Organisation objective
- NHS Mandate from Government
Executive summary
This paper outlines the approach to the development and operationalisation of the 2023/24 winter plan for the NHS in England.
The 2023/24 winter plan is comprised of the following core elements:
- High-impact priority interventions drawn from the UEC recovery plan that all systems will be asked to deliver and provide assurance against.
- Clear roles and responsibilities for each part of the system so that both shared and individual organisational accountability is clear.
- Returns from systems on system-level resilience and surge planning, to avoid systems becoming overwhelmed at times of peak demand.
Action required
This NHS England Board is asked to acknowledge the NHS winter plan for 23/24, and associated letter published today, earlier than in previous years.
Background
1. This year, NHS England published the Urgent and Emergency Care Recovery Plan, underpinned by an extensive programme of work to deliver improvements across urgent and emergency care ahead of winter. This plan, along with the NHS’s primary care and elective recovery plans, and the broader strategic and operational plans and priorities for the NHS, provides a firm basis for preparing for the 2023/24 winter period.
2. Despite recent improvements and ongoing transformation work, the UEC pathway remains fragile. While systems and providers are undertaking significant programmes of work to recover and improve services, there is a collective responsibility to ensure that the NHS in England has plans in place to remain as resilient as possible and respond to operational pressures this winter. The earlier plans can be agreed and stood-up as soon as they are needed, the better this will be for patients.
3. The winter plan builds on the extensive engagement and co-development undertaken as part of the NHS’s UEC Recovery Plan, including with the NHSE Board, but also with clinical and operational experts, and partners in government, social care, and the public.
4. Building on the annual operational planning round, winter planning in 2023/24 will consist of the following products:
- High-impact priority interventions drawn from the UEC recovery plan that we know lead to a safe and effective service to patients. All systems will be asked to deliver these.
- Clear roles and responsibilities for each part of the system so that both shared and individual organisational accountability is clear.
- Returns from systems on system-level resilience and surge planning, to avoid systems becoming overwhelmed at times of peak demand and a narrative return against key lines of enquiry.
5. All the interventions over winter should contribute towards the two key ambitions for UEC performance of:
- 76% of patients being admitted, transferred, or discharged within four hours by March 2024, with further improvement in 2024/25.
- Ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24.
6. This of course depends on the wider health and care system, as set out in the UEC Recovery Plan, including planned increases in social care capacity and improvements in access, and levels of flu and covid being no higher than last Winter.
High-impact priority interventions
7. The high-priority interventions for this winter will be aligned to the UEC recovery plan. These are the evidence-based and clinically supported actions that have already been highlighted as part of the universal improvement offer for systems and the focus for individual providers will be individually tailored to providers following a round of self-assessment due to conclude in August. The list of these interventions can be found at Annex A.
System roles and responsibilities
8. We recognise that there are steps that systems can and should take to deliver a resilient winter service. We will outline these in specific descriptions of roles and responsibilities for each part of the system. This includes actions set out in the Primary Care Access Recovery Plan.
9. Delivery over winter will require all parts of the NHS system to work collectively to deliver the system operational plan, and the high-impact interventions outlined in the UEC recovery plan.
10. In addition to this, it is vital that Trusts fulfil their occupational responsibility to get their staff vaccinated for flu and covid to preventing ill health, reducing staff absence rates and create a resilient workforce.
11. It will also be important that the National and Regional NHS England Teams have oversight of pressures across the system. This will be supported by an Operational Pressures Escalation Levels (OPEL) Framework and strengthened System Control Centres. The UEC Tiering system will also continue to operate over winter to provide support to the most challenged organisations, providing expert operational and clinical support.
System-level resilience and surge planning
12. In line with previous years, we will be asking each system, led by ICBs, to develop a system-level winter plan, which outlines the steps that the system will take to deliver on respective actions, retain resilience, and manage a surge in demand above anticipated winter pressures.
Annex A – High-Priority Interventions
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Action:
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1. |
Same Day Emergency Care: reducing variation in SDEC provision by operating a variety of SDEC services for at least 12 hours per day, 7 days per week. |
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Frailty: reducing variation in acute frailty service provision. Improving recognition of cases that could benefit from specific frailty services and ensuring referrals to avoid admission. |
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Inpatient flow and length of stay (acute): reducing variation in inpatient care and length of stay for key pathways/conditions/cohorts by implementing in-hospital efficiencies and bringing forward discharge processes for pathway 0 patients. |
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Community bed productivity and flow: reducing variation in inpatient care and length of stay, including mental health, by implementing in-hospital efficiencies and bringing forward discharge processes. |
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Care Transfer Hubs: implementing a standard operating procedure and minimum standards for care transfer hubs to reduce variation and maximise access to community rehabilitation and prevent re-admission to a hospital bed. |
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Intermediate care demand and capacity: supporting the operationalisation of ongoing demand and capacity planning, including through improved use of data to improve access to and quality of intermediate care including community rehab. |
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Virtual wards: standardising and improving care across all virtual ward services to improve the level of care to prevent admission to hospital, and improve discharge. |
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Urgent Community Response: increasing volume and consistency of referrals to improve patient care, ease pressure on ambulance services, and avoid admission. |
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Single point of access: driving standardisation of urgent integrated care coordination which will facilitate whole system management of patients into the right care setting, with the right clinician or team, at the right time. |
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Acute Respiratory Infection Hubs: support consistent roll out of services, prioritising acute respiratory infection, to provide same day urgent assessment with the benefit of releasing capacity in ED and general practice to support system pressures. |
Publication reference: Public Board paper (BM/23/24(Pu)