Snowed under? Understanding the effects of winter on the NHS

Nuffield Trust | December 2018 | Snowed under? Understanding the effects of winter on the NHS

A new explainer from the Nuffield Trust unpacks what winter means for the NHS, in terms of its impact on health, demand for services, and how the NHS responds.winter-snow-nature-60561.jpeg

Key points

  • Even moderately cold weather (an average temperature of 5­–8 degrees celsius) results in increased illness and higher death rates.
  • Flu epidemics have a major impact when they occur, but there is significant variation from year to year in how many people and which groups are affected.
  • Primary care deals with most of the increase in winter-related illness. Small changes in the ability of primary care teams to manage peaks in demand become amplified across the wider care system.
  • The number of A&E attendances actually decreases in winter, but the proportion of people admitted increases.
  • A higher proportion of patients with longer lengths of stay in winter means hospitals have less flexibility to manage demand.
  • Given recent trends, we can expect the pressure on the NHS this winter to be similar to last year.
  • Although A&E waiting times tend to grab the headlines, health systems should consider a broader range of factors when assessing winter pressures, from deaths related to cold temperatures and provision of services in the community through to the way acute medical patients are managed in hospital. (Source: Nuffield Trust)


Going Smoke-free: Tees, Esk and Wear Valleys NHS (Mental Health) Trust [Atlas of Shared Learning]

NHS England | December 2018 | Going Smoke-free: Tees, Esk and Wear Valleys NHS (Mental Health) Trust

A nurse led a smoking cessation programme board at Tees, Esk and Wear Valleys NHS Trust implemented a move towards a smoke-free trust, given the demonstrable evidence of the benefits of such an initiative, particularly when recognising the local unwarranted variation of significantly higher numbers of mental health patients at the Trust identified as smokers, compared to the national average.

This led to:

Better outcomes – In a 2016 Friends & Family Test (FFT) 10% of staff who responded identified themselves as smokers. In early 2017 only 8% of staff identified themselves as smokers. Latest FFT data indicated that only 7% of staff identified as smokers in August 2017. The 2018 FFT has completed and the Trust is currently awaiting the final data prior to distribution to staff. Within ‘Trust A’ in the evaluation, the proportion of inpatients for whom smoking status was unknown fell from 39% to 13% over the last 18 months of the study period. There is wider evidence from the clinical audit of smoking status, that smoking prevalence fell within the Trust from 43% in 2015 to 21% in 2018.

Better experience – Both patients and staff have reported that the support provided as a part of the policy has been well-received and a mechanism for change – which is a positive indicator of experience.

Better use of resources – The training and skills provided to staff as part of the initiative have supported them to offer a more holistic approach to care without the need for referral onwards which again will have several benefits to service users and their families. The evidence of the evaluation suggest the monthly cost of prescribing NRT products is not excessive, varying between £3,000 and £4,000 per month within each Trust.

For Trusts looking to go smoke-free, the nurse leadership team at Tees, Esk and Wear Valleys NHS Trust recommend planning at least 12-18 months in advance.

(Source: NHS England)

Read the full case study at NHS England 

Procuring for effective wound management [Shared Atlas of Learning Case Study]

NHS England | November 2018 |Procuring for effective wound management

A case study on the NHS England’s Shared Atlas features an innovation from a nursing team who introduced a centralised procurement system,  generating savings of £45,000 which has been reinvested in services.

The nursing team for the Wound and Lymphedema service at the East London Wound Healing Centre identified significant unwarranted variation in the supply and use of wound care products across their service, with variation in a standardised approach to dressing choice and in some instances the most optimal dressing was not being utilised.


This innovation led to:

Better outcomes – Enabling clinicians to directly order on a patient needs-based approach has improved care and outcomes, helping to identify patients with complex needs and triggering specialist interventions. Standardising wound care based upon best practice will also improve outcomes for patients.

Better experience – The supply system has reduced delays in treatment for patients and keeping track of ordering trends has highlighted training needs and targeted support to some teams and providers. The new system has resulted in effective and efficient access to dressings for patients and improved patient care.

Better use of resources – The scheme has operated within the original budget despite an 18% increase in population. Savings of £45,000 have also been reinvested in services. Total wound care spend per patient in Tower Hamlets is significantly below the national average without compromise on quality of service provision. The procurement system has done this by reducing over-ordering and the associated risk of dressings going unused. The scheme has generated cash savings of £82k that has been reinvested back into services such a wound care projects or interventions.

