NHS readiness for winter 2024/25

This debate pack explains what extra pressures the NHS faces over winter and why, government policy and stakeholder comments. Health policy is devolved. This briefing provides information relevant to England.

For key NHS statistics in England, including on A&E waiting times, hospital waiting lists, ambulance response times, staffing levels and more, please see the library briefing on NHS key statistics: England.

What extra pressures does the NHS face over winter?

Health services are under pressure and face significant capacity issues. An ageing population with increasingly complex care needs, high demand and inflation are all contributing to pressure on NHS finances and a reduction in timely access to services. NHS England has stated that elective care waiting lists have been significantly impacted by the covid pandemic and that it is working to deal with the backlog (see Lords Library briefing on the 75th anniversary of the NHS).

Many health conditions such as asthma, other respiratory diseases and lung conditions can be caused or worsened by cold weather. Winter typically also sees higher incidence of illnesses such as flu, noroviruses and pneumonia that particularly affect the elderly and vulnerable. These factors can lead to more people being admitted to hospital over the winter period. For example, NHS England reported that the number of people in hospital with flu at the end of December last year (an average of 648 patients per day in the week of the 21 December) was four times the figure at the end of November (160 in the week of 26 November). Research from Suffolk suggests that hospital admission rates are significantly higher in colder winters compared to warmer winters.

In winter 2023, there were substantial pressure on hospital beds, with people experiencing lengthy waits to be admitted, ambulances facing difficulties handing patients to emergency departments, and delays in discharging clinically ready to leave people from hospital beds.

Delays in discharging can further lead to long waits for people who need to be admitted to hospital after attending A&E. In recent winters, the number of people waiting more than 12 hours to be admitted (after the decision to admit them was taken) was more than 40,000 in December and January.

According to NHS England data, in February 2024 there were between 13,200 and 14,200 patients remaining in hospital each day who did not meet the criteria to stay. This represents over one in eight general and acute beds in England (see Library article on Capacity pressures in health and social care in England for more details).

Delays in discharging patients can be due to:

• patients needing further assessment, or team’s agreement on what further care patients need
• patients waiting for community health service and/or social care to be set up at home
• patients waiting for a short-term bed, such as for rehabilitation
• patients waiting for a permanent bed in a care or nursing home

All these factors contribute to NHS pressures increasing over the winter, including in GPs, pharmacy services and in hospitals. Pressures can also be compounded by staff vacancies and absences, which are an ongoing challenge for the NHS. Vacancies can worsen in the winter due to factors such as illness or industrial action in previous years. NHS England reported that in the week of 18 December 2023 almost 50,000 staff absences were recorded on average, with Covid related absences up 37% since the end of November.

Government policy

In previous winters, the government has given extra support, such as providing emergency short-term funding, to support local areas in better managing increased NHS pressures over the winter. For example, in September 2023, the government announced £200 million to support NHS services through peak winter months.

The 2019 NHS long-term plan, which aimed to set out healthcare priorities for the next 10 years, said in regard to NHS winter preparedness (p19):

Over the period of this Long Term Plan, by expanding and reforming urgent and emergency care services the practical goal is to ensure patients get the care they need fast, relieve pressure on A&E departments, and better offset winter demand spikes.

In September 2024, NHS England announced plans to “prepare for a busy winter period”. These plans included:

• upgrading its 24-hour live data centres to manage demand
• having front door assessments for patients to ensure they are signposted to the right place for their needs
• regular board and ward rounds throughout the day
• timely discharge for patients who are medically fit to leave hospital such as through a care transfer hub that works across the NHS and social care to manage discharges for patients with more complex needs
• ensuring community care can be provided for “those with complex needs, mental health issues or frail older people” to avoid the need for hospital admission, such as ensuring regional supplies of mental health response vehicles ahead of winter months
• having same-day emergency care services in hospitals with major A&Es so that patients do not need to spend the night in hospital
• vaccinations, including covid and flu jab rollouts for those most at risk of serious illness
• reviews by NHS England of each of the 42 ICS to support them to cut waiting times and improve patient safety and experience

NHS England also has guidance for its organisations, leaders and managers on key actions to support the health and wellbeing of its workforce over winter which include:

• having appointed wellbeing guardians
• prioritising wellbeing conversations and opportunities for peer support
• protecting rest breaks and providing access to good quality rest areas
• communicating support resources and how to access them to staff
• supporting occupational health and wellbeing services
• taking measures to support staff from flu, covid and respiratory illness such as through vaccinations and equipment

More information on the steps NHS England is asking providers to take is provided in a letter from senior leaders (16 September 2024).

Stakeholder comment

Lord Darzi’s final report on the independent investigation of the NHS concluded that the NHS is in “serious trouble” and raised numerous issues including with access, quality of care, funding and NHS structure. In regard to winter, the report said (p89):

The chronic lack of capital investment and cost-improvement targets set alongside imperatives to increase clinical staffing levels means that hospital managers are always under pressure to reduce beds. The result is that the number of beds has fallen more quickly than length of stay, putting many hospitals into a perpetual bed crisis, and damaging productivity. National planning guidance required hospitals to reduce occupancy from 94 per cent to 92 per cent, but even at the reduced level it will inevitably cause occupancy to exceed 100 per cent during peak periods such as a particularly cold snap during winter.

The NHS confederation is formed of organisations that commission and provide NHS services. In September 2024, NHS confederation published an article that cautioned “improvements in NHS performance could be jeopardised by winter”. The article went on to say:

Without immediate funding there is a very real risk the NHS falls into crisis this winter, with ambulance response and handover delays, overcrowded A&Es and people stuck in hospital beds because of a lack of community and social care.

In September 2024, the British Medical Association published a report that recommended the government and health leaders should immediately implement a number of interventions to minimise pressure on NHS services, including:

• communicating honestly with patients about pressures
• protecting the health and wellbeing of staff such as by taking a zero-tolerance approach to violence, protecting staff from infection and challenging “political and media rhetoric regarding the dedication of NHS staff” that risk “undermining staff morale”
• reducing bureaucratic workload such as pausing new initiatives that don’t aid winter pressure
• taking additional measures to maximise workforce capacity, such as supporting staff to control unmanageable workloads
• promoting responsible public health policies such as vaccine uptake and improved ventilation
• directing resources to areas such as the workforce, short-term staffing, dedicated winter funding, urgent repairs on estates and adequate social care

In 2023, a Nuffield Trust article recommended the government should make a sustainable difference to winter pressures by:

• ensuring collaborations and local systems enable people to access good care and support throughout the year
• building the evidence base for different approaches, such as virtual wards