NHS Winter Pressures Explained: Challenges, Solutions, & 2025/26 Plans

The NHS in England faces critical challenges during winter, including increased pressures on accident and emergency (A&E) departments and ambulance services. We’ll discuss the acute pressures experienced in winter 2024/25, including record A&E waits and ambulance delays. The episode highlights strategies to address these issues, such as prevention, increased capacity, and workforce support. Finally, we delve into the government's plans and NHS guidance for winter 2025/26, aiming for significant improvements in urgent and emergency care.

Key Takeaways

• Persistent Winter Strain: Cold weather increases health risks and the spread of viruses (flu, RSV, norovirus, COVID-19), leading to significant pressure on the NHS, especially A&E and ambulance services.
• Acute 2024/25 Challenges: Winter 2024/25 saw increased A&E diverts, a record 11% of patients waiting over 12 hours for A&E admission in January 2025, and 32% of ambulance handovers taking over 30 minutes. Seasonal viruses occupied almost 600,000 hospital beds.
• Core Causes of Pressure: Pressures stem from increased demand for complex care, consistently high bed occupancy rates (exceeding recommended safety levels since at least 2010), and delayed patient discharges due to a lack of social care capacity.
• Addressing Pressures: Efforts include preventing illness through vaccinations and guidance, increasing hospital bed and staff capacity, and supporting the wellbeing of the NHS workforce.
• 2025/26 Strategic Plans: The NHS Urgent and Emergency Care Plan for 2025/26 aims to reduce ambulance wait times, ensure 78% of A&E patients are seen within 4 hours, lower 12-hour A&E waits to under 10%, and tackle delayed discharges. Integrated care boards (ICBs) and Trusts will stress-test their plans in September 2025.
• A&E Waits and Mortality: Research indicates a statistical association between longer waits in A&E and a higher risk of 30-day post-discharge mortality, though it's not definitively proven as a direct cause.

Source: NHS winter preparedness
Research Briefing
Published Friday, 15 August, 2025

Transcript

Amy: 0:00

Hello and welcome again to The Bench Report, concise summaries of debates and briefings from the benches of the UK Parliament, a new topic every episode. You're listening to Amy and Ivan. Today, we're exploring why the NHS faces such, well, such intense pressure during winter, particularly ambulance and A&E services. And crucially, what's being planned for the coming winter, 2025-26? You've provided some really insightful material, and it's clear this isn't just about, you know, a bit of cold weather. It's a critical time for healthcare across the UK. Let's maybe start with the recent winter, 2024-25. What was the actual picture like for NHS services then?

Ivan: 0:40

Well, the health minister, Corinne Smith, was quite direct. She stated that despite all the staff's tireless efforts, patient care just wasn't meeting expectations. And the numbers, they really paint a stark picture. We saw 570 A&E diverts between November 2024 and March 2025.

Amy: 0:55

Diverts meaning they had to send patients elsewhere?

Ivan: 0:57

Exactly. Departments redirecting patients because they're over capacity. And that number has been rising over the past three winters, which is worrying. Even more concerning was the proportion of patients waiting 12 hours before admission from A&E. It's a record high.

Amy: 1:12

A record high?

Ivan: 1:12

Yes, 11%. in January 2025. Now, just for context, before the pandemic, that figure was under 1%.

Amy: 1:19

Under 1%. Wow.

Ivan: 1:21

Quite a jump. Ambulance handover delays also spiked. About 32% took longer than the target 30 minutes. That's up from previous winters, too. And on top of all that, you had nearly 600,000 hospital bed days taken up just by patients battling what they called a quadimica virus. COVID-19, flu, RSV, that's respiratory, syncytial virus, and norovirus. Almost 600,000 bed days just from those.

Amy: 1:44

Those numbers are certainly stark. But it's interesting that you mentioned it's not just about more people getting sick. What are the underlying forces creating this kind of perfect storm each winter?

Ivan: 1:54

Precisely. It's complex. There are several core issues at play. Firstly, increased demand and, importantly, complexity. A&E departments might actually see slightly fewer attendances overall compared to pre-pandemic peaks sometimes, but the cases arriving are often far more serious. More complaints needs.

Amy: 2:13

And the cold weather itself plays a part.

