Time is running out for local health services to be given the extra funding and capacity to fully protect patients this winter.

As the NHS faces up to another tough winter, NHS Providers, the organisation that represents 97% of hospital, mental health, community and ambulance service trusts in England, is calling for an immediate emergency cash injection of between £200 and £350 million to enable the NHS to manage patient safety risk this winter.

NHS Providers is calling for an immediate emergency cash injection of between £200 and £350 million to enable the NHS to manage patient safety risk this winter.

Failure to make this investment will lead to lengthening waiting times for patients in A&E and other services and will also put the safety of patients at risk as local trusts have insufficient capacity to meet extra expected demand.  The extra funding is needed to complement other work currently being undertaken to improve the NHS’ state of readiness for this winter.

In a new report published today, NHS Providers gives its latest assessment of the state of play on planning for what is currently heading for a worse winter than last year – widely regarded as the worst winter for the NHS in recent times. The report has been 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. It follows an earlier report on winter planning published by the organisation in June.

The report finds that the level of planning and support for this winter – led jointly by NHS England and NHS Improvement – is considerably more developed than last year and emergency care performance has been given greater priority. Extra social care funding is helping to increase capacity in about a third of local areas and this should help to reduce the delays faced by some patients in those areas when they are medically fit to leave hospital but unable to do so because of a lack of available support in the community. Local trusts and systems are also putting huge efforts into early resilience planning to ensure patients are protected and face fewer delays.

However, these improvements are being outweighed by a combination of increasing risks: 

• NHS trusts are not consistently benefitting from the extra £1bn of social care investment announced in the spring Budget, as planned. As a result, delayed transfers of care (DTOCs) for patients remain stubbornly high. The Government was targetting an NHS DTOC rate of 3.5% in September to create the extra capacity the NHS needs. The latest data shows this target will now be missed.
• Demand for emergency care is continuing its inexorable rise, while performance against the four hour A&E standard is no better than it was last year, despite the focus local systems have been giving this.
• Key staff shortages are growing.
• Primary and social care capacity, as a whole, remains very challenged.
• And trusts are also under greater financial pressure than last year and therefore less able to afford the extra capacity they urgently need.

The upshot is that trusts do not have sufficient capacity to manage this winter safely. They need an immediate cash injection of between £200 and £350 million to manage this growing risk. But this must not be at the expense of existing expenditure on services that are key to winter performance such as primary care, community care, and mental health care.

NHS Providers says the decision on this needs to be made immediately to ensure trusts have the time to put in place extra capacity in community, ambulance and mental health services as well as in hospitals, and to help pay for more doctors, nurses and care home staff. Failure to ensure this will result in extra money being spent later in the year on short-term agency staffing fees.

The chief executive of NHS Providers, 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.

The overwhelming view of NHS trusts is that without immediate extra funding they will not have sufficient capacity to manage this winter safely.

“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. This risk has been heightened because, in many areas, the £1 billion of extra support for social care announced in the Budget will not ease winter pressures on the NHS, as the Government had planned. Patients will therefore be put at greater risk as local trusts won’t have the extra beds, staff and services they need to meet the extra demand they will face. The only way to mitigate these risks is through an urgent NHS cash injection to ensure the NHS has the necessary capacity this winter.”

A number of NHS trust leaders have expressed their concerns about winter planning and the capacity of their trusts to cope with rapidly rising levels of demand 

Nick Hulme, chief executive of Colchester Hospital University Foundation NHS Trust said: “The first quarter of this year has been as challenging as any I can remember – there has been no let up. Acuity, attendances and admissions have all stayed high. The planning meetings we have had through our A&E delivery board have been dominated by firefighting rather than looking ahead to the winter. Our major concern going into this winter is staffing – going into August we are 50 junior doctors short on our rotas across the hospital. Every day is a constant struggle for junior doctors and registered nurses.

Our major concern going into this winter is staffing – going into August we are 50 junior doctors short on our rotas across the hospital. Every day is a constant struggle for junior doctors and registered nurses.

“We are seeing a mixed response from the local authorities in our area in terms of them using the extra social care funding to help reduce delayed transfers of care. One of our local authorities has taken a pragmatic approach and is passing almost all of the additional funding to a local alliance contract of acute, community and social care providers. However, this hasn’t been forthcoming with another of our local authorities and we have seen very little that convinces me that delayed transfers of care will reduce there.”

John Lawlor, chief executive of Northumberland, Tyne and Wear NHS Foundation Trust added: “A significant concern for mental health services is the growing pressures on our ability to sort packages of care so that our patients can be discharged from hospital when they are ready. Pressures on staffing, especially in psychiatry, are beginning to impact on services and these will become more intense until the new people trained begin to come on stream over the next 5-10 years.”

Read Time is running out to avoid a winter worse than last by Chris Hopson, chief executive of NHS Providers.