• System set target to keep bed occupancy levels below 92 per cent
  • CCGs must ‘submit agreed delayed discharges targets by 21 July’
  • Hospitals set new standards on improving patient flow

NHS bosses have set out a range of new targets for providers and commissioners, amid concerns about the system’s performance against the four hour target and the upcoming winter.

Official data published yesterday showed four hour waiting time performance was in decline year-on-year in spring, despite NHS bosses making it their top priority. This has prompted concerns among professional and system leaders, HSJ understands.

A letter sent to clinical commissioning groups and providers today and a new “winter review”, both jointly from NHS England and NHS Improvement, set out plans for:

  • Hospitals to meet a new set of best practice standards around improving patient flow this financial year or face sanctions
  • A target to keep bed occupancy levels below 92 per cent
  • Closer working with local government to prepare for demand spikes
  • CCGs to “submit agreed delayed discharges targets by 21 July”

The letter, sent out by the NHS’s national urgent and emergency care director Pauline Philip, set out “[the NHS’s] priorities for the next few months, together with actions that have already been taken to build resilience ahead of next winter”.

A new Good practice guide: focus on improving patient flow, which brings together existing best practice guidance in 10 core areas including ambulance handovers, frailty and mental health, sets out the bulk of the provider-side targets (See full article).

In addition, a “winter review”, which set out 10 core recommendations (see below), says providers must ensure they “operate at a bed occupancy level of 92 per cent or below to support patient flow”. This is notably higher than the 85 per cent benchmark that the Royal College of Surgeons maintains represents a safe level.

The review also says that better understanding of “capacity across the whole system”, and better data on community and primary care capacity, in particular, is required.

Meanwhile commissioners have been ordered to agree targets around speeding up discharges by next week. An appendix to the letter titled, Expectations for CCGs to reduce NHS-attributable delayed transfers of care, says: “Each area will need to submit agreed DTOC targets by 21 July 2017, showing at local authority level the planned reduction in social care-attributable delays, and at individual CCG level, the planned reduction in NHS-attributable delays that will be achieved.”

The Royal College of Surgeons raised concerns about official performance data for May, published yesterday, which “shows that A&E performance is continuing to decline”. In May 89.7 per cent of patients seen within four hours in May 2017, down from 90.3 per cent for the same month last year.

The RCS added in a statement: “Performance is even worse for major A&E units. Only 84.6 per cent of Type 1 A&E units met the four hour target, compared to 85.4 per cent the previous May and 85.7 per cent in April.”

RCS vice president Ian Eardley said: “It is also disappointing that A&E performance is worsening despite that this is now a higher priority for NHS England and the government. The NHS needs to better understand why this has happened and whether recently announced measures are sufficient.”

HSJ understands that regulators share concerns about the May data. 

Summary of recommendations in NHS winter review

System Capacity

1. Occupancy levels in acute hospitals should be more actively monitored and actions taken to ensure that they remain below 92 per cent to maintain patient flow and deliver A&E performance.

2. System needs to free up around 2,500 acute beds by reducing delayed transfers of care.

3. System needs to build on the forthcoming additional collection of data on primary care capacity to have a more complete picture of capacity available across the system, particularly in community care.

Peaks in demand

4. All parts of the NHS need to work with local government to ensure that there are enough resources available to maintain patient flow seven days a week and plan effectively for the predictable peaks in demand at weekends and bank holidays.

Variation across the country

5. There needs to be a renewed drive and focus to implement best practice across all systems.

6. Specific action needs to be taken to address workforce shortages in key areas in urgent and emergency care, most notably in primary care and emergency medicine, both for this winter and for the medium-term.

National support

7. The NHS should plan for winter earlier than in previous years.

8. NHS England and NHS Improvement need to build on the recent appointment of Pauline Philip as joint national director to be more aligned.

9. NHS England and NHS Improvement should work with partners to reduce the assurance and reporting burdens.

Urgent and emergency care system

10. NHS England and NHS Improvement should ensure the local NHS make rapid progress over the course of 2017-18 in implementing the wider changes to the urgent and emergency care system reforms.

Source: A review of winter 2016/2017 – NHS Improvement and NHS England (see attached)



Hospitals given new bed occupancy target as NHS braces for winter