• NHSI also publishes long-awaited winter review of last winter
  • Trusts raise concerns that social care funding running out is impacting NHS
  • Pauline Philip sets out winter orders and underlines length of stay drive

Regulators today sent out their latest winter orders to trusts and published a long-awaited review of the 2017-18 winter.

Emergency care chief Pauline Philip re-iterated previously cited goals including eliminating corridor care, better triaging of patients away from emergency departments and called on trusts to improve efforts to cut patients’ length of stay.

Ms Philip’s letter to trust chiefs, seen by HSJ, revealed the 40 worst hospital trusts on ambulance handover delay would receive “intensive support”.  It also underlined new orders around flu vaccination for staff, as reported by HSJ – both of which were flagged up as significant trouble hotspots in the 2017-18 winter review.

The letter followed the government’s announcement it was bringing forward £145m for trusts to upgrade wards and emergency departments as well as open 900 extra beds during the winter flu season.

Ministers said this would contribute to the NHS’s ambitious target to free up 4,000 beds by the end of December 2018, largely by cutting length of stay of super stranded patients – people who have spent more than 21 days in hospital.

The 2017-18 winter review set out how an unprecedented spike in demand and activity surges, the worst flu outbreak since 2010-11, and other issues contributed to one of the NHS’s most challenging winters in recent memory. 

It also shed new light on the depth of the problems caused by ambulance handover and internal hospital delays.

It said: “Ambulance handover delays and delays in transfers to a ward once a decision to admit [had been made both rose].

“[Of the average 13,418 patients transported by ambulance to A&E every day] 10 per cent…faced a handover delay of 30 minutes or more [and] three per cent waited more than an hour for handover.”

On delays in transfer after a decision to admit, the review revealed that ”Eighteen per cent of patients waited more than four hours to move to a ward after decision to admit had been completed.”

NHS Providers welcomed both the review and the winter instructions, although re-iterated a challenging winter lay ahead. It also issued a fresh warning to ministers that any additional funding to support the NHS would be best spent by being given to councils – a plea made by NHS England in the last two winters.

The lobby group warned the NHS was already feeling the impact of the tapering of the additional £2bn of social care funding announced in the Spring 2017 budget, which was front-loaded to last year but contains smaller allocations for 2018-19 and the year after.

NHS Providers chief executive Chris Hopson told HSJ: “Our members tell us their social care partners are coming under increasing pressure and one of the reasons for that is the additional funding tapering off”.

The funding announced in March 2017 was allocated to councils as supplementary funding to their “improved Better Care Fund” allocation. An additional £1.01bn was spent in 2017-18. But this dropped to £674m this year and will drop again to £337m in 2019-20.

The funding proved to be a great source of tension between the two sectors, both trying to influence how it was spent. But the NHS’s insistence that more money should go to councils despite these tensions is further evidence of the depth of the health service’s concern about the sustainability of the social care sector.

Mr Hopson was speaking to HSJ ahead of the group launching a list of of asks of system leaders for the NHS long term plan on Monday.

The document will set out key priorities which include addressing the sustainably of the social care sector, the NHS’s capital funding shortage and the need for more investment in public health and prevention.

The Royal College of Surgeons also raised the issue of social care funding. RCS President Derek Alderson told HSJ: “Until the government resolves the social care question then trying to reduce the number of long staying patients in hospital will remain a Sisyphean task [a task which can never be completed].

“[These] short-term measures are a step in the right direction. But the forthcoming 10 year plan must chart a path to building the capacity that is necessary to provide the timely planned and emergency care that patients rightly expect.”