What is winter looking like for the NHS?

Worrying signs in A&E for October but we are likely to avoid a repeat of the 2022 nightmare winter

State of emergency services

Last week, the Guardian ran a story warning of a massive winter crisis in A&E. A huge 94% of surveyed medics feared that patients are coming to harm because of delays in access emergency care.

The key performance indicators (KPIs) for the NHS are published retrospectively every month, so at the moment we only have data up to October. The Nuffield Trust has started a dashboard tracking these and certainly the signals aren’t pretty.

Ambulance times for category 2 calls (urgent but not life threatening) were at an average of 42 minutes - much higher than the 18 minute target, which has not been achieved since 2021. These times are about the same as October 2023, but better than we saw in both 2021 and 2022. Waiting times for admission to hospital are looking pretty bad though - the number of people waiting more than 12 hours from the decision to admit is almost as high as it was in the last two winters and this is only October.

How bad this winter will get is largely down to how likely it is that we see a spike in all three main respiratory diseases (Covid, RSV, Flu) at once. If we do, like we did in 2022/23, winter is likely to be dreadful but if we see waves peaking at different times, we will be ‘lucky’ and only get a more ordinary bad winter, like 2023/2024.

Trends in respiratory diseases

At the moment, the signs are that we are on course to be lucky. RSV peaked this week last year. The most recent data puts RSV levels near last year’s peak and with luck we will start to see RSV hospital admissions trending down from early December. Flu is increasing but the main flu peak hasn’t hit yet and is likely to come a few weeks after RSV has died down which will help. Of course, if it’s a very bad flu year then it can cause plenty of problems all on its own.

Meanwhile, there is good news on the Covid front. The October peak is still coming down and while it might take off again this winter, its peak would likely be after both RSV and Flu, relieving potential NHS pressure.

But that said, there is no particular sign of a new Covid wave on its way. Wastewater monitoring from Scotland shows the enormous summer wave and smaller autumn ones, but relatively low and flat levels for the past few weeks. This is mirrored in wastewater monitoring from other nearby countries such as Ireland, The Netherlands, and Denmark. There are also no new variants that I’m aware of causing imminent concern. XEC is growing but only slowly and I don’t expect to be a major issue. So - fingers crossed - the NHS might escape with a ‘normal’ winter this year.

Vaccines

Meanwhile, we’ve been trying to vaccinate vulnerable groups against Covid, Flu and RSV this autumn, although confusingly the elgibility for each of these vaccines is quite different (flu is the most broadly available). Covid vaccine uptake (from UKHSA weekly report) shows reasonable uptake in the oldest age groups, but worryingly low uptake in the younger clinically vulnerable groups.

Flu vaccine uptake is higher than that for the Covid vaccine, but lower than this time last year for all groups except for pregnant women and toddlers. The more we can encourage vaccination each autumn, the better we can protect our population and the NHS each winter.

Summary

At the moment then, things are not looking terrible for this winter. But I’ll be keeping an eye out for the November NHS stats (due out in December) and what the three respiratory diseases do over the next few weeks.

And once again, I want to point out how crazy it is that we leave the winter NHS crisis - the single most predictable NHS crisis - down to luck every year, instead of actually planning to be resilient to whatever nature throws at us.

Paul Mainwood, in his substack (which I recommend) put it best a couple of weeks ago: