The NHS is facing another catastrophic winter crisis because Rishi Sunak is failing to meet key targets he set last January for improving emergency care, leaving patients facing more delays for treatment during the busiest months, the Observer can reveal.
Figures on how much time patients have to wait for emergency care, how long ambulances are taking to respond, the number of new beds and the level of bed occupancy are all way behind where they were expected to be under the Sunak blueprint, according to official data.
On Saturday night, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said that it was now clear that firm pledges made by the government less than a year ago to deliver the “largest and fastest” improvement in emergency response times ever, before this winter, would not be honoured.
“They are clearly not achieving what they set out to do,” Boyle said. “And the consequence of this is that we will see the same scenes of ambulances waiting outside emergency departments, and if you are inside an emergency department, people receiving care in corridors.
“Last year was awful and this year is only just a tiny bit better, nowhere near where we need to be, and nowhere near the position we hoped we would be.
“It is very disappointing because it is an utterly predictable and largely preventable problem. It is not a surprise that winter comes along every year.”
Prof Philip Banfield, chair of the British Medical Association council, added: “As we approach what we know will be another incredibly difficult winter, colleagues are not feeling any more optimistic or prepared than last year – rather the opposite. We are still short of beds, have huge rota gaps and patients are not getting the care they need or deserve.
“The waiting list is still unfathomably long, cancer and emergency department performance targets are being missed and ambulance handover delays are unacceptable. Meanwhile, demand and workload in general practice are unsustainable.”
On 30 January this year, amid much fanfare, Sunak announced a new “delivery plan”, which he presented as a blueprint for avoiding another winter of chaos in 2023-24. “I think we will see – in fact I know we will see – the largest and fastest-ever improvement in emergency waiting times in the NHS’s history,” he said.
At the heart of the plan was a series of pledges, including one to ensure 5,000 more beds were brought into NHS hospitals before the winter.
Last week, with winter well under way, NHS England said that only 3,000 more “core beds” were in place, though it claimed more were on the way.
Another “fundamental” part of the plan was a promise to improve bed occupancy rates. However, the latest official figures show a record 94.8% of beds in England were occupied in November. This is higher than any previous month since the Covid-19 pandemic began. The occupancy rates for previous years were 87.4% in November 2020, 92.8% in November 2021 and 94.4% in November 2022.
In the executive summary of the Sunak plan was an ambition to ensure at least 76% of patients are admitted, transferred or discharged within four hours by March 2024. Official data, though, shows the current rate is 69.5%, a fall since last January, and way off target. NHS sources admitted that the 76% level, which is anyway regarded as unambitious and compares with the official accepted level of 95%, was unlikely to be reached by next March.
Another key target was for ambulances to respond to serious category 2 cases on average within 30 minutes during 2023-4. The current average is 38 minutes. Although this has improved, NHS sources concede there is little chance of the target being met by the spring. In the plan, 800 new ambulances were promised but NHS England has not said how many have been delivered, although it admits that many are just replacing ones that have gone out of service.
Labour’s shadow health secretary, Wes Streeting, said: “I think it is outrageous that Rishi Sunak has broken his promises to the NHS and sent it naked into the winter. What we see now is the NHS sounding the alarm, facing what could be the worst winter crisis it has faced, where patients face unacceptable waits and poor quality care.”
Streeting added: “We didn’t have an annual winter crisis when Labour was last in government because we delivered both the investment and reform needed. That is what is going to be needed again after the next general election.
“We have got to shift the centre of gravity of the NHS out of the hospital and into the community. That means not just training thousands more nurses but also double the number of district nurses qualifying so that people can receive care in their own homes.”
Health officials say they have invested in more doctors and nurses, as well as increased diagnostic and surgical capacity. The waiting list for routine hospital appointments fell in October to 7.71m, compared with a record high of 7.77m in September.
A Department of Health and Social Care spokesperson said: “Our work delivered through the urgent and emergency care recovery plan is already cutting both A&E waits and ambulance response times compared with last year as we make progress towards our ambitious targets.
“We are on track to create an additional 5,000 permanent staffed hospital beds this winter and have met our target to deliver 10,000 virtual ward beds, allowing patients to recover from the comfort of familiar surroundings.
“We’re working to get 800 new ambulances on the road and we recently provided £800m to support capacity in the NHS and help patients get the care they need as quickly as possible this winter.”
