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You can find the current article at its original source at https://www.theguardian.com/commentisfree/2018/jan/11/winter-crisis-nhs-fix-care-safety
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| The winter crisis has left the NHS running on empty – it needs a fix, now | The winter crisis has left the NHS running on empty – it needs a fix, now |
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| Things got so tough in the NHS last winter that we said “never again”. Preparations this time have been more thorough and extensive than ever before, but here we are again: resources overstretched, staff run ragged and – too often, in too many places – standards of care compromised and patient safety put at risk. In the past, mild weather and low flu rates helped us scrape by. Maybe if we had been lucky again this year we could, just about, have coped once more. | Things got so tough in the NHS last winter that we said “never again”. Preparations this time have been more thorough and extensive than ever before, but here we are again: resources overstretched, staff run ragged and – too often, in too many places – standards of care compromised and patient safety put at risk. In the past, mild weather and low flu rates helped us scrape by. Maybe if we had been lucky again this year we could, just about, have coped once more. |
| But flu cases are rising, there is more respiratory illness, and the cold weather is taking its toll. Trusts are doing all they can to provide good care for patients. And every day in the NHS there are countless acts of kindness and compassion by staff who rise above these challenges. But the simple truth is that, within the current funding and workforce constraints, the health service can only do so much. | But flu cases are rising, there is more respiratory illness, and the cold weather is taking its toll. Trusts are doing all they can to provide good care for patients. And every day in the NHS there are countless acts of kindness and compassion by staff who rise above these challenges. But the simple truth is that, within the current funding and workforce constraints, the health service can only do so much. |
| If we run the NHS at 100% capacity, day in day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a sudden, but entirely predictable, spike in demand. | If we run the NHS at 100% capacity, day in day out, permanently in the red zone, it’s not surprising that the service can’t cope when we get a sudden, but entirely predictable, spike in demand. |
| The key problem is a lack of capacity: there are not enough beds or permanent staff. This is now a year-round problem affecting mental health, community and ambulance services, as well as hospitals. But in winter we have more patients who are sicker, requiring more care. If bed occupancy rates are higher than 85% it becomes harder to ensure safe care, and there is less resilience to cope with spikes in demand. Most of the NHS was operating well above that 85% capacity level before winter had even started. | The key problem is a lack of capacity: there are not enough beds or permanent staff. This is now a year-round problem affecting mental health, community and ambulance services, as well as hospitals. But in winter we have more patients who are sicker, requiring more care. If bed occupancy rates are higher than 85% it becomes harder to ensure safe care, and there is less resilience to cope with spikes in demand. Most of the NHS was operating well above that 85% capacity level before winter had even started. |
| A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. | A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. |
| NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. | NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. |
| Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. | Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. |
| The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. | The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. |
| Read a full Q&A on the NHS winter crisis | Read a full Q&A on the NHS winter crisis |
| NHS Providers, as the body representing frontline trusts, has written to Jeremy Hunt to call for a proper public review of how well the NHS handled this winter and what could have been done better. We must, in particular, now properly review whether we have sufficient capacity to deal with the demand the NHS knows it can expect. A simple comparison with the last time the NHS met the 95% four-hour A&E standard suggests the NHS may be 10-15,000 beds short of capacity, against a current NHS total bed base of about 130,000, recognising that much NHS care is delivered outside inpatient wards. | NHS Providers, as the body representing frontline trusts, has written to Jeremy Hunt to call for a proper public review of how well the NHS handled this winter and what could have been done better. We must, in particular, now properly review whether we have sufficient capacity to deal with the demand the NHS knows it can expect. A simple comparison with the last time the NHS met the 95% four-hour A&E standard suggests the NHS may be 10-15,000 beds short of capacity, against a current NHS total bed base of about 130,000, recognising that much NHS care is delivered outside inpatient wards. |
| But this, emphatically, is not just about winter. It’s about whether the NHS can provide the right quality of patient care, 24 hours a day, 365 days a year. | But this, emphatically, is not just about winter. It’s about whether the NHS can provide the right quality of patient care, 24 hours a day, 365 days a year. |
