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Government urged to act as managers say NHS has reached 'tipping point'

The NHS has reached tipping point, health service managers are warning.

The NHS Confederation, which represents managers across England, said it was time the Government accepted "limited investment" has "consequences".

The comments come as new figures for November show a health system under strain as it got ready to enter its busiest time ever over Christmas.

They showed acute problems with delayed discharges - where patients are medically fit to leave hospital but are stuck in beds due to problems arranging care in the community.

This impacts on A&E as hospitals struggle to find beds for incoming patients.

Snapshot figures on delayed discharges at midnight on November 24 show there were 6,825 people waiting to be discharged - the highest on record, and up 22% on the figure for November 2015 (5,573).

Trolley waits of over four hours after a decision has been made to admit the patient totalled 52,769 - the second highest figure on record and 54% higher than November 2015.

Waits of over 12 hours totalled 456 - again, the second highest figure on record. This is 16 times higher than the number for November 2015.

The proportion of people seen at A&E within four hours in November was 88.4%, against a 95% target, and lower than the 91.3% in November last year. November's figure of 88.4% is the lowest since March 2016 (87.3%).

Stephen Dalton, chief executive of the NHS Confederation, said: "Pressure on A&E departments is being caused by a lack of funding in primary, community, mental health and social care.

"Health and care staff on the front line are working harder than ever this winter and are continuing to 'just about cope', but this is simply not sustainable.

"We have been issuing warnings of the system approaching a tipping point for some time, but we are now starting to see proof that this point has been reached. The Government must accept that limited investment at a time of increased demand has consequences.

"While broad public health programmes have their place, only further and quicker Government intervention can fix the imbalance in services that is at the root of this crisis.

"We are also calling for an urgent cross-party process to inform public debate on funding and structures, setting out a plan for the long-term sustainability of the health and care system."

Matthew Swindells, NHS England's national director for operations and information, said: "This month's figures show a 42% annual increase in delays in being able to discharge patients as a result of pressures in social care.

"Hospitals report this affects their ability to quickly admit emergency A&E patients, so the NHS is working closely with local councils and community health services to enable older patients to get the support they need after a hospital stay, back at home."

Shadow health secretary Jonathan Ashworth said: "This week we have learnt of the intense pressures on our NHS this winter. Instead of addressing this crisis with a package of urgent support for social care, Government ministers suggested downgrading the A&E target - a move which provoked a widespread backlash."

Liberal Democrat leader Tim Farron said: "As we see A&Es full, people waiting hours on the phone to get a GP appointment or on a trolley in a ward, the buck lies with the Prime Minister and this Conservative government.

"Theresa May has lost control of the NHS crisis and needs to get a grip."

Tim Gardner, senior policy fellow at the Health Foundation, said: "The NHS has begun this winter in a worse position than at any time over the last five years.

"The NHS is being squeezed between rising cost pressures and an underfunded social care system that is reaching breaking point."

Jim Mackey, chief executive of NHS Improvement, said the figures "confirm what we've been saying about the increased pressures the NHS is facing".

But he added: "We are starting to see early signs of this pressure easing in places."

Meanwhile, Pulse magazine reported how N HS managers are drafting in GPs to help discharge and care for patients as hospitals continue to be overwhelmed.

NHS North Lincolnshire clinical commissioning group (CCG) officials have been trying to relieve pressure on Scunthorpe General Hospital, which they said is "facing unprecedented demand" on services, with patients "experiencing extremely long A&E waits".

In Leicestershire, the CCG said patients may be discharged to"'unexpected" settings, including being sent home to be cared for by loved ones.

Earlier, former Tory health secretary Stephen Dorrell hit out at "unfair" criticism of the boss of NHS England reportedly meted out by Theresa May's senior aides.

NHS chief executive Simon Stevens went against the Prime Minister over the state of NHS funding by telling MPs it is "stretching it" to say it got more money than it asked for.

He said an extra £10 billion was being made available to NHS England over the course of six years but overall the health service had "got less" than set out in its five-year plan.

The comments contradict those of Mrs May, who has insisted the NHS got all it wanted in the funding settlement.

Mrs May's official spokeswoman said the Prime Minister had "full confidence" in Mr Stevens.

On the funding issue, she said: "The figures are clear. We have been clear that the NHS will see an increase in real terms in its funding of £10 billion."

A Department of Health spokeswoman said: "Despite the NHS being busier than ever, the vast majority of people are seen quickly - 208,000 more people attending A&E were seen within the four-hour standard in the past year compared to the year before.

"The NHS is facing increasing demand from our ageing population, so we are joining up health and social care to make sure patients are not in hospital unnecessarily, supported by an extra £10 billion per year by 2020 to fund the NHS's own plan to transform services for the future."

In an interview with ITV, the chief executive of Milton Keynes Hospital, Joe Harrison, said: "I've worked in the NHS for 30 years and this is the most relentless pressure we've faced."

Figures obtained by the Guardian show at least 23 hospitals in England have had to declare a black alert this week, which says patient safety is at risk.

University Hospitals of Leicester NHS trust declared a "system critical incident" - even higher than a black alert - on Tuesday, the newspaper reported.

Lewisham hospital in south London became so full on Monday it had run out of beds and in an email to staff it described the situation as "critical" and "not safe".

A statement from the British Lung Foundation said: " We are hearing reports that doctors are struggling to cope with an increase in patients with respiratory conditions.

"This is a huge concern. Severe cold weather poses a serious risk to people living with a lung condition as it can trigger a flare-up of symptoms.

"It is vital that people living with a lung condition are able to access their GP and get a flu jab. They should also be able to have a one-off anti-pneumonia vaccination."

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