Patient safety

Up to 3,000 beds must be freed up to deliver safe care this winter, warns NHSI

The NHS will need to free up 2,000 to 3,000 acute beds to be able to ensure safe, effective care is delivered this winter, NHS Improvement (NHSI) has stated.

In its review of the torrid winter the health service experienced over 2016-17, NHSI said that these bed spaces should be freed up by trusts through a reduction in delayed transfers of care (DTOCs).

However, two influential leaders from the NHS and local government were firmly at odds recently with the government’s decision to outline ‘expectations’ – in other words, targets – of how much areas will have to reduce the amount of delayed transfers of care (DTOCs) that occur in their interface between health and social care.

The report focused on five main themes that to improve the performance of trusts including system capacity, peaks in demand, variation in practice, NHS England/NHSI support alignment and creating a broader, more urgent and emergency care system.

It also stated that NHS partners needed to work with local government partners to ensure that there are enough resources available to maintain patient flow seven days a week and plan effectively for the predictable peaks in demand at weekends and bank holidays.

On top of that, NHSI also emphasised that there needed to be a renewed drive and focus to implement best practice across all systems to reduce variation in care across the country.

“The NHS faced a very challenging winter in 2016-17,” the report read. “National performance against the four-hour A&E standard dipped as low as 85.2% in January 2017. Some patients waited unacceptably long times in crowded A&E departments for admission to hospital.

“Other patients spent long periods in hospital when they were clinically ready for discharge. Hard-working frontline staff worked tirelessly under very significant pressures.

“Lessons from this winter need to be considered so as to shape action for future winters, improve patient care, reduce pressure on staff and deliver better performance.”

NHS Providers welcomed the report’s recommendations to focus on high bed occupancy and prepare for particular days when pressure is likely to be greatest.

“Last winter was very tough for the NHS,” said Saffron Cordery, director of policy and strategy at NHS Providers. “For short periods of time some local services were overwhelmed. Front line staff showed fantastic commitment and professionalism in response to growing pressures, but the situation was unsustainable.

“Our recent Winter Warning report highlighted the importance of avoiding a narrow focus on hospital capacity, and ensuring we also invest in mental health, community and ambulance services as part of a wider programme to manage the extra pressures,” Cordery continued.

“Drawing on a survey and detailed discussions with trust leaders it found those from mental health and community trusts were particularly worried about their ability to meet winter demand. Those concerns are not sufficiently reflected in these recommendations. 

“Trusts urgently need to know where they stand so they can plan properly and secure the extra staff cost effectively. Time for action, including appropriate investment, is running short.”

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