Patient safety

03.01.18

Hospitals told to cancel non-urgent operations to cope with winter pressures

NHS trusts have been advised to postpone elective care and outpatient appointments in order to cope with considerable winter pressures.

The National Emergency Pressures Panel (NEPP), which met yesterday, noted the sustained pressure felt by the NHS over the Christmas period, with high levels of respiratory illnesses and bed occupancy.

The panel, chaired by Professor Sir Bruce Keogh, also acknowledged the early indications of increasing flu prevalence and reports suggesting a rise in the severity of illness in patients attending A&E.

As a result of these pressures, the panel recommended that trusts defer non-urgent elective care until next month, although time critical procedures, such as cancer operations, were not included in this recommendation.

Day-case procedures and routine outpatient appointments should also be postponed where this will release clinical time for non-elective care, the panel also advised.

It is hoped that the recommendations will free up clinical time to enable consultant triage so that patients are seen by a senior decision maker on arrival to A&E, and ensure consultant availability for telephone advice for GPs.

In addition, it is expected that ambulatory care and hot clinic appointments will be used as an alternative to A&E attendances, and that extra inpatient beds will be staffed, allowing for allied health professionals to provide increased support for rehabilitation and discharge.

To cope with the increased demand, the panel also advised that CCGs should temporarily suspend sanctions for breaches of mixed sex patient accommodation.

Sir Keogh thanked the NHS staff who have worked hard under pressure over the Christmas period.

“We expect these pressures to continue and there are early signs of increased flu prevalence,” he explained.

“The NHS needs to take further action to increase capacity and minimise disruptive last minute cancellations. That is why we are making these further recommendations today.”

Director of policy and strategy at NHS Providers, Saffron Cordery, called the recommendations “sensible and proportionate.”

“Preparations for winter in the NHS have been more extensive and meticulous than ever before,” she added. “It is good to see the National Emergency Pressures Panel recognises the scale of the pressures trusts face.

“Many are dealing with unprecedented demand, reflecting the recent rise in cases of flu and respiratory illness, the impact of norovirus and – in some places – primary care including GPs working at more than full stretch.”

Niall Dickson, chief executive of the NHS Confederation, said that the NHS is experiencing “enormous pressure,” and that this decision reflects that.

He explained: “Our members warned repeatedly that this winter was likely to put an already stretched system under intolerable strain.

“Something has to give and this move - although unpalatable - makes sense.”

Dickson continued: “In many ways the health service in England is better prepared than ever before, but that does not prevent a situation where hospitals are having to cope with unsafe levels of bed occupancy.

“The numbers of people needing to be admitted has grown and the shortages in the community too often mean it is impossible to secure appropriate care for patients even when they are better.

“There was some extra money in the budget but £335 million was frankly too little too late – and it did nothing to ease the social care crisis.”

And John Kell, head of policy at the Patients Association, said that the advice indicates how hard the NHS is being hit by winter pressures this year.

He said: “Combined with regular first-hand reports of worsening conditions in hospitals, including growing numbers of patients being treated on trolleys in corridors, it is clear how badly patients are losing out.”

Kell added that ministers must be accountable for the winter crisis, saying that it is the government’s policy decisions that have left the NHS in its current position.

“Objectively, the NHS’s performance and offer to patients are stronger now than they were 15 years ago or more, but the experiences of patients at times like this do not reflect that,” he continued. “Ministers must not allow the NHS to slide backwards in its 70th anniversary year to the point where its improved performance in the later 2000s seems like an isolated peak.”

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