The NHS is well versed in winter planning. Challenges mount every year and the service rises to the test. So what makes this winter any different – and what can we do about it?
This year we have seen challenge upon challenge layer up to create a ‘perfect storm’ as we head into the toughest part of the year. Workforce challenges, industrial action, funding restrictions and population health challenges, combined with a new COVID variant, need for earlier COVID-19 and Flu vaccination programmes and less general monitoring of COVID incidence, will make navigating winter pressures more complex. Add to this the intense scrutiny that inevitably comes as we head into a likely election year, and commissioners and all types of providers will need to work closely together to provide joined-up care for patients and weather the oncoming storm.
Drawing on recent work with system leaders, ICBs and clinical teams, we’ve identified five key areas of focus to strengthen operational resilience as NHS organisations prepare for winter pressures:
1. Relationships: While strategic and operational planning is crucial, so too are the relationships between those working together at place and neighbourhood level to meet the needs of their local populations this winter. Building new, or enhancing existing, relationships across the wider health and care system, including mental health services, services for children and young people, community, primary care and the voluntary, community, faith and social enterprise (VCFSE) sector, is critical in enabling both formal and informal problem solving. Being able to pick up the phone, seek help, share resources and jointly resolve flashpoints in demand helps provide the flexibility and adaptability needed to shift gear at speed and scale.
2. Scenario planning: The impact on schools of concerns over reinforced autoclaved aerated concrete (RAAC) is a reminder that unexpected scenarios can be thrust upon organisations with little notice. Although the NHS already has a well-established programme in place to identify and deal with RAAC, NHS England has just requested all trusts and ICBs build RAAC failure evacuation into their standard business continuity planning, creating another layer of challenge to consider. Advance scenario modelling for winter needs to consider both likely scenarios plus a couple that are more ‘out of the blue’ and build in appropriate contingencies. In modelling solutions, we need to look not just at the numbers but what we might need to do differently, maintaining a constant cycle of ‘plan, execute, review’. This helps to recognise in good time when you might have to flex your plan and respond accordingly, while taking the time to get under the skin of unexpected blockages. If a particular clinic isn’t working as expected, for example, picking up the phone or visiting the site to understand the blockages can sometimes identify surprisingly simple solutions.
3. Good housekeeping: It may not sound exciting, but a comprehensive inventory of resources (including staff, funding, buildings and kit) at your disposal strengthens operational resilience and has traditionally been a strength in the NHS. Operational changes required during the pandemic have impacted the quality of some of that information, while system-based working has made information gathering more complex. However, working with system partners to build a collective understanding of workforce, assets and funding will make it easier to respond quickly to changing requirements and redeploy where needed in the face of new challenges. The bringing forward of the Covid-19 seasonal vaccination programme is a case in point. Rapid access to community buildings that can be used for vaccinations at short notice becomes easier if you have an up to date inventory close at hand.
4. Clear and effective communications: Clear signposting to relevant services early-on can build confidence among patients in how to access care and reduce the burden on GPs and A&E. Working with your communities and those with lived experience can help people share responsibility for good health, understand the triage process and build confidence in access to the right care at the right time. Being more explicit about the proactive work being done to support nursing and residential homes, and other priority groups, can also help to reassure communities that appropriate measures are in place to support more vulnerable residents. Understanding your communities within system and place and making best use of the communication channels available across system partners will enhance success.
5. Leadership and accountability: ICBs are no longer new – 14 months in expectations are on the rise. Within their letter, ‘Delivering operational resilience across the NHS this winter’, NHS England identifies ‘ICBs should ensure effective system working across all parts of the system’ as one of four key areas of focus. Heading into winter pressures is an opportunity to start as you mean to go on, modelling the leadership behaviours you expect to see across your system and working through the toughest challenges together. This is simpler in theory than in practice, of course which is why Arden & GEM continues to deliver coaching interventions for ICBs and wider system partners to help develop more integrated working, but it’s not a quick fix. System leaders and ICBs will need to be confident in holding each other to account while maintaining an integrated, cohesive approach. Local accountability is expected and ICBs should be comfortable with the arrangements and risk management they put in place, considering and planning for what could go wrong.
Winter planning doesn’t happen in isolation but overlays the plans already in place around elective recovery, urgent and emergency care, and primary care. National guidance and local learning will help support optimal outcomes as systems become more open to adapting and adopting models used elsewhere. But how winter plans are managed, as well as the plans themselves, will have a significant impact on success.
By Rose Taylor, executive director of health and care transformation at NHS Arden and GEM CSU
