NHS Providers says trusts are exploring all avenues to support patients and staff as the NHS heads into what trust leaders believe will be the "most difficult winter in the history of the health service".

The organisation, which represents every hospital, mental health, community and ambulance service in England, says that its regular annual survey of trust leaders shows a much higher level of concern about the coming winter than ever before. It is calling for immediate, emergency action to support social care.

Trust leaders are deeply concerned about the combined impact of increased demand for emergency care, growing waiting lists, significant and sustained staff shortages, potential staff burnout, the extra resource needed for vital vaccination campaigns and the prospect of high levels of COVID-19, flu and other respiratory viruses.

NHS Providers' State of the provider sector report shows that, while COVID-19 cases are well below their January 2021 peak, trusts are "beyond full stretch" as they deal with current pressures and prepare for winter by expanding capacity, recruiting more staff, increasing collaboration with partners across health and social care and delivering vaccinations.

The survey shows that trust leaders are particularly concerned about the scale of pressure they are already under before the NHS has reached its traditional peak of winter demand.

   

The survey shows that trust leaders are particularly concerned about the scale of pressure they are already under before the NHS has reached its traditional peak of winter demand which usually runs from mid-November to end-February, with pressure often greatest in January.

The report points to the unprecedented scale of current pressure in the ambulance sector – with all ambulance services on the highest level of alert – as a clear indication of the NHS currently being "beyond full stretch". The similarly unprecedented high levels of bed occupancy in many hospitals for this time of year are, equally, a worrying indicator.

The report also highlights health leaders' call for the government to take immediate, emergency, action to support social care which they describe as "having now headed into even deeper crisis" due to the loss of workforce over the last few months, despite best efforts in the social care sector.

172 board level trust leaders from 114 trusts responded to the survey, accounting for 54% of the NHS provider sector. Findings include:

• 87% said they are extremely concerned about the impact of winter on their trust and local area. When asked the same question last year, the figure was 56%, ahead of what proved to be one of the toughest winters in the history of the NHS.
• 84% are very worried/worried about their trusts having the capacity to meet demand for services.
• 85% are very worried/worried that insufficient investment was being made in social care in their area.
• 94% are extremely/moderately concerned about staff burnout.

Chris Hopson, chief executive of NHS Providers, said:

"The message from trust leaders is loud and clear: judging by the pressure the NHS is currently under, the service is heading for the most difficult winter in its history.

"The current COVID-19 caseload is considerably lower than the peak at the start of the year, but when we consistently run our health and care system at the limit of its capacity, it doesn't take much extra pressure to increase risk to patient safety and quality of care.

"The loss of bed capacity due to COVID-19 infection control; the current level of NHS staff shortages and pressure on existing staff; the resource needed for the vaccination campaigns; the 7,000 COVID-19 patients in hospital; and the recent increase in social care workforce shortages are all combining to bring major, additional, pressures.

But trust leaders are equally clear that it is their responsibility to support their staff to provide the best possible care to all patients who need it.

"But trust leaders are equally clear that it is their responsibility to support their staff to provide the best possible care to all patients who need it, as rapidly and effectively as possible. That's why they are working so hard to prepare for winter and deliver vaccinations as fast as they possibly can.

"The last 18 months have shown how, thanks to the dedication and professionalism of frontline staff and leaders, the NHS is remarkably resilient when faced with extreme pressure.

"Capacity levels for winter are now broadly set. Trust leaders, for example, are saying that even if more funding were made available, they are finding it impossible to recruit extra staff. But there are two immediate areas where they want the government to focus.

"First, they want the government to provide emergency help to enable the social care sector to keep its existing workforce in place over the next few months. If we want to keep hold of the staff that we've got, the government should seriously consider introducing some kind of emergency support for the social care workforce.

"One option is a retention bonus of a minimum of £500 each for the 1.5 million social care staff in England, similar to the schemes now operating in Scotland and Wales. This would add up to a £750m bill, most of which would have to be a draw on the government reserve. While a £500 figure is not as high as some employers in retail and hospital are offering as a 'golden hello' in the run up to Christmas, this is a price worth paying if it helps keep social care functioning as we need it to through the winter.

COVID-19 is still with us and while the NHS will do all it can to avoid another lockdown, stronger, louder and more frequent messaging is needed to reinforce what the public can do to manage the risks from the virus.

"Second, they want the government to give greater leadership on public health. COVID-19 is still with us and while the NHS will do all it can to avoid another lockdown, stronger, louder and more frequent messaging is needed to reinforce what the public can do to manage the risks from the virus.

"Those messages include the fact that it is vital for everyone eligible to be fully vaccinated. But, even if you are fully vaccinated, you can still catch or pass on COVID-19. So we all need to be cautious when mixing with other people outside our normal household. We should all be wearing a mask in crowded or busy places. We should be regularly ventilating rooms where we are meeting other people. We need to hear these messages more emphatically, and more often, from the prime minister down.

"Longer term, trust leaders are clear that this is a completely unsustainable position for the NHS and social care to be in and we have to address the underlying causes – a broken workforce model, insufficient capacity to match growing demand, inadequate funding and a social care system in crisis – which COVID-19 has significantly exacerbated."