Where hospitals can find capacity this winter

Every NHS trust in England was required to have its winter plan signed off by its board by 30 September, and NHS England’s letter set out clear expectations for what those plans should deliver. Trusts were told to implement the Model emergency department, the Model acute pathway and the Model discharge pathway ahead of winter, with eliminating corridor care treated as a patient safety priority while elective capacity is maintained throughout winter.

The scale of the challenge can be seen in the latest national figures, which show an average of 2,973 patients a day receiving corridor care in August, 2,296 of them in emergency departments. This followed a summer when a record 7.27 million people attended A&E during June, July and August.

Winter plans also show how limited the options are for creating additional capacity. The joint winter plan for Derbyshire, Lincolnshire and Nottinghamshire, put to their board on 17 September, states that there is no additional funding for winter and identifies measures equivalent to 244 additional beds between October and March, yet still records a residual bed gap in October and January.

That plan was stress tested against scenarios including problems with discharge and patient flow, and among the highest risks it lists are a failure to sustain progress on corridor care through winter, and the risk that delayed discharge leaves patients weaker and less independent. With no additional winter funding, making better use of existing capacity becomes even more important.

A bed does not become available at the moment a patient is confirmed ready to leave. A porter has to be found and sent to move the patient to the discharge lounge or transport, equipment has to be collected and returned, and the bed space has to be cleaned and made ready before it can be offered to a patient waiting in the emergency department.

Each of those steps usually belongs to a different team, and each is often requested by telephone, radio or pager, which can make the time between each stage difficult to see and manage. The same regional winter plan shows trusts treating this as a live operational concern, with daily meetings held to escalate cleaning delays, and daily reviews to prioritise cleaning so that it does not hold up patient flow.

NHS England’s Model discharge pathway asks hospitals to keep daily oversight of the number of discharges delivered, their timing during the day and their variability across the week, and to compare discharge data with the number of patients waiting more than 12 hours in emergency departments or receiving care in corridors. It also expects senior forums to review delays relating to diagnostics, medicines, therapy, transport and documentation.

However, portering and bed cleaning after the discharge decision are not covered. Once a patient is ready to leave, they still need to be moved, and the bed space cleaned before it becomes available again. Without the same visibility of these tasks, delays can be difficult to identify and address.

Navenio gives hospitals real-time visibility of this activity without any new infrastructure, using AI and the sensors already in staff smartphones to locate porters and cleaners indoors and assign tasks to the most appropriate person nearby. Tasks can be linked together, so moving a patient and cleaning the bed space can be dispatched as a single sequence rather than as separate requests that wait for each other.

At Cumberland Infirmary, task response times fell by 58% after Navenio was deployed. Since the initial pilot in 2022, porter response times have fallen by two thirds and cleaner response times by almost half.

Claire Spencer, Head of Customer Service at Navenio, said: “Winter plans rightly focus on bed capacity, but a bed isn’t available for the next patient until the previous patient has been moved and the space cleaned. Hospitals already have portering and cleaning teams doing this work every day, but delays can build up between each step. Real-time visibility of teams and tasks helps reduce these delays and automatically creating a cleaning task as soon as a patient is moved from their bed during discharge saves clinical staff time too.”

With plans signed off by boards and the winter season now under way, the focus turns to delivering them. Improving patient flow does not necessarily require more beds: reducing the time between a patient being ready to leave and that bed becoming available can help hospitals make better use of the capacity they already have.