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NHS winter crisis: when a plan is not a plan

A new blog from the Kings Fund, written by Matthew Kershaw,  questions the efficacy of the NHS Winter Planning for 2017/18.  The Department of Health and National Emergency Pressures Panel have repeatedly stated that this winter the NHS is better prepared for the challenges of winter pressures than ever before through careful and thorough planning.  However, the experiences and pressures being felt on the front line would appear to suggest otherwise. 

Winter pressure planning commenced early 2017 and involved comprehensive system-wide discussions with a range of partners including social care, voluntary sector organisations and international partners.  The public have also been strongly encouraged to support this plan through advertising campaigns such as flu vaccination, use of alternatives to A&E etc.  However, despite this early and thorough planning, the outcomes for both patients and staff are disappointing. Why? 

Research undertaken by Queen Mary’s University suggests that the strongest predictor of A&E attendance is the presence of multimorbidities.  The study found that patients with at least four long-term conditions were six times more likely to attend A&E than those with no such complications and that in the last 50 years attendances at A&E have more than tripled.

However, the system is also under pressure from emergency admissions.  Data recently released by NHS England  shows that bed occupancy has only been below the generally accepted recommended level of 85% once in the last eight weeks, and below 90% on four days.  This leads to patients waiting, cancelled operations, mixed sex accommodation breaches and additional pressures on both staff and patients.

How has this situation occurred if the NHS has the best winter plan ever?

It is essential that any planning identifies and addresses underlying causes, and has realistic parameters.  If this is not the case, then there is a danger that the focus of the plan will be on technical solutions rather than transformational change, resulting in the service providing the same outcomes but with greater pressure on the system,  staff, and patients.

Educating patients to access alternatives to A&E where appropriate, and improving the flow of patients through A&E and the rest of the hospital/health and social care system will not, on their own, produce the transformational changes needed to bring real improvements.  Examples of transformational changes include Northumbria specialist emergency care hospitals, Norfolk’s focus on geriatric emergency care and the Western Sussex emergency care floor which supports clinical and older people’s care specialists working together within one department.  The author suggests that rather than simply encouraging patients to seek help elsewhere, there is a need for investment in facilities to cope with the demand arising from changing demographics and the rise in co-morbidities.

Therefore, whilst we cannot ignore looking at alternatives to A&E, demand management etc, there is also a more fundamental need to look at the provision of emergency care facilities and associated workforce.  This could include more specialist emergency services focussed on older people and people with multimorbidities, and the development of step-down and non-bed based services.  What we cannot continue to do is more of the same for the sake of both patients and staff.

To read the whole article by Matthew Kershaw please click here.