* Updated 19 January 2023*
This fact sheet sets out action the Department of Health and Social Care and NHS England are taking to improve urgent and emergency care performance including ambulance handover times, A&E waiting times and hospital discharge.
Q: What is your plan to address pressures across urgent and emergency care?
- The pandemic put huge pressure on the NHS. That’s why the government prioritised Health and Social Care in the Autumn Statement, making up to £14.1 billion available for health and social care over the next two years, on top of record funding to reduce waiting times improve urgent and emergency care and returning performance to pre-pandemic levels.
- We are also delivering an integrated COVID-19 booster and flu vaccination programme, minimising hospital admissions from both viruses. This winter, it is vital that eligible people get their booster jab and their flu jab to protect themselves, their loved ones and the NHS.
- The NHS will set out detailed recovery plans for urgent and emergency care, including ambitions to improve Category 2 ambulance response times to 30 minutes and improve A&E waiting times in the new year.
Q. What is driving winter pressures?
- Winter is always a challenging time for the NHS with seasonal respiratory viruses in circulation.
- The pandemic placed huge pressure on the NHS, and many systems including primary care and community services are still recovering. Before the pandemic there were 1,600 people waiting more than 52 weeks for an operation – that number is now over 400,000.
- High levels of Covid and flu cases as well as a surge in Strep A have added to these pressures.
Q. How does this compare to previous years?
- Attendance to hospital is higher than pre-pandemic levels. Attendances in December 2022 were 4.7% higher than December 2019, bringing the total attendances for the month to over 2.28 million.
- Overall bed occupancy is also higher than previous years, General & Acute bed occupancy was 95.7% in the week ending 15 January 2023, compared to 93.2% in the same period last year.
- In the week ending 15 January there were on average 3,226 patients with confirmed seasonal influenza in General and Acute beds across England, compared to just 37 this time last year.
Q: How are you improving access to urgent and emergency care?
- Addressing handover delays is a key priority. NHS England is providing targeted support to some of the hospitals facing the greatest delays in the handover of ambulance patients into the care of hospitals, helping them to identify short and longer-term interventions to improve delays and get ambulances swiftly back out on the road.
- This is alongside work to help other trusts identify the root causes of handover delays and implement best practice.
- NHS England has allocated £150 million of additional funding for ambulance service pressures in 2022/23, and £20 million to upgrade the ambulance fleet, while the number of NHS ambulance staff and support staff has increased by over 40% since September 2010.
- St John Ambulance has also been contracted to deliver auxiliary ambulance services, providing national surge capacity of up to 5,000 hours per month to support the ambulance response during periods of increased pressure, allowing NHS ambulance crews to focus on responding to emergency calls.
- We’re also speeding up hospital discharge, backed by £500 million, to free up hospital beds, improving flow through hospitals and speeding up handovers and get ambulances back on the road faster.
- On 9 January the government announced an additional £50 million capital funding to upgrade and expand hospitals including new ambulance hubs and facilities for patients about to be discharged
- The NHS will create the equivalent of 7,000 beds this winter, and improve discharge from hospital, backed by the £500 million Discharge Fund, alongside improved care for people at home, which will help to ease pressures on emergency departments.
- In 2020-21, £450 million was invested to upgrade A&E facilities in over 120 separate trusts, to boost capacity through expanding waiting areas, increasing the number of treatment cubicles and reducing overcrowding.
Q: How are you getting people out of hospital quicker?
- Following the Autumn Statement, up to £7.5 billion over the next two years will be made available to support adult social care and speed up patient discharge from hospital. This will provide the equivalent of 200,000 additional care packages and the biggest funding increase in social care history. These packages are put together based on patient need and can include basic services such as help with cleaning or shopping, up to home adaptations or a place in a care home.
- The government is making up to £200 million of additional funding available to immediately buy short-term care placements to allow people to be discharged safely from hospitals, along with £50 million in capital funding to upgrade and expand hospitals including new ambulance hubs and facilities for patients about to be discharged.
- This is on top of the allocation of the £500 million Discharge Fund provided to local areas to speed up the discharge of patients from hospital and up to £200 million to buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up hospital beds for those who need them.
- Local areas will determine how spend their allocations which might be through purchasing supportive technology, boosting domiciliary care capacity, or investing in staff recruitment, such as physiotherapists and occupational therapists, to support recovery at home.
- We will be looking closely at the impact of the funding, conducting a comprehensive evaluation and using this data to inform future policy and funding decisions.
- We are also allocating £50 million capital funding to upgrade and expand hospitals including new ambulance hubs and expanding discharge lounges in NHS Trusts – areas where patients can be moved out of acute beds while they wait to be discharged, freeing up beds in the meantime.
Q: What specifically is the NHS doing?
- Ahead of a challenging winter for the NHS and social care services, NHS England announced additional measures to boost capacity, support staff and provide better care for patients at home.
- NHS winter resilience plans include:
- Increasing bed capacity by the equivalent of at least 7,000 general and acute beds, including through a mix of new physical beds and virtual wards.
- Increasing resilience in NHS 111 and 999 services, through increasing the number of call handlers to 4,800 in 111 and 2,500 in 999 services.
- Opening 24/7 “System Control Centres” across the country where teams, including senior clinicians, can use data and local insights to make considered decisions in the face of emerging challenges. For example decisions could be made to divert ambulances to another nearby hospital with more capacity, or identify hospitals that need extra support. Over 40 of these centres are already open across England.
- Expanding falls response services across the country, which will see local teams sent to help people who have fallen in their home or in care homes, preventing unnecessary trips to hospital. Based in local communities, the expansion could see around 55,000 ambulance trips freed up to treat other patients each year, with a quarter of all category three and four ambulance callouts in January last year relating to falls
- The NHS is also investing £10 million to boost mental health support and ease demand on emergency services, with mental health professionals working within ambulance control centres over the coming months, accompanying paramedics on emergency call outs to treat people of all ages who are having a mental health crisis.
Q: What impact will strikes have on urgent and emergency care services?
- Our priority is to keep patients safe. NHS England will work with providers, professional bodies and trade unions to agree the safe level of cover during any industrial action.
- The NHS has tried and tested plans in place to mitigate risks to patient safety and manage disruption, and we are working with them closely.
- People should continue to call 999 as normal if it is an emergency – when someone is seriously ill or injured and their life is at risk – and ambulances will still respond to 999 calls.
- For more information, see the industrial action factsheet.
Q. What is the cause of the rise in excess deaths?
- We knew during the pandemic many of the measures taken would have an impact on excess deaths, including delays to treatment, operations taking longer and cardiovascular conditions. There are also other factors and other countries across Europe are facing similar circumstances such as in France and Germany.
- There are a wide variety of factors contributing to excess deaths. The Health and Social Care Secretary continues to receive regular briefings and it is important not to ascribe all excess deaths to one cause. Some of the increase in excess mortality is due directly to Covid and some indirectly.