Health Service Focus

07.03.17

We need a new approach to winter pressures

Winter is traditionally the busiest time for the NHS. This winter has – in many respects – been the worst for many years.  Demand has climbed to record levels in the midst of the longest and deepest financial squeeze in the history of the health service, writes Deborah Gulliver, senior research analyst at NHS Providers.

Recent media coverage of what has been called the ‘NHS winter crisis’ has drawn on daily winter performance data for 152 hospital trusts, published weekly by NHS England. The publication this Friday of the final data for the peak winter months (December to February) means we can now track those winter pressures and gauge their impact on the NHS.

What does the data show?

Between December 2016 and February 2017:

  • On average each of the trusts admitted at least 80 emergency patients per day
  • Compared to last year, the number of times patients were diverted to other A & E departments due to a lack of capacity almost doubled
  • Bed occupancy rates remained well above the recommended safe level of 85% for all weeks, peaking at 96%
  • In January, the number of escalation beds (opened temporarily to create extra capacity) reached the equivalent of opening an additional eight hospitals 

What does this tell us?

A&E is often seen as the touchstone for the whole health system. Other data reveal similar pressures affecting community and mental health trusts, ambulance services, GPs and social care.

These pressures have contributed to the worst figures on record against the A&E four-hour waiting target; with the latest monthly figures from NHS England (December 2016) showing performance of 79.3% for major (type 1) departments. The target of 95% is far beyond reach. Delayed transfers of care remain at record levels as trusts struggle to find suitable support for patients who are medically fit to leave hospital. And the percentage of the most urgent ambulance calls responded to within eight minutes reached its lowest level this year, 66.4% for Red 1 and 58.8% for Red 2, well below the 75% target.

The “OPEL”, or operational pressures, figures reflect trusts’ judgements about the pressures they face. They range from level one, where all is well, to level four, requiring “decisive action” to ensure patient safety. As they are a new measure, and their definition was changed during the winter, direct week-to-week comparisons are difficult. However, the rise in the number of level three and four alerts from mid-January indicates a service struggling to cope.   

Despite this, most trusts have managed to “keep their heads above water”. The reality is that the we know we are neither facing a “humanitarian crisis” nor “coping well”.

It is clear the NHS has been “running hot” for an extended period. Although trusts are working hard to keep pace with demand, they are operating at capacity levels beyond those which other international health systems would regard as acceptable. 

As pressure continues to grow, the likelihood of more trusts reaching and moving beyond breaking point increases. 

For patients these difficulties are distressing and potentially dangerous. They are also demotivating and demoralising for the clinical workforce, who sometimes feel they are struggling against all odds to provide the best possible care. It is thanks to the extraordinary efforts of frontline staff that we have made it through this winter period without a full-blown crisis. However, trusts are telling us that it was a close-run thing. It is evident that we need a better approach.

Review of winter pressures

NHS Providers has called for a formal review of how the NHS has managed winter pressures, led by NHS England and NHS Improvement, with direct input from NHS trusts which have borne the brunt of rising demand. The review should also include the views of other expert bodies, and the results should be made public so patients and service users can be confident that the health service is learning from this year’s experience. 

It needs to be wide ranging. In particular, it should look at the ring-fencing of winter funding and the impact of cancelling elective operations. It should also explore concerns over access to GPs, and how social care supports the NHS. 

The health secretary has acknowledged that the NHS is facing “completely unacceptable” problems. He should now accept that we can not approach next winter without learning from the events of recent weeks.

The relentless year-on-year rise in demand means winter conditions remain in place year round for the NHS. So, the resilience of trusts to deal with unexpected spikes in pressure, such as flu outbreaks and norovirus, is compromised. We can not afford to ride our luck indefinitely.       

NHS Providers has published a full breakdown of the winter performance data for December 2016 to February 2017 in an interactive briefing

(Image: c. Rui Vieira and PA)

Have you got a story to tell? Would you like to become an NHE columnist? If so, click here 

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

PPE supply in the UK boosted by more than 100 new government deals

27/05/2020PPE supply in the UK boosted by more than 100 new government deals

The UK Government has signed deals with more than 100 new suppliers from across the globe, as well as ramping up domestic efforts, as it signific... more >
Kindness is key to overcoming Covid-19 crisis

26/05/2020Kindness is key to overcoming Covid-19 crisis

Nuno Albuquerque, Group Treatment Lead, UK Addiction Treatment Group, explains why your mental health is just as important as washing your hands ... more >
UK study to examine Covid-19 impact on blood cancer patients

26/05/2020UK study to examine Covid-19 impact on blood cancer patients

A new UK study is being launched by IMPACT to examine how patients receiving stem cell transplants for blood cancers and blood disorders react to... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

the scalpel's daily blog

Pre-diabetes: a hidden healthcare problem

26/05/2020Pre-diabetes: a hidden healthcare problem

Dr Russell Muirhead, Clinical Director of Living Well, Taking Control A third of adults in England have pre-diabetes, according to research published in The BMJ. The study also found that, over eight years, the number of people diagnosed with pre-diabetes tripled. By 2025, it is estimated that five million people will have diabetes in the UK – 90% of which is Type 2 diabetes. Pre-diabetes is related to increasing rates of obesi... more >
read more blog posts from 'the scalpel' >

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >