NHS Providers tells emergency services to brace themselves for what could be the worst winter in years
Despite intensive winter planning, doubts remain over how hospitals in England will cope this winter.
Despite intensive winter planning, doubts remain over how hospitals in England will cope this winter
NHS Providers, which represents NHS trusts, issued a warning after initiatives to relieve the pressure on ‘hard-pressed’ hospitals failed to improve performance over the summer.
The organisation highlighted a lack of progress on delayed discharges, bed occupancy rates and the proportion of patients being admitted or discharged in four hours.
The warning comes despite intensive winter planning by NHS bosses via the ED delivery boards, the extra money pledged for social care and a £100 million pot to help ensure every ED unit has a GP streaming service.
Upper estimate of cost to NHS of managing this winter’s risk safely
In a report looking ahead to winter, NHS Providers acknowledges that the support – led by NHS Improvement and NHS England – was ‘considerably more developed’ than last year. But feedback from NHS Providers members and analysis of latest performance data still suggests the NHS is ‘heading for a worse winter than last year’.
NHS Providers chief executive Chris Hopson says he is worried. ‘Last winter was widely considered the worst in recent times. But everything indicates this could be even worse. It will be difficult for staff. There are real shortages everywhere and without action patients will be put at risk.’
He is calling for an emergency cash injection of between £200 million and £350 million to pay for more beds and staff, which he says could be drawn from extra money earmarked for future years.
But so far the government has not been forthcoming.
The NHS Providers report says the money is needed because delayed discharges remain ‘stubbornly high’ and the £1 billion extra councils have been given for social care has only resulted in progress in a third of areas.
The report highlights figures from the Association of Directors of Adult Social Services which show that in other areas the money was being spent on ensuring current services remained viable rather than looking to provide extra support to help speed up the discharge process.
RCN professional lead for acute, emergency and critical care Suman Shrestha says while there is still time for some of the national initiatives to have an impact, it was clearly going to be ‘very hard for nurses’ this winter.
‘There are high vacancy rates and increased pressure takes its toll in terms of being able to provide safe care. We know that when there aren’t enough nurses, patient care suffers.
‘We also need to think about the well-being of nurses. When they are overworked sickness rates rise.’
Cumulative savings in adult social care since 2010
But that is not the only worrying portent, says Mr Shrestha. ‘If you look at the evidence from Australia, which has just gone through its winter, there was a lot of flu activity. What happens there tends to be a good indication of what will happen here. A bad flu season could case real problems.’
Nonetheless NHS bosses remain confident their plans will help the health service cope. NHS national director for urgent and emergency care Pauline Philip says there will be challenges as there are every year.
But she says: ‘Winter planning is more advanced than last year and special attention is being paid to areas where pressures are likely to be greatest.’
Extra beds are already in the process of being opened, while the social care money could potentially free up another ‘2,000 to 3,000’ beds by the time winter eventually hits. GP streaming will also help, she says.
Her comments come as ministers announced funding for another 19 streaming schemes, bringing the total number of hospitals benefitting from the £100 million pot to 116. The money is being earmarked to help set up the physical infrastructure that the streaming service will be housed in.
Summer 2016 v summer 2017
Attendances and admissions There were 1.92 million ED attendances during August, 0.5% fewer than in August 2016. But emergency admissions were up – to 486,669, 3.4% more than the year before.
Delayed discharges This has been a key priority for ministers. There were nearly 181,692 days of delays in July, compared to 184,578 in the corresponding month in 2016.
ED waiting The four-hour target has not been hit for over two years. In August 90.3% of patients were treated or admitted in four hours, worse than the 91.0% in August 2016.
Bed occupancy It is recommended that bed occupancy is kept below 85%, but in the quarter ending June it was 87.1%, marginally better than the corresponding quarter in 2016 when it was 88.3%.
The aim is that every ED will have some form of streaming in place by October. But while that money has been welcomed, there are still doubts over just how effective the initiative will be.
patients a week currently unable to get a GP appointment
RCN Emergency Care Association chair Janet Youd says it will lead to less crowding in EDs, but the patients who will benefit are not the ones who are ‘generally highly dependent on nursing care’.
She says it is the ‘seriously ill or injured’ such as frail patients with sepsis or fractured hips who suffer most when there is no appropriate inpatient bed for them.
‘The ED environment is not conducive to giving the required level of care with dignity. The ED nursing shortage compounds the insult.
‘Sadly no amount of GP availability will reduce the harm these patients experience or the distress the nurses feel as a result.’
Luton: bucking the trend
The government wants all EDs to have GP streaming arrangements in place by October, arguing they will help reduce the pressure on services.
Luton and Dunstable NHS Foundation Trust already has a system in place with a GP clinic operating from 8am to midnight, seven days a week. It sees about 100 patients a day and helped the trust become one of the few in the whole of the country to consistently hit the four-hour ED target in recent months.
Health Secretary Jeremy Hunt has described the system as working ‘spectacularly’ in Luton and he has urged others to follow suit with the help of the £100 million pot set aside by ministers.
But what Luton’s experience also shows is that GP streaming alone is not enough to make the difference.
It has a 24/7 operations centre, which uses real-time data to keep a constant eye on how the emergency and urgent care system is performing.
The system allows staff to monitor patient flow through the system, including their location, needs, referrals and discharge status.
There is also an integrated discharge team, which works with community providers and local councils to help coordinate arrangements.