The NHS faces the toughest winter on record. With a renewed promise of support from national leaders, integrated care systems now have even more to worry about, writes Julian Patterson

NHS England has published a letter setting out how it will continue to develop key metrics and core objectives to avert a winter crisis in the NHS. The new measures are designed to support ICSs to manage winter pressures and prevent avoidable harm to patients and members of the NHSE board.

The winter letter promised unprecedented levels of performance management and a renewed commitment to assurance frameworks and operational guidance.

It lays out the following core objectives and key actions:

  • To empower ICS to delay winter by developing local plans for sustained mild weather throughout the winter months, without incurring the risk of further heatwaves
  • To stagger the onset of colder weather by prioritising temperature control measures with local partners in social care and the voluntary sector
  • To mitigate the effects of unavoidable cold weather through social media campaigns, encouraging members of the public to wrap up warm, adopt self-heating behaviours such as foraging for firewood, and insulate the homes of elderly neighbours
  • To encourage staff to try harder, for example by sharing inspirational videos of Amanda Pritchard thanking staff during hospital visits
  • To reduce hospital occupancy through use of virtual wards, improved flow, timely discharge, better support for people at home and other measures that may either not have occurred to ICS leaders or may have been tried unsuccessfully in the past
  • To reduce ambulance delays by working more closely with partners such as Deliveroo, Amazon and A1 Taxis on community-based alternatives, and by recruiting people with basic first aid skills (or an interest in acquiring them on the job) as paramedics
  • To reduce overcrowding in accident and emergency departments by removing signage that makes them too easy to find, and by deploying retired GPs as care-bouncers to divert non-urgent cases to other services
  • To increase capacity outside hospitals, for example by employing additional social prescribers in primary care and by spending mental health allocations on mental health
  • To increase the number of physical beds available through local alliances with Swedish manufacturers of flat-packed furniture, with an eventual aim of providing adequate numbers of doctors and nurses to staff them

Beyond outstanding

National leaders are promising to provide targeted interventions to struggling ICSs through a “Be More Mackey” information campaign, including top tips on how to use management consultants to “go beyond outstanding” without wasting millions of pounds of taxpayers’ money.

They are also expected to unleash strategy director Chris Hopson in the run-up to winter. Mr Hopson is currently being recharged and upgraded with new messaging software in the basement of NHSE’s Wellington House headquarters.

ICS leaders will be expected to focus on six key metrics:

  • Understanding of the level of challenge and progress against plan, evidenced through credible and timely reporting
  • Achieving financial balance and hitting other key targets without resorting to magical thinking, creative accounting or outright fraud
  • Increasing workforce capacity and maintaining morale through exhortation, prayer and folk song.
  • Avoidance of negative headlines
  • Average hours lost in responding to freedom of information requests (adjusted for successfully blocked requests denied on grounds of commercial sensitivity)
  • Job occupancy (particularly their own)

Leadership in action

The letter concludes that the combination of covid, flu, seasonal cold weather, fuel poverty, escalating food prices and an absentee government with little or no understanding of the NHS meant that this winter could be “quite challenging”.

ICS leaders responded warmly to the prospect of a national leadership committed to increasing monitoring, scrutiny and document production, with most agreeing that it was the next best thing to a plan.