Last week, NHS England set out guidelines to help Trusts in their winter planning. The NHS is bracing for another difficult winter, expecting high flu and COVID-19 admissions following reports of higher than usual cases in Australia, and following a particularly difficult winter in 2022. The health service is already struggling with pressures from increased demand and high vacancy levels – with a record 7.5 million people waiting for care, and record vacancies across all staff groups. The impact of the COVID-19 pandemic, the cumulative impact of the past 12 months of industrial action, and the record vacancies in the service have contributed to significant delays in patient care.
NHS Winter Planning 2023/24
Last winter saw the service struggle with a 94.5% bed occupation rate, and 31.3% of ambulance handovers were delayed by 60 minutes or more. The service was underprepared and ill-equipped to deal with the increased service demand often seen in the colder months. As a result, NHS England have proposed a range of measures to improve capacity as we move into the autumn and winter months. It is hoped that the early publishing of the plan will give the service enough time to mobilise and adapt according to the plan, ensuring the organisations are ready for the increased demand.
Winter planning for 2023/24 prioritises improving patient flow, by improving access to same-day emergency care, establishing acute respiratory infection hubs, and the expansion of virtual wards. The key objective in all of these initiatives is to bolster NHS capacity, ensuring patients are seen in a timely manner and to reduce, or at least not increase, the current elective backlog.
Improving Patient Flow
Key to increasing capacity is improving patient flow. The expansion of virtual wards will allow clinicians to discharge patients who do not have a clinical need to be in a hospital bed, while still monitoring them. Over 13,000 beds were occupied by patients awaiting discharge in December 2022, reducing the amount of beds available to patients with a clinical need to be in hospital. Improving patient flow will free up significant capacity across all departments. Virtual wards will play a key role in this, allowing clinicians to discharge patients from hospital wards while continuing monitoring.
Delays, often caused by lack of available beds, significantly impact patient outcomes. Longer hospital stays increase the risk of hospital acquired infections, reduced mobility and cognitive function for patients – and ultimately result in a loss of independence for patients.
Expanding Capacity
The expansion of Acute Respiratory Infection Hubs (ARI Hubs) will support the NHS in the consistent roll out of services, help prioritise acute respiratory infection care and improve capacity in Emergency Departments as well as on wards. These Hubs will allow patients to receive care in the community, without having to turn to hospitals, freeing up capacity in hospital settings and improving access to care for patients.
An ARI Hub set up in Leicester in December 2022 was able to treat 99% of patients, and only had to refer 1% of patients to the Emergency Department. Patients were able to avoid stressful hospital visits, long A&E wait times and exposure to other infections, while receiving appropriate care in community settings. National figures show that up to 40% of patients who attend A&E with respiratory symptoms are discharged after a few hours and, in most cases, it would have been more appropriate for them seek community care rather than in hospital. By providing same-day, face-to-face care for respiratory patients, ARI Hubs improve patient experience while reducing demand on Emergency Care Departments.
Improving Patient Experience
In addition to the expansion of virtual wards and ARI Hubs, the plan sets out to reduce variation in Same Day Emergency Care (SDEC). Patients will have greater access to same-day, specialist care without the need for hospital admissions or overnight stays. Expanding SDEC provision will reduce the number of patients needing to attend hospital, free up capacity and ensure patients are seen as and when they need to be, outside of the hospital setting. Again, keeping patients out of hospital entirely or reducing the time they need to spend there will reduce the risk of hospital acquired infection.
The 2023/24 Winter Planning measures also include ‘care traffic control centres’ to manage patient discharges, increasing the number of available beds in hospitals and surge planning. The measures due to be introduced all aim to increase efficiencies across the system, both at national and organisational levels – as well as increase capacity and patient flow.
It is clear that amidst the measures announced, staffing will be key. Expanding services, such as establishing acute respiratory infection hubs, will require qualified and experienced staff to manage them. Increasing the use of virtual beds, while freeing up physical capacity in hospitals, will require increased clinical capacity – experienced doctors and nurses will be required to manage an ultimately increased patient load. Rolling out new technologies and processes will also require additional clinical and operational staff – and with the news of a 30% reduction in ICB budgets, it seems some reduction in the workforce is inevitable. Worries over ‘spreading staff too thin’ in pursuit of widening access to care have already been raised, as well as concerns over ‘confusing’ patients with too many options.
The winter planning proposals can clearly only work with sufficient staffing levels – though plans to ensure adequate staffing levels in the short term are nowhere to be seen. While the Long Term Workforce Plan, published earlier this year, details the government’s long-term plans for NHS staffing, a short to medium term fix is still needed.
With doctor changeover having taken place for 2023, now is the time for organisations to assess and fill vacancies ahead of the increased pressures over the winter months. At Remedium, we have seen the value of recruiting on a permanent basis, ensuring consistent delivery of care for patients as well as reducing agency locum costs for organisations.
If you are interested in hearing how Remedium can support your recruitment and workforce planning, get in touch with us today here.
