Patients are dying in corridors, lying in agony on the floor of overcrowded A&Es and waiting four days for a hospital bed.
Deadly delays in care that would once have been rare horror stories are now daily occurrences at NHS hospitals. The health secretary, Steve Barclay, has remained largely silent during the past few days as doctors report “unbearable” pressure in emergency departments. But with about 500 patients a week said to be dying because of the A&E crisis, action is needed. Here are six immediate steps he could take to help the NHS survive the winter:
Speed up discharges
Hospitals all share one fundamental problem: they have too few empty beds. This creates a bottleneck at A&E, as patients wait hours or days for a bed on a ward to be available.
The NHS cannot do much to stop people arriving, but it can get them out of the back door quicker. Only 40 per cent of patients are discharged from hospitals when they are ready to go. About 13,000 hospital beds a day — 15 per cent — are taken up by patients who are medically fit to leave, the majority held up by delays in arranging social care.
Technology is being deployed by some hospitals to speed up discharges, and could be introduced more widely. New software can keep track of patients, flag empty beds, and predict the date patients will leave so social care services have time to prepare.
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Another solution would be to open temporary social care settings — such as the old Nightingale hospitals, hotels or private hospitals — to act as “step down” facilities for those waiting for a care package.
Impact: 4/5
Pay rise for social care
Hospitals are “full of patients who should be elsewhere”, the College of Paramedics said yesterday, because of a lack of social care. Care homes are shutting their doors to new admissions because they lack the necessary staff.
There are 165,000 vacancies in social care, an increase of 51 per cent in the past year. The average care-home worker earns just £9.50 an hour, and staff are quitting to earn more stacking shelves in supermarkets.
NHS leaders say the “one immediate single change” to relieve pressure on hospitals would be a £10.50 minimum carer wage, funded as part of a “rescue package” for local authorities, to increase capacity in the social care sector. This change has already happened in Scotland and Wales.
Impact: 5/5
Sit down with striking unions
Four days of strikes by nurses and paramedics are planned for this month, with unions warning the action will escalate next month. The government is refusing to discuss pay demands, but this position is becoming untenable.
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NHS leaders, the Labour Party and some Tory backbenchers are calling for ministers to reopen pay negotiations for the sake of patient safety.
Matthew Taylor, chief executive of the NHS Confederation, said: “Four days of strikes on top of the situation we’re in now is the last thing we need.”
However, negotiations are likely to be protracted, and there is no guarantee that nurses would accept a pay offer below their demand of RPI inflation plus 5 per cent.
Impact 3/5
Fix the pensions trap
There are more than 133,000 vacant jobs in the NHS, including a shortage of 47,000 nurses, making it impossible to staff A&E wards fully.
Barclay has focused on international recruitment to plug these gaps, but health leaders say the focus should be on stopping current staff from leaving. One quick fix would be to reform a punitive tax on doctors’ pensions that has led to an exodus of senior doctors. Complicated pension tax rules mean doctors can save money by retiring or turning down extra shifts.
Impact: 3/5
Vaccines
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The NHS is struggling with a “twindemic” as winter viruses bounce back after two years of lockdown. Nearly 4,000 hospital beds in England are taken up by flu patients, and 9,500 are occupied by those with Covid-19.
One easy way to take the bite out of this wave of viruses is to ensure that everyone who is eligible — including all over-50s — comes forward for their free jabs. One in five over-65s still haven’t had their flu jab, and nearly one in three of those eligible haven’t had their Covid booster. A new drive could include drawing on the “jabs army” of volunteers who ensured Britain had one of the world’s fastest Covid vaccine rollouts.
Impact: 3/5
More power to pharmacists
Difficulties getting a GP appointment means some desperate patients end up at A&E just so they can see a doctor. This could be eased by allowing community pharmacists to carry out more tasks, including prescribing medicine such as antibiotics and managing patients with chronic illnesses such as diabetes.
Similar powers have already been given to pharmacists in Wales and Scotland.
Impact: 2/5
