1/25 @NHSProviders today highlighting current & future pressure NHS now facing. And, therefore, vital importance of getting NHS budget for second half of year right. Key Government decision on this due in next few weeks as NHS only got budget for first half of year due to covid.
2/25 Press release here: nhsproviders.org/news-blogs/new…. Letter to PM/Chancellor/Health Secretary and @NHSEngland here: nhsproviders.org/media/691810/2…. News coverage here:independent.co.uk/news/health/nh… and here: news.sky.com/story/nhs-as-s…
3/25 Trust leaders are telling us that, although the shape is different, the current pressures are, in aggregate, as great as they were in January. That was rightly described as the most difficult period for the NHS in a generation. Five main reasons for these new pressures.
4/25 Reason 1. Trusts going full pelt to recover care backlogs that have built up across community, mental health and hospital services as a result of covid-19. Reason 2. Very high, often record, levels of demand for urgent care in emergency departments and ambulance services…
5/25 …EG 9 of 10 ambulance trusts declared highest, level 4, incidents this month due to pressure. One acute trust told us last week A&E attendances were 21% above pre-covid norm and emergency admissions 48% above. Many seen highest days of ED demand ever this month.
6/25 Reason 3. Rising covid-19 cases. 1,100 confirmed covid-19 patients in English hospitals on 16 June. 2,200 on 8 July. 5,055 yesterday. Many fewer than peak of 34,000 in January but still a problem for many trusts given the combined scale of the other pressures.
7/25 But it’s not just the demand side of the equation that's a concern. Striking how many trust leaders last week were just as worried about workforce and capacity issues. Reason 4. c15,000 of the NHS’s usual 100,000 hospital beds out action for infection control purposes.
8/25 Reason 5. Large levels of staff absence at the moment are also a big issue. Three causes. A. Numbers of staff currently self isolating. Though last week’s carefully calibrated announcement allowing staff to return safely if real risk of patient harm will help.
9/25 B. Worrying increase in number of staff off sick with stress/other mental health conditions. One trust told us last week half of its current staff absences fit into this category. C. NHS now hitting peak summer leave period with lots of extra time off held over…
10/25 …from earlier waves of covid-19 when many staff barely took a day off. Last two issues strongly related. Trust leaders absolutely adamant staff must now take delayed leave to protect their health and avoid burnout. All together, a very worrying combination of pressures.
11/25 What’s also worrying trust chief executives is that these pressures will continue and are likely to grow. i. Number of covid-19 patients in hospital likely to continue increasing for some time yet given lag in admissions and the impact of the relaxation of restrictions.
12/25 ii. NHS then has to deliver complex next phase vaccination campaign in Autumn. Jabs for vulnerable children; 1st/2nd doses for younger adults and those not yet vaccinated; booster shots & much bigger flu vaccination programme than usual. Lot more stretching than phase one.
13/25 iii. And then the NHS will face what the Chief Medical and Scientific Officers are already predicting will be one of the most difficult winters in NHS history. With, most likely, more covid-19, much more flu and much more RSV (bbc.co.uk/news/health-57…) than last year.
14/25 NHS leaders must juggle these competing priorities and provide the best possible care to the greatest number of people. But they need maximum support from Government. And they’re worried that, as NHS budget is set for second half of the year, that support won’t arrive.
15/25 The Government is stressing the need to restore public finances. But the NHS can’t meet the pressures it faces without the right funding. Our @NHSProviders letter today sets out the seven funding asks of Government from trust leaders for the second half of the year.
16/25 Ask 1. Extend discharge funding that’s been so successful over last 18 months in enabling medically fit patients to go home / to community settings close to home. Avoiding tens of thousands of discharge delays we used to see. And providing the vital capacity needed...
17/25 … to cope with further waves of covid-19 and flu/emergency pressures likely this winter. Whilst still allowing trusts to maintain full pace of backlog recovery. NHS often struggles to keep going at full pace with elective surgery in winter. Certainty needed by mid August.
18/25 Ask 2. Replenish funding to treat elective surgery backlogs. Trusts recovering activity so fast they’ve already used up most of £1 billion allocated for this task this year. Would seem extraordinary to have to slow down recovery, including urgent cases, for lack of money.
19/25 Ask 3. Emergency round of precious capital funding, similar to £450m NHS received last year. This will enable trusts to speed up backlog recovery and expand their emergency departments, crisis mental health services and community and ambulance capacity in time for winter.
20/25 Ask 4. Full funding of the Government’s recently announced 3% pay award for NHS staff, with full year impact accounted for. So that trusts don’t have to cut patient care to give hardworking frontline staff the pay rise, and recognition, they very obviously deserve.
21/25 Ask 5. Help trusts speed up backlog recovery by funding use of independent sector capacity, as happened in earlier phases of covid-19. Strike a centrally negotiated and funded, but locally controlled, deal for this capacity now. We all know the NHS will need it!
22/25 Ask 6. Recognise trusts aren't ready, at this point, to resume delivery of near record level of efficiency savings made before covid-19, given other pressures they face. Also recognise that too ambitious an ask will force trusts to slow down "at risk" spend on recovery.
23/25 Ask 7. Please do not repeat the distraction and uncertainty from the beginning of the year when trusts were only informed of their budgets 13 days before the year started. Commit now to a clear date when trusts will be told their budgets for the second half of the year.
24/25 Emerging Whitehall mood music suggests some voices are arguing that second half of this financial year is the time to rein NHS spending back in as covid-19 rates drop and we “get back to normal”. For them this would set a clear context for a tough spending review for NHS.
25/25 Trust leaders recognise need for appropriate financial discipline. But they’re very clear that, given scale of pressures they face over next 8 months, vital they’re properly funded to meet them. Failure to do so could have very serious consequences for patient care.
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