Despite best efforts, providers across the NHS have not been able to provide the level of care to patients that they would like. This has been borne out in a number of ways; slipping performance against waiting time targets, the cancellation of elective operations; and mixed sex wards to name a few. This is not the experience NHS trusts want for their patients and the focus for the coming year will be assessing how trusts can improve their current levels of performance.
The relentless pressure on the NHS will still be a day-in, day-out challenge for most staff, well after winter has finished. It is right to recognise the contribution of staff across the NHS but we must be realistic and acknowledge that cases of burnout and staff sickness are more likely to rise during times of such operational strain. In some cases, this may also impact on the retention of staff.
Over this winter we saw a fundamental mismatch between demand and capacity. As the data from this winter demonstrates, demand has increased on last year and we also know that demand for A&E services has grown year on year for at least the last five years. We know that demand for primary and community services is also growing year on year so this is not an isolated problem.
It is right to recognise the contribution of staff across the NHS but we must be realistic and acknowledge that cases of burnout and staff sickness are more likely to rise during times of such operational strain.
The surge in emergency patients not only impacted on A&E departments but has had a knock-on effect for many parts of the NHS, inside and outside of hospitals. The spike in emergency patients displaced a huge amount of elective care activity. This not only impacted on trust finances through the loss of elective income but also had ramifications include a growing waiting list and patients having to wait longer for routine operations.
In response, trusts will have to utilise a range of approaches to help tackle the bulging waiting list including rescheduling and reconfiguring planned services, paying for extra staff through bank and agency shifts, asking the regulators for funding for additional beds; and sending patients for treatment in the private sector.
We cannot continue to be unrealistic about the levels of demand the NHS is experiencing and must have a feasible and deliverable task for the NHS set out by the national oversight bodies.
The surge in emergency patients not only impacted on A&E departments but has had a knock-on effect for many parts of the NHS, inside and outside of hospitals.
As we have publicly stated, this is a watershed moment for the NHS. There are extensive challenges in delivering high quality care, adequately staffing the NHS, and properly funding services across health and social care. The experience of winter 2017/18 is both symptomatic of the intense pressure facing the NHS and a warning that we need to act quickly.
1. The national review of winter 2017/18 that is currently being undertaken by NHS England and NHS Improvement must be meaningful and timely. The review must:
- Take into account the experiences of trusts and those on the frontline and review the strategies employed to respond to the unprecedented levels of demand, at both a national and local level.
- Take a comprehensive review of the capacity available across the NHS, and whether this was sufficient.
- Evaluate the efficacy of the new national planning approach, including the role of national and local assurance as well as the NEPP. NHS national system leaders might want to think about the role of targeted messages and support, in line with local circumstances, rather than national wide.
- Consider the adequacy, timing and allocation of extra winter funding.
- Collate and disseminate the learning from trusts across the wider system to help others in the preparation fro 2018/19.
- Consider evaluating the impact of key targets related to the urgent and emergency care system, in particular the 4 hour target, which might not be in line with modern clinical practices.
2. There must be a new national planning framework that must be based on realistic demand projections and include an adequate contingency margin against events such as flu outbreaks which can have a significant impact on NHS trusts.
3. We must review capacity across the health and care system in good time for next winter. This must include but extend beyond an increase in inpatient capacity. Other parts of the system also need the resources to enhance their capacity and capability of treating patients at the right time and in the right place.