Delivering operational resilience across the NHS in England this winter

NHS England has published guidance outlining the national approach to 2023/24 winter planning including a set of recommended winter roles and responsibilities for each part of the system in England.
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On 27 July 2023, NHS England sent a letter to all ICBs and NHS providers on the approach to winter planning for the upcoming 2023/24 winter season. This is the earliest this letter has been sent out, reflecting the importance of early planning and the scale of the challenge experienced last winter. 

This was accompanied by a ‘system roles and responsibilities’ document which sets out the responsibilities of each part of the system and provides greater clarity on what actions should be undertaken to prepare well for winter. This includes a dedicated section on winter planning for children and young people, and emphasises that winter plans should reflect the needs of the child population and include specific actions to manage pressure across paediatric services.  

The letter builds on the commitments and key ambitions laid out in the Urgent and Emergency Care recovery plan, published in January, and it sets out four areas of focus for systems:

  • Ensuring high-impact interventions are in place – ten high interventions are highlighted, including Same Day Emergency Care (SDEC), care transfer hubs, virtual wards and acute respiratory infection hubs. 
  • Completing operational and surge planning – taking into account multiple possible scenarios in their planning, including how to mobilise additional capacity to respond to peaks in demand while protecting elective recovery.
  • Effective system working across all parts of the system including acute trusts, community care, elective care, children and young people, mental health, primary care, social care and the VCSE sector, with the ICB playing a vital role as system leaders.
  • Supporting the workforce - systems and providers should protect the wellbeing of their staff, including by encouraging flu vaccination uptake, and continue to improve retention.

NHSE also announced a new financial incentive scheme to encourage providers to accelerate their performance against 4-hour A&E waits and ambulance response and handover times.

Winter planning for children and young people

The accompanying roles and responsibilities document provides greater clarity to support providers and systems to develop winter plans. 

The document is clear that winter plans should reflect the needs of children and young people and set out actions to:

  • Implement and scale high-impact interventions for children, including CYP virtual ward models and acute respiratory infection hubs.
  • Develop paediatric critical care surge plans – ICBs and ODNs should work together to develop plans to manage the impact of surges in paediatric respiratory infection on CYP services. 
  • Embed whole-system approaches to winter planning for paediatric services, linking to paediatric critical care surge planning and Level 2 bed provision expansion
  • Ensure disaggregated datasets are available at ICB level to monitor CYP and pressures across paediatric services and the wider care pathway, including acute services, immunisation and school attendance.
  • Ensure elective capacity for children and young people is protected, including for CYP elective surgery, critically ill children and general and specialist services. Continue to monitor and reduce disparity in elective recovery between adults and CYP. 
  • Plan how to maximise uptake of childhood and flu vaccinations as part of winter preparedness.
  • Support self management of minor illness: ensure targeted communication and paediatric advice is available to parents/carers, embedding preventative approaches to support the management of minor illness and support to navigate NHS services.
  • Mutual aid: ensure local winter plans include mutual aid considerations across paediatric and adult teams, between providers, and between systems. This should include regional mutual aid arrangements for Level 3 PIC bed provision and for children on long term ventilation. 

As a College we are acutely aware of the pressures impacting on paediatric services across the country.

Last winter was incredibly challenging for the paediatric workforce with children's urgent and emergency care experiencing unparalleled pressure, with unacceptably long waits. In addition, waiting lists for paediatric care have risen throughout the year resulting in continuing pressure on services. 

It is therefore welcome to see an early national level focus on winter planning and clear roles and responsibilities laid out as to how systems and providers should plan to meet the needs of children and young people over the coming winter.

The College will continue to call for ring fenced funding for paediatric urgent and emergency care to ensure children benefit equally from the investment in acute services, and for greater investment in the paediatric and wider child health workforce that is needed to deliver against the backdrop of increased demand.