Planning for the coming winter

We know winter is one of the most difficult times of year for the health and care system.

We speak to Dr Sean O’Kelly, Chief Inspector of Healthcare, and Dr Prem Premachandran, Emergency Medicine Consultant, Frimley Health NHS Foundation Trust and CQC National Professional Advisor — Urgent and Emergency Care, about some of the challenges and the role of the regulator in encouraging system working and maintaining standards of quality.

It’s now almost clichéd to say that winter is going to be difficult for health and social care. But if it is a cliché, it’s because it’s true. Each year, we talk about this year being the toughest on record. Yet it gets tougher.

This year is no different.

People working in health and care providers are tired. Morale is low. Industrial action looks set to continue. Staff shortages are exacerbating these pressures. This is against a background of rising patient dissatisfaction, with CQC’s latest adult inpatient survey showing increasing frustration with waiting times.

The challenges already seem overwhelming before you even get to heightened demand associated with winter.

This paints a stark picture. But, as Dr Sean O’Kelly, Chief Inspector of Healthcare, says: “We’re not saying anything people don’t know already. Winter pressures are almost perpetual, but here we all are, bracing ourselves for another hard winter”.

So what can we do?

NHS England published the 2023/24 winter plan earlier than usual this year in a bid to support systems to prepare for the winter period. We’re seeing successful use of virtual ward services to prevent avoidable admission to hospital and improve discharge. And we’ve seen continuous flow models work well where each part of the system works together as a whole.

As the regulator, the Care Quality Commission (CQC) has its own role to play. Sean explains: “I’ve not heard anybody saying that the way we’ll get through winter is by tolerating lower standards of care. People working in health and care are dedicated to providing the best quality care they can, under difficult circumstances. Similarly, as the regulator, our focus is patient safety.

“We’ll take a similar approach to this winter as we have in previous years: we will prioritise our visits to providers when we have cause to believe there is a risk of poor care or harm to people.

“We want to help organisations understand where they need to focus. We’re not doing this to be punitive or catch people out. We’re doing it so organisations can have a better appreciation of areas they may need to focus on so that people get good quality, safe care. We want to be able to help providers to pinpoint the key issues — some of which aren’t always immediately obvious — so they can direct efforts to where they are needed most”.

As a former medical director with experience working at NHS trusts during periods of performance turnaround, Sean is sensitive to concerns that regulatory activity can cause disruption at particularly pressured times. He wants to reassure providers: “We’ll visit when necessary, only asking for information that is necessary, and only speak to as many people as is necessary”.

CQC will also be focusing activity in adult social care where we can protect the vulnerable from poor care and help increase capacity. Sean says: “We will engage with local authorities to make sure that we’re making a positive impact”.

As an emergency medicine consultant working in a busy acute trust, Dr Prem Premachandran — who also works with CQC as a National Professional Advisor — recognises the challenges described. He reflects: “Often, the focus is on the emergency department, but what we see there is symptomatic of a much wider capacity problem across the whole health and care system. We all need to work together to keep people safe and provide the best quality care possible”.

Prem leads CQC’s Emergency Medicine Specialist Advisory Forum — a group of senior emergency medicine clinicians who are also CQC specialist advisors. In October 2020, the group supported development of Patient FIRST — a tool providing practical solutions to support good, efficient, safe, urgent and emergency care. Prem says: “The tool has proved useful since it was first developed. However, it was first published during the COVID pandemic and some of the content reflects the guidance that was in place at the time. While COVID remains a source of pressure, such stringent restrictions no longer apply. With this in mind, we have updated some sections of Patient FIRST to make sure it remains relevant and can best support providers to address the current challenges”.

The true impact of the combined pressures that the health and care system faces this winter remains to be seen. However, what isn’t in doubt is the dedication and resilience of its staff. The issues we are seeing are despite tireless efforts. Everyone working in health and care — including CQC — is bound by the shared mission to keep people safe and deliver the best possible care.