Policy paper

The health and social care approach to winter

Published 3 December 2021

Applies to England

Introduction

The government, the NHS, and adult social care providers and local authorities have put in place plans to help people stay well this winter. In total, more than £34 billion of additional funding is being invested by the government this year over and above baseline funding. This funding is helping health and social care services deal with the additional demands of the pandemic and ensuring access to the right care, in the right place, at the right time for those who need it. The importance of these preparations has been brought home to everyone over the last few days with the emergence of the Omicron variant. In this document we set out more details of the preparations that have been undertaken to make the health and care system resilient over the coming months.

In addition to the preparation already undertaken, we are announcing here a breakdown of additional funding provided for the NHS in the second half of the year.

While we are as well prepared as we can be, we recognise that this winter will be more challenging than many faced by the National Health Service and adult social care providers and local authorities. As such, we also set out here what members of the public can do to look after themselves and their families this winter. The measures listed here will help to protect people against the already circulating strains of COVID-19 and the newly emerging Omicron variant. In particular:

• Everyone should have the full course of COVID-19 vaccination for which they are eligible. As of 1 December, 88.7% of people aged 12 and over in the UK have now had one dose of the COVID-19 vaccine and 80.7% have had 2. The booster or third dose programme has reached over 18.6 million people in the UK (and 15.58 million in England). But we continue to push to achieve even higher uptake, and the government has extended the booster programme to include all adults, and reduced the minimum dose interval between second dose and booster dose to 3 months (from 6). Optimising individual protection ahead of a potential wave of infection will provide the largest benefit in terms of reducing the impact of the Omicron variant on the UK population – saving lives and protecting the NHS.

• Everyone who is eligible for a flu vaccination should get one. The flu vaccination programme, which has been running since September, is the largest ever in England with 35 million people eligible. Flu can be a life-threatening illness, but it can be even more dangerous if contracted at the same time as COVID-19.

• We are asking people with urgent medical needs to think ‘111 first’. People should use the free 24/7 NHS 111 online and phone service to get advice on their condition and the best way to get the care they need. Ambulance services and Accident and Emergency departments (A&Es) are open and ready to help those with emergency and life-threatening conditions.

• For people experiencing a mental health crisis or for those supporting such a person every mental health trust in England has established a 24/7 urgent mental health helpline. Details can be found on the NHS website, and in the majority of areas they are now linked to NHS 111.

• We continue to encourage people to practise good hand and respiratory hygiene to help prevent the spread of COVID-19, flu and other viruses which circulate at this time of year. In relation to COVID-19 people should continue to use lateral flow tests regularly, particularly before being in close proximity with others. The public and staff in public facing areas will be required to wear face coverings from 30 November as set out in the Face coverings: when to wear one, exemptions, and how to make your own guidance. People with COVID-19 symptoms should follow the guidance on testing and on isolation following a positive test.

NHS England and NHS Improvement issued the urgent and emergency care (UEC) recovery 10 point action plan on 22 September and updated planning guidance for local health services on 30 September. The government’s adult social care winter plan was published on 3 November. These are the main documents that providers of health and adult social care services are using to plan for winter. This document is consistent with the more detailed requirements set out in those plans. 

The challenge this winter  

There are 5 challenges that we are preparing for in the health and social care system this winter.  

1. COVID-19 rates remain high and could increase

The emergence of the Omicron variant is a reminder that this terrible virus is still with us. Vaccination has significantly reduced the likelihood of severe illness, hospitalisation, and death, saving at least an estimated 120,000 lives up to the end of September. But the overall number of COVID-19 cases is currently higher than during autumn 2020. There are fewer people in hospital compared to the same time last year, but COVID-19 is still putting significant pressure on services. Thanks to actions taken to protect residents and staff, outbreaks and infection rates in care homes are now considerably lower than among the general population, and COVID-related deaths in care homes have also greatly reduced. Everyone can play their part in stopping the spread of COVID-19 by taking up all the vaccine doses they are eligible for as soon as possible, enrolling in therapeutics trials where eligible, and taking the steps described above to help limit the spread of the virus.  

