NHS England director warns ‘we can’t surge beds and capacity’ this winter

National director of urgent and emergency care Sarah-Jane Marsh said the NHS will not have the same ability to quickly increase the number of hospital beds or pay for extra social care support as it has had in previous years.

Ms Marsh told an NHS England board meeting on Thursday she was “very concerned” about the resilience of the service going into winter, despite it making headway with other seasonal preparations.

NHSE has previously pledged to maintain ‘core’ general and acute hospital beds at 99,500 on average across 2024-25 – around 5,000 more than previous years, after successfully lobbying ministers for more funding.

But most previous years have seen the government make available extra funding for capacity over winter during the financial year – in recent years, mostly targeted at short-term adult social care capacity to speed hospital discharge.

Ms Marsh told the board meeting: “One of the things we don’t have this winter that we did have in the previous winter is some of that additional capacity. We are really reliant on our process improvements and our interventions this year, which there has been fantastic progress on.

“But we don’t have that ability to surge our beds much higher than they already are. We don’t have additional money to support social care discharge that we’ve had in previous years.

“We’re doing everything we can to prepare but I think it will be challenging in particular places at particular times.”

NHS England’s annual winter letter last month detailed no additional funding amid a “tight financial environment”, and external calls for more winter funding have so far gone unmet by ministers.

NHS England is sending its improvement teams into some of the most pressured hospital sites in an effort to improve performance ahead of winter, as previously reported by HSJ.

Ms Marsh told the meeting NHSE is also “doing additional work on our operational response” and “how we safely make choices to balance risk across systems” when waits get unacceptably long.

Asked about the resilience of the system going into winter, Ms Marsh said: “We are very concerned about the resilience of the system as we look from here.

“Even in our best performers we are in a position where it only takes a small change in something, a bit of a surge of need for whatever reason, and then some of our flow can really silt up.

“And as soon as one part of that flow silts up then it becomes a problem all the way down the line.”