What is clear from the survey and detailed conversations with NHS trusts on the frontline is that the health and care system needs to act now, and act together, to avoid a number of risks:
- risks to the quality of care patients and the public receive
- risks to the safety of services
- risks to the sustainability of services
- risks to the workforce and increasingly poor morale.
There needs to be an honest conversation at every level – institutional, local, regional, national – about how we plan to manage the immediate challenges we face and how we put in place measures and strategies to tackle demand and capacity issues in the longer term. This must involve every part of the provider sector: acute hospitals, mental health, community and ambulance services. Focusing solely on and prioritising A&E performance will be self-defeating when it is these other services, along with social and primary care, which are at the forefront of urgent and emergency care delivery.
The government’s additional funding of £2bn for social care has been welcomed in every quarter. However there is a clear lack of confidence across NHS trusts delivering care on the frontline that the investment will be spent by local government in a way that overcomes the capacity challenges the NHS faces:
- only 18 % of NHS trusts are confident it will help them meet the NHS England Mandate requirement to reduce DTOC levels to 3.5%
- only 28% of trusts received a specific commitment that the money will be used to reduce DTOCs.
NHS Providers is calling for an additional investment of £350m to tackle the immediate problems. This money needs to be committed directly to the NHS by July or August, or it will not be used effectively or efficiently. At the same time there needs to be a national-level commitment to start work on the longer term strategies that will help solve the underlying structural and capacity pressures we are grappling with each winter.
If this does not happen, the coming winter and all those thereafter will be increasingly challenging, pressurised and most importantly risky. As one trust leader put it:
Our walls are not elastic, and we are unable to simply flex capacity up or down