NHS winter pressures in England 2017/18

This briefing from the House of Commons Library  summarises the current data and trends on winter pressures in the NHS, including ambulance handover delays, bed occupancy, norovirus bed closures, and accident and emergency diverts.

NHS England vaccine advice 'increased risk of flu admissions'

More patients may have been admitted to hospital with flu this winter after NHS England asked GPs to order a less expensive flu vaccine, a senior doctor has warned.


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Exclusive: A&E doctors tell prime minister patients are dying in corridors

Clinical leads for emergency departments warn prime minister of premature deaths in corridors
A&E waiting time performance has dipped to between 45 per cent and 75 per cent at times
Doctors say winter preparations failed to deliver and call for significant funding boost

Senior doctors in charge of more than 60 hospital emergency departments have written to the prime minister warning of “very serious concerns” about patient safety amid the winter crisis, including a case of patients dying prematurely in corridors.

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Exclusive: CQC suspends routine inspections over winter pressures

Routine inspections of some services cancelled by CQC due to winter pressures

Regulator says decision will allow staff to focus on caring for patients

Chief executives criticise decision as a “mockery” and counter to the policy of “minimum standards”

The Care Quality Commission is suspending routine inspections of some hospitals, GP practices and urgent care services during January due to winter pressures, HSJ can reveal.

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What’s behind the ‘winter crisis’?

The NHS is once again hitting the headlines, with many hospitals on black alert and a large number of elective operations being postponed to reduce the extreme pressure on services over this winter period.

A King’s Fund briefing looks at the factors behind what the press refer to as a “winter crisis”.

NHS England enacts winter pressures protocol as services feel strain

NHS England has kicked into gear a series of recommendations to help hospitals handle increased pressure on services, activating the NHS Winter Pressures Protocol.

This includes extending the deferral of all non-urgent inpatient elective care to 31 January, deferring day-case procedures and routine outpatient appointments and advising clinical commissioning groups to temporarily suspend sanctions for mixed sex accommodation breaches.

The measures, put forward by the National Emergency Pressures Panel (NEPP), come in response to strains being felt by NHS services across the country over the festive period.

Daily Insight: Cancelling at Christmas

New year’s resolutions

NHS England has told under pressure hospitals they can cancel non-urgent elective procedures to free up beds for patients coming through accident and emergency.


In a letter to trusts on Thursday afternoon, medical director Sir Bruce Keogh and national director for urgent and emergency care Dame Pauline Philip said the “expectation is that non-urgent inpatient elective care should be deferred until mid-January to ensure beds and staff are available for the sickest patients. By acting early, trusts can avoid last minute cancellations that can be costly and inconvenient for patients.”


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NHS uses sickness data as early warning to cope with winter surges

A sickness surveillance system will help the NHS plan for surges in demand this winter by tracking outbreaks of norovirus, which causes vomiting and diarrhoea, and other illness around the country.

Data gathered by Public Health England will be used by NHS England operational monitoring teams to study winter trends and to help give early warning about rising outbreaks of flu, respiratory syncytial virus (RSV) and norovirus as well as other acute seasonal illnesses.

The findings will allow the NHS to anticipate rises in hospital admissions and produce a planned response by, for example, rescheduling planned surgery in advance to avoid inconveniencing patients as well as free up beds and converting ‘swing’ wards from elective to emergency care for patients with conditions such as respiratory problems.

Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge

This best practice framework from NHS England aims to address two models and the implementation approach that needs to be taken by sustainability and transformation partnerships (STPs) and their provider organisations with ensuing threats to patient safety, during the winter months.

How the health and social care system is preparing for winter

This briefing from the NHS Confederation provides an overview of the key challenges facing health and social care over the winter period and the work being undertaken to prepare for the coming months.

Planning for seasonal demand in respiratory illness

Each winter, emergency departments experience a surge in respiratory attendances and emergency admissions for respiratory conditions double. It is therefore crucial to plan for this inevitable increase in demand so that patient flow is maintained.

A “quick guide” from NHS Improvement highlights ways to manage demand, including ambulatory emergency care, early supported discharge services, and urgent “hot” clinics. Use of these initiatives can reduce avoidable overnight admissions and improve patient flow and outcomes.

Local A&E delivery boards are advised to consider the recommendations as part of plans to manage the seasonal surge in respiratory admissions.

Out in the cold: lung disease, the hidden driver of NHS winter pressure

This report from the British Lung Foundation identifies a seasonal trend in respiratory admissions over the last seven years and argues that a failure to address this annual fluctuation is contributing to winter A&E pressures. It argues that community care and support outside of hospital needs to be strengthened and that service planning for a rise in respiratory admissions is needed to manage this seasonal variation.

Coping with winter pressures: a practical guide

Coping with winter pressures: a practical guide from the AoMRC

Ready and resilient? How NHS trusts have prepared for winter

This briefing from NHS Providers outlines in detail what has been done locally and nationally to ensure safe, high quality care for patients during the winter period. It argues that NHS trusts have done all they can to prepare for extra winter pressures but warns that the health service will be tested in the coming months as it is already working close to full capacity.

Winter service pressures and the role of anaesthetists in training

During last winter some anaesthetists in training were asked to work outside of their usual scope of practice due to unprecedented demands on clinical services. The AAGBI communicated its concerns to Health Education England and issued guidance. 

As winter approaches again, it may be timely for all anaesthetists to note the guidance which remains relevant.

Surgeons asked to staff hospital front doors to head off emergency pressures this winter

The leaders of the Royal College of Surgeons (RCS) have written to surgeons in England, encouraging them to provide support at hospital front doors (e.g. rapid outpatient clinics and A&E) over the coming months as the NHS faces arguably its toughest winter in modern times. The surgeons have also called on government to make further funding available to the NHS in next week’s Budget.

The RCS says there is strong evidence that having more senior decision-makers at the front door of hospitals reduces unnecessary emergency admissions and delayed discharges, thereby freeing up beds for genuine emergencies and patients needing planned operations.

Performance of the NHS provider sector for the month ended 30 September 2017

This report from NHS Improvement finds that despite the NHS treating more patients than even before, more people were seen within four hours in A&E and within 18 weeks for planned care. However, the combined end of year deficit for hospitals in England will be an estimated £127 million worse than planned.

Addressing ambulance handover delays: actions for local A&E delivery boards

Ambulance handover will be a key indicator for both winter monitoring and on an ongoing basis through publication of performance data.

This letter from NHS Improvement outlines its expectations and guidelines for management.

At least £360m extra funding may be needed for NHS to meet four hour A&E target this winter

This winter, the extra capacity needed to help the NHS to meet its four hour A&E target could cost at least £360m, according to new analysis by the Health Foundation.

Recent measures taken to reduce pressures include an increase in people having the flu vaccine, more 111 calls being handled by clinicians and £100m of capital investment. This may reduce the number of people coming to A&E.

However, the impact of these measures is not yet known. New Health Foundation analysis shows that unless the trend of recent years is significantly improved, this winter could potentially see the worst performance against this target since records began in 2004/5.

Preparing for winter

The Preparing for winter guidance from the Royal College of Physicians covers the delivery of care, patient flow, wellbeing of the workforce and minimising unnecessary hospital occupancy.