NHS’s ‘toughest ever winter’: Flu already piling 10 times more pressure than last year

A winter of reckoning has come for the NHS with flu admissions already 10 times higher than last year, with hospital beds and ambulance delays also sky high in officials are saying could be the health service’s ‘most challenging’ season ever.

NHS England’s first weekly winter situation report for 2022 shows an average of 344 flu patients needed hospital care each day from 14 to 20 November. 

This is more than 10 times the level seen at the start of December in 2021, when an average of 31 patients needed care for flu each day.

Last year’s flu admissions, which were predicted to be high after the Covid lockdowns blunted Briton’s immunity to the virus, only peaked at about 140 patients in hospital last winter.

The health service today released the first of seasonal situation reports for 2022, earlier than previous years, amid predictions this could be the toughest winter the NHS has ever faced.

Ambulance handovers also continue to suffer with one in 10 patients arriving at hospital stuck outside waiting to be handed over for over one hour as staff struggle to find room.    

Data in the NHS report shows that general and acute beds are already approaching 100 per cent occupancy, with 19 out of 20 filled by a patient.

This means there is little capacity in hospitals for a potential surge in admissions.

Bed-blocking continues to exacerbate the problem and at an even worse level than previous years.

Over 13,000 NHS beds last week were taken up by patients fit to leave hospital, up from 10,000 in the first week of December in 2021. 

So-called delayed discharges are caused by lack of capacity in England’s social care system, meaning patients who could be looked after at home with periodic visits from health teams are instead stuck in hospital, in some cases putting them at further risk of harm.

Seasonal bugs and workplace stress are also wreaking havoc on NHS staffing levels.

The health service lost 360,000 days of work due to staff absence last week.

NHS national medical director Professor Sir Stephen Powis said the data showed the pressure facing hospitals and staff from a tripledemic of flu, Covid and other winter bugs was already here. 

‘The first weekly data this year shows the considerable pressure faced by staff before we enter what is likely to be the NHS’ most challenging winter ever,’ he said. 

‘The figures also show that flu is unfortunately already with us and so the concerns that we had about the threat of a “tripledemic” are very real.’

He called on the public to book jabs for flue and Covid if eligible to do so.

Professor Sir Stephen said the NHS already had plans in place to deal with winter pressures including recruiting more call handlers, introducing 24/7 control centres to track and manage demand. 

‘Hospitals continue to contend with more patients coming in than going out with thousands of patients everyday in hospital that are medically fit for discharge and so we continue to work with colleagues in social care to do everything possible to ensure people can leave hospital when they are ready,’ he said.

It comes as new ambulance data for October shows emergency services are collapsing even before the predicted busy winter period.

The data shows paramedics couldn’t respond to a quarter of 999 calls last month, a record figure, because they were stuck outside hospitals unable to offload patients. 

This contributed to an estimated 5,000 patients in England potentially suffering ‘severe harm’ as a result of ambulance delays, another grim record. 

Senior ambulance officers said patients were dying every day due to delays, and the emergency could no longer perform its role as a ‘safety net’ for people needing urgent help. 

Martin Flaherty, managing director of the Association of Ambulance Chief Executives (AACE), which represents the heads of England’s 10 ambulance services told the Guardian: ‘The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays and patients are dying and coming to harm as a result on a daily basis.’

Data collected by AACE shows 169,000 hours of ambulance crews time was lost in October due to delays handing over patients. 

Ambulance performance statistics for October show paramedics took longer to arrive to category one, two and three call outs since records began in 2017. Ambulances took an average of 1 hour, one minute and 19 seconds to respond to category two calls (red bars), such as burns, epilepsy and strokes. This is more than three times as long as the 18 minute target

The lost time meant paramedics could not answer 135,000 calls, which represented 23 per cent of the services’ total capacity to respond to emergencies. 

Rachel Harrison, national secretary of the GMB union, which represents 15,000 staff in English ambulance services said the data showed a service in ‘meltdown’.  

‘These figures show that it is on its knees and close to collapse as a result of vacancies, underfunding, morale being at a very low ebb and demand for ambulance care having doubled to 14m calls a year since 2010,’ she said.

