How severe is the pressure on the NHS this winter?

In recent weeks we’ve seen lots of news reports about the pressure on the NHS this winter, especially in A&E—where there have been stories about “corridor care”—and in the ambulance service.

The peak of the crisis often hits in January—though the NHS publishes daily urgent and emergency care situation reports through to the end of March—and last month the NHS itself acknowledged the severity of the situation, with NHS England medical director Professor Stephen Powis saying that hospitals were under "exceptional pressure" and facing “mammoth demand”. 

But how unusual has the situation in the NHS been this year? How do the pressures compare to previous years? And have hospitals really been struggling as badly as they were during the height of Covid? To help understand what’s happening, we’ve looked at the data on a handful of key measures, with new figures out today giving a fuller picture of what’s been happening.

Health systems in the UK are devolved, so this article only looks at the pressure on the NHS in England, which is controlled by the UK government.

How long are people waiting?

NHS England measures A&E performance against a four-hour standard that requires 95% of patients to be admitted to hospital, transferred to another provider, or discharged within that time. This target has not been met for almost ten years, however—since July 2015.

The impact of winter, when hospitals often face extra pressure from seasonal illnesses, is most visible in extremely long waits, however.

The proportion of admitted A&E patients who waited more than 12 hours after the decision to admit them began to increase dramatically after the pandemic, with the worst periods often occurring during the winter months. 

By this measure, the current winter and the two before it have seen extremely long waits for admission become common in A&E. And January 2025 saw the greatest proportion ever recorded in this dataset, which runs back to 2010, with more than one in ten patients (11.21%) waiting more than 12 hours.

It’s important to note that this data shows what’s happening from a national perspective, and that this may hide significant variation at a local level, including some exceptionally long waits that have been reported at individual trusts.

Data published last month by the Office for National Statistics (ONS) showed that people who waited longer in A&E were more likely to die within a month.

It’s not possible to conclude from this that longer waits make patients more likely to die, however. As the ONS says: “Our results… only relate to statistical associations; we cannot say with certainty whether longer times spent in A&E cause higher rates of post-discharge mortality.”

Are ambulances taking longer to arrive?

The speed at which ambulances respond to calls, along with how quickly they hand patients over to A&E, is another indication of how much pressure the NHS is under.

Ambulance services have a range of standards that they are meant to meet, depending on the urgency of the call.

Many of these standards have consistently not been met for several years, with the winter of 2022/23 seeing particularly poor performance, and there appears to have been some deterioration this winter too, especially among the less urgent calls.

Another important but easily overlooked measure of A&E performance is the time it takes for patients to be handed over from ambulances to hospitals. A&E, acute, and urgent treatment centre services are expected to ensure that all handovers between ambulances and A&E take place within 60 minutes, while 95% should be handled in under 30, and 65% in less than 15.

But so far this winter, performance has been consistently below target on all measures. In December, around one in six (16.2%) handovers took more than an hour to complete, with 72.2% taking longer than 15 minutes.

This data comes from NHS England's Urgent and Emergency Care Daily Situation Reports and therefore only dates back to the week ending 1 December. An analysis published by health think tank the Nuffield Trust in April 2024 found that performance against the 30-minute target has broadly deteriorated in recent years.

What about planned care?

We’ve focused in this piece on the data from A&E departments and the ambulance service, because waits for planned treatment are less susceptible to winter pressures, and remain high year round.

We also don’t yet have data on waiting lists covering the full winter period. NHS England figures on the number of patients and cases awaiting non-emergency treatment cover the period up to December, and show that the size of the waiting list has fallen slightly in recent months, but remains close to record highs.

Why is this happening?

Experts at health think tanks say there are a number of different factors behind the struggles of the NHS in recent winters.

Tim Gardner, assistant director of policy at the Health Foundation, told Full Fact the conditions this winter “have been difficult but not exceptionally severe”, adding that the NHS “needs to be able to manage these pressures without experiencing the very high level of operational issues already seen so far this year”.

He said: “The NHS' struggles this winter are a reflection of a health system that increasingly struggles to cope with spikes in demand, following a decade of underinvestment before the pandemic. Winter pressures are inevitable, but an annual NHS crisis is not.”

Danielle Jefferies, senior analyst at the King’s Fund, told Full Fact: “Predictably, the NHS has fared poorly this winter. Many parts of the country face a toxic cocktail of long waiting lists, overcrowding in hospitals, bad bouts of flu and respiratory conditions, alongside chronic long-term issues such as staff shortages, crumbling buildings, and extremely tight finances.

Ms Jefferies also pointed out that winter pressures on the NHS extend beyond hospitals, which we have focused on in this article, adding: “Extreme pressures in A&E are the bellwether for a health care system that is under intense strain. Throughout the year, NHS services are run worryingly close to full capacity, and spikes in demand for care when cold weather, flu or other seasonal pressures hit can be catastrophic.”

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