NHS Finance

Trusts need £350m by July to dodge even more severe winter pressures

An urgent injection of £350m must be committed by the end of July to prepare the sector for the coming winter as nearly half of trusts believe the extra £1bn social care cash committed in the spring will have no impact on their ability to manage growing pressures and delayed transfers of care (DTOCs).

A worrying new report published by NHS Providers has signalled a clear message that, in many places of the health system, the £1bn social care money committed by the government in the Spring Budget will not be useful to reduce related pressures on the NHS.

A key factor in the health sector’s difficulty to cope with last winter period – considered the toughest on record – was the sharp rise in DTOCs, often due to an inability to line up suitable social care for patients ready to be discharged.

The £1bn social care injection committed earlier this year was intended to ease this pressure by reducing DTOCs and, as a direct result, ease pressure on trusts.

But an NHS Providers survey suggested this may not be the case after all. Only around one-fourth of trusts were able to secure a commitment from their local authority that the extra social care funding will be spent in a way that directly reduced DTOCs and frees up NHS capacity. For community and mental health trusts, this figure dropped to a staggering one in 10.

Only 34% of trusts reported that their local authority was giving a high priority to supporting the NHS in reducing DTOCs as opposed to focusing on other social care needs, while nearly half of respondents (44%) believed the money would have no impact whatsoever on their ability to manage incoming winter pressures.

Less than 20% of providers are confident that they will be able to deliver the NHS mandate requirement of reducing DTOCs to 3.5%, and the vast majority of trusts are reporting lack of capacity across all parts of the health and care system to deal with the expected demand. Over 90% of trusts have insufficient capacity in primary care and social care, 80% lack capacity in mental health, 76% in community service, 71% in acute and 64% in ambulance.

There is therefore a clear risk that the difficulties in the next winter period will be even more severe and extensive than last year’s. Less than 60% of trusts are currently confident that they will be able to deliver safe and high-quality care when the cold begins to bite.

“What is clear from our survey and detailed conversations with frontline trusts is that the government’s plan of trying to gain a double benefit from the Budget’s extra £1bn social care funding is not going to work consistently enough. Trusts say the NHS has about a month to plug the gap,” said Chris Hopson, CEO of NHS Providers.

“We are calling for an additional £350m to give targeted support, distributed to those areas where social care funding will have little or no impact on the NHS. This would allow the NHS to put in place extra beds in community and mental health services as well as hospitals whilst also enabling the ambulance service to deal with more patients.

“The investment would also help pay for the higher number of temporary doctors, nurses and care home staff we know the NHS will need. And it could be used to strengthen mental health crisis care to prevent hospital admissions.”

There will be no single right answer for how trusts must use this money, he added, with decisions needing to be taken locally to suit particular needs. But it is clear that there is “no time to lose” on this.

The money could be funded by a repayable advance of early drawdown of the extra £8bn committed to the NHS in the Conservative manifesto.

“One of the key findings in our survey was that trusts need to know about any extra capacity by the end of July so they can plan properly and secure the extra staff cost effectively. Last winter gave us the clearest possible warning that patient safety is now at risk. We have one more month to respond to those warnings,” stressed Hopson.

“It may seem odd to issue a winter warning when we have just been through an early summer heatwave. But the forecast from the NHS frontline is clear: unless we do something now to manage the risk for next winter, there is trouble ahead.”

But NHS Providers’ calls were not well-received by the Local Government Association, which represents councils nationwide.

Cllr Izzi Seccombe, chair of the organisation’s Community Wellbeing Board, told the press that it was “misleading” to see the £1bn social care fund as money designed to ease pressure on the NHS – with the health service itself needing to do much more before criticising councils.

“The NHS could make a number of changes to reduce delays it is responsible for, such as improving patient flow or investing in community care, since waiting for non-acute care is one of the most common causes of NHS-related delays,” she said.