“People are exhausted - they’ve been working flat out ever since the pandemic.” NHS Confederation director Layla McCay tells @mattfrei striking healthcare workers are “anxious about delivering care” at the moment. channel4.com/news/exhausted

Layla McCay Retweeted

NHS Confederation

@NHSConfed

21h

“Healthcare leaders really need the government to sit down with the trade unions and come to a resolution”.

@LaylaMcCay

speaking with

@mattfrei

@Channel4News

this afternoon about next week’s NHS strikes 📺

1:07

417 views

Layla McCay Retweeted

Layla McCay

@LaylaMcCay

Dec 16

Welcome to your Friday winter round-up of what NHS leaders on the ground have been talking to us @NHSConfd about this week. TL;DR Winter pressures and industrial action disruption. 🧵

That's it for this week. As is tradition, I finish with a book recommendation - A Woman is no Man by Etaf Rum, about 3 generations of Palestinian-American women trying to find their way within the confines of a patriarchal culture. Not cheery... but I thought it was brilliant.

NHS leaders are worried about their staff over winter.

@NHSConfed

members said: "the normal pressures are exacerbated by staff sickness (including stress and anxiety), low morale and the cost-of-living crisis". Plus, costs are high for the agency staff needed to fill the gaps.

Primary care and emergency departments are both still seeing lots of increased demand due to Strep A concerns, and it's causing more people to seek urgent primary care appointments both for possible Strep A but also for other urgent matters when they can't get an ambulance.

We're seeing the first winter with high Covid levels alongside other respiratory infections. About 10% of people in hospital have flu or Covid. Hospital admissions with Covid increased this week in all regions (average 28%) and bed occupancy of people with Covid rose by 22%.

On winter, to quote a

@NHSConfed

member from earlier this week, it is already “tougher than ever before”. In particular, there's been a significant rise in respiratory infections. Look at this graph made by

One NHS leader said: "I can’t see what other things we can pull out of the bag to address the increasing demand." Another said: “everything everybody could think of has already been done and now winter is here.’

Flow through the system remains a major challenge; many members reflect that about a third of their beds are taken up by patients who await social care support to be able to be discharged, which "is directly affecting our ability to admit patients in a timely way."

Some leaders reflected that waiting lists are growing faster than expected, and pointed to increased referral rates, alongside workforce shortfalls. But some are seeing improved outcomes too. Mental health leaders noted particular challenges with beds and staffing this year.

All ambulance services in England declared the highest level of alert this week due to ‘extreme pressures’ facing urgent and emergency care and members report “a continuing trend of acutely unwell patients in the ED waiting room where they have made their own way to hospital”.

Health leaders tell us "demand now has such a different profile" with more "high-risk, repeat admissions" and "increasing numbers of more serious cases". One said: "ED is a very tough place to be right now".

A clinician told us this is: "the busiest period I can remember in my 20-year career. The A&E department is the barometer of the whole of the health service, and the reason we have these long waits is because the rest of the health service, the rest of the system, is struggling."

Industrial action has been a big topic this week. Our members spent a lot of time planning and were generally able to deliver essential services on this occasion, but are anxious about the impact of ambulance strikes, and the challenge of repeat/coordinated industrial action.

Welcome to your Friday winter round-up of what NHS leaders on the ground have been talking to us @NHSConfd about this week. TL;DR Winter pressures and industrial action disruption. 🧵

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Layla McCay Retweeted

Michael Chapman

@chapman_mr

Dec 15

This is a massive early Christmas present for everyone involved in health data. Well done and thank you to

and

for ensuring this critical work continues.

Quote Tweet

Understanding Patient Data

@Patient_Data

Dec 15

We are delighted to announce that @wellcometrust has approved a grant application from @NHSConfed to take on hosting Understanding Patient Data. We are excited that we are now at a point where we can let you know about our plans.

understandingpatientdata.org.uk/news/new-home-

Layla McCay Retweeted

BHF Policy

@BHFpolicy

Dec 15

This is fantastic news, such an important initiative 🎉

Quote Tweet

Understanding Patient Data

@Patient_Data

Dec 15

understandingpatientdata.org.uk/news/new-home-

Layla McCay Retweeted

Natalie Banner

@natalie_banner

Dec 15

I am *so* delighted to see the continuation of UPD in a brilliant new home

@NHSConfed

- trustworthy use of health data is ever more important as an issue to understand, explore, and do better on. Thrilled that

@wellcometrust

is supporting and will be watching proudly in 2023 😊

Quote Tweet

Understanding Patient Data

@Patient_Data

Dec 15

understandingpatientdata.org.uk/news/new-home-

Layla McCay Retweeted

Maxine Mackintosh

@Maxi_Macki

Dec 15

Fantastic news!! Congrats

@Patient_Data

and *great* decision

@NHSConfed

👏🏽

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Understanding Patient Data

@Patient_Data

Dec 15

understandingpatientdata.org.uk/news/new-home-

Proud of

and in particular the very hard work of

@RosieARichards

and team for making this cool thing happen. From 2023 Confed will host Understanding Patient Data and it’s going to be great.

