Hospitals have been urged to brace themselves this winter season, as other countries have struggled to cope with an outbreak of flu. Some hospitals in Australia have had to close their doors to patients as they have struggled to cope.
The NHS will have to do a great deal of work over the next 2 months to ensure everything is in place to deal with the winter ahead.
GP services will be put under pressure trying to cope with the high demand of flu vaccinations, while hospitals will have to find extra beds.
The reality is that extra funding is needed to help with the existing pressures. It would help to free up extra bed capacity in hospitals, help to recruit more doctors, nurses and care home staff during winter pressures.
As a nation we love to talk about the weather and in my experience we do so often. It can be a way of starting a conversation with a stranger or a way of breaking an uncomfortable silence with a friend, family member or loved one.
We can’t even escape it if we pick up a newspaper or switch on the television and radio to listen to the news. It can unite us and it can divide us. In fact, so significant is the impact that the weather is having on people that it is no wonder it features regularly as a topical item for discussion.
In relation to healthcare, most professionals dread the winter months, as during this period our elderly and most vulnerable are at the greatest risk from the extremes of the weather.
Primary and secondary care nearly buckles under the weight of unprecedented demand year after year and each winter takes longer and longer to recover from.
Indeed, many who work in healthcare are already bracing themselves for this year’s winter onslaught.
There is already panic spreading into every boardroom of every Hospital and CCG across England, as the sudden realisation dawns upon us that all of the winter pressure wards are still open from last year, so where will we put our patients?
But it isn’t just the cold that we need to concern ourselves with. This year has seen severe snow, lots of rain, flooding and not enough sunshine.
The lack of sunshine becomes even more problematic, especially if we consider sunshine in relation to Vitamin D. Small amounts of Vitamin D can be obtained from food such as oily fish, eggs and fortified cereals, but mostly it is synthesized by the body through exposure to sunshine.
Vitamin D deficiency can lead to bone and muscle problems – yet another impact of the unpredictable weather patterns here in England.
The question therefore is, “should everybody in England be on Vitamin D supplements at certain times of the year?” Previous advice suggested this should be the case, particularly for pregnant women, people who are not exposed to the sun regularly and ethnic minority groups with dark skin.
New guidelines from Public Health England extend this advice to cover everybody in the UK during autumn and winter months.
The advice from Public Health England is supported by research carried out by the University of Manchester and Salford Royal Hospitals.
In a study of white children aged 12-15 it was found that 16% of those involved had lower than required levels of Vitamin D in their blood by the end of the summer period. This study focused on one season of the year and when it was extended to cover all four seasons, the study concluded that 75% of those involved failed to reach the level it should be by the end of winter.
As such, future studies are now underway focusing on people aged 65-84. The impact of poor muscle and bone health will be another significant health concern and financial headache for the NHS in the future, especially with an ageing population.
If 1 in 5 of the population will not get the necessary Vitamin D from the sun that is required to prevent bone disease, then action must be taken.
Regardless of how impractical or undesirable it is, the only course of action is to consider supplementation for all. At first glance, this may seem like yet another thing for GPs to do in their already busy day. But, if Vitamin D was prescribed to all during autumn and winter then these recommendations have the potential to alleviate some pressure on services, at the very least by avoiding the need to refer patients for screening for Vitamin D deficiency.
NHS 111 which was meant to offer help to patients and direct them away from emergency services has come under fire in recent months by both Government and Senior Clinicians, about its effectiveness at performing this function.
As the latest data released by NHS England shows, of all calls triaged by NHS 111, a staggering 12% had ambulances dispatched, while a further 8% were referred to A&E. Of note, 62% were recommended to primary care, 4% were recommended to another service and only 14% were managed directly by the service. The figures for further referral represent the highest ever recorded since the service first began in 2010.
The service is currently facing criticism on many fronts with many of its referrals being regarded as inappropriate and therefore placing unnecessary pressure on frontline services.
Is this the service, or is this a product of the system as a whole, which is widely regarded as inefficient and cost ineffective?
This criticism is also being fuelled by the fact that the majority of the workforce do not have a Nursing or Medical background, and therefore lack the necessary knowledge and skills to triage appropriately, without recourse to an automated rigid computer algorithm.
There is a growing body of evidence suggesting that many patients are being inappropriately referred on to A&E because of issues arising in primary care. For example, at the peak call times for NHS 111, there are a significant number of calls for urgent repeat prescriptions. These patients are then booked into out of hour appointment slots as the call handler cannot triage the urgency of the missing medications. This blocks OOH slots which would be better utilised by GPs assessing patients with higher medical acuity. Instead, appointments are full and because of the risk adverse nature of the 111 service, patients are referred on to A&E.
With a public perception of lack of appointments and inadequate services in primary care, there is growing pressure on GPs to provide leadership on improvement and change within the NHS.