NHS uses sickness data as early warning to cope with winter surges

A sickness surveillance system will help the NHS plan for surges in demand this winter by tracking outbreaks of norovirus, which causes vomiting and diarrhoea, and other illness around the country.

Data gathered by Public Health England will be used by NHS England operational monitoring teams to study winter trends and to help give early warning about rising outbreaks of flu, respiratory syncytial virus (RSV) and norovirus as well as other acute seasonal illnesses.

The findings will allow the NHS to anticipate rises in hospital admissions and produce a planned response by, for example, rescheduling planned surgery in advance to avoid inconveniencing patients as well as free up beds and converting ‘swing’ wards from elective to emergency care for patients with conditions such as respiratory problems.

Outpatient appointments can be switched to ‘hot clinics’ that avoid A&E referrals by providing direct access to GPs and staff can be moved from planned activity to support general medicine, care of the elderly, those with breathing problems or stomach bugs.

Planning also allows hospitals to isolate infectious patients rather than unintentionally spreading them around multiple wards, something that is particularly important with the norovirus which causes outbreaks of diarrhoea and ward closures.

These data were first gathered in 2012 to try and predict illnesses that could have impacted the Olympic Games.

Public Health England have gradually increased scope and content and now carry out a comprehensive daily data collection across GP practices,  111, out of hours GPs and A&Es.

This year, that information is being fed back into the system through regional winter operations teams to help manage pressures and anticipate surges. In winter, there are approximately three visits to A&E departments for one emergency hospital admission.

Professor Keith Willett, NHS England’s Medical Director for Acute Care, said: “The impact major outbreaks of these illnesses can have on our hospitals cannot be underestimated – leading to whole wards having to be closed, with the loss of beds just when we need them most.

“We can look at the trends across all of the PHE health data sources and try to anticipate surges in demand.

“The breadth and variety of surveillance data from PHE gives us vital time to put escalation plans in place, to free up beds and reconfigure wards. We can plan how to best provide care to a higher number of patients with a specific illness, and to corral patients who are suffering the same illnesses. It also means we can better predict when things will return to normal and plan accordingly.”

The data will be used alongside other information such as weather forecasts to anticipate demand for the week or so ahead. For every one degree drop in average temperature below 5C, there is a 10.5% rise in elderly people going to the GP with breathing problems.

The NHS is therefore advising the public to take sensible precautions to ensure they minimise the after effects of extreme cold weather. The elderly are advised to keep warm, both indoors and out. They should heat their homes to at least 18C, and there is still time to get their flu jabs to avoid unnecessary hospital stays.

Professor Paul Cosford, Medical Director at Public Health England, said: “It is widely known that every year we see an increase in illness during the winter, and this means we need to do all we can to support the NHS during this time of increased pressure. Our world-leading surveillance systems can track serious upsurges as and when they’re beginning to emerge and support central coordination of NHS resource.

“Even at relatively moderate temperatures there is nearly a 4% increase in deaths and nearly a 1% increase in emergency admissions for every one degree drop in temperature. A combination of Met Office weather alerts and the PHE surveillance data, which includes syndromic data, offers the NHS vital tools for approaching seasonal demand for health care.”

The health service has prepared more intensively and comprehensively for winter than ever before. Record levels of flu vaccinations and more joined-up care will enable us to keep frail older people out of hospital.

The national winter operations team will report directly to Pauline Philip, NHS England’s National Urgent and Emergency Care Director.

She will be able to call on a new National Emergency Pressure Panel (NEPP) to advise her on pressure and clinical risk. Chaired by NHS England National Medical Director Sir Bruce Keogh, members include NHS Improvement’s Executive Medical Director Kathy McLean, and Chief Nursing for England Professor Jane Cummings as well as Professors Willett and Cosford along with experts from the CQC and the Royal Colleges.