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BMA calls for increased funding to end annual winter crisis

It says NHS still lags behind many European countries on health spending

Mark Gould

Wednesday, 03 January 2018

As hospitals are told to delay elective surgery and outpatient appointments in a bid to ease winter pressures, the BMA says the only solution is for NHS funding to be raised to the levels of other European health systems.

Yesterday, the NHS National Emergency Pressures Panel, chaired by NHS England medical director Sir Bruce Keogh, made a series of recommendations to help reduce demand.

The panel noted that the NHS has been under "sustained pressure" over the Christmas period with high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es.

Sir Bruce also paid tribute to NHS staff "who have worked incredibly hard under sustained pressure to take care of patients over the Christmas".

"We expect these pressures to continue and there are early signs of increased flu prevalence. The NHS needs to take further action to increase capacity and minimise disruptive last minute cancellations. That is why we are making these further recommendations today," he said.

As well as extending the deferral of all non-urgent inpatient elective care until the end of January to free up capacity for the sickest patients, the panel also recommended:

  • Day-case procedures and routine outpatient appointments should also be deferred where this will release clinical time for non-elective care.
  • The clinical time released by these deferrals should be re-prioritised to implement consultant triage on arrival at the Emergency Department.
  • Ensure consultant availability for phone advice for GPs.
  • Maximise the usage of ambulatory care and hot clinic appointments as an alternative to Emergency Department attendance and/or hospital admissions.
  • Increasing support from Allied Health Professionals, for example physios and therapists, for rehabilitation and discharge.
  • More staff for inpatient beds.
  • Twice daily review of all patients to facilitate discharge.

To ensure patient safety comes first, the panel has also asked that Clinical Commissioning Groups (CCGs) should temporarily suspend sanctions for mixed sex accommodation breaches. But the panel reiterated that cancer operations and time-critical procedures should go ahead as planned.

Dr Anthea Mowat, BMA representative body chair, said the panel's recommendations demonstrate that "short-term fixes, however well meaning, will only get us so far".

"Each winter the pressure on the NHS worsens, and politicians are not taking the long-term view needed to ensure the NHS can keep up with rising demand. We have to look again at NHS funding, which remains well below what other comparable European countries spend on healthcare, to ensure the NHS has the staff and the capacity needed to deal with the pressures it faces year in, year out, but which are compounded during the winter months.”

John Kell, head of policy at the Patients Association, said: “NHS England’s decision to defer elective surgery throughout January and authorise the use of mixed sex wards is a sign of how hard winter pressures are hitting the NHS this year. Combined with regular first-hand reports of worsening conditions in hospitals, including growing numbers of patients being treated on trolleys in corridors, it is clear how badly patients are losing out.

“Ministers must be accountable for this winter’s crisis. The policy decisions that have left the NHS in this position are taken by the government, and it is ministers who are directly accountable to Parliament, and to patients when they vote at elections. It has long been obvious that all but the very mildest winter pressures would stretch the NHS mightily, and so it has proved.

Mr Kell said that, objectively speaking, the NHS’s performance and what it can offer to patients in terms of treatments and services are stronger now than they were 15 years ago or more, "but the experiences of patients at times like this do not reflect that".

"Ministers must not allow the NHS to slide backwards in its 70th anniversary year to the point where its improved performance in the later 2000s seems like an isolated peak.”

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