Winter woes: What's it like accessing hospital care in an emergency?
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The NHS faces a 'crisis' in most winters caused by seasonal illnesses and the cold, but this year, reports have been particularly stark.
In December, NHS England warned of pressure on hospitals due to the rising number of flu infections, norovirus, and RSV.
By early January, over ten NHS hospital trusts had declared critical incidents because of the level of demand their emergency departments faced.
But what does this feel like from the patient's perspective?
We look at winter pressures' impact on patients' ability to get an ambulance, attend A&E, and receive urgent and emergency care. We suggest steps that will help improve patients' experiences now and in the future.
Waiting a long time for ambulances
Response times for ambulances vary according to the severity of the illness or accident. Still, the latest data shows that many patients are not getting an ambulance within the NHS target response time.
For life-threatening conditions like heart attacks, the target is seven minutes. However, the mean ambulance response time for people with life-threatening conditions was eight minutes 40 seconds.
For less critical situations, such as broken bones, the goal is to respond to 90% of calls within two hours. However, the average ambulance response time was over three hours, with the NHS answering 90% of calls within seven hours.
The experience people share with us of response times varied. Some reported ambulances arriving within minutes of being called, while others waited for hours.
We heard that 999 call handlers told people to get their own transport to the hospital if possible where waiting times were particularly long:
"A seven hour wait for my 80-year-old mother who had had two falls in the night. She doesn't usually fall. She was increasingly drowsy and couldn't be roused. I had two calls from the dispatcher going through scripts asking me to assess the patient/patient to answer questions. I had the same experience seven weeks ago. After four hours I took her to a hospital myself. One dispatcher advised me to do this when I rang to cancel the ambulance." - Story shared by Healthwatch Sunderland.
Even when an ambulance arrives, people might find themselves waiting in an ambulance for some hours outside the Emergency Department because there isn't enough room in the waiting room for them.
"The paramedics were brilliant and the ambulance response time excellent for my 90 year old dad, but then we sat in the back of an ambulance for 6 hours, listening to pleas from their call handlers for any staff available for critical calls. No one was able to go." - Story shared with Healthwatch England
A long, uncomfortable wait in A&E
In November 2024, 71% of patients in A&E were seen within the target of four hours, a decrease from 83% in February 2020. Evidence suggests that those waiting over 12 hours in A&E are twice as likely to die within 30 days than those who left A&E after two hours.
People told us they had to wait much longer to be seen – in one case, someone said they'd waited 20 hours. Sometimes, people gave up and went home because they were waiting for so long. It is often unclear to individuals how much longer they will need to wait.
People described the conditions in which they waited to be seen at A&E. We heard about people waiting in a clean waiting room, with access to food and drink if needed.
However, in other stories, people reported waiting for long periods in hot, dirty, overcrowded waiting rooms without access to refreshments.
"A man took his mother to A&E and was appalled by the conditions. There were not enough seats for all the patients, it felt cramped and there was no ventilation. They left after waiting a few hours and not managing to be seen by anyone." - Story shared by Healthwatch Cumberland.
People described the ambulance and A&E staff as helpful, professional, and kind. However, we also heard that A&E staff were overworked, which meant that some patients were overlooked and not treated promptly. Patients and relatives described having to be persistent to get appropriate care.
"I was not feeling very well at all so my GP made a quick referral to Shrewsbury A&E. No bloods were taken and A&E said it was a possible infection, but they discharged me. I was still not feeling very well, so went back to my GP and she said she wanted blood taken, once done it was clear I had sepsis and was put on medication on that day" - Story shared by Healthwatch Shropshire.
The latest NHS data shows that, compared with December 2023, the number of patients admitted to hospital who had to wait more than 12 hours for a bed to become available has increased by 24%.
The Royal College of Nursing recently published the results of a survey of its members, which found that almost seven in ten respondents were delivering care in unsuitable places such as corridors. In the report, nurses described the devastating impact of 'corridor care' on the quality of care they could provide, including a lack of equipment and patient privacy.
Patients and their relatives have also told us about the impact of corridor care. Their feedback highlights:
- Crowded conditions: People told us about waiting hours on trolleys or chairs in overcrowded corridors before a bed in a ward became available. One person with a bowel obstruction, who waited over ten hours on a trolley, said they could "touch the patients either side of me it was so crowded".
- Cumulative impact of waiting: Distressing experiences regarding the cumulative impact of waiting while in pain, first for an ambulance, then to be seen at A&E and then to be given a bed. One individual recounted to Healthwatch Slough how their father, diagnosed with stage four terminal lung and lymph node cancer: "had to wait 6 hours for an ambulance and then had to wait a further 10 hours in A&E in extreme pain".
- Problems getting pain relief: People described the difficulty of getting pain relief whilst waiting in corridors for a bed. One person who was referred by another hospital and expected to be met by staff and admitted straightaway described to Healthwatch Doncaster how they "spent 11 hours sat in pain, exhausted in a waiting room, without any pain relief".
- Lack of dignity: People left in corridors shared the lack of dignity and comfort they experienced whilst waiting for a bed. One patient described how, when waiting over 14 hours, they "shared an IV stand with the gentleman on the next chair. So we had to unhook everything when either of us needed the toilet."
8 hours waiting: Why we need to end corridor care
One family member's story, whose father experienced chest pains during the night, highlights why we have joined a coalition of organisations asking the Government to take action on the issue:
Day one
08:45: "He arrived at A&E ....and then sat on a chair for about eight hours before a consultant told my father he had had a mini heart attack and the consultant wanted him admitted so that they could undertake surgery as soon as possible. He was then moved to the A&E comfortable waiting area where he was offered food and a warm drink for the first time.
22:00: "When I left ... we were advised that my father was likely to have to stay in this chair all night. At some point in the night, my father was moved to a side ward as there was a temporary bed available and he finally managed to get some sleep. My father had advised the staff that he was experiencing a tightening in his chest but at no time was he seen by a doctor.
Day two
16:00: "My father was advised they had a bed available, and he was moved. Where I left him around 6pm as he was tired and wanted to sleep having had very little sleep since when he first experienced the chest pain and then having to be sat in a chair for approaching 20 hours from arrival."
24:00: "However, this wasn't the end of the matter as at midnight, my father was woken to be advised that they were moving him to another ward. However, upon arriving at the ward, my father has been put in a corridor as no beds were available and is now unable to sleep due to the bright lights and noise.
"Since arrival my father has been unable to wash or shower as at no time was he offered basic hygiene facilities until I complained this morning and they offered him a shower room."
Current winter pressures result from multiple factors affecting NHS and social care teams.
NHS England's plan to help urgent and emergency care recover needs to consider these wider factors to help tackle the long waiting times patients face. Issues include access to timely GP appointments, hospital discharge delays, properly resourced social care services, better management of NHS bed capacity, and a focus on people's experiences of care.
Specific steps that will help include:
- Mapping a return to constitutional waiting standards in A&E, focusing on those waiting the longest to address patient safety concerns and reduce avoidable deaths due to A&E delays.
- Collecting real-time data on patient experience in A&E. By reporting and reviewing performance alongside clinical targets, A&E teams can gain valuable insights into what matters to patients. This includes the speed of initial triage, access to food, water, and pain relief, as well as the quality of communication while patients are waiting for care.
- Better communication with A&E departments regarding how long people can expect to wait for their assessment and the process for prioritising patients when conditions become more serious is needed. Action on these issues will help to maintain and improve patient confidence while they wait.
- The NHS must implement better processes and resources to support an improved and coordinated flow of patients from the decision to be admitted from emergency departments through to discharge from the hospital. This should include plans for tracking bed capacity and improving bed management across multiple teams.
- Data on the number of people being held in corridors or other inappropriate spaces must be collected and published for each hospital. More transparent information will help improve resource targeting.
