• 03 January 2018
• Posted in: Healthcare

As the new year starts, familiar problems are hitting hospitals in England. The winter surge in demand, attributed to cold weather and increases in cases of flu and norovirus, puts the health service under intense pressure each year. Despite intensive planning from NHS England, and the promise of additional government funding, 2018 could well be the worst winter for decades.

There are growing numbers of hospitals declaring a black alert, the highest form of alert in the NHS. The alert is used when there is an increased potential for patient care and safety to be compromised and hospitals are unable to deliver comprehensive care due to demand. There are reports of hospitals being forced to create makeshift wards, patients waiting 12 hours to receive A&E care, hospitals running out of bed capacity and queues in corridors becoming commonplace.

NHS England's National Emergency Pressures Panel, which met on 3rd January, have taken unprecedented measures to stabilise the service. These include extending the deadline for deferral of all non-urgent inpatient elective care - such as hip or knee replacements - to 31 January, to free up capacity for the sickest of patients. Further measures include cancelling day case surgery and outpatient appointments; permission to use mixed sex wards if necessary; and deploying consultants in A&E units to assess whether patients face a medical emergency.

The Department of Health released a statement detailing the government’s intention to support the NHS with an additional £447m of funding this winter. Despite intensive planning from NHS England to meet rising demand, and the welcome additional funding, early signs point to the service being under severe strain; even more so than previous years.

Recent findings from the Royal College of Emergency Medicine Winter Flow Project show that more operations were being cancelled this winter, at an average of 3,351 a week compared with 1,948 in 2017. Additionally, A&E performance was worse in the run-up to Christmas than in the same period last year, hospitals treating 80.6% of patients within four hours this year compared with 83% last year.

The rise in prevalence of flu, recognised by NHS England as a significant factor in the increased demand of patients arriving at emergency departments causes further issues for hospitals dealing with a high number of patients and capacity problems. There are concerns from health leaders that if flu circulates further, significant pressures within respiratory and emergency flow will be further escalated.

Pressures are being compounded by staffing problems. Despite extra bed and wards being opened to meet capacity demand, shortages of doctors, therapists and nurses has resulted in patient safety being put at risk. Longer, more intense shifts and lack of sleep are putting NHS staff at risk of ill health at a time when the service can ill afford to lose them.

Although the media reports focus on waiting times, managing the winter demand covers far more than A&E and acute services. The flow of patients through the system is fundamental to try and ensure that valuable bed space is not being blocked by outpatients being unable to be safely discharged. Issues are heightened when social care and supporting services are also under resourced to meet demand. Additional funding for social care was noticeably missing from the autumn budget statement.

In 2018 Open Forum Events are producing several health and social care events to help meet the challenges facing the NHS. In September we will be hosting our annual urgent care conference that will focus on practical measures that can alleviate the congestion and successfully restore dynamic patient flow.

Budget cuts, sweeping healthcare reforms and austerity have pushed the NHS workforce to breaking point. You can join us on Thursday, 17th May 2018 at NHS Staff: Skills, Retention and Recruitment a national conference that aims to deliver actionable strategies for recruiting, retaining and upskilling NHS staff; as well as how to effectively allocate waning investment in the NHS to best serve its staff and patients.