15 Dec 2023
by Policy, Practice and Innovation Team

With industrial action by junior doctors scheduled from 20 December to 23 December and from 3 January to 9 January, and coming at a challenging time for the NHS due to pressures from flu, Covid and norovirus, Claire Armstrong, Director of Adult Social Care Delivery, has written to Directors of Adult Social Services (13 December 2023).

The letter refers to a communication on 12 December 2023 from NHS England to NHS organisations which:

  • Asks systems to work with their local authority partners to reduce hospital occupancy levels as far as possible ahead of Christmas and the New Year to ensure there is sufficient headroom to safely manage normal increases in bed occupancy in the two weeks following Christmas.
  • Emphasises that it will be particularly important that trusts are able to maximise the impact of the normal working days between Christmas Day and 3 January to ensure occupancy is as low as possible, ahead of the second period of industrial action. 
  • Asks acute, mental health and community inpatient providers to continue reducing delayed discharges within hospital control, including reducing variation across the week and maximising the discharge of clinically fit patients on weekends. This should include running Multi-Agency Discharge Event (MADE) style events, if not already planned, and maximising use of Community Response, intermediate care, falls prevention and Enhanced Health in Care Homes, to enable more patients to leave hospital and receive the care they need closer to or ideally in their own home.
  • States that systems should be working with their local authority partners to plan to increase discharges before the period of industrial action, and then maintain hospital flow 7 days per week during the period to ensure patients continue to be discharged into appropriate care settings.
  • On derogations, says NHS England is discussing the current derogations process with the BMA and further information will be shared when possible. Trusts and ICBs should not plan on the basis that derogation requests will be agreed.
  • Puts in place pre-action self-assessment and reporting obligations on Integrated Care Boards.

Claire Armstrong notes the Minister for Care set out in July that it is essential a ‘whole system’ approach is taken to supporting people and their carers this winter, with integrated care partnerships, integrated care boards, local authorities, health and care providers and the voluntary sector working together.  Claire comments in her letter of 13 December that reducing hospital occupancy will require concerted action by the NHS, local authorities and other partners – including effective communications with local care providers - both to prevent avoidable hospital admission and accelerate patient discharge processes.

She thanks those involved in advance for the critical additional work that will be needed over the Christmas and New Year period to accelerate discharges, maintain hospital flow and protect patient safety.

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