Trust leaders are warning that they are more concerned than ever before about the level of risk they will need to manage for patients and their staff this winter.

Striving to deliver: NHS Providers winter briefing 2019/20 is an assessment of readiness looking into the areas of concern facing the NHS and the extensive planning they and their local partners have put into place to mitigate this.

Trusts have extensively prepared for additional demand over winter by working more collaboratively and innovatively with partners across the health and care system, meaning that some extra capacity may be created. Trusts have also benefitted from an effective national improvement offer to support urgent and emergency care performance.

However the briefing also identifies seven areas of concern for trusts this winter. These are:

• the increase in demand for urgent and emergency care – both in terms of volume and acuity
• the inability of secondary care capacity to keep up with demand
• the instability of the primary and social care sectors
• a lack of a 'recovery period' during the summer months, meaning the NHS is starting out in a much worse position than usual this winter
• systemic workforce shortages, especially across various specialisms, and high levels of burnout among NHS staff
• current problems with the taxation of NHS pensions reducing availability of some senior clinicians
• the lack of dedicated winter funding this year.
  
  

Trust leaders are worried about the cumulative impact these pressures may have on patient safety as demand for hospital, mental health, ambulance and community services rises.

NHS Providers sets out a series of actions which the health and care system needs to reduce winter pressure on the service each year. These include:

• a major review of urgent and emergency care demand and capacity across the system
• rapid clarity on the performance levels the NHS should be working to on emergency care
• addressing the crisis in social care
• an urgent and long term solution to the workforce challenge, which has been exacerbated by the current pensions problem for all NHS staff
• a multi-year capital investment regime to rebuild our NHS.
  
  

Commenting on the briefing, Saffron Cordery, deputy chief executive of NHS Providers, said:

"Despite best efforts to plan and prepare for winter, trusts are already under immense pressure, with some already declaring highest level black alerts. Although NHS staff are working flat out, the NHS is far from where it wants to be.

"With demand continuing to rise at rapid rates, severe workforce shortages, capacity issues and a lack of a sustainable solution to social care, we anticipate winter will be very difficult this year.

Although NHS staff are working flat out, the NHS is far from where it wants to be.

Saffron Cordery    Interim Chief Executive

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"NHS staff continue to go above and beyond to treat patients safely and as quickly as possible. But there is no denying that NHS trust leaders are the most worried we have ever seen them. This year we are starting winter from the worst performance position we have ever been in, having not been able to keep up with unprecedented demand over a very busy summer.

"And these pressures are felt right across the health and care system beyond acute care, including in primary care, care homes, community services, ambulance and mental health services.

NHS staff continue to go above and beyond to treat patients safely and as quickly as possible. But there is no denying that NHS trust leaders are the most worried we have ever seen them. This year we are starting winter from the worst performance position we have ever been in, having not been able to keep up with unprecedented demand over a very busy summer.

Saffron Cordery    Interim Chief Executive

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"We welcome the fact that the new government has made the NHS a top priority. We need to see those commitments turned into action by delivering on solutions to the NHS’ workforce challenges, the social care crisis, and by delivering appropriate investment in buildings, equipment and services across the NHS."