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Increasing the NHS’s low bed capacity has been one of the main planks of the NHS’s winter preparations this year, with a central drive on delayed discharges and a chunk of the £335m winter pressures money being used on extra beds.
With the traditional post-Christmas demand surge nearly upon us, here is a rundown of how well preparations have gone and how it’s panning out so far.
The atmosphere at the top of the shop in NHS England was “tense” this week (as one might expect), according to one well place source, “but not one of panic” (yet).
The source admitted the system’s fortunes were largely in the lap of the gods - made material via extremely cold weather, virulent flu and/or norovirus - but that there was a genuine belief that the planning process has been thorough and no stones have been left unturned.
There was even some good news on total bed numbers, which have been in overall decline for over a decade and the Royal College of Emergency Medicine has regularly raised concerns about. The data suggests there are more beds in the system this year than last winter.
There were an average of 96,187 general and acute beds in the system between 1 and 11 December 2017, which is 1,534 more than in the same period last winter, according to NHS England’s weekly winter situation report data.
The national commissioner estimated a further 1,150 beds (of all types, not just acute as with the sit-rep data) have been made available by the drive to free up delayed transfers of care beds, funded by the £2bn social care funding boost in the March budget.
NHS England claimed this would increase to 2,500 beds (a target originally set for September) in the coming weeks, following the additional £335m from autumn’s budget.
The 2,500 extra beds (all types) are not directly comparable with the additional 1,500 hospital (general and acute) beds indicated in the sit-rep data.
But both NHS Providers and the Nuffield Trust concurred that while it was not possible to calculate a definitive bed number with the existing data (more on that below), there were significantly more beds at the system’s disposal this winter than last year.
The bad news is that despite this, bed occupancy levels were higher for the first 10 days of December (94.3 per cent, compared with 93 per cent for the same days in 2016), as the capacity was gobbled up. Some trusts are already recording 100 per cent bed occupancy in their daily numbers.
This is, of course, above the 92 per cent bed occupancy benchmark set by NHS England in the summer and way out from the 85 per cent above which the Royal College of Surgeons says care quality can be compromised.
Moreover, NHS England’s bed occupancy data underestimates the severity of the problem because it is of beds counted at midnight (“Anyone can find a bed at midnight, it’s finding them between 10am and 11pm that’s the problem,” one senior doctor vented to me this week).
Whichever way you cut it, the system is already running hot.
The consequences of high bed occupancy are “longer waits at A&E and increased [risk of] the spread of infection. This makes the NHS as a whole less resilient to sudden shocks like an outbreak of flu or norovirus,” Nuffield Trust chief executive Nigel Edwards said.
NHS Providers deputy chief executive Saffron Cordery said: “Anecdotally, flu is already starting to hit and we know it’s a particularly virulent strain this year. We’ve already had one cold spell, meaning things like respiratory conditions are now starting to be an issue.”
The latest data shows norovirus is steadily rising (see a neat graph from the RCS here). To compound matters, there are two strains of norovirus this year, which means it can take longer to clear wards where there is an outbreak.
The winter pressures funding was “welcome, although very late” Ms Cordery added, but it was not possible to calculate how much capacity it would generate quite yet. She pointed out that the bulk of the money was being used to compensate trusts for additional capacity that they had already purchased.
I also understand a smaller, but significant, chunk of the money is being allocated to trusts to financially compensate them for freeing up elective beds for emergency admissions.
NHS England needs to sort the data out
One of the reasons for the lack of clarity about the system’s performance is NHS England’s decision to change the data it publishes this winter.
The most notable example is the centre’s refusal to publish this season’s figures for the number of trusts forced to issue an alert under the operational pressures escalation levels (OPEL) framework.
The first purpose of the data is to assist the system operationally. But there is a palpable sense of frustration among those trying to track progress this winter, as well as political critics calling it a deliberate cover up.
As Ms Cordery pointed out: “It’s hard to compare apples with apples when they are reporting apples and pears. The changes to what gets reported make it very hard to work out what’s going on. To understand the impact on the ground, we may have to wait for monthly data.”
She added that it was not just a case of needing to report problems. She said: “If trusts are performing better than last year then it is important to be able to report that back to frontline staff as well.”
Mr Edwards added: “While it is good that the [OPEL] data is still being used within the system to monitor pressures, the decision not to make it public signals a lack of transparency, which hampers our ability to compare this winter to last, and could prevent us from learning important lessons for the future.”
Trusts allowed to cancel elective work until mid-January
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