Coping with winter pressures

Creating a healthcare system that can cope with winter pressures

Nine out of 10 health and care leaders across England are “concerned” about their organisation’s ability to cope with winter pressures, with nearly two thirds (62%) saying they are “extremely concerned”, a poll from the NHS Confederation has revealed1.

With the NHS already perceived by many as at ‘breaking point’2, a severe outbreak of influenza and the additional and variable demands this would bring, could be the final straw that could breaks the veritable camels back.

The concern expressed by health and care leaders is also exacerbated by the recent outbreak of flu in Australia and New Zealand, where hospitals were forced to turn new patients away. And whilst it is impossible to predict the severity of this year’s ‘flu’ season – as it is mainly dependent on both temperature and the exact flu strain in circulation – the situation in Australia and New Zealand has prompted some experts to predict a bad flu season in the UK.

In June this year, Jeremy Hunt announced a further £20.74 million to be awarded to 27 hospitals in England to ease pressure on hospital emergency departments ahead of this winter, following the initial £55.98 million that was given to 70 hospitals in April.

The wider impact

So with the extent of winter pressures difficult to predict, how can our healthcare system plan for the looming winter pressures?

A Kings Fund survey published in March showed that more than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.3

With multiple factors contributing to the NHS’s failure to meet patient’s winter needs and the impact felt across the entire health and social care system, the solution will not be simple.

Funding an “all year round crisis”4

At their recent party conference, Labour called for an extra £500-million injection for the NHS to help avoid a winter crisis this year. In response to this, the head of the NHS Confederation, Niall Dickson criticised Labour’s lack of understanding about the ‘all-year-round crisis’ caused by the winter pressures. Dickson went on to say: “Although additional money is always welcome, in terms of the next few months there is a limit to how much additional resources can make a difference. In many cases trusts are simply not able to recruit the staff they need.”3

Dickson’s insinuation is that whilst last minute funding is helpful, to enable the NHS to meet the burden of winter pressures and improve patient care, then longer-term, integrated planning is key.

Guidance from NHS England and NHS Improvement

The recognition of the benefits of longer-term planning are also reflected in the guidance from NHS England and NHS Improvement on how to plan for Winter 2017/18. This came in the form of a letter from the National Urgent & Emergency Care Director, Pauline Philip, which was circulated to health care leaders in mid July 20175.

The guidance included sections on: Ensuring there is enough capacity to meet the pressures of Winter (through reducing delayed transfers of care (DTOC), reducing variation in best practice and Primary Care streaming); Reforming and redesigning the wider urgent and emergency care systems (through Urgent Treatment Centres and The Ambulance Response Programme), and Flu planning (through the National Flu Immunisation Programme, launched in March 2017). But the final and perhaps the most interesting part of the guidance was the section on National support and Winter planning, with formal Winter planning started in July and local plans submitted in early September. If we are to view Winter planning as an ‘all-year-round-crisis’, then longer-term, integrated planning that tackles prevention as well as meeting emergency pressures is vital.

Strength in integration

Medical and social care systems need to be aligned, so that commissioners can work together to provide a longer-term plan that addresses needs across the two systems. Tackling winter pressures in health and social care silos will mean the system is not robust or flexible enough to cope with the variance of winter pressures. A clear and unified strategy is vital.

Tackle wider public health issues

Keeping our elderly and vulnerable warm, fed and mobile during the winter months is a key preventative measure in alleviating the pressures that the winter months bring. As is ensuring adequate social care.

Reduce demand by improving self-care

Self-care and empowering people by providing them with information could help reduce the winter burden on general practice. Encouraging patients who have conditions, which do not necessitate being seen in general practice to better manage their own healthcare needs, can help reduce demand.

Think long-term

Short-term responses to efficiency savings are rife in the NHS, with some savings coming directly from acute trusts that may already be grappling with winter pressures. Ensuring stability across health and care systems throughout the year will allow for better-value, longer-term efficiencies to be made. This longer-term view will enable underlying structural issues that allow winter pressures to present serious problems, to be addressed.


NHS Confederation, Poll of over 130 senior health and care leaders, October 2017

Mark Porter, Chairman of the British Medical Association (BMA), February 2017

Kings Fund, Quarterly Monitoring Report, March 2017

Niall Dickson, Head of the NHS Confederation, Press release, September 2017

NHS Improvement and NHS England, Pauline Philip, Preparation for Winter 2017/18 letter, 14 July 2017

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