systems have worked together to prepare for surges in demand.

Although we saw good examples of systems working collaboratively to plan for winter pressures, the reviews raised concerns about the timeliness of this planning and the extent to which all partners across the system are involved in the planning process, with independent social care providers and voluntary, community and social enterprise organisations often less engaged.

The ongoing trend of increasing demand on health and social care services shows no signs of abating, and it is clear that changes in the way local systems work are needed if a sustainable way forward is to be found.

Professor Ted Baker     Chief inspector of hospitals

The ongoing trend of increasing demand on health and social care services shows no signs of abating, and it is clear that changes in the way local systems work are needed if a sustainable way forward is to be found. There are no quick fixes to a problem that requires a system-wide response, but I hope the examples of good practice and practical solutions featured in the report can support you in maintaining safe, high-quality care in the face of the operational pressures you face.

About the author

Professor Ted Baker profile picture

Professor Ted Baker
Chief inspector of hospitals

Ted became chief Inspector of hospitals in August 2017. He joined CQC in 2014 as deputy chief Inspector of hospitals.

Before joining CQC, he worked in clinical practice for 35 years. He was medical director and deputy chief executive of Oxford University Hospitals NHS Trust from 2010 to 2014 and medical director at Guy's and St Thomas' NHS Foundation Trust from 2003 to 2010. He has held numerous other clinical and academic appointments both in the UK and internationally.

While he was at Oxford University Hospitals NHS Trust, he chaired the first of CQC's comprehensive inspections in September 2013 and led his trust through its own CQC inspection in 2014. He led major service improvements and operational and strategic change while he was at Oxford and Guy's and St Thomas' trusts.

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