2. Responding to COVID-19 has a wider impact on capacity

The NHS and social care providers have put comprehensive measures in place to reduce the spread of COVID-19 over the last 18 months. This has been important in ensuring that people are less exposed to the virus, but these measures do mean that physical capacity has been decreased in many settings, in particular some beds are not being used in hospitals (typically around 3 in every 100 beds are unavailable for use at any time). The number of residential care home beds has remained largely flat (0.4% lower in October 2021 than in March 2020), but there has been a significant reduction in occupancy. During winter people will continue to see infection control measures in place, to ensure all of our continued protection. To help stop the spread of the virus everyone should take the COVID-19 measures appropriate to the setting they are in, for example wearing masks where recommended and washing hands regularly.

3. We have seen high levels of demand for health services since the spring, and this could continue into winter

Attendances are approaching pre-pandemic levels in major A&Es. Also, appointments at general practice are at higher levels than during the same period prior to the pandemic: including COVID-19 vaccinations appointments on average there were 1.62 million appointments per working day in October 2021, a rise of 20.6% compared to the same month in 2019. Excluding COVID-19 vaccinations there were still 1.45 million appointments per working day, a rise of 8.0% compared to October 2019. Pharmacists or GP practices should be the first port of call for non-urgent medical issues. For urgent (but non-emergency) medical conditions contact 111. This will help ensure that A&E departments are able to focus on people with emergency and life-threatening conditions. Mental health services also face pressures this winter, with crisis referrals up 30% compared to pre-pandemic. But new 24/7 urgent mental health helplines are taking around 200,000 calls each month, and mental health services have supported around 1.3 million people in August 2021. People of all ages with urgent mental health needs during winter will be able to access free, local 24/7 NHS urgent mental health helplines via NHS.UK.

4. Risks from other infectious diseases

During the pandemic, social distancing measures led to a lower circulation of other infectious diseases such as influenza (flu), norovirus (D&V) and respiratory syncytial virus (RSV). This means there may be higher infections this year due to lower immunity levels, putting pressure on both health and care services. In a typical winter, the month with the highest flu pressure sees average daily admissions of about 4,000. This includes flu and flu-like illnesses and pneumonia, and RSV. People should not enter health and social care settings (including as visitors) if they are feeling unwell, even if they have tested negative for COVID-19 and are fully vaccinated, unless requiring urgent medical treatment. Experts have indicated that flu levels could be 50% higher than in a typical year and potentially cause up to 60,000 deaths. While it is too early to tell if that will happen, we do know that there are more RSV infections in children than usual. This is why it is essential that everyone who is eligible comes forward to receive their free flu vaccine. Eligible adults can book an appointment to get their free vaccine from pharmacies, their GP, a midwifery service if pregnant, and care home staff and residents can access theirs in a care home. If social care staff are unable to access a flu vaccine through their place of work, then they can get one from their GP or any pharmacy. School age children up to year 11 should receive the vaccine through the school programme, and eligible children not at school should receive a vaccine through their GP.

5. Pressures on the workforce

People working in the health and social care system have worked incredibly hard to withstand the challenges posed: responding to COVID-19, maintaining services, and continuing to provide high-quality care to those who need it, as well as delivering the vaccination programme. Since the spring, they have enabled a major increase in the number of people receiving care and treatment, even while constrained by measures introduced to limit the spread of COVID, such as infection prevention and control (IPC) guidance in hospitals and social care settings and staff isolation requirements. 

That said, we recognise that there are challenges faced by the workforce. Although the NHS workforce has grown by 1 to 3% year on year over the last 8 years, with increased growth of 4.8% during the pandemic, there remains roughly an 8% vacancy rate across all staff groups. Following 9 consecutive years of growth, we are now starting to see shrinkages in the adult social care workforce. Skills for Care workforce data suggests around a 3% reduction in overall staff numbers in Care Quality Commission (CQC)-registered care homes and home care since March 2021. To provide additional support to the social care sector ahead of the winter, on 21 October we announced a new £162.5 million Workforce Recruitment and Retention Fund. Since 3 November local authorities across England have been able to access the fund based on their need, helping to boost the number of people working in adult social care and supporting those already working in the sector to continue to deliver high-quality care. The fund is part of a series of measures in the short and longer term to support social care and ensure there is the right number of staff with the skills to deliver high-quality care to meet increasing demands.

