Department of Health and Social Care
Oral statement on new discharge funding and NHS winter pressures - 9th January 2023
The Secretary of State for Health and Social Care Steve Barclay updated on what the government is doing to help the NHS deal with immediate winter pressures.
Mr Speaker, I wish to take this first opportunity to update the House on the severe pressures faced by the NHS since the House last met.
I and the government regret the experience for some patients and staff in emergency care has not been acceptable in recent weeks.
I’m sure the whole House will join me in thanking staff in the NHS and social care who have worked tirelessly throughout this intense period, including those clinicians in this House who worked on wards this Christmas, including my Honorary Friend the Minister for Mental Health and the Shadow Minister for Mental Health.
Pressures this winter
Mr Speaker, there’s no question it has been an extraordinarily difficult time for everyone in health and care.
Flu has made this winter particularly tough – first, because we’re facing the worst flu season for 10 years. The number of people in hospital with flu this time last year was 50 – this year, it was over 5,100.
Next, because it came early and came quickly, increasing seven-fold between November and December. It also came when GPs and primary and community care were at their most constrained.
And just as flu affects the population, it affects the workforce too, leading to absences that constrain supply as they increase demand.
This pressure from flu comes on top of Covid, with over 9,000 people in hospitals with Covid, while Strep A has created further pressure on A&E.
And all of this comes on top of a high, historic starting point. We didn’t have a quiet summer, with significant levels of Covid, and delayed discharges were more than double what they were during the pandemic.
To put this in context for the House: in June 2020 there were just 6,000 cases of delayed discharge per day – those patients ready to leave hospital who are medically fit to do so – whereas throughout last year, it was between 12,000 and 13,000 per day.
So Mr Speaker, the scale, the speed, the timing of our flu season has combined with a high level of Covid admissions in hospital, and the pandemic legacy of high delayed discharge, to put real strain on frontline services.
What we did to prepare
Mr Speaker, since the NHS began preparing for this winter, there was a recognition that this year had the potential to be the hardest ever.
That is why there was a specific focus on vaccination; there were 19 million flu shots and 17 million autumn Covid boosters, we extended eligibility more widely than in the past to cover the over-50s, and became the first place in the world to have the bivalent Covid vaccine, which tackles both the original Covid strain and the Omicron strain.
NHS England also put in place plans for the equivalent of 7,000 additional beds, including the introduction of virtual wards of the sort one can see at Watford General Hospital.
That innovation is still at an early stage of development but has the potential to be significant in reducing pressure in bed occupancy in hospitals. In Watford alone, it has saved the equivalent of a hospital ward of patients.
In addition, Our Plan for Patients put £500 million specifically into delayed discharge this year, with a further £600 million next year, and £1 billion the year after that.
While the funds are already starting to make a difference, efforts have taken time to ramp up operationally with local authorities and the local NHS.
In addition, our 42 Integrated Care Boards, recognising how bed occupancy in hospitals and social care is connected, will fully integrate health and care in the year to come, but likewise are at an early stage of maturity, with ICBS only becoming fully operationalised in July 2022 – less than six months ago.
More to do
Mr Speaker, our plans involving:
- additional funding into discharge,
- increased step-down capacity,
- the equivalent of 7000 additional hospital beds,
- and the vaccination programme at scale
have provided groundwork for the government’s response.
But it is clear we need to do more right now in light of the level of Covid and flu rates given hospital occupancy remains far too high and emergency departments too congested.
Recognising this, we launched the Elective Recovery Taskforce on 7 December, and in the coming weeks, we will publish our Urgent and Emergency Care Recovery Plans.
NHS England and DHSC have been working intensively over Christmas on these plans, which were reviewed with health and care leaders at an NHS Recovery Forum in Downing Street on Saturday.
The recovery falls into three main areas of work:
- First, steps to support the system now – given the immediate pressures we face this winter.
- Second, steps to support a whole-system response this year to gain better resilience during the summer and autumn, because as we saw with the heatwave this summer, the levels of Covid pressure is now sustained throughout the year – not just as in the past in autumn and winter.
- Third, our work alongside those two areas on prevention to maximise the step-change potential of proven technology such as virtual wards, and the wider adoption of innovations such as operational control centres and machine reading software to treat more conditions in the community away from reaching the emergency department in the first place.
Supporting the system now
Mr Speaker, let me address the first of these with the measures I can announce today to provide support to the NHS and local authorities now.
Easing hospital pressure
First, we will block-book beds in residential homes to enable between 2,500 to be released from hospitals when they are medically fit to be discharged.
When combined with the ramping up of the £500 million Discharge Funding, which will unblock a further 1,000 to 2,000 delayed discharge cases, capacity on wards will be freed up, which in turn enables those patients admitted by emergency departments to move to wards, which in turn unblocks ambulance delays.
It is important that we learn from the deployment of a similar approach during the pandemic by ensuring the right wrap-around care is provided for those patients released to residential care, which I’ve asked NHS England to particularly focus on, so that it is the shortest-possible stay on their journey home and into domiciliary care, and it is in the NHS’s interest for those stays to be as short as possible.
Taken together, this is a £200 million investment over the next three months.
