It’s no secret that winter is traditionally the busiest time for health and care services. The last few winters have laid bare the pressures that the NHS is facing from the increase in demand for services, more patients with multiple, complex and long-term conditions, a funding squeeze and very high and worrying staff vacancy rates. Winter pressures now act as the barometer for the media, politicians and the public of a system under pressure.
So, you could be forgiven for thinking that the summer may provide some respite for NHS staff. But this year, while many of us are enjoying the record-breaking temperatures, we are seeing a very different, but sadly familiar, picture emerging within some NHS trusts.
As the mercury soared to over 35C last week, one hospital chief executive told us that the last three weeks have seen demand pressures “equal to or above” the worst days during the winter. The NHS is seeing a surge in demand that is resulting in more people seeking treatment at A&E. Similarly to winter, this is coupled with staffing pressures and estates and maintenance issues that mean that trusts are not in as strong a position as they would like to cope the effects of a prolonged period of hot weather.
If, as is predicted, Britain will see hotter summers, is it time to rethink our approach to preparing for summer? And ensure that we are taking the steps we need to so that trusts are as resilient as they can be?
Surge in demand
As temperatures rise, NHS trusts have seen a dramatic surge in demand for A&E services, emergency admissions and ambulance services. In some places, we are seeing a return of winter conditions but it’s a different type of demand with different care needs.
The majority of this increase over the last few weeks comes from the very old or the very young. A number of trusts have reported a worrying increase in the number of admissions from care homes. The elderly and young children are particularly susceptible, with respiratory and other long-term conditions made worse by the heat. They are also at an increased risk of suffering from dehydration and heatstroke.
In hospitals the increase in demand for A&E services is pulling resources away from other areas. This extra activity is leading to delays for patients requiring planned operations such as knee and hip replacements. On top of this, we also see the effects of frail older people entering hospital and staying longer than they need to while an appropriate care package is sought for them at home or in a community setting.
As always, the pressures are not just felt at A&E departments. Services are constantly running hot right across the acute, mental health, ambulance and community services sectors, with mental health beds for children and young adults falling below the levels needed. This is a symptom of the demand pressure for beds all-year round.
Pressure on staff
Staff working across the NHS are feeling the effects, as are trusts who are trying to ensure that they have the right staffing levels to meet this increased need and provide high-quality care at the same time. The most recent workforce statistics from NHS Digital show that the number of vacant positions for doctors, nurses, midwives and therapists are running at the highest level since records began three years ago.
Although trusts have fewer staff sickness absences to contend with over the summer, they need to be able to accommodate gaps in rotas from annual leave requests. This has left a number of trusts reporting that they are finding it difficult to arrange cover doctors and nurses which could result in additional spend on agency staff.
The working environment for staff is another important factor here. Trusts are and will continue to ensure that hospitals are comfortable and safe environments for patients and staff, but encouraging staff who are already working under tremendous pressure, coupled with the heat, to take on overtime or additional bank shifts is proving to be a difficult task.
Investing in the NHS estate
The extreme heat has also highlighted the shortcomings of ageing buildings which are not designed or equipped to deal with these conditions. We know that in recent years, funding to maintain and develop NHS buildings and equipment has been used to prop up day to day NHS spending. This approach only stores up problems for the future.
Many trusts have older buildings that are simply not built for longer spells of high temperatures, making them uncomfortable for patients and staff. Some trusts have told us that to cope with these temperatures they have had to rent air conditioning units for wards – which comes with its own financial implications. More and more services, including theatres and emergency departments, are based in small buildings which do not have the space to accommodate moments of very high demand.
We need to tackle the growing and severe maintenance backlog. Many of these issues, if addressed, could have helped trusts to better prepare for summer and become more resilient against increasing demand – which is now an all-year problem and not confined to either winter or summer. We must ensure that this is a key priority for the upcoming NHS ten year plan to ensure that services are sustainable for the future.
It is often only when things are running out of the ordinary that we see the problems in plain sight. Spikes in demand are now an all-year event. The NHS must be able to improve its resilience and its capacity to handle rapid increases in demand. If, as the Environmental Audit Committee argues in its report, by 2040 British summers will regularly exceed 38.5C, we must address the issue of future-proofing the service now, particularly as we have an ageing population.
And of course – we can all do our bit to help. Everyone can stay well hydrated, avoid the sun in the hottest part of the day, and, critically, look out for those who are most vulnerable, particularly the frail elderly and the very young.
Saffron Cordery is the deputy chief executive of NHS Providers, which represents all acute, mental health, ambulance and community NHS trusts.