Autumn has arrived a bit earlier than last year, and with it have come warnings that the NHS faces the worst winter in its history.
Headlines include “Overburdened NHS faces ‘winter of woe’, leading doctors warn” (The Guardian, 14 September), “NHS needs £350m to avoid bleak winter” (The Times, 4 September), “NHS is given six weeks to empty beds in flu alert” (The Times, 13 September) and “Two junior doctors left to care for 436 patients amid dangerous staff shortages, NHS report warns” (The Telegraph, 17 September).
As a consumer, that’s scary. But, as health professionals who know that scary stories sell papers, do we need to be more concerned than usual? In particular:
- Is there any reason it’s going to be worse than any other winter?
- What is being done to minimise the risks to patients?
- Will it be enough?
Why will this winter be worse than usual?
The basic reason is the usual one: increasing demand and the NHS not keeping up with it. The good news is that Trusts are “better prepared” now than they were last year, according to NHS Providers. The bad news is that that’s not nearly enough.
Hospitals are full
According to the Guardian, a total of 181,692 bed days were lost in hospitals in England in July to “delayed transfers of care”, when patients are fit to leave but cannot be safely discharged. Prof Derek Alderson, the president of the Royal College of Surgeons, said hospitals’ ability to cope with the coming winter was at risk because so many beds were tied up with such patients.
Social care initiatives that were funded to help resolve this problem appear to be having no significant impact. They appear to be failing to help patients leave hospital fast enough to deal with the expected demand this winter.
NHS Providers comments “last winter was widely regarded to be the most challenging in recent times, yet the NHS is currently on a trajectory towards at best similar, but more likely worse, performance this coming winter, with heightened patient safety risks”.
There are staff shortages
In addition to the beds issue, staff shortages are expected to bite hard this year, exacerbated by the uncertain immigration outlook caused by Brexit.
A report from Plymouth Hospitals suggests that the situation is already difficult after two junior doctors were left in charge of over 400 patients during one shift. The Medical Director of the Trust was quoted in the Telegraph as saying “like other trusts nationally, we do have difficulties recruiting to and filling our junior doctor posts and so, as our responsibility to ensure our junior doctors and the hours they work are safeguarded, we have had to explore other options, where we can”.
There’s a high risk of a flu epidemic this year
Australia has suffered a major flu epidemic this year during the southern hemisphere winter. Simon Stevens has warned that the virus is likely to strike Britain hard. He said “the signs from Australia and New Zealand . . . are that it has been a heavy flu season and many of the hospitals down there have struggled to cope”.
NHS flu vaccination will shortly get under way and while it will include the H3 strain dominant in Australia, health chiefs never know in advance how well the jab will protect patients. Last year the vaccine did not work in the elderly but protected children.
What is being done to minimise risks?
- Simon Stevens has given the NHS a 6 week period to empty beds ahead of the anticipated demand, although how that is achieved is a local matter.
- Dame Pauline Philip, NHS national director for urgent and emergency care, said that trusts were planning to open an extra 3,000 beds over the winter. The Department of Health said that the NHS was more prepared for winter “than ever before”.
- Flu vaccinations are starting, including amongst children who may have passed on the virus to the frail elderly.
Will it be enough?
It’s too early to say, but it doesn’t feel like adequate funding is being made available to prepare for what may be a terrible winter.
It’s been the case in past years that the system has just about made it through winter by the skin of its teeth, stretched thin. Each year we claim to have learned the lessons, but it is possible that a really brutal winter combined with a flu epidemic could lay bare a fundamental lack of capacity and funding. We may have to cross our fingers.