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Is the NHS prepared for the upcoming winter season?

Published on 26/10/17 at 10:52am

After the health service struggled through the same period last year, Amber Jabbal, Head of Policy at NHS Providers sets the record straight on the current state of affairs as we approach the winter season.

How do you feel the preparations for the coming winter have gone?

At a national level, preparations have been a lot more coordinated than in previous years, particularly compared to last year. Obviously, NHS trusts have been doing a lot of hard work to plan and prepare for winter. However, the feedback we’ve been getting back from NHS trusts and foundation trusts is that the risk, as we get closer to the winter, is growing rather than decreasing. I think that the support that they’ve been getting has been helpful but hasn’t quite been enough.

When you mention ‘risk’, what in particular do you mean?

The risk I mentioned is that the potential is there for the situation to be worse or more challenging than last year, due to rising demand and the amount of capacity there is in the system to be able to react to this increase. There has already been talk this year of a potentially higher risk of flu due to the colder weather. Essentially, this is what is meant by risk: the ability for the system to manage these pressures.

What were the particular challenges that were faced last year over what was termed by the British Red Cross as a “humanitarian crisis”? Presumably there is still similar concerns ahead of this winter?

I think that trusts, at a local level, have done all they can and I think, as far as we know, that they are still hoping to increase the number of available beds over the winter period. The difficulty that arises is a system-wide issue – the challenges are not just within our hospitals and within our trusts; they are also in social care and primary care.

We’ve been calling for additional funding to try and help mitigate the risks this winter, which we were calling for quite a while ago. At the beginning of the summer we were asking that if there was going to be any additional funding then it needed to come sooner rather than later, so that trusts could plan accordingly. It’s not just opening up about beds and more wards, it’s about having the staff there to manage those wards. Along with finance, in terms of what’s on our priority list for our members, workforce is also a huge priority.

When the struggles of last year happened, we were saying that one of the reasons that the NHS was able to keep its head above water last winter was due to the heroic efforts of the staff – that’s something that will continue, as they are putting in that level of effort all year round.

Jeremy Hunt has promised to create 5,000 new nursing placements – how do you react to this pledge?

Obviously, we’ve supported the expansion of new routes into nursing and a flexible approach is essential. We think the move is necessary but this step will take time to fulfil and there may be further difficulties presented by Brexit, depending on how things pan out. From our perspective, we are yet to see the full impact of nursing bursaries, so while the new placements are welcome, unless there’s a pipeline of nursing students and those willing to take up those places given the situation with the bursaries, it might not make as much impact as we would be hoping.

Labour emerged from its party conference with a headline figure of £500 million to get the NHS through the winter. Is this enough to help during this hard time?

It’s important that all political parties recognise the importance of the added pressure that winter brings and takes this seriously – we’ve consistently warned of the necessity for extra funding to provide more staff and more beds. We first called for the funding in June, calculating the need of £350 million, and called for this again in September. The problem is that it is getting late in the day, and whilst funding will always be welcome, trusts already have plans in place, despite receiving no indication of an increase in support, to create extra capacity and open up escalation beds when they can. The financial support would then be able to mitigate any negative financial impact that will have been made by the readying for the winter.

One measure that was taken was to give £2 billion to social care over the next three years, in order to alleviate the burden on the NHS. How has this progressed so far?

There are a number of different social care organisations calling for additional funding from last year’s budget as they face a number of challenges, and we need to recognise that a strong social care system will benefit the NHS. There was £1 billion put in this year and it was expected that this would be used to reduce the number of delayed transfers of care, which is where, if a patient is medically fit to leave hospital, then they can. However, the thing that is delaying this is that they don’t necessarily have the kind of social care support that they need to live at home. There was a level of expectation that the extra money would benefit the NHS and we did some work over the summer to determine how this money would be spent. We wanted to ascertain it was benefiting the NHS and it was going into significantly reducing delayed transfers of care. We found that it was only impacting the NHS in a third of areas.

There were a number of different reasons why it only seemed to work in a third of areas: one is because the money was allocated to local authorities without any formal conditions placed on the funds, though there was an expectation that they would be used in social care. A lot of councils faced significant cuts in previous years and, in many areas, are propping up their social care budgets with money from other areas, so perhaps the money was being spent in other ways. Another reason is simply down to increase in demand – even if more beds are being opened up then there is a constant need for beds, so the impact seems to be minimal.

Beyond additional funding, is there anything more that can be done?

I think there needs to be all-year round contingency planning because something our members often say to us is that, ‘It is worse in winter but actually it feels like its winter all year round”. When we were talking earlier about extra capacity being put in the system and one of the reasons it seems to be difficult to open up further beds in the winter is because they have already opened up all of their escalation beds; this is down to already having a pressurised spring and summer.

I think we’re getting to a point now where we need a credible plan and debate on how much the NHS can actually deliver on its current budget. We need to be honest about what the NHS can realistically deliver on that. For instance, if funding isn’t going to increase then what can be delivered?

Ahead of the winter, what would your message be to the general public?

I think it’s about people bearing in mind the added pressure on the NHS during the period and particularly to use alternatives to A&Es when they can – that was our main message back in January and February when things became extremely challenging. However, I would reassure the public that trusts are working hard to deliver high-quality and safe services. We, as a collective, need to avoid undermining patients’ trust in the NHS and this was one of the main difficulties that was faced earlier this year – people were worried that things were unsafe. I would emphasise that the NHS trusts are doing a wonderful job and the public can have confidence in them.

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