The NHS is under enormous pressure, with the strain being felt across all parts of the service. No wonder that many NHS leaders are saying it feels like “winter in summer.”

Last week’s performance figures showed us that July 2021 had the second highest number of the most serious type of A&E attendances ever. The highest ever was in June 2021. There were more than a million 999 calls answered, an unprecedented number.

NHS leaders are telling us the same about demand pressures for community services, mental health, ambulance services and primary care. There are 5.45 million people on the waiting list and some hospitals are having to stand down care because of covid-19. These pressures will get more intense as we head into the traditionally busy months, with the Institute for Fiscal Studies predicting that the waiting list could go as high as 13 million.

NHS leaders are clear that emergency departments cannot be the system point of failure. That is why we need system wide solutions to the demand crunch that frontline services are facing, with national support in place to help staff and their teams.

We brought together leaders from across the system to explore the practical measures that need to be put in place to ensure the NHS is not overwhelmed over the winter. The focus was on what we can learn now in order to plan well—as a system—for the winter.

The starting point is that we must be collectively honest about the challenges and the support needed and, ultimately, we must allow local leaders to lead.

But most important is the need for true integration and an opportunity to “transform our way out of it,” as one NHS leader said. We have seen local leaders work collaboratively throughout the pandemic and take the lead on innovative changes to patient pathways that improve both quality and responsiveness, such as effective nurse triage models in rapid assessment areas and same day access to diagnostics. They have also been able to better manage patient treatment lists by sharing patient data. 

This approach now needs to be adopted at a system level for the longer term, and organisations and local systems will need support to do so. 

We have laid out in a briefing ten key areas that need to be focussed on. They include clarity on the funding model, which includes extending funding so that patients can be discharged from hospital quickly with the right support in place once they are medically fit, and—crucially—confirmation of budgets for the second half of the year. There is also the need for clarity on efficiency targets and money needed to support maintenance and improvement to often-dated facilities and other infrastructure that can hold services back.

Implementing 24/7 urgent care models for mental health and extended hours to aspects of primary care, with maximised walk-in facilities and system solutions for staying in touch with patients on the waiting list will make significant system-wide differences too.

In the face of rising pressures on all parts of the NHS, this is the time for all parts of the system to come together to find solutions. And we need those in Government and the national bodies to enable this as we are still seeing some inconsistencies in how the regulators are working with frontline providers, with some being supported while others are facing more punitive approaches. Only by taking a system approach to risk management will we be able to avoid organisational intervention for what are system-wide issues that need tackling.

James Devine, programme director for acute care, NHS Confederation. 

Competing interests: none declared.