Next, our A&Es are also under particular strain.
From my visits across the country, I’ve seen and heard how they often need more space to enable same-day emergency care, and short stays post-emergency department.
So our second investment today is in more physical capacity in and around emergency departments. By using modular units, this capacity will be available in weeks, not months.
And our £50 million investment will focus on modular support this year, and we will apply funding from next year’s allocation to significantly expand this programme ahead of the summer.
We are giving Trusts discretion on how best to use these units to decompress their emergency departments.
That might be spaces for short-stay post-A&E care where there’s no need for the patient to go to a ward for further observation, or for discharge lounges where previously they’ve not been able to take patients still in a bed – many of those are often simply chairs – and also additional capacity alongside the emergency department at the front end of a hospital.
Mr Speaker, the third action we are taking to support the system right now is to free up frontline staff from being diverted by CQC inspections over the coming weeks, and the CQC have agreed to reduce inspections and focus on high-risk providers in other settings like mental health.
Better resilience this year
Mr Speaker, those are the actions we’re taking that will have an immediate effect.
Turning now to the measure which we are taking now that will give greater resilience into this summer and next winter.
NHS System Control Centres
We now have 42 NHS System Control Centres in operations across England staffed 24 hours a day, 7 days a week, tracking patients on their journey through hospitals and helping us identify blockages earlier and getting flow through the system.
Where we have implemented these systems, such as the one I saw in operation in Maidstone, they have had a clear impact, so we’re going to allocate funding in next year’s settlement to apply this more widely.
AI & Data
Similar to this, we have also seen how the use of artificial intelligence and data can demonstrably reduce demand and release patients sooner.
NHS England has been tasked with clarifying and simplifying this procurement landscape, taking on board best international practice so that a small number of scalable interventions are taken forward where international experience shows they can deliver meaningful benefits to patients.
Next Mr Speaker, we will capitalise on the incredible potential of virtual wards.
Last week at Watford General Hospital, I saw how patients who would have been in hospital beds were treated at home through a combination of technology and wrap-around care.
Where patients released sooner were often much happier knowing they’re receiving clinical supervision, and always have the safety net of being able to quickly return to hospital should their condition deteriorate.
There is scope to expand this to many more conditions, and many more hospitals in the months ahead.
Next Mr Speaker, we are opening up more routes for NHS patients to get free treatment in the independent sector, and offering ever greater patient choice.
The Elective Recovery Taskforce is helping us find spare operating theatres, hospital beds and outpatient capacity.
There are also steps we must take in primary care.
We are clear there are many more things our community pharmacists can support with, which will ease pressure on general practice, and from the end of March community pharmacies will take referrals from Urgent and Emergency Care settings, and later this year we will also start offering oral contraceptive services.
But I want us to do even more and indeed as they do in Scotland, and we will work with community pharmacists to tackle barriers to offering more services, including how we better use digital services.
The primary care recovery plan will set out a range of additional services pharmacists can deliver.
Finally Mr Speaker, notwithstanding the very severe pressures, we know that to break the cycle of the NHS repeatedly coming under severe pressure, the best way to reduce the numbers through our front doors is to address problems away from the emergency department itself.
On Friday, we signed a memorandum of understanding with BioNTech – a global leader in mRNA technology – to bring vaccine research to this country.
This will give as many as 10,000 UK patients early access to trials for personalised cancer therapies by 2030.
This builds on the 10-year partnership we struck with Moderna in December to also invest in mRNA R&D in the UK and to build a state-of-the-art vaccine manufacturing here.
We’re also reviewing our wider care for the frail and elderly patients in care homes long before they would ever get to A&E or in our hospitals.
Take for example the brilliant work they’re doing in Tees Valley, where they’re using community teams to help with falls to prevent unnecessary ambulance trips to hospitals.
We have looked at what more support we can offer elderly patients further upstream. With an ageing population, and many more people with more than one condition, it is clear we have to treat patients earlier in the community, and go beyond individual specialities to better reflect patients with multiple conditions, and indeed to give the right support to people where they are, which is often at home or in residential homes.
Mr Speaker, today’s announcement provides a further £250 million of funding, which recognises that the spike in flu on top of Covid admissions, on top of high delayed discharge numbers from the pandemic, will provide immediate support to reduce hospital bed occupancy and decompress A&E pressure and in turn, unlock much-needed ambulance handovers.
This builds on the £500 million announced for discharge specifically at the Autumn Statement, which is ramping up, and the additional funding for next year.
All of this work ultimately builds on the much-needed greater integration of health and social care through the 42 Integrated Care Boards, which we will strengthen through the Hewitt Review and through a step-change in capability, including operational control centres.
This immediate and near-term action sits in parallel with our wider life-science investment like those deals with BioNTech and Moderna, and underscores our commitment to both recognising the immediate pressures on the NHS and investing in the science that will shift the dial on earlier, upstream treatment at scale, particularly for the frail and elderly, and long before a patient reaches an emergency department.
This is, Mr Speaker, a comprehensive package of measures, and I commend this Statement to the House.
Original article link: https://www.gov.uk/government/speeches/oral-statement-on-new-discharge-funding-and-nhs-winter-pressures
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