How we have prepared for this winter

In preparation for this winter, and to help respond to these challenges, teams across the NHS, the Department of Health and Social Care (DHSC) and local authority leaders have been working together to ensure we have put in place appropriate measures. The measures have increased capacity and established system-level oversight so we can respond collectively to challenges as and when they arise.

1. Increasing protection through vaccination

Our COVID-19 vaccination rollout is a world recognised success. As of 28 November, 88.6% of those aged 12+ in the UK have had one dose of the vaccine, and 80.6% have had 2 doses. As of 28 November, over 17.8 million booster vaccines and third primary doses have been delivered across England, and the booster programme has now been extended to all adults.

Vaccinated people are far less likely to get COVID-19 and even more unlikely to become seriously ill from the virus, be admitted to hospital, or to die from it. While we do not yet know the extent of protection COVID-19 vaccines will provide against the Omicron variant, we have good reasons for believing they will provide at least some level of protection. So the government is expanding the COVID-19 vaccination programme and urging everyone to get their COVID-19 vaccines when eligible. This includes those who have not yet come forward for their first and second doses.

Sustaining high levels of vaccination among health and social care staff is important to minimise the risk of outbreaks in care homes and nosocomial infections. As of 21 November, 93.5% of staff in older adult care homes across England had received a second dose of a COVID-19 vaccine.

We want people working in the NHS and social care to be vaccinated against COVID-19 in order to protect the people they care for, themselves and their colleagues. Care home residents are some of the most vulnerable to the effects of COVID and care homes are at high risk of experiencing outbreaks due to the semi-closed nature of these settings. Therefore regulations are already in force which mean that people working or volunteering in care homes need to demonstrate that they are vaccinated or have a medical exemption. Further regulations have also been laid to extend vaccination as a condition of deployment to health services and wider social care services.

We have extended the flu vaccination programme for the 2021 to 2022 flu season. Over 35 million people are eligible for a free flu vaccine. This will be the biggest flu vaccination programme in UK history, building on the record number of vaccines we were able to deliver in the 2020 to 2021 winter season. 

Vaccines have helped us build a wall of defence and return to a more normal way of life. Continuing to roll out the COVID-19 and flu vaccine programmes at pace will remain important this winter. Everyone eligible should boost their immunity with a flu vaccine as winter approaches. COVID-19 vaccination is critical to help us bolster our defences against the Omicron variant, and everyone should take up the offer of a first and second dose of COVID-19 without delay, and a COVID-19 booster vaccine as soon as eligible. 

2. Antivirals and therapeutics

Antivirals and therapeutics are a vital part of our pharmaceutical defences, alongside vaccines, to manage COVID-19 and mitigate the health and economic impacts of the disease as we learn to live with the virus. COVID-19 treatments are especially important for people who cannot take a vaccine for medical reasons or for whom vaccines may be less effective, such as those who are immunocompromised.

We are proud of our work so far to identify treatments to prevent progression to severe disease and make these available to UK patients. Several treatments are already available through the NHS for patients with COVID-19, including tocilizumab and dexamethasone, which are widely used across the United Kingdom to reduce hospitalisations, save lives and manage down pressure on the NHS and economy. We are working closely with the pharmaceutical industry, NHS and others in the supply chain to help ensure patients can access the medicines they need when they need them. 

Building on this success we have secured several novel COVID-19 treatments for this winter. We procured Ronapreve, a novel monoclonal antibody treatment. Ronapreve is already available to treat the most vulnerable patients, including those with severe COVID-19 and without antibodies (seronegative), and high-risk patients who acquire infection while in hospital.

On 20 October we announced the procurement of 730,000 patients’ courses of 2 different antivirals. These will be made available through a national study to eligible patients. The first, Lagevrio, has already received Medicines and Healthcare products Regulatory Agency (MHRA) approval and will be available this winter. The second, Paxlovid, will also be made available this winter should it receive MHRA approval.

