• NHS leaders push for in-year funding to help plug deficit
  • New drive on length of stay of “super stranded” patients planned
  • System bosses also want major expansion of ambulatory care provision

NHS national leaders have estimated the service is at least 4,000 beds short for next winter and are pushing for fresh funding this year to help plug the deficit, HSJ understands.

HSJ has been told the funding plea is being made as part of discussions with ministers about the new long term funding deal, with an announcement expected later this year.

A cash boost would mark a significant policy change, after the NHS England planning guidance published in February said “there will be no additional winter funding in 2018-19”.

But it would not be the first time this has happened in recent winters, many of which have featured unscheduled funding injections largely aimed at trying to address deteriorating four hour waiting times performance.

One senior source told HSJ the 4,000 figure was at the “low end” of estimates of what the system needs to return to meet the four hour waiting time and the 92 per cent bed occupancy targets.

It is considerably less than NHS Providers’ estimate that the beds shortage could be as high as 15,000 beds – around 12 per cent of the system’s 128,000 total bed base.

Senior sources told HSJ because of the workforce shortage, most of the focus was on optimising the existing bed base. Key planks of the 2018-19 winter plan would be around further efforts to cut length of stay, especially for “stranded patients”; to optimise existing capacity; and increasing the use of ambulatory care, to curb overnight admissions, multiple sources said.

The new initiatives would build on existing efforts to cut delayed discharges, which system leaders estimated freed up 1,700 beds this winter. However, nearly all the gains were cancelled out as the beds were filled by patients with flu and norovirus.

Additional funding could be used to help trusts establish or build on existing ambulatory emergency care units in a similar way to how streaming services were funded this winter.

There are also discussions around making it a mandatory requirement for every acute site to have an ambulatory emergency care unit. However, tariff payment rules need to be reformed to cut perverse incentives for trusts to admit patients overnight in order to collect a bigger payment.

Meanwhile, efforts on cutting length of stay will be targeted at “super stranded” patients – people who have been in hospital more than 21 days.

NHSE declined to comment on the beds shortages or funding negotiations, but a spokesman highlighted comments made by chief executive Simon Stevens to the Commons health and social care committee last week.

An NHSE spokeswoman added: “As Simon Stevens told the [committee] last week, around 18,000 people currently in hospital have been ‘stuck’ there for more than 21 days. That’s the equivalent of 36 acute hospitals being ‘out of action’ because of delays getting patients out of beds.

“Building on recent success in reducing DTOC, the operational focus or the year ahead will now turn to reducing superstranded patient numbers in partnership with local community health providers and social care services.”

Discussions are ongoing about how to best incentivise trusts to improve their length of stay performance and whether to introduce a new target. Social care providers could also face new guidelines to ensure they prioritise care packages for “super stranded” patients, HSJ understands.

A Department of Health and Social Care spokesman said: “We know that demand continues to grow, and that staff have never worked harder, which is why the NHS was given £1.6bn for 2018-19, on top of a planned £10bn a year increase in its budget by 2020-21.

“The prime minister and health and social care secretary have committed to a long term plan with a sustainable multi-year settlement for the NHS to help it manage growing patient demand, which will be agreed with NHS leaders, clinicians, and health experts.”