| And, make no mistake, we have now reached a key watershed moment. Put simply, the NHS can no longer deliver the standards enshrined in its constitution; standards that were drawn up to reflect safe, decent, levels of patient care. | And, make no mistake, we have now reached a key watershed moment. Put simply, the NHS can no longer deliver the standards enshrined in its constitution; standards that were drawn up to reflect safe, decent, levels of patient care. |
| Last year, for the first time, all the main targets for A&E, ambulances, planned operations and cancer treatment were missed. The government committed last March to recovering the four-hour A&E target by the end of 2018. This will not now happen. While we recognise the rationale for cancelling elective operations to prioritise emergency care, this will knock performance against this target further off course. Across the piece, we are losing all the hard-won gains the NHS made in the 2000s. | Last year, for the first time, all the main targets for A&E, ambulances, planned operations and cancer treatment were missed. The government committed last March to recovering the four-hour A&E target by the end of 2018. This will not now happen. While we recognise the rationale for cancelling elective operations to prioritise emergency care, this will knock performance against this target further off course. Across the piece, we are losing all the hard-won gains the NHS made in the 2000s. |
| We must therefore now urgently review the long-term funding settlement for health and care so that we can either sustainably deliver the constitutional standards (which is what NHS trusts want to do), or change them. There has been a lot of speculation about how such a review might be carried out, including calls for a royal commission and some form of cross-party review. | We must therefore now urgently review the long-term funding settlement for health and care so that we can either sustainably deliver the constitutional standards (which is what NHS trusts want to do), or change them. There has been a lot of speculation about how such a review might be carried out, including calls for a royal commission and some form of cross-party review. |
| But we do not have the luxury of time. We need urgent decisions – and only our elected government can take them. Increasing funding for health and social care in our taxpayer-funded system has a major impact on overall public expenditure, the tax system and other public services, which all go to the heart of the mission of any elected government. | But we do not have the luxury of time. We need urgent decisions – and only our elected government can take them. Increasing funding for health and social care in our taxpayer-funded system has a major impact on overall public expenditure, the tax system and other public services, which all go to the heart of the mission of any elected government. |
| We are all for building a consensus around what needs to be done. But the last time we saw a structural increase in health funding, with the rise in national insurance under a Tony Blair and Gordon Brown government, that did not require a royal commission. It was a clear political decision, supported by a review commissioned and overseen by government-commissioned, run from the Treasury. | We are all for building a consensus around what needs to be done. But the last time we saw a structural increase in health funding, with the rise in national insurance under a Tony Blair and Gordon Brown government, that did not require a royal commission. It was a clear political decision, supported by a review commissioned and overseen by government-commissioned, run from the Treasury. |
| There is plenty of high-quality work for this government to now draw on, notably from the Office for Budget Responsibility on future health and care spending, the Barker commission on how to pool health and care funding, and several all-party parliamentary committees that have looked at what is needed to create a sustainable NHS. This is not just about funding, but is also about ensuring we have the right workforce and deliver care in the best way to meet future needs. | There is plenty of high-quality work for this government to now draw on, notably from the Office for Budget Responsibility on future health and care spending, the Barker commission on how to pool health and care funding, and several all-party parliamentary committees that have looked at what is needed to create a sustainable NHS. This is not just about funding, but is also about ensuring we have the right workforce and deliver care in the best way to meet future needs. |
| This work should underpin a clear government-led process so that the key decisions can be announced in this November’s budget. Failure to act now will lead to the targets moving further beyond reach. This would harm the quality of care, causing delays and distress for patients and weakening staff morale. It could also undermine public faith in the NHS. There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the government’s court. | This work should underpin a clear government-led process so that the key decisions can be announced in this November’s budget. Failure to act now will lead to the targets moving further beyond reach. This would harm the quality of care, causing delays and distress for patients and weakening staff morale. It could also undermine public faith in the NHS. There is so much at stake. We can fix this, but there must be no more delay. The ball is now firmly in the government’s court. |
| • Chris Hopson is chief executive of NHS Providers | • Chris Hopson is chief executive of NHS Providers |