Quote Tweet

Rosie Richards

@RosieARichards

Dec 15

We're thrilled to announce that the NHS Confederation will host a new phase of Understanding Patient Data from 2023 with support from @wellcometrust @NIHRresearch @The_MRC @NHSTransform. Read more about UPD's exciting future and apply to join the team

understandingpatientdata.org.uk/news/new-home-

Layla McCay

@LaylaMcCay

Dec 15

That's quite a gradient.

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Joe Plewes

@JoePlewes

Dec 15

Flu and 111 probably the interesting returns in the winter sitrep this week at a glance - 111 calls up 60% week on week (440k to >700k) - driven by Strep A, while flu beds occupied trajectory continuing upwards... england.nhs.uk/statistics/sta

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Layla McCay

@LaylaMcCay

Dec 14

Great thread.

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Ben Zaranko

@BenZaranko

Dec 14

The NHS has more funding and more staff than it had pre-pandemic. At the same time, across most types of care, the NHS is treating fewer patients than it was pre-Covid and is clearly struggling heading into the winter. What's going on? A thread, based on new @TheIFS research

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, remembering us getting lost in this snowy landscape! (Not metaphorically)

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Benjamin Glahn

@BenjaminGlahn

Dec 12

For all @SalzburgGlobal Fellows that love the serenity of our Schloss Park, here it is with a fresh blanket of winter. Perfect scene setter for our next Education Program, Education Transformation and Gender: Better Outcomes for All! #sgsedu @cmmillett #BigEdConversation

Layla McCay

@LaylaMcCay

Dec 12

I'm really enjoying the #CelebratingCommunityServices hashtag this week - some lovely videos (and I'm told, more to come) that give real insight into what community services do, and why they are brilliant. Follow along!

Quote Tweet

NHS Confederation

@NHSConfed

Dec 12

"Community services are there for people at the start, in the middle and the end of their lives in a variety of ways and places.” #TheCommunityNetwork chair @SiobhanMelia on her career journey and why we're #CelebratingCommunityServices this week. @NHSProviders

1:28

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Layla McCay

@LaylaMcCay

Dec 11

Most intriguing thing I read in the FT this week is that Kiwi shoe polish has stopped selling in the UK because since the pandemic we don’t wear shoes that need polishing, and we don’t polish the ones that do. #pandemicimpact

Layla McCay Retweeted

Rob Hastings

@robhastings

Dec 10

A condensed version of my article is also the

@theipaper

splash today It includes the views of An NHS A&E registrar An NHS paramedic

Read it here: inews.co.uk/news/health/nh

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Layla McCay Retweeted

Layla McCay

@LaylaMcCay

Dec 9

Welcome to the second of my weekly NHS winter roundups, sharing intel that's come directly from the frontline across the system about what things feel like in the NHS right now, and what NHS leaders are worrying about, according to

members. 🧵

But if you only want to read about health, we have a nice positive new report out today on how to unlock the NHS's social and economic potential and it's a great read. Happy weekend.

nhsconfed.org

Unlocking the NHS’s social and economic potential

Explore what social and economic development is, why it matters to the NHS and how ICSs can develop more productive systems.

And that's it for this week. I was reminded that last year I always ended these twitter threads with a fiction book recommendation for the weekend. This week it's The Only Woman in the Room by Marie Benedict, about Hedy Lamarr - love the juxtaposition of movie star and scientist.

Meanwhile in mental health, our members are seeing increased demand alongside increased complexity and acuity. We hear about social care as a barrier to discharge, but in mental health, members tell us up to 19% of people are delayed from discharge due to not having a home.

But it's not all about beds, or space in A&E. Members remind us that staffing is the other limiting factor in increasing flow and capacity and in many cases, the key limiting factor. There are about 132k vacancies now.

Flow through the system is the key challenge for the NHS. Members describe more than a quarter of their hospital beds full of people who don't need to be there, while at the other end, people are queuing to get in. One said: "flow is the only way we'll get through this winter."

As for Covid, looks like levels have gone up a bit in the population, in hospital admissions (by about 12% this week), and in overall numbers of people in hospital with Covid (by about 11%). Here's me saying things about that today.

nhsconfed.org

NHS Confederation responds to the latest figures from the ONS on Covid-19 infections

Dr Layla McCay responds to the ONS figures showing a rise in Covid-19 infections.

This extra demand means disruption to other services/waiting lists as capacity is used up, plus distribution issues with antibiotics. Hoping to see more clear public communications to help people understand when to worry, and what actions to take.

Strep A concerns are causing disruption across the system. In primary care, there's been a sharp increase in demand with waiting rooms in general practice being described as ‘like a paediatric A&E’; and in A&E members describe double the usual number of children coming in.

It's a difficult time because as winter beds in, things are becoming challenging. More than 13,300 people in hospital beds when they don't need to be there, flu, Covid and Strep A worries, and category 1 ambulance call outs and A&E attendances reaching concerning levels.

Workorce is a big priority for health leaders right now, with sickness absence impacted by winter, vacancies impacting on the substantive workforce, cost of living crisis, and disruptions with industrial action. One said to us: "It's hard to keep staff buoyant at the moment."

Industrial action is in the news. With the first strike due on Thursday, we hear 2 big questions from leaders trying to prepare: what will be included in derogations (services maintained during strike), and can the different sides begin negotiations and prepare to compromise?

members. 🧵