3. Test, trace and isolate

The test, trace and isolate system remains critical to the government’s plan for managing the virus over the autumn and winter. It helps to find positive cases and their contacts, breaking chains of transmission. This helps reduce pressure on the NHS, as well as enabling individuals to manage their own risk and the risk to others. Testing is also crucial to enable us to find variants and take rapid action to limit onward spread.

The following measures will help to keep people safe and to limit the spread of the virus this winter:

1. It’s critical that anyone with COVID-19 symptoms isolates and takes a free polymerase chain reaction (PCR) test immediately. Those who test positive for COVID-19 must self-isolate for 10 days. A positive test may also lead to access to early treatment, where appropriate.

2. While we continue our efforts to understand the effect of the Omicron variant, we have taken swift precautionary action to protect public health by introducing travel restrictions.

3. Rapid asymptomatic testing is an important tool to help reduce the spread of the virus, while supporting people to manage their own risk and the risks to others. The government will therefore continue to provide the public with access to free lateral flow tests in the coming months. People may wish to use regular rapid testing to help manage periods of risk such as after close contact with others in a higher risk environment, or before spending prolonged time with a more vulnerable person. At a later stage, as the government’s response to the virus changes, universal free provision of lateral flow devices will end, and individuals and businesses using the tests will bear the cost. The government will engage widely on the form of this model as it is developed, recognising that rapid testing could continue to have an important, ongoing role to play in future.

4. Contact tracing will continue through the autumn and winter. This means NHS Test and Trace will continue to check with all positive cases whether they need support to self-isolate, find out who they may have passed the virus onto and alert those contacts, and ask all contacts to take a PCR test as soon as possible to help identify positive cases. Where contacts are over 18 and not fully vaccinated, they will, as now, be legally required to self-isolate unless they are taking part in an approved daily contact testing scheme. As a temporary and precautionary measure, all contacts of suspected or confirmed Omicron variant cases will also be legally required to self-isolate, regardless of their age and vaccination status. The government will continue to offer practical and financial support to those who are eligible and require assistance to self-isolate.

5. The government will continue to encourage the use of the NHS COVID-19 App, a key health protection tool.

4. The NHS

Since the beginning of autumn, every local part of the NHS has been planning for winter with actions being taken in key areas to ease or respond to anticipated pressures. These measures reflect plans to bolster capacity and resilience across the urgent and emergency care system as well as across the NHS more widely. The NHS is:

1. executing its urgent and emergency care recovery 10 point action plan, developed with Royal Colleges and published in September. This includes a range of actions across urgent, primary and community care to better manage emergency care demand and capacity. In particular, additional support of £55 million has been invested in ambulance services to boost staff numbers ahead of winter and £75 million to increase 111 call handler and pathway clinician capacity

2. improving access to primary care over winter. This is supported by the £250 million Primary Care Winter Access Fund which will enable GP practices to employ more doctors and other staff over winter, supplementing existing recruitment and retention schemes and helping to improve patient access and experience

3. supporting adult and children’s mental health needs by allocating a further £48 million to mental health services between now and March. This will support more people with mental health needs to stay well at home, and to reduce long waits in A&E, long lengths of stay in inpatient care and people having to be care for a long way from their local area

4. improving how quickly and efficiently people can move through hospital, including through the restoration of same day emergency care (SDEC) services to pre-pandemic levels and the issuing of further guidance to promote direct access referrals

5. enabling safe and quick discharge from acute hospitals through measures such as increased voluntary sector support and COVID-19 virtual wards. Specific plans are also being put in place for the most challenged trusts in terms of patient flow in each NHS region. In addition, a significant investment is being made to facilitate discharge to adult social care, this is discussed in more detail below. The benefits of improved discharge will be felt right across the urgent and emergency care pathway: improving discharge from hospitals increases the number of available beds, which allows for faster admissions via A&E. This in turn creates more capacity in A&E, reducing ambulance handover delays

6. protecting and developing NHS capacity to ensure people can access more routine treatment such as hip surgery and diagnostic tests. An elective recovery plan will be published soon, setting out further details

