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

Ear infections should not be treated with antibiotics, doctors advised

22/09/2017Ear infections should not be treated with antibiotics, doctors advised

Common ear infections should no longer be treated using antibiotics, NICE has this week recommended. Publishing new draft guidance into the ... more >
NHS staff paid £3,800 less per year compared to 2010

22/09/2017NHS staff paid £3,800 less per year compared to 2010

Years of real-terms pay cuts have seen NHS workers earn on average £3,800 less than they would have if salary rises had kept up with inflat... more >
BMA finds ‘chronic shortage’ of doctors across key medical specialities

22/09/2017BMA finds ‘chronic shortage’ of doctors across key medical specialities

Patient safety is at risk due to a “chronic shortage” of doctors across a number of areas of medicine, the BMA has today warned. ... more >

editor's comment

13/06/2017Tackling the major challenges facing the NHS

As you will have gathered from the front cover, a theme that runs throughout this edition of NHE is about empowering and involving the workforce in order to deliver innovative change across the system.  Professor Jane Dacre, president of the Royal College of Physicians, highlights on page 16 the importance of sustainability and trans... read more >

last word

Your personality, your leadership

Your personality, your leadership

Deirdre Wallace, clinical skills manager at UCL Medical School, discusses the importance of learning about leadership and self while at medical school. Approximately five years ago, I was ch... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Ensuring quality in the new NHS

11/09/2017Ensuring quality in the new NHS

Dr Marion Andrews-Evans, member of the NHS Clinical Commissioners (NHSCC) Nurses Forum steering group and executive nurse & quality lead at NHS Gloucestershire CCG, sings the praises of CCG quality leads who are working in often unseen roles to help deliver safe and effective patient care. As the NHS goes through a time of change, we need to make sure that the quality of services that we provide for patients is protected. Patient ex... more >
read more blog posts from 'the scalpel' >

comment

We must ensure every STP succeeds

30/08/2017We must ensure every STP succeeds

Niall Dickson, chief executive of the NHS Confederation, considers what else must be done to ensure all sustainability and transformation plans a... more >
Changing our digital culture and safeguarding patient data

08/08/2017Changing our digital culture and safeguarding patient data

Joanna Smith, chief information officer at Royal Brompton & Harefield NHS FT (RBHT), says that as the NHS becomes more digital it has to get ... more >
A centre for medicines optimisation research and education

04/08/2017A centre for medicines optimisation research and education

Dr Yogini Jani, a consultant pharmacist at University College London Hospitals NHS FT (UCLH), discusses a collaboration with UCL School of Pharma... more >
Unlocking the benefits of age-friendly cities

04/08/2017Unlocking the benefits of age-friendly cities

Stefanie Buckner, Calum Mattocks and Louise Lafortune from the Cambridge Institute of Public Health, alongside Melanie Rimmer from the School of ... more >
A community service

04/08/2017A community service

Louise Watson, NHS England director of the New Care Models programme, discusses the emerging success stories from the vanguard areas across the c... more >

interviews

Improving care at the touch of a screen

08/08/2017Improving care at the touch of a screen

When it comes to dementia, having a calm and safe environment can have a substantial impact on a patient’s quality of life. NHE’s Jos... more >
A new approach to talent management

25/07/2017A new approach to talent management

Martin Hancock, national lead for talent management at NHS Leadership Academy, and Gill Rooke, the organisation’s senior operations manager... more >
Enabling greater integration through ACSs

25/07/2017Enabling greater integration through ACSs

At this year’s NHS Confed, Simon Stevens revealed the first wave of accountable care systems (ACSs). NHE speaks to Ian Dodge, the director ... more >
How NHS organisations can protect themselves against cyber crime

25/07/2017How NHS organisations can protect themselves against cyber crime

On 12 May, a global cyber-attack occurred on an unprecedented scale. It affected organisations across the globe and, though it did not specifical... more >
Working collectively to improve cancer outcomes for patients

20/06/2017Working collectively to improve cancer outcomes for patients

Last year, the cancer vanguard established the Pharma Challenge. Rob Duncombe, pharmacy director at the Christie NHS FT, gives NHE an update on t... more >