Winter was ‘watershed moment’ for NHS, report claims

Mapping the NHS winter said that a range of indicators showed an overwhelming lack of capacity across the country. With an ambulance arriving once every 15 minutes on average, 24 hours-a-day at all 137 trusts with major A&E departments, delays in handing over patients to hospitals were widespread. Two-thirds of trusts saw handover delays of more than an hour each week.

Winter attendances grew by 5% compared to last year, meaning the NHS saw an additional 261,000 people and there were an additional 85,000 emergency admissions to hospital. More temporary beds were needed this year – reaching a peak of 4,700 in the first week of January, while the severe flu outbreak and norovirus closed 813 beds on average each week across the whole system.

Demand for services was also substantial across community, mental health, primary care and social care services.

Despite the increases in demand, the NHS still managed to treat, admit or discharge more patients than before within four hours. A&E performance is currently the worst it has been since data collection began in 2010. However the NHS saw an additional 160,000 people within four hours compared to last winter, the report said.

Providers’ representative body said the experiences of frontline trusts should help shape the national review of winter, which is being carried out by NHS England and NHS Improvement. It also called for a new planning framework based on realistic demand projections, and a review of capacity right across the health and care system in good time for next winter.

‘The unprecedented demand for care last winter exposed the vulnerability of health and care services which – despite heroic efforts – lacked the resources to ensure the standards of care that patients have a right to expect, and that trusts and their staff want to provide,’ said NHS Providers head of analysis Phillippa Hentsch. ‘We must learn from last winter’s experiences to ensure services are safe and resilient next time.’

The latest performance figures from NHS England show that there has been a 2% growth in A&E attendances in the last 12 months (including April) and a 4.1% growth in emergency admissions. In April, 88.5% of patients were seen within four hours, compared with 84.6% in March 2018 and 90.5% in April 2017. The 95% standard was last met in July 2015. For type 1 A&E departments, the 4-hour figure was 82.3% - an improvement on the previous month but lower than the 85.7% for the same month last year.

Waiting lists for elective care at the end of March have increased by 5% compared to a year ago, with 87.2% of those waiting doing so for 18 weeks or less – a fall from 90.3% the year before.

In March 2018, patients spent a total of 154,600 extra days in hospital beds waiting to be discharged, compared to 199,600 in March 2017. This equates to an average of 4,987 beds occupied each day in March 2018 by a patient subject to a delayed transfer of care, compared to 6,440 12 months earlier.

Richard Murray, director of policy at The King’s Fund, said the figures represented ‘another dismal month for patients’. ‘The waiting list has hit 4.1 million people, with more than 2,700 patients waiting more than a year,’ he said. ‘The government must look at how the targets are working, and make sure that they do more to protect patients who are facing very long waits for care.