Leaders of NHS trusts in England are deeply concerned about the NHS’s ability to respond to mounting pressures next winter, according to a new report published today by NHS Providers.

Winter Warning highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS.

Winter Warning highlights the worries of many NHS trusts that extra funding for social care is not consistently getting through to the NHS.

The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. Despite extraordinary efforts from staff, the health and care systems struggled to cope under sustained pressure.

A key factor was the sharp rise in delayed transfers of care (DTOCs), for patients who were ready to be discharged, often because of difficulties in lining up suitable social care.

The government’s response in the spring budget was to use the £1 billion of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts.

The clear message in Winter Warning is that, in many places, this is not happening.

The report draws on a survey and detailed discussion with leaders of NHS hospitals, mental health and community trusts and ambulance services.

 The survey addressed discussions NHS trusts have had with their local authorities about the additional social care funding:

• Only around one in four (28 per cent) said they had a specific commitment that the funding would help reduce delayed transfers of care (for community and mental health trusts, the figure was one in ten)

• Only one in three (34 per cent) said their local authorities were giving a high priority to supporting the NHS reduce DTOCs as opposed to other social care needs

• Nearly half (44 per cent) thought the money would have no impact on their ability to manage winter pressures

• 92% of trusts reported a lack of capacity in primary care; 91% a lack of capacity in social care; 80% a lack of capacity in mental health; 76% a lack of community service capacity; 71% a lack of acute capacity and 64% a lack of ambulance capacity to manage next winter. 

There is a clear risk that, as pressures continue to grow, the difficulties encountered last winter will be more severe and extensive this coming winter. Worryingly, only 57% of trusts are currently confident they will be able to deliver safe and high quality care this winter. To manage this risk the health service needs the added NHS capacity that the extra social care funding was intended, but is failing, to secure. 

There is a clear risk that, as pressures continue to grow, the difficulties encountered last winter will be more severe and extensive this coming winter.

The report calls for a funding injection of £350 million, committed by the end of July at the latest. This would be funded by a repayable advance or early draw down of the extra eight billion pounds committed to the NHS in the Conservative Party manifesto. The money could be used to:

• Put in place extra beds in community and mental health services as well as in hospitals.
• Help pay for more doctors, nurses and care home staff
• Enable the ambulance service to take more of the patient load
• Strengthen mental health crisis care to prevent hospital admissions

The report also highlights the need to develop a realistic and sustainable long term approach to funding health and social care, and a comprehensive workforce strategy that takes account of what the NHS is being asked to deliver.

The chief executive of NHS Providers, Chris Hopson, said: 

“Last winter NHS staff responded heroically to extraordinary pressures. But safety and standards of care were compromised. In too many places the NHS was overwhelmed for short periods of time. We must not allow that to happen again.

“What is clear from our survey and detailed conversations with frontline trusts is that the Government’s plan of trying to gain a double benefit from the Budget’s extra £1 billion social care funding is not going to work consistently enough. Trusts say the NHS has about a month to plug the gap.

In too many places the NHS was overwhelmed for short periods of time. We must not allow that to happen again.

“We are calling for an additional £350 million to give targeted support, distributed to those areas where social care funding will have little or no impact on the NHS. This would allow the NHS to put in place extra beds in community and mental health services as well as hospitals whilst also enabling the ambulance service to deal with more patients. The investment would also help pay for the higher number of temporary doctors, nurses and care home staff we know the NHS will need. And it could be used to strengthen mental health crisis care to prevent hospital admissions. There will be no single right answer for the use of this money, but decisions would be taken locally to suit particular needs. 

“There is no time to lose. One of the key findings in our survey was that trusts need to know about any extra capacity by the end of July so they can plan properly and secure the 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”.