NHS prepares for hard winter

3 Sep 98
NHS managers face another tough winter after Frank Dobson, the health secretary, insisted the service must manage the rising tide of emergency admissions and continue to cut waiting lists.

04 September 1998

Last winter the government told the health service to concentrate on coping with emergency admissions. But this was achieved at the expense of longer waiting lists. Now health ministers have pledged to cut waiting lists to 1.6 million by next April. The lists have been rising since March last year, and ministers are keen not to lose this momentum over the winter months.

In a letter sent to health authorities, trusts and councils this week, Mr Dobson recognised he was setting a 'tough agenda', particularly when the bodies were grappling with the year 2000 problem and gearing up for structural changes. But he insisted health and social services should repeat their efforts of last winter when they worked together to free beds for emergency cases.

Mr Dobson also called on both services to work together to provide better support in the community. This would help avoid unnecessary hospital admissions. He said casualty departments must not be closed to emergency admissions and insisted that financial control must be maintained.

Despite the success with emergencies last winter, it was revealed this week that the NHS was lucky to have coped. The report of the government-appointed Emergency Services Action Team (ESAT) found that emergency admissions grew by 3.3% over the winter. Non-emergency admissions rose by 1.7%. Though the growth in urgent cases was the lowest for five years, the team pointed out that the weather was mild and 'flu levels remained low. A severe winter or a 'flu epidemic would cause problems.

The NHS and council social services departments shared £300m to help them cope with the winter pressures – undoubtedly the picture would be worse if this money had not been forthcoming. Though the government is poised to plough an extra £21bn into the NHS over the next three years, none of it will be available before next April.

Allocations for the next three years will be announced in the autumn and the NHS could borrow against that funding to meet the health secretary's twin demands. But that would compromise the NHS Executive's plans to get the service's finances back into balance by April 1999.

In a survey of 11 parts of England, ESAT found that hospitals were operating on 95% bed occupancy – the British Medical Association recommends that it should be 80% to allow for unexpected rises in admissions.

Suzanne Tyler, deputy director of the Institute of Health Services Management, said a repeat of the success of last winter could not be guaranteed. 'Managing emergencies last year was significantly easier than previous years because of the mild winter. Thankfully, there were no major epidemics. No-one can predict what this winter has in store,' she said. Ms Tyler added that it was important the government's plans for tackling the winter pressures were workable.

Mr Dobson has asked ESAT to continue its work for a further year. It will provide targeted, additional help next winter and will support contingency planning for the health service over the millennium holiday.


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