Trusts raise concerns over lack of winter preparations

The concerns were raised to HSJ as official data revealed performance against core standards, including the four hour target, had worsened. There are also fears ministers will not make additional funding available for next winter.

“Given current workforce and demand pressures and the absence of dedicated winter funding, trusts tell us they are concerned,” NHS Providers chief executive Chris Hopson told HSJ.

He also warned: “Whilst national leaders are understandably focusing on the 10 year plan, a new secretary of state, and recruiting a new NHS executive board, we mustn’t lose sight of how difficult this winter is likely to be.”

An acute trust chief executive told HSJ: “There is nothing to suggest winter will be any different than it was last year”. The source added that NHS national urgent and emergency care director Pauline Philip phoning up or summoning in chief executives to demand improvements when performance deteriorates in winter “will do bugger all” to help.

Trust chiefs questioned why a review of winter, which was expected by providers in May or June, so that learning could be incorporated for the coming winter, had not yet been published. The review has been discussed at recent NHSI board meetings, but the item has always been restricted to the private part of session.

“If the NHS is to be the learning organisation we all talk about, we need to see the results of the winter review published as soon as possible,” Mr Hopson added.

HSJ understands NHSI does still plan to publish the document, although a date has not been set.

Questions also surround at what stage the overall planning has reached for the coming winter. Last year a letter setting out winter planning went out in July sent by Ms Philip. It set out priorities, including reducing delayed transfers of care, reducing variation in best practice, primary care streaming. There has not been a similar national call this year.

NHS England chief executive Simon Stevens did confirm in June that a major cornerstone of the plan would be cutting length of stay for patients in hospital for more than three weeks by a quarter to free up 4,000 beds. Trusts have been set local targets. System leaders will also prioritise a push on improving weekend discharge rates.

But trust chiefs told HSJ there has been little in the way of system wide correspondence since. 

NHSI declined to address questions about the review. But in a statement the national body insisted winter preparations were “in place” and that the arm’s length body had been working with local systems “for some time”.

Ms Philip said in the statement: “Preparations for the winter months have in fact been in place for some time. We have been working throughout the year, including directly with system leaders across the country, to prepare local capacity plans, many of which are well underway.”

Concerns around the system’s resilience was, however, reflected in a letter sent out by NHS England national director Matthew Swindells and NHSI medical director Kathy McLean on 3rd August which plans to reduce excess bed days.

The letter said: “Most parts of the country are currently not meeting waiting standards or reducing their emergency bed occupancy to the required levels to confidently prepare for winter.”

The Department of Health and Social Care declined to comment directly on whether there would be additional funding for winter. But its statement highlighted that additional funding had previously made available this year.  

A spokesman said: “For this year 2018-19, the government has provided the NHS with an additional £1.6bn to support and improve A&E and elective care performance.”

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