Tougher winter predicted - but NHS plan offers hope

The forthcoming NHS long-term plan offers an opportunity to break the recurring cycle of winter crises, but will come too late to have a positive effect on this winter, NHS Providers has warned.

The provider organisation said in its report, Steeling ourselves for winter 2018/19, that this winter is likely to be more difficult for patients, staff and trusts. Though improvements had been made, some of the challenges the service will face are even greater than winter 2017/18.

However, the long-term plan offers an opportunity to ensure that winter pressures do not affect the rest of the year, it said. 

‘We must escape the current and unsustainable cycle of severe winter pressures, which leaves the service playing catch-up throughout the rest of the year,’ said Saffron Cordery (pictured), NHS Providers’ director of policy and strategy and deputy chief executive.

‘The long-term plan represents an opportunity to do this, but we must be realistic about what resource is needed, and where it is needed, to meet future demand and recover performance.’     

Trusts will need adequate time and resources to bring their operational performance back to the levels set in the NHS Constitution, the report said. Immediate and long-term workforce solutions were also needed. And there must be more investment in integration and new models of care – particularly on helping frail elderly patients remain in their own homes or local community rather than in an acute hospital.

NHS Providers said the coming winter looked difficult, though some welcome steps had been taken to help the service prepare. The Department of Health and Social Care recently announced additional winter funding for the NHS (£145m in capital funding) and adult social care (£240m).

NHS Providers said these factors, together with significant reductions in delayed transfers of care and the potential for the flu season to be less severe than last winter, could lead to better care this time.

In 2017/18, an extra £337m was allocated in the autumn Budget for winter pressures. But it was difficult for trusts to make the most of the funding, as it came so late in the day. And, with a harsh winter and surging demand for urgent care, provider finances were hit hard. The sector recorded a deficit of just under £1bn at the year end, with two-thirds of acute trusts finishing the year in the red. Much of this was attributable to winter pressures.

This year, the Department received an extra £1.7bn in overall funding, but NHS Providers said none of this had been ring-fenced at a national level for winter pressures.

Ms Cordery said the extra funding for capital projects and social care was welcome. However, the report said the capital schemes must be completed, staffed and operational by 24 December or the full capital costs will be clawed back in 2019/20.

Providers were spending the funding in a variety of ways, such as additional A&E cubicles, walk-in units and medical assessment areas next to A&E. However, they told NHS Providers that earlier notice would have helped the trusts and improved system-wide planning.

Ms Cordery added that there were clear warning signs that pointed to a more difficult winter this year. These included the sustained increase in demand; the continued decline in A&E performance; higher levels of vacancies; and the weaker state of social care. 

‘All things considered, trusts fear that this coming winter will be more difficult than the last,’ she said.