7. changing how paediatrics services are delivered by flexing capacity as required to respond to a surge in demand for urgent care while maintaining elective services for children. For example, in anticipation of an increased risk of RSV infection rates we brought forward the Palivizumab immunisation programme to July

8. supporting staff to make their workload more sustainable, continuing to reduce the risk of infection in hospital settings, and minimising isolation or sickness disruption. DHSC formally announced (9 November) that all staff engaging with patients in England must be fully vaccinated against COVID-19 no later than 1 April 2022 to protect patients. Everyone who is eligible is being supported to take up COVID-19 boosters and flu vaccinations in the lead up to winter

9. ensuring the NHS is prepared and supported to enact any interventions of last resort should systems risk being overwhelmed

Targeted Investment Fund

In September, the government announced the package of additional funding to support the NHS for the second half of this financial year (to March 2022). The £700 million Targeted Investment Fund was established to support NHS systems and providers to go further on elective recovery.

Funding has now been allocated to regions on a weighted population basis, with investment of:

• £112 million in North East and Yorkshire

• £97 million in the North West

• £131 million in the Midlands

• £78 million in the East of England

• £105 million in the South East

• £69 million in the South West

• £109 million in London

At least £330 million will be invested in NHS estate, and a further £250 million will be spent on digital initiatives that aid elective recovery efficiency and reconfiguration. A further £120 million will support associated or additional revenue costs.

Around 780 bids have so far been approved to speed up elective delivery, allowing systems to restore activity to pre-pandemic levels with greater financial certainty, including proposals for:

• additional day surgery units to maximise activity and minimise length of stay

• additional permanent and modular theatres and surgical hubs to improve productivity in specific pathways

• investment in outpatient space to deliver more productive outpatient clinics

• investment in imaging, including upgrades to MRI and mobile breast screening units

A number of high-value schemes exceeding £5 million have been approved including:

• £13.8 million investment in new wards at University Hospitals Birmingham, delivering an expected 164 additional adult inpatient beds across the trust

• £14.4 million at St George’s Hospitals to deliver a new modular facility providing 20 ITU beds

• £10.2 million to develop a new South Mersey Elective Hub, with 2 new theatres and recovery areas

• £10.5 million for new outpatient accommodation facilities in Roehampton, building capacity to deliver Gynaecology, Ear, Nose and Throat, and Audiology services

• £10 million for a day surgery site in Castle Hill Hospital in Hull, which will house 4 theatres, as well as all supporting services

• £7.1 million to build a modular ward at the Royal Shrewsbury Hospital with 32 beds

• £7.8 million to build the second phase of the new critical care unit at Kings College Hospital

• £7.5 million to develop a new critical care unit at Queen’s Hospital in Romford, housing a new 15 bed critical care unit which can flexibly increase to 25 in surge conditions

• £7.4 million to construct 2 new modular theatres (with supporting anaesthetic rooms and recovery space) at Guy’s Hospital

• £5.9 million at Bedford Hospital to create 20 flexible multi-purpose outpatient rooms

Across all of these actions the NHS is taking additional measures to ensure that it is serving all communities and where possible preventing ill health rather than just treating conditions. This includes much better monitoring of who is accessing and benefiting from services in order to address disparities and continuing to roll-out preventative programmes to tackle obesity, smoking and other factors which lead to poor health. 

5. Adult social care

For adult social care, DHSC has announced the adult social care: winter plan 2021 to 2022, which sets out the actions national government will be taking to support the sector, along with the steps local authorities, the NHS and care providers should take to prevent and control COVID-19 and other respiratory viruses. The key points from the plan are:

1. providing £388 million in further funding to support infection prevention control, testing and vaccination uptake in adult social care settings – this includes £25 million which has been specifically made available to support care providers and social care staff with the costs associated with accessing COVID-19 and flu vaccinations

2. recognising the challenges that providers and local authorities are currently experiencing in recruiting and retaining social care workers, we have announced a new £162.5 million Workforce Recruitment and Retention Fund to provide additional support to the sector ahead of the winter

