The NHS has comprehensive winter plans to manage risk at national, regional and local levels. As outlined above, this planning has significantly improved over the last three years. Trusts tell us that they believe all that possibly could be done within the current context has been done. Key features of the plan include a strong focus on the trusts most likely to come under greatest pressure and mobilisation of extra support where required.
Trusts report that they also feel there is greater realism nationally and regionally this year about what can be achieved. The reality, as already shown in current performance statistics, is that consistent delivery of the four-hour constitutional standard will be impossible in all but a very few places.
Performance, in many trusts may drop to levels which cause concern for patient safety. There is helpful agreement, across the service, that trusts should therefore concentrate on keeping patients safe – minimising ambulance handover delays, overcrowding and corridor care. This is the right focus. But it should be a cause of concern that this is the likely prevailing level of performance and we must now take the right long-term steps to address the underlying challenges which are driving this worrying, and seemingly endless, deterioration in performance. Whatever the outcome of the current clinical review of standards, there is widespread agreement that the performance levels inherent in the current four hour standard represent a good proxy for the level of care the NHS should be providing to its urgent and emergency care patients.