This time of year it is common to hear local news stories of NHS hospitals declaring ‘black alerts’. This term has been used to describe the operational difficulties hospitals find themselves in when demand for their services outstrips their capacity to provide it. This usually means hospitals having to divert patients elsewhere to receive emergency care.
‘Black alert’, and other terms to describe these periods of operational difficulty like ‘major incident’ and ‘critical incident’, are undoubtedly evocative. But they have lacked a centrally agreed definition. Instead each trust’s board declared these incidents as they saw fit, leading to much local press coverage but little opportunity for analysis of how widespread or comparable these incidents really were.
Introducing OPEL – a new way to understand winter pressures
This year, a new system has been introduced which permits a little more analysis of the operational pressures facing NHS hospitals in winter. Trusts have been required to record any days on which they have reached any of four different Operational Pressures Escalation Levels, known as OPELs.
As the table below shows, OPEL 1 involves ‘meeting anticipated demand within available resources’, and OPEL 2 denotes a trust ‘starting to show signs of pressure’. Levels 3 and 4 correspond more closely to the old terms such as ‘black alert’ or ‘major incident’.
What do the OPEL figures tell us about winter so far?
So far this winter we have had data published since the start of December, allowing us to get a sense of how the NHS is coping with the considerable pressures it is facing.
While it may be too soon to tell how winter 2016/17 is affecting the running of NHS hospitals, a look at the OPEL data does offer us an early clue.
The figures published by NHS England for the period 1-27 December* show that:
- Around a third (50) of the 152 trusts that sent data into NHS England declared an OPEL 3 or 4. Of those, seven were OPEL 4s.
- In total, 201 OPEL 3 or 4s were declared between 1-27 December, of which 15 were OPEL 4s.
- The start of the weeks of the 12th and 19th of December saw two peaks in number of trusts at OPEL 3 and 4.
- The worst day in this period was Tuesday 13 December, with 23 trusts at the highest levels, including four at OPEL 4.
After our analysis was originally published, more recent figures were released by NHS England, completing our picture of the week following Christmas and covering the weekend of the New Year. For much of this period, the number of trusts declaring high operational pressures this year remained above those experiencing serious difficulties last year. There was an improvement in the first weekend of 2017 with only three trusts at the higher levels: however, two of these were at the highest OPEL 4 level. Overall, the picture remains one of great pressure with fluctuations caused by the events of the holiday season.
It’s worth remembering that we are still in the early part of winter, so it is hard to know how things will look later on in the year. We do know from previous years that pressures on trusts get much worse from early January onwards, but the purpose of the OPEL system is to flag up these problems early on and put in place plans across the whole local health system to tackle them. If the OPEL framework is working as it should, we might expect to see fewer 3s and 4s as time goes on.
Chart 1: OPEL 3 and 4 declarations during December 2016
Chart 2: Map of OPEL 3 and 4 declarations by week, December 2016 - January 2017
How does this compare to last year?
Winter is here
* We have maintained the original figures for this analysis, which covered only 1-27 December. However, more recent data are now available and we have added an extra paragraph analysing the last week of December separately. Charts have been updated for style but cover the original dates of analysis.
13/01/2017: We have now included a new chart, chart 2, to map the OPELs by trust on a weekly basis. This includes new data for the first week of January.