Ivan: 2:15

Absolutely. It directly contributes. You see increases in hypothermia, more falls, especially among the elderly, and it worsens existing long-term conditions like asthma or COPD. Plus, naturally, viruses just spread more easily when we're all indoors more.

Amy: 2:28

Makes sense. What else?

Ivan: 2:30

Secondly, high bed occupancy is a persistent major problem. Hospitals have consistently been operating above the safe 85 percent threshold.

Amy: 2:38

That's the level recommended by the Royal College of Emergency Medicine, isn't it?

Ivan: 2:41

That's the one. They've also been hitting over 92 percent occupied since the winter of 2017-18. It's also worth noting the UK context. We have fewer hospital beds per thousand people compared to many similar European countries like France or Germany.

Amy: 2:55

Fewer beds overall makes high occupancy even harder. Exactly.

Ivan: 3:00

And finally, delayed discharges. This is a huge factor. As of January 2025, almost one in every seven hospital beds was occupied by a patient who was medically fit to leave. largely due to a lack of capacity elsewhere in care homes or in community social care services needed to support them at home. The data showed capacity issues were the primary reason for nearly a third. Thirty two point eight percent of those delays in January.

Amy: 3:29

So putting this all together, if we look ahead to winter twenty, twenty five, twenty six, what are the government and NHS planning to do differently? What are the strategies?

Ivan: 3:36

They're focusing on a few key areas, prevention, managing demand and trying to increase capacity on prevention. There's a big push for vaccinations, flu, covid Yes, adding extra beds

Amy: 3:55

and

Ivan: 4:00

staff is part of the plan. Act by short-term funding. Though, as you can imagine, short-term funding makes long-term planning a bit tricky. NHS England also has its urgent and emergency care plan for 2025-26. It sets some, quote, ambitious targets for this winter.

Amy: 4:16

Ambitious how?

Ivan: 4:17

Well, they're committing to making it significantly better. Specifically, they aim to reduce ambulance waits for Category 2 calls. Those are serious but not immediately life-threatening, like a suspected stroke by over 14%. The target is an average wait of 30 minutes, down from 35. OK.

Amy: 4:34

And in A&E itself?

Ivan: 4:35

They want 78% of patients admitted, transferred, or discharged within four hours. That's up from the current figure around 75%. They also aim to get those really long 12-hour waits for admission down to less than 10% of the time. And crucially, tackling those discharge delays we talked about, focusing on patients stuck in hospital 21 days or more after they're ready to leave.

Amy: 4:55

And how do they know these plans will actually work under pressure?

Ivan: 4:57

They're doing some stress testing. Integrated care boards and Trust the Local Health planning bodies will take part in something called Exercise Ages in September 2025. It's designed to test their plans against different scenarios, like big surges in respiratory illnesses.

Amy: 5:14

This brings up a really critical point you highlighted from the material. Is there actually a proven link between these longer waits in A&E and worse patient outcomes, specifically mortality?

Ivan: 5:26

That is a critical question. The Office for National Statistics, the ONS, published analysis on this back in January 2025. What they found was a statistical association. Patients who waited longer in A&E were statistically more likely to die within 30 days of being discharged.

Amy: 5:42

How much more likely?

Ivan: 5:43

For example, someone waiting 12 hours for non-immediate care had 2.1 times higher odds of dying within 30 days compared to someone waiting just two hours.

Amy: 5:51

Two times higher odds. That sounds significant.

Ivan: 5:54

It certainly sounds it. However, and this is really crucial, the ONS is very careful to state this is a statistical association, not necessarily direct causation.

Amy: 6:02

Meaning the wait itself might not be the direct cause of death.

Ivan: 6:05

Exactly. They use the analogy Thank you for watching. Perhaps they were sicker to begin with, which caused both the longer wait and the higher risk.

Amy: 6:29

Yeah.

Ivan: 6:30

They can't definitively separate those things out from the data they have.

Amy: 6:33

So a link exists in the data, but we can't say for sure the weight caused the outcome. Still, it's a deeply concerning association.

Ivan: 6:40

Absolutely. It underscores the urgency of tackling these delays.

Amy: 6:43

So thinking about all this, what does it really mean for you, the listener? This clearly isn't just about abstract numbers or targets. It genuinely impacts lives and the care people receive. As always, find on social media at Bench Report UK. Get in touch with any topic important to you. Remember, politics is everyone's business.