Comment

19.07.17

Time to heed the winter warning from the frontline

Phillippa HR editAs we head into the peak of summer most people will be thinking sunbeds rather than hospital beds. But as a new report by NHS Providers indicates, trusts need to start planning and investing now or risk serious pressures when winter bites, writes the organisation’s head of analysis, Phillippa Hentsch.

The challenge of creating sufficient capacity – in the form of physical space, beds and staff – to deal with sicker and frailer patients is no longer confined to the winter period. Many trusts now face constant day-to-day, and even at times hour-to-hour, pressures to ensure they have enough beds to meet patient demand. 

Our report ‘Winter Warning’ shows trusts are now very concerned about their ability to respond to demand across the health and care system this winter. It revealed that 92% of trusts reported that they expect there to be a lack of capacity in primary care, 91% in social care and 80% in mental health services. 

Crucially, if a trust has too few beds this will have a knock-on effect on patient flow through hospital and accessing care when they leave hospital. This matters because when space is tight, trusts may be forced to resort to a one in, one out approach to admission and discharge. This causes queues and backlogs elsewhere, such as ambulance handovers, emergency admissions and transfers to other and potentially more appropriate care settings. 

This is why the ballooning number of delayed transfers of care (DToCs) is so concerning, and needs to be tackled now. Failure to do so would place NHS staff under extraordinary pressure, and could compromise safety and standards of care. 

There is much that the NHS can and needs to do itself to improve patient flow within its own trusts. A key priority has to be in tackling the number of DToCs caused by the lack of social care provision. These delays are increasing sharply and for the first time, in February, we saw the majority of DToCs linked to a lack of social care provision. 

In March, the government announced extra funding for adult social care, including £1bn for this financial year. The money was designed to improve adult social care provision, in turn easing pressures on the NHS by freeing up between 2,000-3,000 extra beds

ThinkstockPhotos-629429900

But only one in four trusts said they had a specific commitment that the extra social care funding would help reduce NHS DToCs. For community and mental health trusts, the figure is one in 10. This pattern is concerning given that although hospital trusts understandably account for the highest number of DToCs, it is in mental health and community services where the rate of delayed transfers has been increasing at a faster rate. 

Nearly half of trust leaders thought the additional funding would have no impact on their ability to manage winter pressures this year, risking a repeat of the well-publicised pressures of last winter. 

If we fail to invest now in the capacity gaps facing the NHS this winter, there is a serious possibility of wider failures than last winter with the safety of more patients at risk. We have already had three exceptionally tough winters in the NHS, and we cannot afford to put frontline staff under that level of pressure again. 

Trust leaders have told us that, in many places, the funding set aside by the government to invest in extra capacity is not enough. NHS Providers is calling for an additional £350m to manage next winter’s risk safely. This additional funding would allow the NHS to commission the extra community, mental health, ambulance and hospital capacity required, and crucially additional staff to respond to the levels of demand. This could be funded by a repayable advance on or early drawdown of the extra £8bn committed to the NHS in the Conservative manifesto.  

We recognise that this approach can be no more than a sticking plaster over what has become a very fragile health and care system. We need to look beyond this winter to develop a sustainable, long-term approach to funding health and social care, in particular the urgent and emergency care system. 

We need to act quickly. The majority of trusts have told us that August is the very latest they would need to know about any additional investment to make a positive difference this winter.

Alongside funding, we also need capital investment to grow infrastructure to meet rising demand, a comprehensive workforce strategy to tackle shortages, and better planning focusing on prevention rather than crisis management. 

We need to heed the warnings from the frontline and prepare for winter now.

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