Weeks after the start of meteorological spring, the NHS in England is still mired in winter pressures.
Almost 1,700 people a day spent more than 12 hours in accident and emergency last month after doctors had decided to admit them, according to official data published on Thursday. More than one in seven beds were occupied by patients unable to be discharged, often because of a lack of community care.
But a group of European countries offers instructive evidence that it is possible to navigate seasonal strains without big disruption to services.
Nothing in the approaches that have allowed countries such as Sweden and the Netherlands to emerge relatively unscathed from the chillier months — when the NHS faced a “quad-demic” of flu, norovirus, Covid-19 and respiratory syncytial virus — would surprise UK policy experts or health leaders.
Many would like to emulate their smart use of data to identify the neediest patients and seamless collaboration across the system to minimise unnecessary admissions or speed up discharge.
Yet as ministers and hospital chiefs chart a new future for healthcare after the abolition of NHS England, the arm’s-length body, under-investment in health and social care over the past three decades means the country may struggle to follow the same prescription.
Siva Anandaciva, head of policy at the King’s Fund think-tank, said there was nothing unique in how England had experienced the “quad-demic”. What distinguished it from peers was its inability to manage predictable waves of illness.
“We just simply don’t have the resources to be a resilient service over winter,” he said.
One of the most glaring examples lies in the performance of England’s urgent and emergency care system. More than one in 10 people are spending more than 12 hours in A&E after arrival, according to a Financial Times analysis of NHS data.
Figures published by the Office for National Statistics this year found that patients who endured such long waits were twice as likely to die within 30 days as those treated, admitted or discharged within two hours.
Adrian Boyle, president of the Royal College of Emergency Medicine, a professional body, said such lengths of stay would have been “unthinkable” as recently as 10 years ago. In most European health systems, they still are.
In Sweden, 62 per cent of patients are seen within an hour of arriving in A&E, according to official data for February. Meanwhile, in Denmark’s largest region the average wait in emergency departments ranged between just 27 and 45 minutes in the final quarter of last year, depending on the hospital.
Caroline Hällsjö Sander, senior consultant at Karolinska University Hospital in Stockholm, said that if crowding in A&E reached a pre-determined level, doctors on duty in general wards came in to prevent backlogs.
The approach meant that, in early 2025, only 2 per cent of patients spent 12 hours in A&E before being discharged, admitted or referred elsewhere, with a further 1 per cent waiting between 12 and 16 hours.
Heyo Kroemer, chief executive of the Charite hospital Berlin, one of Germany’s biggest teaching hospitals, said if A&E was “completely overcrowded” patients sometimes had to wait “a couple of hours” to see a doctor. But it would be “really rare” for even those suffering from minor conditions to have to wait 12 hours, he added.
Medical professionals spoke of the importance of triage, to ensure patients were directed to more appropriate care without entering emergency wards.
But such an approach requires a strong network of out-of-hospital care, which England generally lacks. Data this week, showing a daily average of 13,388 patients in hospital despite being well enough to leave, laid bare the extent of the problem.
More than 20 years ago the Dutch government decided to strengthen out-of-hospital care, notably through a large investment in general practitioners, whose numbers have fallen in England even as demand has risen.
Johanneke Mulder, director of acute care at Erasmus MC, an academic medical centre in Rotterdam, said GPs “know the neighbourhood, they know the people, so that really takes the pressure down”.
The maximum time, on average, that patients spent in her own emergency department was four hours, with no one waiting more than two hours for initial assessment by a doctor, she added.
Similarly in Spain, other layers of care help relieve pressure on hospital wards. Albert Salazar, chief executive of Vall d’Hebron University Hospital in Barcelona, said: “We have alternatives to hospitalisation in co-ordination with the community, such as the emergency department short-stay unit, ‘home hospitalisation’ with patients monitored remotely in their own homes, or day hospitals.”
In February 85 per cent of the hospital’s beds were occupied — a level seen as the international benchmark for safe care because it leaves a buffer for an unexpected surge in demand and helps infection control. The equivalent figure for England was 94 per cent.
Matthew Taylor, chief executive of the NHS Confederation, which speaks for health leaders, said an array of projects across England were bringing ambulance services, primary care, the acute sector, and community care closer — but few if any released capacity, let alone cashable savings, in hospitals.
“A lot of the time, it feels like you’ve got an overflowing bath with both taps running, and these initiatives are like people scooping water out . . . It might be reducing the overflow, but it certainly isn’t staunching it,” he said.
Denmark underlines the importance of getting the incentives right. Jørgen Schøler Kristensen, formerly medical director at Aarhus University Hospital, said even as recently as about 15 years ago, the country was facing pressures caused by the difficulty of moving patients from hospital into social care.
A rule requiring municipalities, which control social care, to pay a fee for each day a patient well enough to leave hospital was forced to remain there had helped to turn the tide.
He added: “The municipalities realised that it was cheaper to make more places in their care settings.”
England has long been short of “step down” capacity, facilities for patients who no longer need hospital care but still require significant support.
Thea Stein, chief executive of the Nuffield Trust think-tank, said: “Instead of just calling an ambulance for somebody who’s fallen again, you can . . . look at the way in which you step people down into intermediate care, or step people up into a ‘virtual ward’ environment.”
“All these things have been part of policy and direction for a few years now. The issue is the scale of them.”
Professor Sir Stephen Powis, NHS national medical director, said this winter had been “one of toughest yet for emergency health services”.
“Services prepared for this demand by rolling out measures to free up hospital capacity, including our world-leading virtual wards programme . . . and same-day emergency care units.”
The Department of Health and Social Care said it was “determined to break the annual cycle of winter crises”. It added: “Learning from our neighbours will be an important part of that, which is why department ministers and officials recently visited Denmark to understand more about the benefits of their health system.”
Data visualisation by Amy Borrett
