PERFORMANCE: The NHS in London must improve cross-boundary working, review staff contracts and enlist the help of the third sector to better meet emergencies, a report uncovered by HSJ reveals.

The report, prepared by the Health Protection Agency, assessed an exercise testing emergency planning in a “winter pressures” scenario.

It said organisations worked well together within their sector but less effectively across boundaries. This led to a “lack of clarity” about when winter pressures had reached emergency levels.

The report on the exercise, carried out in October, was released to HSJ under the Freedom of Information Act last week.

It praised the capital’s system for monitoring bed occupancy, but warned it “does not seem well understood or embedded”. It said: “All trusts need to be committed to updating and maintaining it [as] a high priority.”

The acute sector was also praised for its ability to free bed space by faster discharge, flexing operating theatre capacity and “altering admission criteria”.

But the report noted there was no information on the number of beds in the community. In a winter pressures scenario, planners should also include independent sector and mental health trust beds, the document said.

A key recommendation was a single NHS-wide staff contract that would be transferable across organisations, allowing trusts to use retired staff or staff who live locally if needed.

The document said: “Otherwise it would be an indefensible risk to use the services of an unknown nurse or doctor who presented themselves at a hospital offering help.”

Other recommendations included securing hotel accommodation for staff, using volunteer drivers to transport patients, and encouraging “voluntary groups, faith groups and the public” to look after vulnerable neighbours.

“Perhaps for those elderly and vulnerable people in the community there needs to be a winter friend, similar to a flu friend, as this may prevent admissions into hospital,” the report said.

Snow, the H1N1 virus and seasonal flu this winter saw London accident and emergency departments deal with 90,413 patients in the week ending 2 January – the highest ever.