It may seem odd to issue a winter warning when we have just been through an early summer heatwave. But the forecast from the NHS front line is clear: unless we do something now to manage the risk for next winter, there is trouble ahead.
Let’s remember what happened last winter. NHS staff responded heroically to extraordinary pressures. But safety and standards of care were compromised in too many places. As demand increased, so did pressure on beds, staff and the whole health and care sector. That meant delays in A & E and more patients waiting on trolleys for a bed. This had knock-on effects for ambulance response times and there were similar pressures in mental health and community services.
unless we do something now to manage the risk for next winter, there is trouble ahead.
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To make matters worse, growing numbers of patients faced delays once they were ready to be discharged, often because of difficulties in lining up suitable social care. These delayed transfers of care (DTOCs) rose sharply in hospitals and in NHS community services where, in January, they accounted for nearly 30 per cent of beds.
Demand will continue to rise
There is every prospect that, over the next 12 months, demand will continue to rise. Growing workforce shortages and the squeeze on funding also threaten the NHS’s ability to match the capacity provided last year which, at its height, included the equivalent of extra eight temporary District General Hospitals.
In March the government announced extra funding for social care including £1 billion for this financial year. The money was designed to not just help social care, but also reduce NHS DTOCs, freeing up 2000-3000 extra NHS beds. But trust leaders have told us that, in many places, this funding is not buying the double social care and NHS benefit the Government hoped it would.
Trust leaders have told us that, in many places, this funding is not buying the double social care and NHS benefit the Government hoped it would.
chief executive
In the new survey of NHS trusts we’re releasing today, only one in four trusts said they had a specific commitment that the extra social care funding would help reduce NHS DTOCs. For community and mental health trusts, the figure was one in ten. Nearly half thought the money would have no impact on their ability to manage winter pressures.
It was striking how worried trusts were about insufficient capacity, right the way across the health and care system. 92% of trusts reported a lack of capacity in primary care to manage next winter; 91% a lack of capacity in social care; 80% a lack of capacity in mental health services; 76% a lack of community service capacity; 71% a lack of acute hospital capacity and 64% a lack of ambulance capacity. Only 57% of trusts were confident they could provide safe and high quality care this winter.
Only one in four trusts said they had a specific commitment that the extra social care funding would help reduce NHS DTOCs.
chief executive
If we fail to invest now to cover those capacity gaps, there is a serious risk of wider failures than last winter with the safety of more patients at risk.
We are therefore calling for an additional £350 million to give targeted support to those areas where the extra social care funding will have little or no impact. This would allow the NHS to commission the extra community, mental health, ambulance and hospital capacity required. There will be no single right answer for the use of this money, but decisions should be taken locally to suit local needs. The money should be funded by a repayable loan or an advance drawdown on the extra £8 billion promised for the NHS in the Conservative manifesto.
No time to lose
We must also look beyond this winter to develop a sustainable long term approach to funding health and social care, including enabling NHS infrastructure to grow to meet growing emergency demand. Alongside this, we need a comprehensive workforce strategy that matches NHS staffing to what the NHS is being asked to deliver so we stop asking NHS staff to deliver the impossible day in day out.
There is no time to lose. Our survey says trusts need to know about any extra capacity by the end of July if they are to plan properly and secure extra staff cost effectively. Last winter gave us the clearest possible warning that patient safety is now at risk. We have one more month to respond to those warnings.
This article first appeared in the Guardian on 27 June 2017