Saffron Cordery

Week by week, day by day, and hour by hour the battle to keep on top of demand in the NHS continues. The BBC2 documentary series Hospital  offers compelling evidence of the pressures clinical staff and managers face, and the painful compromises and trade-offs required in trying to help ever more patients with limited resources. That is the daily reality of the modern NHS, never more so than this winter. We can not go on like this.

The latest data from NHS England show winter pressures remain severe. There was a rise in attendances at A&E,  an increase in emergency admissions, and once again dozens of trusts reported serious operational pressures. Bed occupancy rates were well above recommended levels for patient safety.

In recent weeks we have also seen some of the worst performance figures on record against the 4-hour target in A&E. More patients are waiting for longer on trolleys. Delayed discharges are worse than ever. There has been a rise in cancelled urgent operations.

The figures tell only part of the story. The consequences, in terms of prolonged pain, uncertainty and distress are profound. When the system becomes overstretched, as it is now, it is patients who suffer.

NHS staff have responded heroically, treating more people than ever before. The service has, so far, just about managed this year’s winter pressures without a crisis or a meltdown, but it has been a close run thing, and some trusts have failed to cope for short periods of time.

We cannot carry on trying to manage well known winter pressures in this way. Trusts tell us their resilience and ability to cope with these pressures is diminishing year by year and that their ability to consistently provide the right quality of care, safely, is now being compromised.

That is why NHS Providers has called for a review of how the health service manages winter pressures. This should be led by NHS Improvement and NHS England. As it is NHS trusts that bear the burden of the current approach, they should have the chance to set out what has worked for them and what needs to change. Experts bodies such as the Royal College of Emergency Medicine should also be consulted.

The review should look at how effectively the NHS prepared for this winter, including the role of A&E delivery boards. It should also consider whether dedicated winter funding should be reinstated to ensure extra capacity, and the impact of cancelling elective operations.

We must ensure NHS staff have a reasonable workload over the winter pressure period.

Another key question will be how to ensure social care and GPs fully support hospitals, community and ambulance services, recognising that many of the pressures are beyond the control of NHS trusts.

We must explore how to rapidly and consistently implement the important new A&E performance work. NHS Improvement has signalled a more standardised approach to streaming patients, prioritising support for the sickest patients and ensuring there is a consistent and holistic view of providers’ performance on emergency care. Beyond that, the review should look at how to enhance the support providers receive from NHS Improvement and other NHS system leadership bodies.

Finally, it should examine what short term measures can be taken to close the current gap between supply and demand for key staff groups such as A&E consultants, particularly in smaller rural hospitals. We must ensure NHS staff have a reasonable workload over the winter pressure period.

The review should be completed by the end of April, and the results should be made public so those who use and pay for the NHS can see that the service is seeking to learn from this year’s experience and is adopting a sustainable approach to managing winter pressures.