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5 January 2018updated 07 Aug 2021 9:18pm

Why has this winter hit the NHS so hard?

Some trust leaders say the pressures on urgent and emergency care are the worst they have ever seen.

It’s not as if we didn’t see it coming. Winter always hits the health service hard. Yet now, just a few days into the new year, some trust leaders are saying the pressures on urgent and emergency care are the worst they have ever seen. This is despite planning more meticulous and extensive than ever before. 

A time-lag in the official figures means it will take a while for the full picture to emerge, but trust leaders we have spoken to and social media posts show the service is struggling to keep up with demand. 

This message to us from a trust in the north of England was typical: “Really busy – seriously ill patients – flu starting to kick in – 111 overwhelmed – staff working so hard to do their best – norovirus doesn’t help.” 

Many others speak of staff “pulling out all the stops”. A hospital trust chief executive tweeted: “I’m 34 years in and never seen anything like this. Relentless and staff have been brilliant.”

So why is the pressure this year so great? In part, it is down to demographic changes and advances in treatment, which result in more patients requiring complex care. But feedback from the frontline suggests there is more respiratory illness than expected, and rising levels of flu. There are fewer beds available than last year. Some are unavailable because of norovirus. Cuts to social care have made matters worse. In some places, the pressures on primary care – with GPs working at more than full stretch – spill over into A&E. 

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Ambulance services are also bearing the brunt. One reported the “busiest ever Christmas”. Others have emphasised the priority given to life-threatening emergencies.

Trust leaders tell us they are doing everything they can to cope – organising extra beds, calling in staff to work extra shifts and delaying non-urgent work. Needs must. Trusts will always seek to ensure patient safety. And that is why the recommendations from the NHS National Emergency Pressures Panel – including the cancelling of non-urgent operations and a relaxation of the rules on mixed-sex wards – are realistic and sensible. 

These measures give trusts the best chance to provide the quality of care we would all want to see. It was also right to highlight the guidance for people seeking advice for non-emergencies, so staff in A&E can focus on the sickest patients, needing most help.

However for others, this will mean delays, uncertainty and frustration. We should not underestimate the impact on patients who will see their procedure or appointment rearranged. On top of that there will be a price to pay for trusts in delaying more routine work, such as knee and hip operations, in terms of lost income and an even greater challenge to meet waiting time targets. Clearly once the dust has settled, we need to make sure the impact of these measures is widely understood and taken account of. But despite this it is the right thing to do to safeguard patient safety

And, in amongst all this, we mustn‘t lose sight of the amazing work that is going on day-in day-out in such difficult circumstances. These include extraordinary acts of kindness and compassion. Staff on one of the wards at Northampton General Hospital NHS Trust decided to bring Christmas a day forward for a woman dying of cancer, providing a tree, decorations and presents. Then there was the paramedic from West Midlands Ambulance Service who camped out close to work in sub-zero temperatures to ensure he would be available for the morning shift. 

We need to ask ourselves why it has come to this: despite the NHS preparing better than ever before for winter, and the heroic response from many of its staff, it still faces such difficulties sustaining the performance people have a right to expect. We know the answers. We will always face these struggles until we fix the more fundamental problem of how we resource the NHS. How bad must it get before we take the fundamental steps needed to equip our health and care services for winter pressures in years to come?

Saffron Cordery is the director of policy and deputy chief executive of NHS Providers, the trade association for NHS hospital, mental health, community and ambulance services.

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