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’. 

Figure 1: Operational Pressures Escalation Levels (NHSI/NHSE)

File 10907

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 2016File 10910

Chart 2: Map of OPEL 3 and 4 declarations by week, December 2016 - January 2017

How does this compare to last year?

As OPEL figures were not collected until this year, it is not possible to accurately make comparisons between years. But trusts did have to declare to NHS England any days on which they considered they had ‘experienced serious operational problems’. So we can run a crude comparison between these days in winter 2015/16 and OPEL 3 and 4s in winter 2016/17.  As the chart below shows, the OPEL 3 and 4 declarations during the middle two weeks in December outstripped the numbers of serious operational problems. This suggests that winter 2016/17 is already causing more of the traditional ‘black alert’ scenarios than last year. Only time will tell if this trend continues.  Chart 3: Comparing December 2015 with December 2016File 10911 

Winter is here

It has become almost a cliché to say that the NHS is under extreme pressure this winter. With A&E targets missed, hospitals running at very high occupancy levels and record numbers of people who are medically fit to leave hospital unable to do so, there is no doubt that the health service is facing an extremely tough few months.  The real pressures usually start to show as winter gets into full swing later this month. But an early look at the OPEL data shows that winter is most certainly here and already tough across the NHS. Time will tell whether trusts are able to manage the considerable pressures under which they are operating. We will be watching the OPEL data closely.  


* 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.

20/01/2017: Chart 2 has been updated to include data from the second week in January.

27/01/2017: Chart 2 has been updated to include data from the third week in January.

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