Extra measures to ensure safe and high quality care this winter
This year is shaping up to be one of the busiest years on record for our hospitals – driven by high numbers of patients attending A&E or waiting for planned care. Patients are often also sicker and frailer than in previous years, which means they may need extra support to leave hospital as well as when they are here.
Our winter operational plan includes a raft of additional measures to help us maintain safe and high quality care, including when we are very busy or at full capacity. Our plan has three key areas of focus:
1 Helping patients avoid inpatient stays where possible
We offer a range of services that allow patients to be treated in dedicated same-day clinics or virtually, at home. This helps avoid unnecessary hospital admissions and keeps beds available for those who need inpatient care.
Initiatives in place to avoid unnecessary hospital stays this winter include:
• Making full use of our virtual wards service – for suitable patients with conditions such as chronic obstructive pulmonary disease, diabetes or heart failure, providing equipment that allows them to be closely monitored at home by a dedicated clinical team. Our service – now available to over 170 patients a month – had a particularly positive rating in this year’s national adult inpatient survey.
• Expanding our same day emergency care (SDEC) services – by directing more A&E patients to same or next day specialist clinics in our outpatient departments, allowing us to see more patients within our dedicated SDEC units each day.
• Supporting ambulance crews to reduce unnecessary A&E attendances through the new, North West London Integrated Care Coordination hub. The hub offers London Ambulance staff on the ground rapid access to remote clinical consultations from a team of experienced clinical decision makers, including a number of our consultants. This expert advice, including onward referral to other services where appropriate, is helping many patients to get the care they need without having to attend an A&E department.
2 Reducing unnecessarily long hospital attendances or stays
Once patients have had the investigations and treatment they need from our services and are clinically stable – whether in A&E or as an inpatient - ongoing care is better provided at home or closer to home. Sometimes, patients might need specialist care, such as mental health care, that we do not provide ourselves. We want to ensure patients are able to leave hospital promptly and smoothly once they are clinically fit to do so. We work closely with a range of health and care partners to identify and organise the right support and follow-on services. In an average month, 227 patients remain on hospital wards when they no longer need to be, due to delays with the discharge process or getting the right ongoing support in place.
Measures we have taken to reduce unnecessarily long hospital attendances or stays include:
• Rolling out a successful pilot which involves nurses and allied health professionals being able to approve hospital discharges using a clear set of criteria, rather than having to wait for a doctor to sign off. This approach increased discharges at the weekend by three per cent when it was trialled at St Mary’s Hospital in July 2025.
• Extra pharmacy support in A&E to help manage the prescribing, supply and management of medicines to avoid delays caused by patients waiting for medication before they can leave.
• Working with our local mental health trusts to support people with mental health needs. This includes referring suitable patients to north west London’s Mental health crisis assessment service.
3 Ensuring we manage surges in demand safely and thoughtfully
Due to demand throughout the year, additional beds we opened last winter have remained open and we don’t have any other ‘spare’ beds to open anywhere across our sites.
To manage surges in demand, we do all we can to increase ‘operational flow’ through our hospitals – reducing unnecessary attendances and long stays so that we can care for more people within the same capacity. We are bringing our internal alerts for managing operational pressures in line with the national ‘OPEL’ (operational pressures escalation levels) framework. This will help us to be even more coordinated across the Trust and the wider health and care system in our response. As we move up the four OPEL levels, we trigger a specific set of actions and support. We will also share information about our OPEL level with all staff, patients and the public.
Like other hospitals, when we are at or near full capacity, one of the actions we take is to put extra beds or trolleys temporarily into existing wards or units – for example in outpatient areas like endoscopy or, more commonly, in our A&E departments.
We only use these 'temporary escalation spaces’ when absolutely necessary. We have introduced clearer processes for recording and monitoring the use of these spaces and ensuring we are doing everything needed to keep patients safe and as comfortable as possible.
Ian Bateman, chief operating officer at Imperial College Healthcare NHS Trust, said: “The coming months will be challenging and so we have planned very carefully to prioritise safety and quality, to keep waits – in A&E and for planned care – to a minimum, and to ensure our staff stay safe and well too.
"We will be here for everyone who needs us, but we also need everyone to do all they can to stay healthy and get the right care at the right time. NHS111 is available 24/7 – online or via phone – to give advice about where to go as well as treatment for minor injuries and illnesses. If you’re eligible, please make sure you get your flu and Covid vaccinations – it’s one of the best ways to keep well this winter. And, for all of us, kindness and collaboration will be more important than ever.”
