NHS system leaders need to decide, in the next fortnight, whether to invest between £200m and £350m to enable the NHS to manage patient safety risk this coming winter. Following our Winter warning publication in June, this briefing provides an update on the latest state of play on planning for this winter. Despite better national-level planning and a lot of hard work by trusts, the latest frontline intelligence suggests that risk is growing rather than reducing. Failure to make the required investment risks worse performance than last winter, widely regarded to be the most challenging winter in recent times.

Key points

  • Last winter was widely regarded to be the most challenging winter in recent times, yet the NHS is currently on a trajectory towards, at best similar, but more likely worse, performance this coming winter, with heightened patient safety risks.

  • NHS system-level planning and support, led jointly by NHS England and NHS Improvement, is considerably more developed than last year and emergency care performance has been given greater priority. Extra social care funding should help reduce NHS delayed transfers of care, increasing NHS capacity, in about a third of systems. Trusts are doing all they can to stablise and improve their A&E performance in advance of this winter, in the face of demand increases and competing priorities.

  • However, these improvements are being significantly outweighed by a combination of increasing risks. Trusts are not consistently benefitting from the extra social care investment, as planned. Delayed transfers of care remain stubbornly high. Demand is still rising by around 3% year on year. Workforce shortages are growing. Primary and social care capacity, as a whole, remains very challenged. Trusts are under greater financial pressure than last year and therefore less able to afford extra capacity. Current emergency care performance is either worse or the same as last year. Trusts report that they do not currently have sufficient capacity to manage this coming winter safely.

  • The NHS provider sector needs an immediate emergency cash injection of between £200m and £350m to manage this growing risk. But this must not be at the expense of existing expenditure on services that are key to winter performance such as primary care, community care and mental health care. The decision on this investment needs to be made immediately to ensure trusts have time to create the required extra capacity and minimise the amount spent on short term agency staffing fees.