There is nothing better than waking up to a clear, crisp day. Breathing in the cold, fresh air as we slip on our Wellington boots and head out for a brisk walk, can be more pleasurable than the heavy, humid days of summer. In many ways, the winter months can feel healthier. The air feels cleaner, making us feel more energised and refreshed than we did before. But while picturesque walks, blazing fires, hot chocolate drinks, the likelihood of snow and the countdown to Christmas, are just some of the reasons to love winter, for some, it can be dreaded in equal measure. Many health conditions can worsen during the winter months. For asthmatics, the delight of an open fire or the joy of a cold, crisp day, can often trigger symptoms. Viruses, like flu and the common cold, are easier to spread the more time we enjoy cosy evenings in together. And then of course, there’s the added complexity of COVID-19. Before you know it, the winter months feel less appealing and infinitely more challenging. For the trusts, the situation is far more problematic. More illness = more patients = more pressure for the NHS. So, as the NHS heads into winter already in bad shape, what can we expect this year?

WHAT IS WINTER PRESSURE?

Winter pressure is a term widely used in the UK, where the demand for health and social care services are significantly increased. The reason for this increase, is primarily caused by spending more time indoors, making it easier for viruses like flu, stomach bugs and COVID-19 to spread. During the winter months, the air is less humid outside and becomes drier, which means viruses live for longer. As the nights begin drawing in, people inevitably head inside together and it is these conditions that make the perfect breeding ground for viruses to flourish, especially this winter where it’s highly possible that the impact of flu may be greater due to the low levels over winter 2020/21.

“The NHS is struggling presently, and this is before we’ve had any serious spells of cold weather. It’s a real concern,” says registered nurse, Hannah Morris. “In the colder months, typically between November to March/April, significantly more patients are admitted to hospital. Before the pandemic, the large increase was due to a wide range of illnesses, such as pneumonia and flu in the elderly, patients with chronic lung conditions, and falls on ice or slippery conditions, leading to broken bones. The increase in admissions means that escalation beds need to be opened as there are often more patients requiring hospitalisation than available beds. Unfortunately, due to winter pressures, people also dismiss symptoms that could be important as they are reluctant to sit in A&E for hours or may struggle to contact their GP. It’s a very stressful time.”

WINTER PRESSURE PLUS COVID

According to GOV.UK, as of 17th October 2021, a total of 45,377,411 people received their second dose of the COVID-19 vaccine. But while these figures are encouraging, particularly as defence now lies in vaccinations rather than lockdowns, there is a long way to go. Already, the number of positive COVID-19 cases are rising dramatically every day, with over 5,000 COVID-19 patients in hospitals alone. However, thanks to the vaccine, a case of COVID-19 means your chances of becoming hospitalised are heavily reduced, but with suggestions that protection against catching the virus wanes after six months, not to mention the threat of new variants emerging, it’s a cause for concern. Fortunately, booster vaccines are currently being rolled out to the same priority groups as before, with the NHS racing ahead to deliver over three million COVID-19 boosters in just four weeks. But with the NHS still facing a large backlog of non-COVID 19 care, plus the added pressures of winter, the situation is set to become increasingly more difficult.

“Since the onset of COVID-19, hospitals have never been out of this pressure situation,” says Hannah. “Despite the vaccines, patients who have tested positive to COVID-19 continue to come through the hospital. Extra wards have opened, but as these are not a permanent fixture, they are staffed by sending staff from other wards or departments, which means those areas are left struggling. It’s also important to note, that what affects members of the public, also affects us. Seasonal illness as well as COVID-19, means that many members of staff are sick, isolating, or having to care for children who are isolating. Sadly, the stress of the last 18 months has also taken its toll on the mental health of many NHS staff. Some have left the profession to pursue other avenues of work and this has left a huge number of vacancies that need to be filled. With the pandemic far from over, along with the winter pressures, we are heavily reliant on agency staff to treat the backlog of patients. Many hospitals are recruiting from overseas, but this isn’t easy.”

STAFFING ISSUES

Attempting to fill the many positions the NHS so desperately need has been challenging to say the least. According to NHS Digital, between 1st January and 31st March 2020, 84,393 full-time vacancies were advertised in England alone. It’s problems such as these that do not paint an optimistic picture.

“Lack of overseas staff is one of the biggest issues we are currently facing in recruitment,” says Chris Woods from Entrada. “A lot of nurses came from Eastern Europe, but with Brexit and COVID-19, many have returned home and there has been no one coming over to replace them. For us in AHP, the biggest challenge has been the lack of Antipodean candidates. Around 50 to 60 percent of my working candidates have historically been from Australia and New Zealand. However, as both countries made it extremely difficult for candidates to return home during the pandemic, this in turn discouraged them from coming here, especially as they may need to return home at various times, particularly for family events or illness. The huge travel restrictions over the last 18 months, has removed that opportunity so most of them are waiting until some sort of normality returns.”

WHAT CAN BE DONE?

According to The Health Foundation, the announcement on 6th September of an extra £5.4 billion to support the COVID-19 response for the remainder of 2021/22 was “extremely welcome”. The additional funding brings the Government’s total investment in health services for COVID-19 for 2021/22 to over £34 billion. In the longer term, the government has announced significant additional funding for the NHS over the next three years. But still, with the surge in winter pressure imminent, and COVID-19 continuing to cause a dramatic impact, it’s going to be a struggle.

“The focus for us and GP’s, will be to try and clear the backlog of patients,” says Hannah. “Despite the increase in hospital admissions and high-bed occupancy, we aim to improve admission, accelerate discharges and get patients home as soon as we can. Reducing the length of stay, will free up beds and subsequently relieve the pressures in A&E. Asking people to seek advice from a pharmacist or GP first, rather than letting problems escalate, will also help A&E in what will be their busiest time of the year.”

Positive steps such as the COVID-19 free zones currently set up in hospitals in order to minimise transmission, the roll out of the COVID-19 booster jab, vaccinating the 12 to 15-year-olds, not to mention the increased uptake of the flu vaccine, is key in helping people to stay healthy over the winter months. The NHS are also able to build on what they’ve learned during the pandemic, which will make a vital difference. Already a number of non-essential services that were reduced during the first wave of the pandemic have now resumed. Delivering and restoring services, is extremely reassuring, however, the high level of demand during the winter months will put a tremendous amount pressure on the NHS. With staff already reporting increased levels of stress from working longer hours, not to mention an increase in mental health issues, this is not going to be easy. 

“I’m certain I speak on behalf of the majority of nurses when I say that while our jobs are rewarding in so many ways, we feel mentally and physically exhausted right now,” says Hannah. “We are trying desperately hard to do our best in situations that are far from ideal.”

It’s hard to predict with certainty what will happen this winter, but without question it’s the NHS who continue to deserve our support and appreciation the most.

For more information on winter pressure and the NHS, please visit The Health Foundation at health.org.uk

By Leah Fielding – 21st October 2021

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