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Exposing a hidden crisis in the NHS this winter

Patient having blood pressure taken

The 2018/19 winter saw the NHS once again under intense pressure, with A&E attendances and emergency admissions up, dangerously high bed occupancy, cancer waiting times growing and 4.3 million people now waiting for treatment. Many doctors worked extra hours and morale suffered.

Despite huge winter pressures reoccurring, there has been noticeably less attention and public debate on this issue compared to last year. Nevertheless, in several key respects, this could be described as the worst winter on record for the NHS. This winter’s NHS pressures are a hidden crisis.

Download the report for 2018/19

Views from a doctor on the front line

Headline Statistics

  • Almost 1 in 4 waited over 4 hours at major A&Es
  • 214,000 patients left waiting over 4 hours on trolleys
  • 292 A&E diverts across 32 trusts (of 134)
  • 24% of cancer patients had to wait over 2 months for their first treatment
  • Almost a third of NHS Trusts hit 100% bed occupancy at some point over the winter
  • The waiting list for treatment rose to over 4.3 million people
  • 2.23 million GP appointments involved a wait over 28 days
  • Most doctors work outside their regular hours and 4 in 10 NHS staff report feeling unwell as a result of work stress
  • Zero parliamentary debates on the NHS winter crisis

In A&E departments across England performance against the four hour target remained very poor over the 2018/19 winter; just 0.1 percentage points better than the worst winter on record, last year. Although trolley waits over four hours were down compared with winter 2017/18, 214,000 trolley waits over four hours still represents historically very high levels. They have only ever been over 180,000 in a quarter twice, this winter and last winter.

Additionally, A&E diverts were routine over the 2018/19 winter for a number of trusts (11 trusts implemented 10 or more A&E diverts), and almost one in four had to implement a divert.

Excluding the festive period (21st to 29th December), bed occupancy did not drop below 92%. Bed occupancy remained at 94% in the first few days of March, before NHS England stopped publishing winter situational reports. NHS Improvement has said that at bed occupancy levels over 92%, emergency care standards will deteriorate, while the NAO put the suggested maximum safe bed occupancy levels at 85%. Only 5 trusts kept their average occupancy below 85% between 3rd December 2018 and 3rd March 2019.

In cancer care, trusts failed to meet the target of 93% of patients to be seen by a specialist within 2 weeks of an urgent GP referral. Far more providers missed the 93% target than last year. A significant majority of providers, close to 70%, missed the target for 85% to be treated within 62 days of referral.

Primary care was stretched too, with fewer same day appointments and significant rises in the number of appointments involving a wait of over a week.

In our 2018/19 report, we make 9 recommendations for action to relieve this continuing pressure. These include the provision of adequate funding in-line with comparable countries, more hospital beds, better data collection, a select committee inquiry, and action on NHS pensions. These actions are needed to ensure the wellbeing of staff and the safety of patients.


Download our analysis

Read the 2018/19 NHS Pressures report

Read the 2017/18 NHS Pressures – winter analysis

Read the 2016/17 NHS Pressures data analysis

Read the 2013 briefing


  • Media coverage

    Since the start of 2017, there has been widespread media coverage surrounding the unusually severe pressure on NHS hospital and GP services, what has caused this ‘crisis’ and what can be done to alleviate the strain on health and social care services.

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