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Shortages of beds and staff, plus flu, will mean NHS is 'sorely tested' in coming winter

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Trusts are recruiting extra staff and putting in place additional support for nurses but the health service is likely to be “sorely tested” this winter, say healthcare leaders.

Shortages of key staff including emergency care nurses and consultants, a lack of beds and what is potentially the worst flu strain the NHS has seen 20 years are among factors that mean the coming months will be tough, according to a new report from the body NHS Providers.

“We cannot say with certainty how tough this winter will be, but the likelihood is that services will be sorely tested”

Chris Hopson

The report – titled Ready and Resilient – sets out steps taken locally and nationally to prepare for the onslaught of winter such as work to improve discharge, develop joint resilience plans with social care, and encourage more staff to take up the free flu jab.

However, it warned that the health service may still struggle to cope, as it is already working at or close to full stretch, while extra funding provided in the recent budget has “come very late”.

Key issues outlined in the report include the fact the NHS is already running at 87% bed occupancy, which is above recommended levels and “means there is very little give in the system”.

Staffing shortages are also a concern. While there has been a 2% increase in the total number of full-time equivalent staff since August 2016, there are now fewer nurses than there were at the same point last year, said the report.

The government announced in the 2017 autumn budget on 22 November that the NHS would receive an additional £335m this year to help it through the winter.

“This extra money is welcome but has come very late to be used to maximum effect,” said the report, which suggested the funding could be used in a number of ways, including to buy care home places to get patients out of hospital more quickly.

Trusts may also use the cash to bolster community provision to prevent people needing to come to hospital in the first place and some is likely to be spent on agency staff in the community as well as on escalation wards.

West Midlands Ambulance Service NHS Foundation Trust said it had already brought in extra nurses, paramedics and GPs to its call centres.

“This alarming report shows the amount of strain the NHS is under even before winter pressures have kicked in”

Sara Gorton

Chief executive Anthony Marsh said this would allow more patients to be helped over the phone, reducing the number being taken to hospital, and would also support handovers between ambulance and hospital staff.

Meanwhile, Lancashire Teaching Hospitals NHS Foundation Trust has invested in extra support for frontline nurses.

“We’ve created something called a ward liaison officer role and those are people who work on each of the wards to support the nursing staff,” said trust chief executive Karen Partington.

“It takes away some of the administrative roles, chasing up scans, making sure we’ve got pharmacy in place, and that means the nurses are then free to look after the patients on the wards,” she said.

But the report warned that “this year’s flu strain is potentially the worst we have seen in two decades”, having already placed Australia and New Zealand under severe pressure earlier this year.

As part of the health service’s flu planning, trusts have been offered incentive payments to reach targets for having their staff vaccinated, with a goal of getting at least 75% to have the jab.

“We’ve created a ward liaison officer role who work on each of the wards to support the nursing staff”

Karen Partington

Trusts have also been developing their own flu plans with nurses at the forefront. For example, in Luton and Bedfordshire, a community nursing vaccination service is being introduced.

This will ensure nurses vaccinate all patients on their caseload and encourage carers to have their jab at their local GP practice.

National measures include extra funding for the development of GP streaming services in emergency care to divert patients from over-stretched emergency departments and additional support for trusts at greatest risk of having difficulties this winter.

Local areas have also been told to develop escalation plans to ensure patients are not treated on corridors, and “escalation beds have the necessary staffing and equipment to ensure safe care”.

NHS Providers chief executive Chris Hopson said winter always presented a “big challenge” to the NHS but admitted that last year the pressures were “intolerable”.

“Services were stretched up to, and in some places beyond, breaking point. This time preparations have never been more thorough,” he said.

Chris Hopson

Chris Hopson

Chris Hopson

Even so, Mr Hopson said health providers were “not where we would want to be as we head into winter”. “We cannot say with certainty how tough this winter will be, but the likelihood is that services will be sorely tested,” he said.

“We must hope the considerable efforts to curb the impact of flu are successful,” she said. “What we can say with confidence is that NHS trusts have prepared for the challenge and will do all they can to provide high quality care for every patient, whatever the pressure.”

Unison head of health Sara Gorton said: “This alarming report shows the amount of strain the NHS is under even before winter pressures have kicked in.

“A lack of beds, staff shortages and the funding squeeze are all issues the government should have addressed years ago,” she said. “Even with the extra money announced in the budget, it still falls well short of what the NHS needs.

“It’s incredibly difficult for the NHS to plan for a crisis when it is already running at capacity and staff are stretched all year round,” noted Ms Gorton.

She added: “It is only through adequate funding and long-term planning that the NHS will ever be in a position to anticipate the winter months with confidence.”

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