Winter pressure in A&E: response to Health Select Committee

The government’s response to the House of Commons Health Select Committee report on winter pressure in accident and emergency departments.

This report responds to each of the 27 conclusions and recommendations in the Health Select Committee’s report, Winter Pressure in A&E Departments . It highlights how the NHS prepares for winter, as part of its year-round operational resilience planning, to ensure the health and social care system in England is fully prepared for the increased pressures at that time of year.

Full document: Government Response to Health Select Committee Report on Winter Pressure in Accident and Emergency Departments

Winter warning: managing risk in health and care this winter

Leaders of NHS trusts in England are deeply concerned about the NHS’s ability to respond to mounting pressures next winter, according to a new report published today by NHS Providers.

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Winter Warning highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS.

The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. Despite extraordinary efforts from staff, the health and care systems struggled to cope under sustained pressure.

A key factor was the sharp rise in delayed transfers of care (DTOCs), for patients who were ready to be discharged, often because of difficulties in lining up suitable social care.

The government’s response in the spring budget was to use the £1 billion of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts.

The clear message in Winter Warning is that, in many places, this is not happening.

Sicker patients the main reason for A&E winter pressures

Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.

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Eighty per cent of NHS finance directors who responded to the latest Kings Fund survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. In contrast, only 27 per cent pointed to poor access to GPs and 20 per cent identified shortages of clinical staff as key factors.

The survey also highlights the effort made by the NHS to prepare for increased pressure on services during the winter. 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.

Read the full report here

Winter Insight: NHS 111

An analysis of how NHS 111 has fared, especially over the winter period | Nuffield Trust

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Image source: Nuffield Trust

Key Points:

  • The proportion of callers being dispatched from NHS 111 to emergency services over the last three years has risen. There has been a particular rise in the share of people who are passed to ambulances.
  • There is great variability between different areas in how likely NHS 111 is to send people to A&E or the ambulance service. This might suggest that some areas are too likely, or not likely enough, to send people to emergency services. NHS 111 is also more likely to dispatch an ambulance than to simply send people to A&E – which is the reverse of the usual pattern of NHS use. This lends credence to claims that the service is too risk-averse in some cases.
  • However, contrary to criticism that it adds to the pressure on A&E, the service overall seems to steer people away from emergency services. Patient surveys suggest as many as 8 million more people would have gone to A&E and the ambulance service over the last three years without 111. The call line also soaks up extra demand during winter, when it becomes less likely to refer people to urgent services.
  • NHS 111 still answers the vast majority of calls within a minute, and few people hang up after having to hold for more than 30 seconds. However, it has not met its target of answering 95 per cent of calls within 60 seconds for two-and-a-half years, and it seems prone to serious under-performance when calls spike after Christmas and the New Year.

Read the full report here

Royal College of Physicians: ‘Quality of patient care threatened’

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Members of the Council of the Royal College of Physicians (RCP) have  written to the prime minister, Theresa May MP, to set out their concerns about the capacity and resources needed to meet the demands on the NHS.

The letter was signed by RCP president Professor Jane Dacre and 49 members of Council, representing 33,000 doctors across 30 specialties as well as 750 physician associates.

They say in their letter that the increase in patient need is outpacing the resources available, that services are ‘too often paralysed by spiralling demand to transform and modernise’, hospitals are ‘over-full, with too few qualified staff’ and services are ‘struggling or failing to cope’, and there are ‘increasing reports of staff contemplating the sad decision to leave the NHS’.

The Council members say that ‘current investment levels are not sufficient to meet current or future patient needs’ and the immediate actions needed are ‘the reinvigoration of social care services and urgent capital investment in infrastructure’.

Introducing OPEL: a new way to understand winter pressures

This year, a new system has been introduced which permits a little more analysis of the operational pressures facing NHS hospitals in winter | Nuffield Trust Blog

Trusts have been required to record any days on which they have reached any of four different Operational Pressures Escalation Levels, known as OPELs. OPEL 1 involves ‘meeting anticipated demand within available resources’, and OPEL 2 denotes a trust ‘starting to show signs of pressure’. Levels 3 and 4 correspond more closely to the old terms such as ‘black alert’ or ‘major incident’.

So far this winter we have had data published since the start of December, allowing us to get a sense of how the NHS is coping with the considerable pressures it is facing. While it may be too soon to tell how winter 2016/17 is affecting the running of NHS hospitals, a look at the OPEL data does offer us an early clue.

The figures published by NHS England for the period 1-27 December show that:

  • Around a third (50) of the 152 trusts that sent data into NHS England declared an OPEL 3 or 4. Of those, seven were OPEL 4s.
  • In total, 201 OPEL 3 or 4s were declared between 1-27 December, of which 15 were OPEL 4s.
  • The start of the weeks of the 12th and 19th of December saw two peaks in number of trusts at OPEL 3 and 4.
  • The worst day in this period was Tuesday 13 December, with 23 trusts at the highest levels, including four at OPEL 4.
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Image source: Nuffield trust

Read the full blog post here

Pressure on NHS beds could risk patient safety

Pressure on beds in the NHS in England has become so acute that on any given day last winter, the equivalent of more than five extra hospitals’-worth of beds had to be brought into service to cope with surges in demand | Nuffield Trust

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Image source: Nuffield Trust

On the single busiest day last winter, an extra 4,390 beds had to be opened, equivalent to more than seven extra hospitals in one day.  And on average, over 95% of beds across English hospitals were occupied every day last winter, despite evidence that once bed occupancy rates exceed 85%-90%, there is an increasing risk of infection (see note 1). Given that pressures on the health service have not lessened over the last 12 months, Trusts will face similarly high bed occupancy rates this winter.

Read the full overview here

Read the full report here