• Nursing vacancies could impact NHS’s ability to manage winter demand
  • Dame Pauline Philip says “we are starting to see a deterioration” in A&E performance
  • Planning for winter “more detailed and intensive” than previous years

Nurse staffing levels will be the “determining factor” for NHS trusts in opening extra capacity to cope with winter pressures.

NHS Improvement’s board was today warned that nursing vacancies could hamper the ability of the NHS to safely manage demands for more beds in the event of high numbers of patients attending accident and emergency departments.

Pauline philip

Dame Pauline said ‘nursing levels will be a determining factor around the number of beds we can safely provide’

Dame Pauline Philip, the national urgent and emergency care director, said at NHSI’s board meeting the health service was already seeing a deterioration in performance against the four hour waiting time standard.

She said performance for October and the year to date was around 90 per cent of patients being seen and treated within four hours.

She said November was starting to look “more difficult”, highlighting that an increase in respiratory issues in children meant “we are starting to see a deterioration” in A&E performance.

Dame Pauline told the board staffing levels for doctors and other staff were important but “nursing levels will be a determining factor around the number of beds we can safely provide”.

NHSI nursing director Ruth May reiterated the concern over nursing levels, telling the board it was a “very real risk”.

She said: “There are nursing vacancies. Trusts and boards are making decisions day by day to make sure they can staff their wards. But it is not just about hospitals, but staff in community teams as well.”

Dame Pauline said some trusts had achieved a 100 per cent vaccination rate against flu but that there was variation with some community organisations only achieving vaccination rates in the low thirties.

She said planning for winter was “more detailed and intensive” than previous years and focused on targeted support to organisations under the most pressure, alongside continuous monitoring and live data. There are also contingency plans being put in place to tackle peaks in demand.

Changes made ahead of winter include:

  • 85 per cent of type one A&E departments having a primary care streaming service in place after £100m of investment;
  • access to urgent treatment centres is being standardised and booked via NHS 111; and
  • more than a third of 111 calls are being answered by nurses, paramedics and doctors, compared with 22 per cent last year.