NHS England » Winter and H2 priorities (2024)

Classification: Official
Publication reference:PRN01454

To:

• integrated care board:
  • chairs
  • ­chief executive officers
  • ­chief operating officers
  • ­medical directors
  • ­chief nurses/directors of nursing
  • ­chief people officers
  • ­chief financial officers
  • integrated care partnership chairs
• all NHS trust and foundation trust:
  • chairs
  • chief executive officers
  • chief operating officers
  • medical directors
  • chief nurses/directors of nursing
  • chief people officers
  • chief financial officers
• regional directors

cc.

• Local authority:
  • chief executive officers

Dear colleagues

Winter and H2 priorities

Further to the meeting with ICB and provider chief executives on 3 September, we are now confirming operating assumptions for the remainder of this financial year.

This letter outlines the steps NHS England is going to take, as well as those ICBs and providers are asked to take, to support the delivery of safe, dignified and high-quality care for patients this winter.

Planning and financial framework

You are all aware of the tight financial environment both across the NHS and for the government more widely; it remains essential in H2 that systems continue their work to return to their agreed 2024/25 plans.

Providing safe care over winter

As set out in our letter of 16 May, we are in the second year of the delivery plan for recovering urgent and emergency care (UECRP).

Colleagues across the country have worked incredibly hard to implement the priority interventions identified in the UECRP. This has delivered improvements in performance on the 4-hour emergency department (ED) and Category 2 ambulance response time ambitions, against an extremely challenging backdrop.

The delivery priorities for this winter remain unchanged from those agreed in system plans.

We all recognise, however, that despite these improvements, far too many patients will face longer waits at certain points in the pathway than are acceptable.

Given demand is running above expected levels across the urgent and emergency (UEC) pathway, ahead of winter we collectively need to ensure all systems are re-confirming that the demand and capacity plans are appropriate and, importantly, are taking all possible steps to maintain and improve patient safety and experience as an overriding priority.

Supporting people to stay well

As a vital part of preventing illness and improving system resilience, it will be important to maximise the winter vaccination campaign.

As well as eligible population groups, it is imperative that employers make every possible effort to maximise uptake in patient-facing staff – for their own health and wellbeing, for the resilience of services, and crucially for the safety of the patients they are caring for.

More detail on eligible flu cohorts is on gov.uk:

• National flu immunisation programme 2024 to 2025
• COVID-19 autumn/winter eligible groups

We confirmed campaign timings for both vaccines in our system letter on 15 August.

This year for the first time, the NHS is offering the respiratory syncytial virus (RSV) vaccine to those aged 75 to 79 and pregnant women. This is a year-round offer but its promotion ahead of winter by health professionals is vital, particularly to those at highest risk.

To support vaccination efforts, NHS England will:

• ensure all relevant organisations receive information as quickly as possible for flu, COVID-19 and RSV
• maintain the National Booking Service, online and through the NHS 119 service for COVID and flu (in community pharmacy settings)
• continue to share communication materials to support local campaigns

ICBs are asked to work with:

• local partners to promote population uptake with a focus on underserved communities and pregnant women
• primary care providers to ensure good levels of access to vaccinations, ensuring that plans reflect the needs of all age groups, including services for children and young people and those who are immunocompromised
• primary care and other providers, including social care, to maximise uptake in eligible health and care staff

NHS trusts are asked to:

• ensure their eligible staff groups have easy access to relevant vaccinations from Thursday 3 October, and are actively encouraged to take them up, particularly by local clinical leaders
• record vaccination events in a timely and accurate way, as in previous campaigns
• monitor staff uptake rates and take action accordingly to improve access and confidence
• ensure staff likely to have contact with eligible members of the public are promoting vaccination uptake routinely

Maintaining patient safety and experience

We recognise this winter is likely to see UEC services come under significant strain, and many patients will face longer waits at certain points in the pathway than acceptable.

It is vital in this context to ensure basic standards are in place in all care settings and patients are treated with kindness, dignity and respect.

This means focusing on ensuring patients are cared for in the safest possible place for them, as quickly as possible, which requires a whole-system approach to managing winter demand and a shared understanding of risk across different health and care settings.

Evidence and experience shows the measures set out in the UECRP are the right ones, and systems and providers should continue to make progress on them in line with their local plans, with assurance by regional teams.

