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Leaders warn NHS is set for worse winter

NHS needs £200m-£300m cash injection to survive winter

Adrian O'Dowd

Monday, 04 September 2017

The NHS in England needs an urgent cash injection of £200 million to £300 million to help it survive anticipated demand this coming winter, according to NHS leaders.

NHS Providers, which represents 97% of hospital, mental health, community and ambulance service trusts in England, is seeking an immediate emergency cash injection to enable the NHS to manage patient safety risk this winter.

In a report* published at the weekend, NHS Providers presented its assessment of the state of play on planning for what it described as possibly a “worse winter than last year” – one which was widely regarded as the worst winter for the NHS in recent times.

The report is informed by regular feedback from front-line NHS trusts and discussions with system leaders, as well as analysis of the latest data on key performance targets such as the four-hour A&E standard and bed occupancy levels.

NHS Providers acknowledged that the level of planning and support for this winter – led jointly by NHS England and NHS Improvement – was considerably more developed than last year and emergency care performance had been given greater priority.

Extra social care funding was helping to increase capacity in around a third of local areas to help reduce delayed discharges from hospitals, and local trusts and systems were also putting huge efforts into early resilience planning.

Nevertheless, the report warns that these improvements are being outweighed by a combination of increasing risks including:

  • demand for emergency care continuing to rise inexorably, while performance against the four-hour A&E standard is no better than last year, despite the focus local systems have given this
  • primary and social care capacity, as a whole, remains “very challenged”
  • key staff shortages are growing
  • NHS trusts are not consistently benefitting from the extra £1 billion of social care investment announced in the spring Budget, as planned
  • trusts are under greater financial pressure than last year and therefore less able to afford the extra capacity they need.

NHS Providers warned that failure to make this extra cash investment would lead to lengthening waiting times for patients in A&E and other services would also put the safety of patients at risk as local trusts had insufficient capacity to meet extra expected demand.

Trusts did not have sufficient capacity to manage this winter safely and needed an immediate cash injection of between £200 million and £350 million to manage this growing risk, it argued.

However, the organisation stressed that this should not be at the expense of existing expenditure on services that were key to winter performance such as primary care, community care, and mental health care.

NHS Providers chief executive Chris Hopson said: “Last winter the health service came under pressure as never before. At its height, the NHS had to provide 4,500 additional beds a day – equivalent to more than eight extra hospitals.

“Patient safety was compromised as local services struggled to cope with the pressures. At times, in some places, the NHS was overwhelmed. We must act now to prevent the situation becoming even worse this winter.

“Trusts are doing all they can to prepare for this winter in the face of increasing demand for their services and competing priorities. And they are benefiting from much better national level planning from NHS England and NHS Improvement which is helping to identify and support those local areas that are most at risk.

“But despite this, the overwhelming view of NHS trusts is that without immediate extra funding they will not have sufficient capacity to manage this winter safely.”

Pauline Philip, NHS national director for urgent and emergency care, said preparations for winter included:

  • the introduction of front door streaming at A&Es directing patients to the right place for their care and freeing up beds for people who need them
  • increasing GP appointment availability and extending these to evenings and weekends to try to prevent the need for patients to go to A&E
  • establishing a nationwide network of urgent treatment centres that offer a standardised level of care closer to home and prevent the need for patients to attend busy A&Es.

Philip said: “The NHS will face challenges this winter, as it does every year, but as NHS Providers have stated winter planning is more advanced than it was last year and, as they argue, special attention is being paid to areas where pressures are likely to be greatest.

“We are currently in the process of assessing how many extra beds trusts are planning to open over winter and early returns indicate that this will be more than 3,000. This is something we will continue to review on the basis of evidence rather than arbitrary estimates.”


* Winter warning: managing risk in health and care this winter - update. NHS Providers. September 2017

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