3. providing eligible frontline social care workers and carers with a free flu vaccination this autumn and winter season, ensuring pharmacists can vaccinate staff and recipients of care in care homes. To boost flu vaccine uptake among social care staff, GP practices will be able to vaccinate care home staff that are not registered at their practice

4. providing care home residents and health and social care workers with COVID-19 booster vaccines, usually by visiting them at work. A new communications toolkit has been launched for social care providers and stakeholders including a core narrative, links to shareable social media content, expert videos, case study videos and blogs

5. continuing the designated settings scheme, to provide appropriate care for people likely to be infectious with COVID-19 in a COVID-secure environment. The continuation over the winter will support safe and timely discharge and protect care home residents and staff from COVID-19. The Designated Settings Indemnity Support has also been extended to cover the winter period until 31 March 2022, to maintain the current level of support for these vital settings

6. continuing to provide free personal protective equipment (PPE) for COVID-19 needs to the adult social care sector until the end of March 2022, with sufficient stock to cope throughout winter

7. regular asymptomatic COVID-19 testing will be maintained throughout winter for all staff and unpaid carers in adult social care, as well as more intense testing regimes for higher risk settings

8. continuing to support care providers to make the best use of technology to enable remote monitoring, facilitate secure online communications, and enable people within care homes to remain connected with friends and families

9. continuing the national recruitment campaign across broadcast, digital and social media, highlighting the vital work care workers do

10. launching an IPC Champions Network, led by the Chief Nurse, to provide a forum for the sector to share best practice in infection prevention and control, and publishing a good practice guide covering best practice IPC examples, including ventilation

6. Health and social care working together

DHSC, NHS, local authorities, the Local Government Association, and the Association of Directors of Adult Social Services are working together to ensure that health and social care services collaborate to maximise the services provided during winter. The importance and success of this approach has been evident throughout the pandemic, for example in the delivery of the ground-breaking COVID-19 vaccination programme.

One of the key areas for whole-system collaboration is around the safe and timely discharge from hospital. This is important because it means patients can get back home as quickly and safely as possible, and that beds in hospitals can be used for the sickest patients. For the winter months, this process will be supported by the £478 million funding being made available to help cover some of the cost of post-discharge recovery and support services, rehabilitation and reablement care following discharge from hospital, for up to 4 weeks. It will also see the continuation of the designated settings scheme to minimise the risk of those with COVID-19 infecting those in care homes.

It continues to be important that patients infectious with COVID-19 are not discharged into a care home. The discharge funding should be used to ensure each local authority has access to designated settings provision. Decisions should continue to be made at a local level about how best to deliver designated settings over the coming months, including where such settings are shared with neighbouring authorities, in partnership with the NHS.

To continue to support those designated settings that are unable to obtain sufficient insurance cover to accept COVID-19 patients on discharge from hospital, the Designated Settings Indemnity Support has also been extended until 31 March 2022.

Collaboration will also characterise the response to other challenges, building on joint working which was enhanced in responding to the pandemic. For example, the voluntary and community sector, local authorities and NHS are working closely together to deliver enhanced mental health support this winter.

More widely, services have come together to produce joint plans. There are 42 integrated care systems (ICSs) in England, each with its own plan relevant to the needs of its population. There are also regional and national level plans. There is national oversight to ensure that these plans are delivered.

7. Supporting our workforce

To bolster the dedicated adult social care workforce, the government has announced a £162.5 million Workforce Retention and Recruitment Fund, on top of the £388 million Infection Control and Testing Fund. The ring-fenced funding, available until the end of March 2022, will support local authorities working with providers to recruit staff. It will also be available to help retain the existing workforce – through overtime payments and staff banks of people ready to work in social care – and will provide further capacity to support their health and wellbeing through occupational health. The fund is part of a series of measures in the short and longer term to support social care and ensure there is the right number of staff with the skills to deliver high-quality care to meet increasing demands.

