Providers deliver stark warning on NHS

In a letter to health and social care secretary Jeremy Hunt, the providers’ representative body said the current pressures being faced by the service marked a watershed moment. The NHS could not recover its performance to once again meet statutory targets on A&E and elective care, for example; maintain high quality care; meet the NHS capital requirements; and address the wider policy agenda on transformation and integration of care under current funding.

Figures published today by NHS England showed around 85% of patients attending A&E in December were seen within four hours, compared with the 95% standard, which was last achieved in July 2015.

A letter from senior A&E doctors to prime minister Theresa May set out a picture of a service at breaking point in some hospitals, with patients sleeping in makeshift wards, trolley waits of up to 12 hours before admission to a ward and delays in transfer from ambulances due to lack of capacity in A&E. It warned that more than 120 patients a day are being cared for in corridors in some hospitals, with some dying prematurely.

In its letter to Mr Hunt, NHS Providers said that despite the extensive planning this winter, there were not enough beds and staff to ensure patients received the correct levels of care and safety. Increases in flu cases, respiratory illness and cold weather had put additional pressure on the service.

It argued that decisions must be taken on the long-term funding of health and social care to allow the NHS to hit its constitutional standards or the standards should be changed. And these decisions must be made before November’s Budget or there would be a risk that the service’s performance would further deteriorate. A full review of how the NHS handled this winter was also needed, it said.

NHS Providers’ chief executive Chris Hopson (pictured) said the health service had planned better than in previous years, but these plans are being derailed by rising flu and respiratory illnesses.

‘The NHS is no longer able to deliver the constitutional standards to which it is committed. We need to be realistic about what we can provide on the funding available,’ he said.

‘If we continue to run the NHS at close to 100% capacity, day in day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a high, but entirely predictable, spike in demand.’

He called for a government-led review of long-term funding, building on work from economists and think tanks such as the Institute for Fiscal Studies, the Office for Budget Responsibility and the King’s Fund Barker commission.

‘Failure to act now will lead to targets moving further out of reach. This would harm the quality of care, causing delays and distress for patients and weakening staff morale. It could also undermine public faith in the NHS,’ he said.

‘There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the government’s court.’

The NHS England performance figures were mixed. There was a reduction in delayed discharges – an average of 5,169 beds occupied each day in November 2017 due to a delayed transfer of care compared with 6,440 a year earlier. This was the lowest since January 2016 when the figure was 5,114. The proportion of delays due to social care fell slightly compared with November 2016.

However, elective waiting lists grew by 4.2% between November 2016 and November 2017 – at the end of November 2017, 89.5% of patients had been waiting 18 weeks or fewer (90.5% a year earlier).

Responding to the performance figures, Taj Hassan, president of the Royal College of Emergency Medicine said patients are suffering due to inadequate planning and resourcing. 

‘December saw the worst ever four-hour performance at our major departments at just 77.3%. In the first week of January bed occupancy stood at 95% – a danger to patient safety, with around 7,000 fewer beds open than in the same period last year. 

‘In the last week we’ve seen images of patients laying on floors while they wait to be seen or treated – patients deserve better than this. The frustrations of our overstretched staff are plain to see; with a large group of emergency department clinical leads pushed to the point of writing to the prime minister to ask for action. The sentiments and solutions within the letter are echoed by the college.’

Nicola Burgess, associate professor of operations management at Warwick Business School, said overcrowding and delays in emergency departments were often symptoms of poor patient flow out of hospital into the community.

‘Hospitals must create slack in the system to be able to cope with the increased demand over the winter months. This means ensuring bed occupancy levels across the hospital do not normally exceed 85%, and thus to maintain this slack, we need to be able to safely discharge patients into the community, safe in the knowledge that those in need can access the social support they require to live well.’

The solution required a focus on the wider system, she added. ‘This means better service integration across the NHS and improved accessibility of community care, working in partnership with frontline care providers to ensure a steady flow of patients out of hospital in a manner that safeguards, and arguably enhances, the quality of care the NHS can offer.’