Four primary causes of NHS winter crisis identified

An expert reference group has proposed ‘doable and fully achievable’ actions to address NHS winter pressures   

Six major organisations, representing patients, NHS staff and providers, have issued a joint statement calling for urgent and emergency care reform to address the ongoing winter crisis.

They have identified four primary causes of the problem or "diagnoses" and proposed solutions to address these challenges.

The Patients Association, Royal College of Emergency Medicine, Royal College of General Practitioners, College of Paramedics, National Association of Primary Care, and Association of Ambulance Chief Executives have joined forces as an expert reference group to work collaboratively with the government and NHS in England to find solutions.

Their statement highlights the ongoing struggles faced by the NHS during winter months, impacting patients, staff, and the overall quality of care.

They stated that poor standards of care are “normalised and accepted” as an inevitable part of the expected annual winter crisis, leaving clinicians “exhausted and demoralised” while working tirelessly to care for patients despite the overwhelming pressures.

The organisations argue that preparing for winter pressures require not only short-term measures but also mid- and long-term actions.

They stress the importance of early planning, stating that “if we are going to be properly prepared for next winter, the planning needs to begin now.”

According to them, four key factors contributing to the crisis are:

1. Insufficient capacity in primary care to meet the growing patient demand.
2. Lack of proactive care for patients who are frequent users of urgent and emergency care to stop them from getting so unwell.
3. A fragmented and disjointed NHS urgent and emergency system makes it hard to navigate patients to get the right care.
4. Severe overcrowding in emergency departments (EDs) due to lack of flow into and out of hospital beds.

To increase primary care capacity, propose uplifting funding, improving triage systems to free up GP time, and introducing a national alert system for unsafe workloads.

Additionally, they recommend implementing integrated neighbourhood working by aligning community services to primary care networks and using paramedics for home visits and face-to-face services to support primary care.

To improve care for frequent users of urgent and emergency services, the group suggests providing annual body check-ups for older people, delivering NHS services directly in residential and nursing homes, and creating accessible care plans for patients on palliative care pathways.

They also advocate for identifying high-frequency emergency care users and creating personalised care plans to reduce ED visits, along with increasing support for patients in deprived communities.

The group proposes creating a single, 24/7 service in each ED catchment area that combines urgent community response teams, virtual ward teams, and ED teams into a multi-disciplinary team focused on caring for patients at home.

They also highlight the need to improve hospital flow by addressing bottlenecks caused by delayed discharges, which are primarily due to insufficient bed capacity and a lack of social care funding.

The organisations believe that these actions are all “doable and fully achievable” within the next few years with collaborative efforts, with a step change improvement next winter.