Last week the media announced the leaked plan for the NHS to hand over the vast majority of operations to private firms in an attempt to beat the winter crisis this year.

The leak also revealed that Trusts have been instructed to do as much as they can to discharge patients in an attempt to free up bed space to help cope with the expected influx of patients this winter. This is part of NHS England’s plan to bring down bed occupancy levels to 85%. The Telegraph reports “in the three months to the end of September, 89.1% of acute and general beds were full, compared with 87% last year”. With bed occupancy already at stretched levels, this will only get worse as winter starts to take hold.

More worryingly, it seems Trusts have been banned from declaring “black alerts”. This is the highest level used when a hospital is unable to cope with demand. Keeping quiet instead of declaring a major incident won’t help the situation and patients will suffer while Trusts struggle to cope.

It is alarming to think that in order to meet these targets many patients may be discharged too early, when they are not well enough. This creates a vicious cycle with people needing readmission, probably in a worse condition than if they had been able to recover in hospital with access to the care they need. Careful consideration needs to be given as to when to discharge a patient balanced against the policy aims of trying to free up beds.

Why do hospitals continue to struggle in winter?

Demands on the NHS are stretched to their limit, and this will only increase in the winter months.

Every year you see repeated stories of Trusts declaring major incidents over winter, many shutting their doors as they struggle to cope. Ever decreasing resources make this more and more difficult to achieve.

We live in a society with an increasingly ageing population, and with significant cuts to care in these communities, it is inevitable that hospitals will bear the brunt of the pressure to deliver care where cuts have been made elsewhere.

Winter brings cold conditions and bad weather, meaning that people are more likely to become ill or be involved in accidents. The increasing incidence of flu and other winter illnesses over the winter months is something which is always going to be predictable and yet it always seemingly comes as a surprise to the health industry.

The Guardian recently reported Dr Mark Holland, President for the Society of Acute Medicine, predicting parts of the NHS to “implode’” this winter. He predicted a worrying but likely inevitable outcome; “Over the coming weeks and months, if we see a major increase in admissions due to flu or bed closures due to norovirus, we will collapse”.

A recent report by the Commons Health Committee has estimated that Accident and Emergency Departments would need around 3,000 more doctors to be able to cope with the pressures on the NHS that will be inevitable this winter, and without them there could be a major emergency.

Nigel Edwards, chief executive of Nuffield Trust was recently quoted warning “The NHS is going into its toughest winter yet with the odds stacked against it. Demand for healthcare is on the rise, funding for both health and social care is being squeezed and A&E departments are missing their targets.”

NHS Campaign: Stay Well This Winter

NHS England is trying to combat demand with its campaign ‘Stay Well This Winter’. The campaign aims to encourage those at higher risk of being unwell during the winter months to prepare for the colder months ahead.

NHS England reports 25,000 more people die in the winter months than at any other time of the year. NHS England research has shown for every one degree centigrade drop below five degrees in outdoor average temperatures, there is more than a 10% increase in older people seeing their GP for breathing problems, a 0.8% increase in emergency hospital admissions and a 3.4% increase in deaths.

The campaign aims to provide practical tips and advice in an attempt to reduce the number of winter illnesses and to also help relieve pressures on the NHS.

This is however yet again tackling the problem from the wrong front. More people will need to access A&E services, and so those services need to be expanded to meet demand. A campaign is good on the face of it, but investment is the only solution.

Patient Care Issues

Stretched resources and staff working beyond their limits for longer hours, combined with increased delays in waiting times in A&E, may result in patients receiving less than acceptable standards of care. This can result in increased chances of missing a vital diagnosis, premature discharge and mistakes being made, which is tragically something we all too often see.

What is important is that patient safety remains paramount and that should the NHS succumb to increased winter pressures on the system, patient welfare should be the forefront of any response.

We should not enter every winter with serious concern at the numbers of patients who may suffer due to inability to access emergency care. Until the NHS invests in a winter emergency care fund, these fears will continue.