Last week’s shock announcement of the big top-down reorganisation of the NHS, with the decision to scrap NHS England (announced just three days after Health Secretary Wes Streeting called for its staffing to be halved), seems to have diverted a lot of news media from the ongoing problems at the front line in hospitals and mental health services.
The Royal College of Emergency Medicine (RCEM) was quick to respond on the day to Keir Starmer’s speech abolishing NHSE, with a press release headed: “Abolishing NHSE ‘must not distract’ from focus on quality of patient care”. It argued:
“Patients in Emergency Departments continue to experience dangerous and unacceptable conditions – with more than 141,000 people having to endure waits of more than 12 hours in A&Es [from their time of arrival] in England last month.”
Monthly figures also show that in February 47,623 patients waited more than 12 hours from the decision to admit. The RCEM also cites NHSE’s Situation Report for the week of 3 March to 9 March which reveals hospitals are running almost full – standing at 95.5% bed occupancy, and points out that “The level considered safe is 85%.”
A key factor in this is that “Each day, there was a daily average of 13,717 patients [filling more than one in eight acute hospital beds] who were considered to be medically well enough to leave but remained in hospital. This is often due to the lack of social care.”
Dr Adrian Boyle, President of RCEM said, “The system is gridlocked. When there is so little capacity, the flow of patients through the hospital grinds to a halt.”
But the problem is not only one of emergency care. The Guardian in early February reported analysis of new NHS figures by Radiotherapy UK which shows that in the decade to November 2024, 506,335 cancer patients in England waited more than 62 days for treatment.
The NHS has not met its target for 85% of cancer patients to start treatment within 62 days since December 2015 – currently, an average of just 69% begin treatment within the two-month target, with some hospitals falling significantly below.
In January Wes Streeting told the Health Service Journal he could not guarantee that the NHS would meet national cancer standards by the end of this parliament (in 2029). In the same interview he stated his commitment to keeping NHS England!
There are also growing problems for adults, children and young people accessing mental health services, some of which results in them inappropriately seeking help in A&E departments.
The latest figures show a massive 29% increase in numbers of adults with serious mental health problems accessing community mental health services since March 2022 (up 142,000 to 650,386 in January 2025), while even larger numbers of children and young people are seeking care: up 21% since 2022 to 817,308 in January 2025.
And numbers of urgent, very urgent and emergency referrals to crisis care teams more than trebled, from 1795 in April 2023 to January 2025.
Sadly, none of these issues seems to be anywhere near Wes Streeting’s list of priorities, and with the government now switching resources from public services and welfare to military budgets, there seems little chance of the extra cash needed to remedy the years of underfunding. Nor, of course, is there any prospect in the near future of the capital investment needed to repair and, in some cases, rebuild crumbling hospitals whose worsening £14 billion worth of backlog maintenance is a serious obstacle to improving efficiency and productivity.
There is another problem, too: Streeting’s focus on reorganising the top tier of the NHS has meant he and the government have pushed the growing crisis in social care to one side. They have instead commissioned Baroness Louise Casey to chair an independent commission into adult social care … that will not publish the first part of its findings until the end of next year and the second part in 2028.
Meanwhile, the chronic shortage of domiciliary and care home services to support patients discharged from hospital has been augmented by cash cuts imposed as trusts and Integrated Care Boards struggle to make “savings” of £8 billion in 2024/25.
The first high-profile victim of this has been Finney House, which was opened by the NHS just over two years ago to provide care home and hotel-style accommodation for up to 64 patients from Royal Preston Hospitals who would otherwise have nowhere to go. It is being run down and closed to address a £5m cash shortfall.
It’s likely that, as the new cash squeeze starts to bite other NHS trusts will also be forced to hold back or cut back on spending on services and resources that help to ease flow through the hospitals, but which are not strictly part of the NHS’s remit.
The bottlenecks delaying access to emergency admissions remain a major frustration, impeding not only emergency departments but also holding back potential progress on elective services.
Back in February Dr David Oliver published a scathing 2,500 word analysis of the state of front line services in the valuable Byline Times. He is an experienced NHS Consultant in Geriatrics and General Internal Medicine, and a former National Clinical Director for Older People in the Social Care Division of the Department of Health, so he knows what he is talking about.
His article is headlined ‘The A&E Crisis Shows How the NHS Is Getting Worse and the Government Has No Real Plans to Fix It.’ It points out that the problems reach far beyond the “year round permacrisis” of A&E departments and queueing ambulances:
“the root causes lie outside A&E itself in the wider health and social care system. They result from years of harmful policy decisions or complacent inaction over several parliaments.”
Oliver points out that the problem of 12-hour waits in A&E in the first quarter of 2024 were 1000 times worse than the same period ten years earlier (up from 150 to 150,000). The delays, combined with pressure on hospital trusts to minimise hand-over times for ambulances, have resulted in a big increase in “corridor care,” that can leave patients stranded for hours or even days at a time without a proper bed, food or anything to drink, access to toilet facilities, or regular care. All this is serious because:
“A report … from the Office for National Statistics showed that patients who wait 12 hours or more in departments are over twice as likely to die in the following 30 days as those waiting two hours or less.”
The delays and poor care also lead to demoralised and burnt-out staff, which in turn worsens the staffing problems in key services, as explained with graphic detail by the recent Royal College of Nursing report “On the frontline of the UK’s corridor care crisis.”
Hospitals have no control over the numbers presenting at Emergency Departments, and they can’t escape the current ‘permacrisis’ without political action reaching far beyond the scope of the NHS. Oliver blames a series of policy failures:
Too few beds: “For a population of 57 million, we have only 100,000 General and Acute Beds, and those beds are now routinely running at around 95% midnight occupancy. This makes every day a struggle to find beds to admit patients or to find patients to discharge from them.”
Inadequate community and primary care services: “around 12% [of acute beds] are currently occupied by patients who are medically fit to leave but cannot do so – largely due to delays in accessing step-down support when they’re discharged. …”
Oliver refers to the 2018 National Audit of Intermediate Care which estimated that we only have around half the places we need to help keep people out of avoidable hospital stays.
No Social Care Policy Solutions: after fifteen years of cuts in local government spending, it’s clear that apart from legislation for a fair pay agreement, [Labour] have made zero plans to improve local government funding, without which social services budgets remain inadequate.
And the Crisis in Primary Care: “Contrary to some popular narratives, poor access to GPs is not the major reason for long waits and overcrowding in A&E and accounts for a minority of attendances. However, there has been no increase in the number of qualified GPs since 2010 … GP list sizes now average around 2,000 per doctor.”
Six weeks on from Oliver’s article there is still no sign that Wes Streeting has any short of medium term plans to address any of these problems, and has opted instead to concentrate on a top-level reorganisation along with a laser-like narrow focus on the minuscule reductions trusts are somehow managing to deliver each month in the 7.4m waiting list total.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
Comments are closed.