The Health Foundation: Did the NHS experience record pressures this winter? (28 April 2025)

Summary

The health service in England has endured a punishing winter. Stark warnings about a potential ‘quad-demic’, the ‘busiest year on record’ for A&E and ambulance services, and ’jampacked’ hospitals prompted comparisons with the COVID-19 pandemic. 

But how bad was winter 2024/25? The Health Foundation present analysis of routinely collected and publicly available data on health service performance and the possible contributing factors. 

Content

Key points:

• This winter saw the NHS in distress. Only 73% of A&E patients were treated within 4 hours, similar to the last two winters, and far below the 95% constitutional standard. The number of people experiencing 12-hour waits before admission reached a new record high. Numbers of A&E diverts and ambulance handover delays were worse than over previous winters.
• Looking at operational performance, winter pressures and other factors, the analysis explores the extent to which disruptions to urgent and emergency care were caused by higher than usual levels of winter illnesses and/or systemic weaknesses within the NHS.
• Levels of flu and diarrhoea and vomiting were higher than usual. Hospital admissions for flu reached a similar peak to winter 2022/23 but took longer to fall, leading to a 50% higher total number of flu bed days. However, hospital admissions for RSV were similar to previous winters, while admissions for COVID-19 remained low.
• Winter A&E attendances have risen steadily each year. However, slightly fewer patients attended major A&E departments in winter 2024/25 than in 2023/24, and emergency hospital admissions fell slightly. This suggests the NHS struggled to cope with a small increase in demand from patients needing emergency hospitalisation, while also expanding elective activity in line with government commitments to improve elective performance.
• Bed occupancy during winter has been rising for the last 15 years, exceeding the NHS 92% threshold for the first time in winter 2017/18, highlighting a system at its limits. Since COVID-19, a substantial increase in delayed discharges is likely to have obstructed the flow of patients out of hospitals, worsening bottlenecks upstream in the care pathway from A&E into wards and from ambulances into A&E.
• Overall, the conditions this winter, while severe, were similar to those in recent years and not far above what the NHS can normally expect. Attributing operational problems to external factors such as winter illnesses and higher demand risks offering false comfort about the resilience of the health service.
• The shows the health service performing far worse than before the pandemic and reporting record or near-record levels of operational problems across urgent and emergency care. Ahead of the government’s forthcoming Urgent and Emergency Care Plan, this raises key questions about what might be behind some of the underlying issues contributing to what has now become an annual winter crisis.