Another winter of discontent looms for NHS urgent and emergency care

With a sense of inevitability and clear predictability, urgent and emergency care in the UK is rapidly heading into another winter of discontent. We are seeing signs that we will experience another winter of patients facing prolonged waits to access emergency care. The result will be patient harm, corridor care in emergency departments and acute medical units, and delays in ambulance response times.1 Each of these metrics have deteriorated over the past decade, with politicians failing to understand and deliver on the priorities that could reverse this decline.

Hospital occupancy levels remain dangerously high.2 This leaves no room in the system to cope with a surge in demand. The “quad-demic” of influenza, respiratory syncytial virus, covid-19, and norovirus will simply be overwhelming. Disturbingly, a measurable increase in any of these conditions would cause hospitals to struggle—with the impact most noticeable in urgent and emergency care.3

The discontent is felt and experienced by staff and patients. In November 2024, 45 791 patients waited more than 12 hours in emergency departments; an increase of 7.7% compared with last year. Most of these are patients who are older and frail, lie on trolleys in corridors resulting in increased levels of harm including delirium, pressure sores, and psychological distress. When patients are moved from a corridor in an emergency department, often to an initial sense of great relief, it is to suffer a further degrading wait in a corridor in an acute medical unit. Patient confidence in the NHS is rapidly deteriorating, and this is well founded.

The discontent among urgent and emergency care staff has also never been greater.4 Witnessing and delivering sub-standard care in appalling conditions has inevitably led to burnout, moral injury, and high levels of staff absence. Large numbers of clinical staff simply can no longer tolerate the situation and have either left the profession or moved overseas; further reducing the capacity to meet the increasing demands.

The discontent is not easy to fix. As the crisis deepens, the solutions take more time and resources to implement; neither of which are politically desirable. However, this is the stark reality that needs to be accepted. Multiple reports from expert think tanks, the BMJ Commission on the Future of the NHS and medical royal colleges, describe a route to crisis recovery with increased resources and the need for greater transparency at their heart.56 The much-vaunted “quick wins,” such as acute respiratory hubs, are not effective and continue to fail to deliver any improvement.7 Focus must be moved away from this approach.

Demand for urgent and emergency care will not decrease.8 Predictable, and non-predictable, periods of excess strain are inevitable. Solutions led by clinicians are at the heart of any recovery; but without long term investment that is focused on delivering noticeable increases in staff and thus capacity, the well placed sense of discontent will simply become permanent.