In addition, NHS England will continue to support patient safety and quality of care by:

• standing-up the winter operating function from 1 November:
  • providing capabilities 7 days a week, including situational reporting to respond to pressures in live time
  • this will be supported by a senior national clinical on-call rota to support local escalations
• completing a Getting It Right First Time (GIRFT) data-led review of support needs of all acute sites:
  • across all systems, and deploying improvement resources as appropriate, to support implementation of key actions within the UECRP, with a dedicated focus on ensuring patient safety
• convening risk-focused meetings with systems:
  • to bring together all system partners to share and discuss key risks and work together to agree how these can be mitigated
• expanding the Operational Pressures Escalation Levels (OPEL) framework:
  • to mental health, community and 111, and providing a more comprehensive, system-level understanding of pressures

NHS England will continue to support operational excellence by:

• co-ordinating an exercise to re-confirm capacity plans for this winter, which will be regularly monitored
• running an exercise in September to test the preparedness of system co-ordination centres (SCCs) and clinical oversight for winter, including issuing a new specification to support systems to assess and develop the maturity of SCCs

NHS England will continue to support transformation and improvement by:

• continuing the UEC tiering programme to support those systems struggling most to help them to enact their plans
• reviewing updated maturity scores for UEC high-impact interventions with regions and ICBs, to identify further areas for improvement
• as part of NHS IMPACT, launching a clinical and operational productivity improvement programme in September:
  • this will include materials and data for organisations to use, as well as a set of provider-led learning and improvement networks, to implement and embed a focused set of actions

ICBs are asked to:

• ensure the proactive identification and management of people with complex needs and long-term conditions so care is optimised ahead of winter:
  • primary care and community services should be working with these patients to actively avoid hospital admissions
• provide alternatives to hospital attendance and admission:
  • especially for people with complex needs, frail older people, children and young people and patients with mental health issues, who are better served with a community response outside of a hospital setting
  • this should include ensuring all mental health response vehicles available for use are staffed and on the road ahead of winter
• work with community partners, local government colleagues and social care services to ensure patients can be discharged in a timely manner to support UEC flow
• assure at board level that a robust winter plan is in place:
  • the plan should include surge plans, and co-ordinate action across all system partners in real time, both in and out of hours
  • it should also ensure long patient delays and patient safety issues are reported, including to board level, and actions are taken appropriately, including involving senior clinical decision makers
• make arrangements through SCCs to ensure senior clinical leadership is available to support risk mitigation across the system
• review the 10 high-impact interventions for UEC published last year to ensure progress has been made:
  • systems have been asked to repeat the self-assessment exercise undertaken last year, review the output, consider any further actions required, and report these back through regions

NHS trusts are asked to:

• review general and acute core and escalation bed capacity plans:
  • with board assurance on delivery by the peak winter period
• review and test full capacity plans:
  • this should be in advance of winter
  • in line with our letter of 24 June 2024, this should include ensuring care outside of a normal cubical or ward environment is not normalised; it is only used in periods of elevated pressure; it is always escalated to an appropriate member of the executive and at system level; and it is used for the minimum amount of time possible
• ensure the fundamental standards of care are in place in all settings at all times:
  • particularly in periods of full capacity when patients might be in the wrong place for their care
  • if caring for patients in temporary escalation spaces, do so in accordance with the principles for providing safe and good quality care in temporary escalation spaces
• ensure appropriate senior clinical decision-makers are able to make decisions in live time to manage flow:
  • including taking risk-based decisions to ensure ED crowding is minimised and ambulances are released in a timely way
• ensure plans are in place to maximise patient flow throughout the hospital, 7 days per week:
  • with appropriate front door streaming, senior decision-making, regular board and ward rounds throughout the day, and timely discharge, regardless of the pathway through which a patient is leaving hospital or a community bedded facility

Next steps

In addition to existing guidance in the UECRP Year 2 letter and elsewhere, we have recently published further evidence-based guidance in the following areas to support further optimisation of winter plans:

• Same day emergency care service specification
• Single point of access hubs
• Virtual wards operational framework

As set out above, system risk discussions will follow during September.

We want to thank you and everyone across the NHS for your continued hard work this year.

Sarah-Jane Marsh,National Director for Urgent and Emergency Care and Deputy Chief Operating Officer
Dr Emily Lawson DBE, Chief Operating Officer
Professor Sir Stephen Powis, National Medical Director
Duncan Burton, Chief Nursing Officer for England