With winter fast approaching, Kathy Oxtoby looks at how ICBs and the wider health system are preparing for winter and the challenges they are facing
It’s that time of year – when ICBs and the wider system are preparing for healthcare’s busiest season.
Last winter, the NHS faced a ‘quad-demic’ of Covid, flu, RSV and norovirus, while uptake of free flu vaccinations fell for both older eligible people and younger high-risk groups. The NHS faced near-record levels of operational problems across urgent and emergency care and performed ‘far worse’ than before the pandemic, according to a report by The Health Foundation.
But, this winter could be even busier than the last. With flu and other seasonal respiratory illnesses coming to the forefront, alongside threats of resident doctor strikes, and a time of uncertainty when ICBs are undergoing reorganisation, it seems set to be another stretched winter season for the health service.
‘ICBs are going through quite a significant amount of churn, with clustering, merging and redundancies. Having their capacity reduced will also put pressure on the system this winter,’ says Professor Andy Brooks, clinical chair of the National Association of Primary Care (NAPC).
But preparations to manage these winter pressures are already underway.
Following the publication of the Urgent and Emergency Care Plan 2025/26 by NHS England, ICBs received instruction in a winter planning and preparedness memo, including a checklist asking ICBs to confirm their likely winter demand and plans to meet that.
Boards were also asked to confirm they are addressing priority prevention programmes, such as RSV vaccination for pregnant women and older adults (age 75-79), alongside annual winter flu and Covid vaccination campaigns. And they were told to stress test these plans in September.
Following these tests, Sir Jim Mackey, chief executive of NHS England, thanked systems for their efforts in testing their winter plans, and added that ‘fine tuning our plans and completing preparation is critical’ heading into the colder months.
So, what is included in these plans and how are ICBs preparing?
Focus on prevention
One of the major areas of winter preparedness – and a focus of the 10 year health plan – is prevention. This includes vaccination strategies and a renewed focus on boosting uptake, particularly as this has been low recently.
Vaccines to protect against Covid, flu, RSV and pneumonia are ‘really important’, says Professor Brooks.
ICBs will also need to ‘strengthen the childhood vaccination offer’, says Jonathan Blades, director of external affairs at Asthma + Lung UK.
‘Increasing vaccine uptake among children is one of the most impactful interventions, with every thousand childhood vaccinations saving around four hospital admissions,’ he adds.
Community pharmacies can be used as part of this work this year, as they are able to offer flu vaccinations to children aged 2-3 years old.
Anil Sharma, director of Medicines 4 U Limited – a chain of pharmacies based in Cambridgeshire and Suffolk – and Community Pharmacy England Regional Representative for the East of England, has registered his pharmacies to take part in the trial.
He says this will have a ‘huge impact’. ‘If we can stop children having flu, then less adults will also have flu and there will be fewer hospital admissions.’
It will also ‘ease pressures on ICBs and the wider system’, he says.
He envisages the trial will become a standard service delivered by community pharmacies from next year, alongside the Pharmacy First service which can also help with easing winter pressures.
When preparing for winter, ICBs should make the most of pharmacies, he adds. ‘Pharmacies are willing and prepared to deliver services promptly, efficiently and in a timely manner, and are an effective option for easing winter pressures, taking the burden off GPs and hospitals.’
Cornwall and Isles of Scilly ICB is ‘putting prevention and innovation at the heart of our preparations’, with a neighbourhood approach to winter planning, including pharmacies, says Dr Chris Reid, chief medical officer for NHS Cornwall and Isles of Scilly.
Their winter plan focuses on prevention, with an expanded vaccination programme covering flu, Covid-19, RSV, pneumococcal and pertussis.
‘To make vaccines easier to access, we are running clinics in schools, nurseries and maternity services, alongside pharmacies and GP practices, mobile and walk-in services,’ says Dr Reid.
‘Targeted outreach is in place for communities with historically lower uptake, supported by our team of Community Health and Wellbeing Workers who make home visits, and our network of voluntary and community sector partners,’ he says.
North East and North Cumbria ICB are also prioritising prevention, with the ICB running a ‘be wise, immunise’ campaign in October, which aims to boost vaccination rates by 5%.
Treatment
Alongside prevention of winter viruses, systems also need to build in extra capacity to treat respiratory conditions over the season.
Mr Blades says respiratory conditions are ‘England’s third biggest killer and the biggest single driver of NHS winter pressures’.
‘Delivering good, year-round basic care in the community is vital to keeping patients well and out of hospital, particularly in the winter months. Many ICBs will run seasonal information campaigns with tips for managing COPD, asthma, and other respiratory conditions,’ says Mr Blades.
During this time ‘virtual wards’ – digital tools and self-management apps – are ‘especially vital as they can help reduce the incidence of exacerbations and emergency admissions for people living with lung conditions’, he says.
Many ICBs will set up temporary Acute Respiratory Infection hubs. ‘These hubs reduce pressure on GP practices and A&E departments by offering same-day access to diagnostics, treatment, and follow-up care for patients who need urgent but not necessarily hospital-level support,’ says Mr Blades.
But treatment initiatives such as respiratory clinics are ‘very different across the country’, says Professor Brooks.
He points out that those attending specialist respiratory clinics who are frail may not just have a respiratory illness – they may also have diabetes or heart disease, for example. ‘The risk with single disease approaches is that we do not recognise people are whole people and we need to see them holistically, with various illnesses that interact with each other.
‘We have to be careful we don’t design the system for the ease of the specialists or one organisation or system. That’s not really patient centred care,’ he says.
Enhancing the respiratory pathway is one of the three core priorities identified in North East and North Cumbria ICB for their winter preparedness, alongside maximising prevention and home-facing care and improving in-hospital flow and discharge.