The pandemic has been a challenging time for many health and social care staff and our priority is to support staff health and wellbeing. We have put in place a package of measures specifically aimed at supporting the mental health and wellbeing of the adult social care workforce. This includes making resources available on how staff can manage their own mental health in light of the pandemic, as well as guidance for their employers on how to support wellbeing at work. The government has collaborated with the Samaritans, Shout, Hospice UK, and Mind to create ‘Our Frontline’ which provides information, emotional support and access to a crisis text service. Staff mental health and wellbeing hubs have been set up to provide health and social care colleagues with rapid access to assessment and local evidence-based mental health services and support where needed. We recognise that Registered Managers face particular challenges and, in partnership with Skills for Care, have created a package of support for them. This includes a series of webinars and a dedicated advice line.

The guidance sent to all health care providers by NHS England in October sets out that supporting the health and wellbeing of staff and accelerating recruitment and retention is the first priority in ensuring that the NHS can serve patients effectively this winter, which involves:

• ensuring staff have the support they need to maintain their health and wellbeing, such as:

  • staff taking annual leave and having time to recover

  • individual health and wellbeing conversations for all staff, including updating risk assessments and ensuring access to health and wellbeing support

  • access to occupational health and psychological support (through the ICS-based mental health and wellbeing hubs, so far accessed over 37,000 times)

• taking the short-term actions needed to identify and address current workforce gaps, including:

  • identifying and addressing gaps in consultant workforce (by specialty, by trust), taking account of local constraints and risks

  • expanding the workforce by 18,000, including nurses, healthcare support workers, medical support workers, and use of Landmark

  • leveraging temporary staffing (especially bank) and the independent sector

  • enhanced discharge, expansion of digitally enabled virtual wards response

  • improving workforce availability through retention and reduced sickness

These specific actions are accompanied by a commitment to enhance the dialogue between staff and NHS leaders.  

Accessing services this winter

We are doing more than ever to support people to stay well this winter and increase our protection against the Omicron variant. This includes rolling out COVID-19 vaccines, as well as winter flu vaccines for at-risk groups.

Public communication and engagement campaigns will continue to help drive uptake of vaccinations, as well as regular asymptomatic testing, isolating if they have symptoms, and taking other precautions to limit the spread of COVID-19. The government’s Better Health campaign is also currently signposting young people in particular to online self-help support to manage low level mental health difficulties such as anxiety and depression.

While the public have an important role to play in helping NHS staff by doing what they can to keep themselves and their families well, it is important to emphasise that people should continue to access treatment and care when they need it. 

Those who require advice or treatment for urgent, but not life-threatening, medical issues should continue to seek NHS support via the NHS 111 online or telephone service as the first port of call. 111 services can arrange the right care in the right place depending on an individual’s needs, including booking appointments in A&E, other urgent care services and community pharmacies, or arranging an ambulance if this is needed. People requiring urgent mental health support can find their local 24/7 NHS urgent mental health helpline and other support options at nhs.uk/urgentmentalhealth. For those with less urgent health concerns, or worrying symptoms, additional investment is being made available to help GPs and their teams of healthcare professionals to continue to make more appointments available, both remotely and in person.

Community pharmacies are also providing a wide range of services, including consultations for minor illnesses, as well as support for managing new medicines following discharge from hospital, helping reduce readmission.

To be clear, ambulance and A&E services remain available for those who require emergency care.

Due to the planning we have been doing to keep services running safely over winter, people may find that we are organising things differently to how they may have been in the past. For example, appropriate social distancing and infection control measures have remained and will continue in all healthcare settings, including requiring people to wear masks unless they are medically exempt.

We are anticipating that the NHS and care homes will continue to support visits by relatives, but will ask the public to follow advice, get tested in advance and wear a mask throughout their visit.

Despite the need for additional measures such as PPE and testing to protect care home residents, care providers have worked hard to ensure residents are able to continue to take part in activities vital to their health and wellbeing, including ensuring visits from friends and relatives can continue and that residents can take part in activities outside of the home. The government continues to provide guidance on how to support care recipients throughout COVID-19 on our dedicated adult social care guidance portal.

As in all winters, contingency plans are being drawn up at each level, should any part of the system reach severe pressure and patient safety be put at risk. These measures reflect learning from the pandemic and include redeployment of clinical staff, increased focus on timely and safe discharge processes for re-prioritising resources between emergency care and planned care. Patient safety and care for those in most in need remains the priority for the NHS and adult social care.