The data also recorded the average handover time for ambulance crews to A&E in October was 42 minutes, up 12 minutes in October 2021’s figure.

Additionally the total number of one, two, three and 10-hour handovers was the highest ever recorded.

The crisis is being driven a combination of increased demand and hospitals grappling with bed-blocking, patients who are well enough to leave hospital but can’t as the social care system doesn’t have capacity to look after them at their homes.

More than 13,300 hospital beds across the country — or one in seven — were filled with patients declared fit for discharge each day last month, on average. 

NHS ambulance performance statistics for October show paramedics took longer to arrive to category one, two and three call outs since records began in 2017.

Ambulances took an average of 1 hour, one minute and 19 seconds to respond to category two calls (red bars), such as burns, epilepsy and strokes, more than three the 18 minute target.

Meanwhile reports have emerged that Government could be looking to ditch key NHS targets after failing to meet them for years.

The cull could include health service metrics of A&E waits, cancer treatment and ambulance response times.

Health Secretary Steve Barclay said there will be fewer targets in the health service and has vowed to be ‘ruthless’ in axing NHS bureaucrats.

The stripping of NHS performance metrics could take the form of removing all targets apart from the goal of all non-urgent patients being seen by a specialist with 18 weeks, according to one health minister.

It would mean that targets such as 85 per cent of cancer patients starting treatment within 62 days – something that has not been achieved since January 2016 – could face the chop.

Another in line for the chopping block are new A&E targets that would meant a patient should be seen by a doctor or nurse within 15 minutes of arrival.

Meanwhile, emergency care performance has deteriorated to fresh lows. More than 1,400 A&E attendees were forced to wait in more than 12 hours for care every day in October (yellow bars), while the lowest proportion ever recorded were seen within four hours — the NHS target (red line)

Cancer care plummeted in September. Just 60.5 per cent of patients started cancer treatment within two months of being referred for chemotherapy or radiotherapy (red line). The figure is down from 61.9 per cent one month earlier and is the lowest ever recorded in records going back to October 2009. The NHS states 85 patients should start treatment within this timeframe

Instead the Health Service Journal reported that this has been ‘effectively ditched; in favour of the easier goal of having 95 per cent of patients admitted, treated or discharged within four hours of arrival. 

Like cancer treatment times, A&E performance has also deteriorated to new lows.  

NHS figures show more than 1,400 attendees waited 12-plus hours each day in October, while the lowest proportion ever recorded, 70 per cent, were seen within the NHS target of four hours. 

Almost all of A&E attendees (95 per cent) are supposed to be admitted, transferred or discharged within four hours. But this target has not been met nationally since 2015. 

The prospect of NHS goals being axed has sparked alarm among health charities. 

Minesh Patel, head of policy at Macmillan Cancer Support, told the Times a lack of targets could mean ‘there is a real danger that we lose accountability for performance and see treatment delays spiral out of control even further’.

On the topic a Department of Health and Social Care spokesperson said the NHS ‘will publish a full recovery plan, including interim milestones, in the new year’, adding that it will receive an extra £6.6billion in the next two years. 

The NHS crisis is primarily being fuelled by a lack of staff unable leading to record care backlogs and treatment times as medics struggle to keep up with demand.

One potential solution touted by a senior figure at No10 is to blur the line between nurses and doctors.

Bill Morgan, Prime Minister Rishi Sunak’s health adviser, has argued the health service will only get a grip on the crisis if doctors and nurses get more flexible about their job roles.

Currently nurses and doctors are expected to only act within the limits of their competence, recognising the differences in each profession’s skills and specialties. 

NHS data shows there are about 130,000 vacancies in the health service in England, about one in 10 positions. 

In a paper written before he entered Number 10, and published this week, Mr Morgan argued that training times for doctors and nurses, which are in excess of three years, may have to be reduced to meet NHS demand for staff. 

He also argues for the development of entirely new medical professions.

More broadly, Mr Morgan said he wants ministers to create an Office for Budget Responsibility-style body to predict future workforce needs for the NHS.  

Chancellor and former health secretary Jeremy Hunt has previously called for Government to create a long-term workforce plan for the NHS.