‘With the highest COPD prevalence in England – at 2.8% regionally compared to 1.86% nationally – a concerted focus on the respiratory pathway is vital,’ says Dr Catherine Monaghan, medical director at North East and North Cumbria ICB. ‘Key to our approach is a network of Acute Respiratory Infection hubs – last winter saw 43 hubs caring for more than 36,000 patients.
‘That meant patients were treated quicker, pressure on highly stretched services was reduced, and fewer infectious patients were sitting coughing in emergency departments or practice waiting rooms.’
Backed with targeted proactive care, hospital at home step-up and step-down support and two-hour urgent community response services, this is expected to provide a stronger respiratory pathway. Respiratory and frailty patients will also benefit from care coordination hubs and a wider MDT approach in communities across the region.
The ICB also has a traffic light system to track progress across the region, and real time monitoring of the operational system.
A wide range of mental health crisis options such as safe haven drop-ins, and increased use of same day emergency care will also be in place to help reduce A&E attendances. Meanwhile, two new urgent treatment centres will open at sites co-located with emergency departments in Newcastle and Carlisle, helping to improve streaming of patients to the most appropriate service for their needs.
Dr Monaghan adds that North East and North Cumbria has a ‘history of relatively strong performance in urgent and emergency care, so the region has a good base to build on for winter – but like other areas, there are plenty of challenges to face’.
Lancashire and South Cumbria ICB has also allocated extra funding to support schemes including respiratory services and virtual wards.
‘A crucial part of Lancashire and South Cumbria’s response to the inevitable winter pressures is the continuous implementation of local urgent and emergency care improvement plans,’ says Professor Andy Knox, medical director at NHS Lancashire and South Cumbria ICB.
‘These plans aim to reduce inappropriate hospital attendances and admissions, improve in-patient flow, and facilitate timely hospital discharges,’ he says.
The plans encompass a wide range of initiatives to support the winter response. These include the development of care coordination, improvement of ambulance handovers, and maximisation of urgent community response and virtual wards. They also include the expansion of same-day emergency care, and additional intermediate care capacity.
He added that there would be a system coordination centre that would play a ‘vital role’ in daily monitoring of operations and identifying early signs of system pressures.
Neighbourhoods and winter
Regarding the role of new neighbourhoods this winter, Professor Brooks says though the 10 year plan ‘clearly puts neighbourhoods front and centre in the future NHS’, there is a risk around relying too much on these.
‘The risk is these are very new and very variable, the National Neighbourhood Health Implementation Programme (NNHIP) [has just] started, and that too much burden is going to be placed on them.’
Their role this winter ‘will depend on the maturity of neighbourhoods, the maturity of ICBs, and the relationship between the two’, says Professor Brooks. ‘What we would hope for is that there are sensible conversations recognising what exists now with an eye to the future in terms of how we think neighbourhoods can develop.’
In Cornwall and Isles of Scilly, neighbourhood health will be at the heart of the ICB’s approach to winter.
‘Our framework for the delivery of neighbourhood health is via investment into integrated neighbourhood teams (INTs) which bring together GPs, nurses, social care, voluntary organisations and community partners to support frailty prevention, crisis response and care coordination,’ says Dr Reid.
‘Alongside these teams, our network of VCSE partners provide community hubs and warm spaces, community support with transport schemes, and hospital-to-home services – all helping people stay safe and well in their communities over winter.’
The INTs will identify people most at risk – for example, frail older adults – and put care plans in place before problems escalate. They also provide urgent ‘step-up’ support, meaning that when a crisis does happen, it can be managed at home or in the community instead of in hospital. Community Health and Wellbeing will also visit households to offer welfare checks, connect people to warm spaces, and promote winter vaccinations.
The ICB boasts strong voluntary sector support from more than 50 VCSE partners who are running community hubs and warm spaces, hospital-to-home schemes, and the Community Gateway helpline linking residents to food, transport, social connection and health services every day of the week, including Christmas Day.
Together, these services form a safety net around people – tackling not only their health needs, but also the wider factors that determine whether they stay well over winter: warmth, food, companionship and confidence.
By keeping more people independent and supported at home, the neighbourhood model helps prevent unnecessary hospital admissions, speeds up safe discharge, and eases pressure on emergency care during the most challenging months of the year, the ICB says.
And it says neighbourhood health is proving that ‘strong community partnerships, rooted in prevention, are central to building a sustainable NHS – during the winter months and beyond’.
A whole year plan
Any winter plan ‘should be part of a whole year plan, so that we think about when to use the resources of the NHS in the best way to keep people as well as possible, prevent illness and prevent those that have illness from deteriorating’, says Professor Brooks.
‘For example, we know those with chronic lung conditions often get more infections in winter. So, have they been reviewed, have they had their flu jab, and if necessary, have they got plans in place that mean they know what to do if they become ill?’
He says this sort of approach requires a proactive approach, despite the traditional winter plans being ‘reactive’.
‘If we are true to the vision of the 10 year plan, we should be focusing much more on the prevention than the treatment,’ he says.
While ICBs and colleagues in local health systems are ‘working hard on the ground to deliver, we need to ensure that respiratory gets the national priority it deserves’, says Mr Blades. ‘This would help drive investment, and make it clear why respiratory, like other conditions such as CVD and mental health should receive a Modern Service Framework.’
With healthcare’s busiest season about to begin, ‘I feel for ICBs going through reorganisation at a difficult time,’ says Professor Brooks. ‘However, I would encourage them to think very locally, to think about prevention and the key role that primary care plays in easing system pressures, and to ensure that their resources for the winter plan follow where the activity is.
‘Be prepared to be flexible and local to meet the needs of the local population. And be holistic, and not disease centred.’
