Throughout the year, trusts do all they can to provide the right care at the right time in the right place. This is particularly important in winter when the pressures are greatest and capacity to manage additional numbers of patients is more constrained.

There are a number of key challenges that trusts will face over the winter period. These are set out below, along with examples of how they are being addressed in different parts of the country.

  • Good patient flow supports clinical safety, improves patient experience and reduces pressure on staff. Trusts will be doing all they can to manage patient flow during the winter period. For example Worcestershire Care and Community NHS Trust has used the Red2Green approach to improve patient flow within the community. This approach identifies whether each patient’s bed day is red (not adding value) or green (adding value). The approach is designed to minimise red days and ensure as many bed days as possible are green.

  • Trusts will agree local resilience plans with local partners to ensure a joint approach is taken to addressing challenges over winter. For example, Leicestershire Partnership NHS Trust plans to implement a multi-agency discharge event (MADE) in preparation for Christmas to create improved patient discharge in December and again in January.

  • Ensuring adequate mental health provision is in place will help ensure patients with mental health needs are treated in the right place, rather than in A&E. East London NHS Foundation Trust has expanded provision of mental health care liaison, which will see a specific team supporting GP practices across the region. Dudley and Walsall Mental Health NHS Trust operates an adult on-call system for all crisis mental health provision 24 hours a day, 365 days a year. Its adult psychiatric liaison service operating within A&E is available seven days a week, 6am to 11pm, and a crisis treatment at home service provides out of hours support for children and adolescents, and assists with discharge from the acute hospital.

  • Taking a ‘human factors’ approach makes it easier for staff to do the right thing, which is particularly helpful when they are working under pressure. For example University Hospitals Bristol NHS Foundation Trust is using an emergency department safety checklist to standardise and improve delivery of basic care. All trusts have now been asked to ensure they have this checklist or an equivalent in place.

  • Trusts will be leading local communications campaigns to complement the Stay well this winter national campaign. They will engage with local populations through social media, Facebook advertising, weather alerts, and video case studies.