National bodies understandably continue to emphasise the need for operational grip and continued transformation as trusts enter the winter period. Alongside the review of winter (detailed below), Pauline Philip, national director of urgent and emergency care, wrote to NHS leaders outlining the challenges of the previous winter and emphasising the need for winter plans to commit to 90% performance against the four-hour A&E target.
National support for winter resilience
The letter brought together several pieces of advice, toolkits and guidance to help systems manage demand and capacity during this busy period. These included the repurposing of the emergency care improvement support teams as well as the continued expansion of access to GP services. The letter also confirmed the continuation of the National Escalation Pressure Panel (NEPP), which will set national policy and provide expertise throughout winter and is broadly welcomed by providers.
National bodies understandably continue to emphasise the need for operational grip and continued transformation as trusts enter the winter period.
Review of winter 17/18
As in previous years, NHS Improvement has published it's winter review (NHS Improvement, 2018). This had been due earlier in the summer but was only released in September, alongside the capital funding announcement. It identified the challenges the sector had faced, from long A&E waiting times, to high bed occupancy. The review also set out six key priorities to work towards for the upcoming winter:
- developing robust and credible demand planning across systems.
- major focus on reducing bed occupancy.
- tailored support for systems and trusts, along with improved system working across pathways.
- standardised operating approach, including increasing healthcare worker vaccination levels.
- continued strong national and regional leadership, managing Emergency Care Improvement Programme resources.
- continued transformation of UEC services, including the roll out of NHS 111 services.
Capital funding
Following a rapid bidding process, the DHSC brought forward £145m worth of capital funding for a number of providers to improve emergency care this winter. This is a welcome and much needed injection of capital for trusts. However, these schemes must be complete, staffed and operational by 24 December 2018, otherwise the full capital costs will be clawed back in 2019/20. Trusts told us they were spending the money in a variety of ways – including extra cubicles in the emergency department, creating a medical assessment area next to A&E, and the creation of a new walk-in unit. This fund was welcomed by those in receipt but ultimately it would have been more useful for providers and system-wide planning had greater notice been given.
Following a rapid bidding process, the DHSC brought forward £145m worth of capital funding for a number of providers to improve emergency care this winter.
Elective care
In August 2018, CCG and trust leaders were asked to carry out a number of actions to address the growing elective waiting list ahead of winter. Contingency plans have been drawn up, which include provisions to divert work to the independent sector, but it remains unlikely the service will be able to achieve the target, set out in the planning guidance, for waiting lists to be no higher in March 2019 than in March 2018.
Social care funding
Ahead of the Conservative party conference, the secretary of state announced £240m for local authorities to spend on social care capacity. This will be used to ensure more patients are discharged promptly into appropriate care settings this winter. The money is very welcome will go some way to reducing delays in transferring patients, but to put this into perspective, according to the Association of Directors of Adult Social Services annual budget survey (Association of Directors of Adult Social Services, 2018), published in March, councils had budgeted to reduce adult social care spending by £700m this year. Short-term funding is not the solution to the social care crisis. The government’s forthcoming green paper will need to set out bolder action for the long term.
Ahead of the Conservative party conference, the secretary of state announced £240m for local authorities to spend on social care capacity. This will be used to ensure more patients are discharged promptly into appropriate care settings this winter.
Flu and vaccination
Last year the worst strain of flu in seven years put additional pressure on the NHS over winter. The severity of the strain was known in advance and trusts took the steps they could to prepare. Flu data shows that not only were more people taken ill, those that were admitted into hospital were sicker and stayed for longer than usual. The data also showed an increase in deaths related to flu.
There is currently a national drive for NHS trusts to immunise 100% of staff who work directly with patients. Guidance has been issued to trusts around local procedures and reporting which includes trusts publishing a self-assessment against the best practice management checklist in board papers by the end of December 2018. The guidance states that greatest protection should be giving to patients with specific immune-suppressed conditions. Boards will ensure they prioritise having the right staff, with the right skills in these areas.
Trusts aim to immunise as many staff as possible, but there will be exceptions where this is not appropriate for some individuals. NHS trusts continue their key role in promoting the flu vaccine to people who use health and care services, especially those who are most vulnerable and susceptible.