Winter in the NHS: A Bleak Outlook

It seems that every winter we are told that the NHS is now at breaking point and we discover that long delays in Accident and Emergency Departments are just the norm. We are informed that this year’s winter crisis is more severe than previous years, resulting in ever more unnecessary suffering of ill patients and overwhelming stress of stalwart staff. The politicians roll out the platitudes and promises or try to shift the blame elsewhere but every year, with monotonous regularity it happens yet again. So, in the winter season of 2019/2020, how is the NHS shaping up? Can we expect a repeat performance from previous years?

Yes, it looks like we are in for a re-run of winter stress

Sadly, health service leaders in NHS England are predicting that this winter will be, ‘the worst on record’.[1] The reason for this? Even before winter began, waiting time targets were missed, including those in time sensitive specialisms such as accident and emergency, surgery and cancer treatment.

The latest figures from NHS England show that during November 2019:

• The number of people attending Accident and Emergency Departments and being admitted to a hospital bed as an emergency, soared to record highs.
• Only 71% of people attending an Accident and Emergency Unit in November were managed within four hours. This figure is a record low.
• Despite doctors urging that up to 85% occupancy of hospitals is safe, hospitals were averaging at a level of 95%.
• There are 4.45 million people waiting for non-urgent surgery.

Interestingly, these worrying figures should have been published earlier, but officials postponed the release until after the general election.

The NHS is sick

Richard Murray, chief executive of the Kings Fund think-tank said, ‘These sobering figures show the urgent need for the new Conservative Government to make good on its promises to focus on our ailing health and care services’.[2]

Already more than half of NHS hospitals have opened extra beds to cope with admission pressures. Furthermore, nearly half of these ‘escalation beds’ which are supposed to be used only during the winter season, have remained open from the previous winter, a clear indication that the so-called winter crisis has become a year-round issue. The chair of the British Thoracic Society, Professor Jon Bennet said, ‘As the winter season starts, life is already really tough at the coal-face of the NHS. It is a sign of the intense year-round pressure […] that more than half of hospitals have already opened extra ‘winter beds’ […] and that many haven’t closed them from last year’.[3]

NHS Medical Director raises warning

Clearly the NHS is in bad shape even before we get into the full swing of winter. Professor Stephen Powis is the Medical Director for the NHS. He predicts that the NHS is in for, ‘a very tough few months’.[4] To back up his prediction, he cited a rise in healthcare demand, especially for those over 65 years old, as well as workforce pressures rising from the ongoing pension crisis which restricts the working hours of many experienced clinicians. Furthermore, there is a large gap in staffing, with currently more than 100,000 vacancies throughout the NHS, putting additional pressure on staff that are already overworked: this figure includes 40,000 nurses and 10,000 doctors in NHS England alone. In addition, the NHS has had little respite during the summer months and politicians have provided no extra money for the upcoming winter season.

The consequences of an NHS on its knees: Black Alerts

Already NHS Trusts have been forced to cancel planned operations, divert ambulances from their Accident and Emergency Departments and oblige patients to suffer long waits on trollies.[5] Black Alerts are called when the bed capacity has been reached and anyone arriving at Accident and Emergency who requires admission, will be transported to another hospital. The NHS classifies calling a Black Alert as a serious incident, which means that the system is under severe pressure and therefore unable to provide comprehensive emergency care.[6]

Before Christmas, the Queen Alexandra Hospital in Portsmouth declared a Black Alert after the number of attending ambulances rose by 46%, while in the Lewisham and Greenwich Trust in London, a Black Alert was raised after 605 patients attended its Accident and Emergency Department in one day. Hospitals in Nottingham, Middlesex and Stoke Mandeville also reported significant rises in the number of people attending for emergency treatment.

Advice for the winter season

Considering the present difficulties, many NHS Trusts have issued advice to their patients on how to manage their healthcare problems over the winter period. Royal Bolton Hospital in Manchester has warned that patients should only attend in a genuine emergency and that anyone unsure where to get appropriate treatment should ring NHS 111. Along a similar vein, Yorkshire Ambulance Service ran its #ChristmasWish campaign, urging people to dial 999 only in a serious or life threatening emergency and the Leeds Teaching Hospitals NHS Trust has issued clear guidelines on the best place to get appropriate treatment: options include self-care and attending a pharmacy for advice.[7]

Best outlook?

Since 2013, NHS winter crises have escalated. By addressing the current staffing and bed shortages, and with a renewed focus on protecting the NHS, the new Government could make this 2019/2020 the last ever winter crisis.

[1] https://www.theguardian.com/society/2019/dec/13/nhs-england-on-its-knees-as-performance-figures-hit-new-lows

[2] https://www.dailymail.co.uk/news/article-7791361/NHS-braces-worst-winter-figures-abysmal-E-delays.html

[3] https://www.theguardian.com/society/2019/dec/02/nhs-winter-crisis-extra-beds-created-by-52-per-cent-of-uk-hospitals

[4] https://www.dailymail.co.uk/news/article-7791361/NHS-braces-worst-winter-figures-abysmal-E-delays.html

[5] https://www.independent.co.uk/news/health/nhs-hospitals-boris-johnson-winter-crisis-emergency-beds-a9242961.html

[6] https://www.itv.com/news/west/update/2016-01-05/what-does-black-alert-mean/

[7] https://www.leeds-live.co.uk/news/leeds-news/how-you-can-ease-enormous-17408307