Useful documents, links and information

Winter grab guides

NHS England and NHS Improvement have developed in partnership with the Queen’s Nursing Institute (QNI) five key digital grab guides in recognition of the pressures and challenges that can continue to build in the system during the winter months. The guides include a checklist to help health and social care colleagues to take prompt practical actions and use every opportunity to prevent delayed transfers of care. Through using these guides, health and social care staff can address the evidence that staying in hospital for longer than required drives adverse outcomes for patients:


Operational Pressures Escalation Levels (OPEL) Framework and Action Cards


Onward Care




Mental health


Care homes


National winter letters

Seasonal flu letters


National dashboards




Escalation triggers based on Trust ED Performance

Acute Trusts will continue to report daily to NHS Improvement. The following have been identified as key measures that will trigger intervention from the Programme Management Office (PMO):

  • An A&E 4 hour performance of less than 95%, but there will be a particular focus on trusts whose performance is below 85% for the previous day.
  • Deterioration of A&E performance of more than 10% compared with the same day 6 week average,
  • Ambulance delays where more than five have been delayed for more than 60 minutes.
  • One or more 12 hour breach in A&E.
  • An increase in beds closed due to D&V by 20 beds from one day to the next.
  • In addition, any major patient safety incidents worthy of discussion at a national level will be highlighted.
Where performance has triggered one indicator PMO to discuss with STP lead
Where performance has triggered two indicators Regional Director to contact STP lead
Where performance has triggered three or more indicators Regional Director to contact Trust CEO


RBH Celebrating Patient Flow Workshop


Reducing long hospital stays – The #longstaywednesday approach


Winter planning