Read the full case study at NHS England 


‘The gloves are off’ campaign [Shared Atlas of Learning Case Study]

NHS England | December 2018 | ‘The gloves are off’ campaign’

The use of non-sterile gloves has been associated with a significant potential for cross-contamination and transmission of healthcare-associated infections (HAIs). This is because they are often used when they aren’t needed, put on too early, taken off too late or not changed at critical points (Source: NHS England)

A case study recently added to NHS England’s Shared Atlas of Learning, addresses the over-use of non-sterile gloves through education and training. The Lead Nurse for Infection Prevention and Control and two Lead Practice Educators at Great Ormond Street Hospital NHS Foundation Trust (GOSH).


Actions included establishing a working group to develop an educational awareness programme for staff. This included an updated educational package for when gloves should be worn generally in practice and a risk assessment strategy for use of gloves when preparing intravenous medication.

Staff were asked to risk assess when they would wear gloves for giving medication. Gloves were only needed for:

  • any medication where you could be in contact with a bodily fluid. e.g. eye drops, nose drops
  • any therapeutically active cream
  • any liquid hormones or cytotoxic medications.

As a result of the nurses’ actions, the case study reports:

Better outcomes – There has been a reduction in staff attendances to occupational health for hand or skin related problems. The CVL infection rate remains within normal parameters and there has been no adverse rise in hospital acquired infections including Vancomycin-resistant Enterococci (VRE), viral respiratory and enteric infections.

Better experience – The father of a child with learning disabilities gave feedback that his child is hospital and gloves phobic and the project has improved the quality of their life.

The main focus of the project was to provide education and training so that staff felt empowered to risk assess when they used gloves, which has been achieved.

Better use of resources – There has been a significant reduction in the amount of gloves ordered into the hospital. The most recent mean for gloves ordered is 163,125 per week, which is taken from the baseline period between the weeks beginning 15 April 2018 and 29 July 2018, which is a significant reduction on the previous mean of 199,733 units per week a difference of 36,608.

The outcomes of the project are continuing to be monitored and are reported quarterly to staff across the Trust and Nursing Board.

Read the case study at NHS England 

Rough Sleeping Strategy: delivery plan

Ministry of Housing, Communities & Local Government | December 2018 | Rough Sleeping Strategy: delivery plan

In the Rough Sleeping Strategy, published in August 2018, the Ministry of Housing, Communities & Local Government committed to publish a delivery plan setting out how they intend to deliver the 61 commitments they made.


The Rough Sleeping Strategy: delivery plan provides an update on their progress so far, further information including key milestones on all 61 commitments, and information on next steps.

The rough sleeping strategy is a wide ranging document which lays out the government’s plans to help people who are sleeping rough now and to put in place the structures to end rough sleeping for good (Source: The King’s Fund).

Download Rough Sleeping Strategy: delivery plan 

In the news:

BBC News Young homeless blocked from renting, says report

The Guardian 24,000 sleeping rough or on public transport in UK, charity says 

Ways of integrating care that better coordinate services may benefit patients

NIHR | December 2018 | Ways of integrating care that better coordinate services may benefit patients

In one of its latest Signals, the NIHR highlights a systematic review identified 267 pieces of literature from the UK and countries with a comparable economy, all published from 2006onwards, which analysed and described new models of integrated care. 

The review- funded by the NIHR-  looked at the international literature to understand how new care models may affect patients, providers and systems. Almost half of the 267 studies came from the UK. Most investigated integrated care pathways, often as part of a multicomponent intervention including multidisciplinary teams and some form of case management. Most studies focused on older people.



The review finds some positives, but overall highlights the complexity of implementing and assessing new models of care. The reviewers found the complexity and variability of interventions across the literature, a hindrance in understanding the effect of specific changes. Most studies were at risk of bias, with few comparison studies as these are often not appropriate for organisational research (Source: NIHR).

Read the NIHR Signal in full here 

Published abstract here



Domestic abuse victims suffering in silence at work

University of Central Lancashire | December 2018 | Domestic Abuse Victims suffering in silence at work 

University of Central Lancashire (UCLAN) and Sheffield Hallam University researchers have found that victims of domestic abuse working in both the public and private sector generally do not discuss their experiences with their employers. Victims found that in most instances victims of domestic abuse will only disclose this if they are being faced with disciplinary action or sanctions, which are a consequence of the abuse. 


The researchers interviewed trade almost 40 trade union officers from across the north of England about their views on and experience of working with line managers and HR staff who had supported victims of domestic violence.

A key finding of the study is that the workplace is a haven for many victims, financially, physically and emotionally. It also highlights that many managers were still unaware of the signs that their employees are suffering  domestic abuse (Source: UCLAN).