The mild days of late autumn are barely gone, yet concerns about a looming winter crisis in the NHS are already hitting the headlines. With financial pressure growing, performance targets slipping and hospitals already overstretched, a political storm has hit Westminster and Whitehall. Could another cold snap tip the NHS over the edge?
A SLIPPERY SLOPE?
Winter pressures in the NHS happen every year, as a result of higher emergency admissions and increased numbers of people requiring hospital care (e.g. people with respiratory conditions or winter viruses). Most of those affected are older people, many of whom have higher care needs and can be more vulnerable to the cold.
Yet, despite anticipatory planning and the usual precautions, there are growing concerns that accident and emergency (A&E) services are heading inevitably towards a midwinter meltdown. NHS statistics have revealed that A&E performance in late autumn this year has been worse than in the depths of last winter.
On average over the past four weeks, just 93.5% of patients attending A&E in England were seen within four hours, with 23 trusts failing to reach 90% last week. By contrast, above 95% of patients were seen within the required timeframe last winter.
WHAT ABOUT PATIENT SAFETY?
The unprecedented demand on A&Es has serious implications for older people’s health and experience of care. The high levels of bed occupancy have led to people being held in ambulances outside the hospital or waiting on trolleys for many hours. This has also had a knock-on effect on other hospital services, with patients having their appointments and operations cancelled.
For the many older people who are lonely and isolated, or living with frailty or dementia, the inability of A&Es to respond to their needs can be disastrous. Due to a lack of appropriate support in the community, they are often forced to wait until they reach a crisis for a response and rely on emergency admissions for help. Arriving in a worse state of health, they are then faced with a fraught and overstretched urgent care centre or A&E.
TOO LITTLE TOO LATE?
Amid growing concerns about A&E performance and its likely political impact in the run-up to the General Election, the Health Secretary, Jeremy Hunt, pledged to inject an extra £700m to help the NHS get through the winter. Is this enough?
Recent reports from Monitor and the NHS Trust Development Authority have shown that over the first six months of the financial year, NHS providers in England were £630m in the red, even after the injection of extra Government funding into the worst performing trusts.
This financial struggle explains why health chiefs are so keen to see new money for next year and have put pressure on Whitehall to take action. The Chancellor George Osborne’s commitment in the Autumn Statement to a £2bn boost for the NHS next year is very welcome, yet concerns remain over what the winter might do to the NHS in the meantime. With projections of a £30 billion shortfall in NHS funding by 2020, the problems stretch far beyond A&E departments.
A PORT IN THE STORM
Crisis funding into the NHS just before (or at) tipping point mirrors the wider response to the care of older people. It only becomes necessary because steps to prevent the crisis have been missed. Age UKs across the country are engaged in a wide range of approaches to the challenges older people can face.
For example, home from hospital support helps prevent people being readmitted within days of being discharged, an all too common occurrence. Properly planned care linked into voluntary sector services, such as befriending and falls prevention, can put people in a much better position to support themselves and remain active, particularly during the winter months when it is harder to get out. Primary care services – admittedly as stretched as A&E – that focus on the whole person rather than a single health problem can help to root out other issues that might not emerge until much later.
These proactive approaches not only keep people well and independent for longer but put A&E and urgent care services in a much stronger position to deliver effective care for everyone. Emergency care must be seen as just one arm of the NHS, a port in the storm supported by proactive and person-centred approaches across the service.
TAVISTOCK SQUARE DEBATES
It may be too soon to make firm predictions about this winter as much will depend on temperatures. Should we have another mild winter like last year, we might be able to just pull through. However, what would happen if temperatures plummeted from January as in 2012/13, where an estimated 31,100 people in England and Wales died due to the cold weather? Can the NHS survive another bad winter?
These questions will be the subject of a debate organised by Age UK, the British Red Cross and the Royal Voluntary Service at Tavis House, on Tuesday 9 December from 6-8pm. For more information on the event and to reserve your place today, please click here.
- Dave West, Senior Bureau Chief, Health Service Journal (Chair)
- Karen Partington, Chief Executive, Lancashire Teaching Hospitals NHS Foundation Trust
- Dr Charles Alessi, Chair of the National Association of Primary Care
- David McCullough, Chief Executive of the Royal Voluntary Service.