“Look after yourself this winter. If you know someone who is frail or elderly or has a serious health problem, then help look after them too. Help or encourage them to go to their pharmacy or GP before one problem leads to another and they end up in hospital.”
Senior clinicians at NHS England today (Friday) urge the public to seek early advice if they feel unwell over winter, particularly those who are very young, the elderly and frail or have existing health problems.
They are publishing analysis that shows many of the pressures faced by the NHS over the winter occur because of a seasonal rise in the number of patients attending A&E departments who need to be admitted to hospital.
They say a key way of addressing this winter’s pressures on hospital A&E departments is to encourage the prevention and early treatment of illnesses, particularly breathing problems.
Later today NHS England will publish the first of its weekly updates on how the NHS is handling winter, giving the public better information than has previously been available.
And earlier this week Professor Sir Bruce Keogh, NHS England’s National Medical Director, addressed the longer-term issues such as the relentless rise in demand, publishing a blueprint for how the NHS should organise urgent and emergency services in future.
Perhaps surprisingly the number of people arriving normally sees a seasonal dip over the winter months; in fact A&Es see fewer patients in January and February than in the summer. Despite this, there are still more breaches of NHS operational standard, which says patients should be treated within four hours. In the winter months we see a much higher proportion of frail and elderly patients who require much more assessment in A&E and in the absence of alternatives often need a hospital bed. – this accounts for our congested A&E Department.
The NHS England analysis of available data suggests that the average (median) time in A&E for patients not admitted to hospital is 1 hour 49 minutes, with less than five per cent of patients spending 4 hours or longer in A&E.
For patients needing an inpatient hospital bed, the median time in A&E is 3 hours 37 minutes averaged across the whole year. In the winter months, it is these patients that account for most of those who exceed the 4 hour standard.
The analysis also shows that older people make up the largest proportion of those who need a hospital stay. For those over age 75 years there is a greater than 80 per cent chance of needing admission from A&E, whereas for the under 30, it is less than 20 per cent.
While patients admitted to hospital are generally older, they are also increasingly frailer and have more complex care needs.
Analysis of the types of illnesses that prompt admission to hospital over the winter months shows that respiratory disorders peak to twice the summer level.
Professor Keith Willett, National Clinical Director for Acute Care for NHS England, said:
“Our A&Es are a safety net. They are trusted by the public. They reflect what is going on in our communities and the pressures that build in other parts of the health and social care system.
“The pinch point in winter is the increase in the number of emergency admissions – patients predominantly with respiratory conditions or transient worsening of other chronic conditions usually brought on by the cold weather, reduced activity and viruses.
“Thanks to the hard work and dedication of staff, average waits in A&E are low. However problems arise when a patient needs admitting to hospital.
“Most of those who need a stay in hospital are our elders and the vulnerable who have increased care needs as much as medical need. Once in A&E they need a bed from the outset and until they are discharged from hospital and, if the support to return them to their home is limited, delays occur and new patients cannot be received.
“Demand in winter can best be managed by better self-care, surveillance by family and carers to ensure prompt recognition of illness and early access to medication, as well as by good access to the General Practice team.
“We need quicker facilitated discharge into community services and social care either from A&E, rapid assessment and treatment units, or from in-patient beds. This needs access seven days a week to senior clinical input, routine diagnostics and pharmacy.
“If we are serious about tackling winter pressures in A&E then these are the areas on which we have to concentrate attention.”
Professor Mike Morgan, National Clinical Director for Respiratory for NHS England said:
“Each winter we see a spike in the number of emergency admissions for patients that are triggered by respiratory problems. In the elderly, minor respiratory illness, such as the common cold, can prompt care needs associated with frailty.
“For those with existing chronic respiratory conditions, such as asthma or COPD, cold weather and viral infections that are common over the winter months can lead to deterioration and patients may need more care and support than usual.
“My message to the public is simple: look after yourself this winter. If you know someone who is frail or elderly or has an existing health problem and they are feeling unwell, encourage them to seek early advice, go to their local pharmacy or GP before one problem leads to another and they end up in hospital. People with existing lung conditions should follow their self-management plans and seek help if uncertain”
- Winter pressures report: Understanding Winter Pressures in A&E Departments