Health and social care - surge and winter preparedness: national planning priorities and principles

Maximise system capacity and capability by improving patient flow and access, reducing delayed discharges and long waits, minimising unmet need, and using data and intelligence to support real-time decisions across the whole system. Strengthen urgent and unscheduled care pathways, including hospital at home and virtual capacity, and protect access to planned care and established care services

There is a continuing focus on maximising system capacity and capability of our health and social care systems, and in the longer term this will be addressed through the reform and renewal actions set out in the SRF and PHF. However, during periods of surges in demand it is important that local planning is in place to maximise existing capacity to meet areas of increased demand whilst ensuring that other services are protected and maintained. It is recognised that it may not always be possible to meet increased demand without impacting on other areas; however, the core surge planning principle should be to protect services delivering care and treatment for people.

Actions and improvements to maximise system capacity are best and most sustainably delivered in an integrated and co-ordinated way across the health and social care system. There continues to be a national focus on addressing sustained pressures across the whole system and reducing levels of delay from hospital. These delays remain centred around ensuring the best possible care for that individual is delivered.

Reducing delayed discharges remains a key ministerial priority and a central focus of the OIP. The OIP sets out a range of national actions to reduce unnecessary hospital stays, including optimising alternatives to admission, improving discharge planning from the point of entry, and enhancing coordination across health and social care. These actions are designed to support acute hospitals in achieving optimal occupancy levels and improving patient flow. Local surge and winter plans should reflect this national direction by embedding early discharge planning, multi-agency coordination, and proactive care transitions as core components of their approach. This alignment will help ensure that people receive the right care in the right setting, while also supporting system resilience during periods of increased demand.

There is a need to ensure that each discharge delayed is clinically assessed, and a decision made that hospital is not the best place for them to receive the ongoing care that they may need. If a person is kept in hospital longer than clinically necessary, their outcomes and overall health risk being negatively impacted.

There are many reasons a patient’s discharge from hospital can be delayed, from lack of discharge planning, awaiting assessment, ensuring a suitable care package is in place, or legal challenges that may be experienced where an individual does not have the capacity to make decisions for themselves. This is worsened during periods of sustained pressure, where demand and admissions are high across the system.

It is also crucial that planned and established care services are protected, especially during periods of sustained pressures. If planned care is stepped down during periods of surge, people will be left waiting longer for the care they need. The longer someone waits for treatment or appropriate care services, the higher the risk of this requiring immediate care in emergency departments. Given the detrimental impact that cancelled or delayed appointments can have on patients themselves, the sustained delivery of planned and established care services ensures continued progress on reducing waits and delays and limits the flow of demand into unscheduled and emergency care.