Was the NHS overwhelmed last winter?

Throughout the pandemic, politicians and other policymakers have emphasised the need to protect the NHS from collapse or overwhelm: even before Covid-19, the health service struggled to stay above water given worsening capacity, staffing and demand issues, especially during the colder months. So what happened to urgent and emergency hospital care last winter, when another wave of the virus hit the country during a time when it would be stretched to its absolute limits even absent of a pandemic?

The often-repeated mantra of 'protecting the NHS' has been a defining feature of the Covid-19 pandemic. One of the most effective ways of ensuring continued support from the public for health measures to control the virus, health service overwhelm is the yardstick by which policymakers have navigated the response to Covid-19.

Yet for nearly a decade before the pandemic, the NHS’s performance on some key measures of urgent and emergency and hospital care has been deteriorating, particularly during winter, when there are normally additional illnesses such as flu and norovirus, and excess deaths resulting from respiratory and cardiovascular problems.

So if we look at the most recent pandemic winter of 2021/22, was the NHS successfully protected from the worst effects of the pandemic, or did it become overwhelmed, unable to withstand the huge extra pressure from Covid during a time when it has strugged to maintain good standards of access and care even without a novel coronavirus to contend with?  

Key points

We found:

  • Ambulance response times were longer last winter than other recent winters. The average waits per month for people in emergency situations, such as after a heart attack or stroke, ranged between 38 and 53 minutes last winter. The average waits ranged between 18 and 30 minutes the winter before, and between 21 and 28 minutes the two winters before that.
  • In December 2021, there was particularly poor performance, with one in 10 patients in these situations waiting nearly two hours for an ambulance on average. But this is not just a winter effect, as response times were longer throughout 2021/22 than previous years.
  • Waiting times at A&E departments increased further last winter. At major A&E departments (type 1), nearly 1.25 million attendances waited more than four hours before admission, transfer or discharge – affecting almost two out of five attendances at these departments. The number of these long waits was nearly twice as many as the previous pandemic winter, and compares to one million occurrences or fewer in previous recent pre-pandemic winters.
  • The number of times patients who waited more than 12 hours to be admitted to a ward after a decision to admit last winter was nearly 46,000. These ‘trolley waits’ massively increased last winter and were five times more than in the previous winter.
  • These long backlogs in A&E departments then further impacted on ambulance services, causing increases in ambulance handover delays. Not only were there more of these delays last winter, they were also longer. The number of ambulances delayed by more than 60 minutes was more than double the number in any of the previous four winters. In total, the estimated minimum amount of time lost in delays last winter was equivalent to over 13,000 12-hour ambulance shifts being lost.
  • Difficulties in admitting patients to beds was not just down to bed occupancy rates, which were lower last winter compared to before the pandemic, but also to reduced capacity through other mechanisms, such as enhanced infection control measures and the additional pressures that Covid-19 infections can create for other conditions.
  • On average per day, over 11,500 patients who met the current criteria for leaving hospital were not discharged last winter – nearly three in five patients per day who could be discharged but weren’t. This means that, on average, over one in 10 of available general and acute beds per day were occupied by a patient who, according to the criteria being used, was fit to leave hospital but who was not discharged. Over the winter period, the number of people deemed fit to leave hospital but not discharged grew at a faster rate than those who were successfully discharged.

The NHS has historically prioritised care at the point of need, with urgent care services being a safety net for responding to urgent illness and injury. The last two years have seen extreme demands on the health and care system. This has been punishing for staff, leading to burnout and low morale. The capacity of the system to recover from periods of intense demand now appears to have been reached, and performance levels indicate widespread instances where NHS services are overwhelmed and unable to meet emergency care needs.

Suggested citation

Fisher E and Scobie S (2022) Was the NHS overwhelmed last winter? Briefing, Nuffield Trust.