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12 Aug 2022

What the NHS needs from the winter plan

What the NHS needs from the winter plan
There are things that can and should be done right now to make sure we protect patients and staff as much as possible ahead of winter.

With NHS England’s winter plan due in a few days, Dr Layla McCay outlines the steps that must be taken to minimise patient harm and overcome current challenges, all while taking the present ‘political paralysis’ into account.

Winter is closer than the current heatwave would have us believe, and many are predicting it will be one of the most traumatic winters the NHS has ever seen.

The good news is that we are expecting a winter plan soon. And that follows the health and social care secretary’s comments earlier this week in which he called for urgent winter planning to start now amidst the political paralysis we are seeing during the leadership contest.

It is in the power of NHS England to promptly set sensible priorities and confirm what work can be deprioritised or delayed over winter, all of which will help NHS leaders make smart plans

All of this will be welcome news to NHS leaders given that winter plans and extra funding often come too late in the year for local services to use them best.

It is in the power of NHS England to promptly set sensible priorities and confirm what work can be deprioritised or delayed over winter, all of which will help NHS leaders make smart plans

The stakes couldn’t be higher given the already stretched state of the health service, combined with the expected return of flu, norovirus and further COVID-19 variants. All of this on top of huge staffing gaps and a cost of living crisis.

We know what’s coming, but what can we do about it?

Many of the obvious solutions that would help the NHS and social care sector transform and deliver need to play out in the long term. Things like capital investment, a fully funded workforce plan, and social care reform. But that’s for the future. There are things that can and should be done right now to make sure we protect patients and staff as much as possible ahead of winter.

People and funding

First, within the limits of what is available, by acting fast we can get the NHS prompt access to more of what it needs to get through the winter: people and money.

We are losing skilled staff unnecessarily and this has to stop if we are to have any chance of eating into the backlog. 

On people, we wrote to the Chancellor last week to recommend ministers must amend the calculations on pension growth so that senior doctors feel more able to do as much as they might want to tackle the urgent task of the growing elective backlog. We are losing skilled staff unnecessarily and this has to stop if we are to have any chance of eating into the backlog.

NHS England must also make the agency cap flexible enough that it avoids the unintended consequence of unsafely staffed wards. They can also amend the ARRS rules (Additional Roles Reimbursement Scheme ), at least temporarily, to help primary care see more people by expanding the number and types of roles to which primary care leaders can recruit under the scheme.

On money, any new funding available must be allocated immediately. Too often in the past, extra funding for winter is provided so late in the year that NHS leaders can’t use the money well.

For instance, leaders might elect to use some of those funds to boost staffing, but as we know, it can take several months to recruit. As part of this, NHS England should deliver its financial guidance for 2023-2025 now, as it said it would do in the 2021 planning guidance, so that services can plan ahead of the winter and recruit the staff they need.

System working

Second, as well as acting fast, we can build on what we do well. More can be done right now to empower all parts of the health and care system to work together effectively this winter. As part of this, we need clear priorities to be set, which includes confirming the work that can be deprioritised or delayed over winter. This will help NHS leaders make smart plans.

The winter plan must also set out a clear direction for how the NHS should work with social care, local authorities and the voluntary sector, making sure older and vulnerable people get the right care outside of the NHS to keep them well and avoid unnecessary hospital admissions.

A plan for how ambulances and community services can work better together this winter is also key. This must incorporate lessons from successes like Mid and South Essex integrated care system, where their urgent community response team provides a single integrated service that responds to people experiencing an acute medical crisis in their own home. Or South Warwickshire Foundation Trust, which has developed a virtual ward that resulted in 48 per cent of conveyances for over 80s being avoided.

Prepare communities

Finally, the government and NHS England can help put the population in a stronger position going into winter. They can reduce the impact of COVID-19 and flu surges on the NHS by making sure as many people as possible are vaccinated, and in good time. This means excellent and timely planning; support and communication for these vaccination programmes; and learning from last year, when this happened too late for maximum benefit.

The government and NHS England must also take on board lessons from COVID-19 and make sure they plan and provide clear public communications this winter, so the public know what to honestly expect. This includes the range of professionals they may encounter beyond doctors and nurses, ensuring they know how to access physical and mental health care when they need it, and are empowered to protect their own health. This may include support to mitigate the health impacts of the cost-of-living crisis.

We know this is going to be a hugely challenging winter on the back of three traumatic years dealing with COVID-19. Steve Barclay has rightly called for urgent action to be taken now to put the NHS in the best possible position to deal with what’s coming down the track. Working with NHS England, he needs to be true to his word and follow through immediately with the support the NHS needs, or risk putting patients and staff at avoidable risk.

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