NHS winter performance 'challenging but manageable'

Published on Tuesday, 21 January 2014 09:46
Written by Daniel Mason

NHS performance during the winter so far has been "challenging but manageable", and greater working at a local level will help alleviate the long-term pressures in accident and emergency, say members of the NHS Confederation.

A drop in temperatures might bring increased demand, so the NHS is alert to the dangers.

Ahead of today's health select committee where urgent and emergency care issues will be discussed, which includes appearances by Professor Sir Bruce Keogh and Professor Keith Willett from NHS England, the NHS Confederation has taken a snapshot of views to gauge how its members are coping and continue to cope with the winter pressures in urgent and emergency care.

It found that some are coping with winter pressures, although there was variation across the country in the numbers of patients providers were seeing. One clinical director of an acute trust said: "The number of patients attending medical wards is roughly the same compared with last year. However, there is noticeable variation with increases of up to 30 per cent at weekends."

Dr Anthony Marsh, chair of the Association of Ambulance Chief Executives, and CEO of West Midlands Ambulance Service NHS Foundation Trust and the East of England Ambulance Service NHS Trust, acknowledged that "the additional £14m winter funding is proving very helpful which is mainly dedicated to recruit extra staff and better manage ambulance handovers".

However, members are still concerned that the funding they receive to help with winter pressures is still arriving too late which makes it difficult to recruit staff. Michael Scott, chief executive of Norfolk Community Health & Care NHS Trust, said: "It would be beneficial to have such funding sooner so that recruiting for the additional capacity could begin earlier."

Several members cited improvements to local planning and the difference it makes when providers work together. Dr Mark Newbold, chief executive of the Heart of England NHS Foundation Trust, said: "Better collaborative working has created more capacity outside of hospital, so we have achieved more timely discharge, which has helped enormously."

The NHS is rising to the challenge using innovations such as Patient Flow Support Officers to increase clinical capacity by providing care at the right place and time. Through roles such as Paramedic Practitioners, the NHS is bringing together teams of health and social care professionals to assess and treat patients.

Commenting on the findings, chief operating officer at the NHS Confederation, Matt Tee, said: "This snapshot provides an insight into the reality of the NHS this winter, and our findings reveal that the members we spoke to are coping.

"The issues of recruiting and retaining staff, the increase in patients with complex issues and funding being given too late are the same issues each year and continue to be a problem. Winter should come as no surprise and our members prepare for it, but A&E always bears the brunt. The NHS as a whole needs to have better winter plans in place, with a focus on prevention and using local and community services, so that it can cope with any increase in demand. If money is needed, it needs to be given much earlier so that providers can use it effectively.

"Pressures that continue to be felt in urgent and emergency care are symptomatic of pressures felt in other parts of the NHS, so we need to stop talking about A&E in isolation and start talking about all parts of the system working together. It's great to see our members tackling the problems head-on and coming up with innovative ways of working, including collaboration between health and social care.

"Sustainable access to local primary and community care is key to prevent patients from using urgent and emergency care services when they don't need to. The focus has to shift from patients using A&E by default to an NHS which provides the right type of care, in the right place and at the right time."

Stacey Hunter, director of operations at Airedale NHS Foundation Trust acknowledged one of the biggest challenges facing the NHS is staffing, specifically recruiting middle grade doctors and acute physicians as "trusts are not always able to have sufficient capacity to respond if there is a surge in demand".

Dr Mark Newbold, chief executive of the Heart of England NHS FT said: "Front line staff are tired and demoralised - they do not see improvements or change, and this is now urgently required".

A medical director from an acute provider added: "It is important to remember that acute trusts do not have an army of clinical staff waiting to be called in for action, or additional bed capacity to be spared for moments of crisis. The fundamental change needs to be in the way in which resources are used. Improving patient flow, especially at weekends, will allow for efficiency gains, which in turn will create additional capacity, allowing the system to 'flex' when experiencing spikes in demand."

Source: NHS Confederation

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