Extended winter plan targets falls, respiratory infections and capacity

Alongside the control centres and falls services, new respiratory infection hubs will be developed in local areas, giving patients same day access to out-of-hospital care, while also creating additional capacity for hospitals and ambulance services.

In a letter to NHS systems, providers and GP practices, NHS chief executive Amanda Pritchard (pictured) said the measures would line up alongside vaccines and previously announced plans as part of the service’s defence this winter. ‘Every one of these initiatives will make a real impact on the ground – helping to relieve pressure on frontline staff as well as seeing patients quickly and directing them to where they can receive the best possible care,’ she said.                                                                                             

Saffron Cordery, interim chief executive of NHS Providers, said the measures would help ease some of the pressure on urgent and emergency care services at a time when the entire system is under strain. The control rooms should support collaboration and respiratory hubs could help manage any surges arising from a potential ‘twindemic’ of flu and Covid.

But she warned that the NHS remained in a precarious position. ‘Without major action to tackle workforce shortages, staff exhaustion and burnout, and the inability to free up capacity by discharging medically fit patients in a safe and timely way, the NHS could still be thrown off course this winter,’ she said.

Emergency admissions for falls in people over 65 have increased year on year from 185,000 in 2020/11 to 234,000 in 2019/20. The new falls response services would deal with the less serious level one and two falls that can be dealt with in the community. These services already exist in many areas, but there is variation in coverage.

Under the new proposals, all integrated care boards (ICBs) will be required to have full geographical coverage between the hours of 08:00 and 20:00, seven days a week – removing the need for a double crewed ambulance response for level one and two falls.

In particular, ICBs have been asked to work with care homes on community-based response options – 25% of falls in care homes result in serious injuries and up to 40% of admissions from care homes are falls related. ICBs will be expected to ensure care homes have easy access to local services through a single point of access and to identify providers with higher ambulance call-out rates.

The new data-driven control rooms should provide visibility of operational pressures and risks across providers and systems. The approach has already been successfully tested during the pandemic, where operational control centres helped to maximise capacity across whole systems.

According to guidance, the new centres should: improve situational awareness; enable holistic and real-time management of capacity and performance; support coordinated action and mutual aid; and improve clinical outcomes by optimising admissions, assessments, treatments and discharge pathways.

Acute respiratory infections are one of the most common reasons for emergency attendance and admission. There are concerns that the presence of both Covid-19 and flu this winter could lead to high numbers of beds being occupied by respiratory patients.

The hub model supports patients with urgent clinical needs by giving them same-day access to secondary care ‘hot clinics’ and testing. It aims to reduce ambulance callouts, A&E attendances and hospital admissions for patients that can be managed in the community. It should also help to reduce nosocomial transmission.

NHS Confederation chief executive Matthew Taylor (pictured) said the winter could be the toughest on record for the NHS. ‘[This] is exactly why services are working together early on to make sure patients get the care they need, where they need it most,’ he said. ‘With falls leading to thousands of ambulance callouts and admissions to A&E, it is vital that the NHS uses its limited resources to best effect as this will provide value for money to taxpayers and improve patient experience.’

The steps to boost capacity and resilience build on actions already announced in the summer including an increase in bed capacity, supported by an expansion of virtual wards, and funding to support timely discharge out of hospitals.