Hospitals in England ‘face dangerous winter overcrowding due to discharge delays’ | Hospitals

England’s hospitals are facing dangerous overcrowding this winter as even more patients than last year are “stuck” in beds, an analysis of NHS figures shows.

The findings come as the health service struggles to cope with the early onset of its usual winter crisis brought on by a crippling ‘nami’ and as the NHS in England prepares for a five-day strike by resident doctors from Wednesday.

Hospitals will have fewer beds available this winter than usual because “late discharges” — beds occupied by people who are medically fit to leave but have nowhere else to go — have been even worse heading into the cold season than last year, according to a Health Foundation study.

Senior doctors and NHS leaders said the lack of beds identified by the think tank would make an already “truly shocking” situation for hospitals even more difficult this winter. They said it would lead to building queues for ambulances outside emergency departments, patients facing long waits to be seen, widespread “hallway care”, increased spread of the flu virus – and an even greater risk that seriously ill patients would die due to delays in finding them a bed.

The Health Foundation analyzed late discharges in hospitals in England from July to September last year and the same period this year. He found that:

• The percentage of bed days used by patients whose discharge was delayed increased from 10.1% in 2024 to 11% this year, an increase of 9% or 19,000 bed days.

• This increase is due to an 8% increase over one year in the number of discharges, the equivalent of approximately 3,800 patients per month.

• The total number of NHS beds, around 100,000 general and acute beds, occupied last winter by late discharge patients, reached a peak of 14%, but is likely to be even higher this winter.

“Winter has already started, but the NHS is already under intense pressure, with an unprecedented rise in flu cases for this time of year,” said Francesca Cavallaro, senior analytics manager at the foundation, which undertook the analysis.

“The growing pressures are compounded by the increasing number of patients stuck in hospital beds despite being medically fit to be discharged compared to last year.

“Our new analysis shows that an additional 19,000 hospital days were lost due to delays in discharging patients between July and September compared to the same period last year. These delays are harming patients and increasing pressure on overburdened A&E departments.

“Last winter saw a record number of patients forced to wait 12 hours or more in emergency rooms, suggesting that this winter could be even more exhausting than the last.”

The failure of cash-strapped local councils to put in place a suitable welfare scheme for patients who are medically fit to leave hospital is one of the main reasons for the rising number of late discharges, but doctors and NHS leaders say the aging population and advances in medical science that are keeping people alive longer are also important factors.

Society of Acute Medicine president Dr Vicky Price said chronic bed shortages this winter would lead to patient deaths. The Royal College of Emergency Medicine estimates that 16,600 people died avoidably last winter due to delays in getting A&E care or a bed.

“These results are consistent with our clinical experience and underestimate the problem,” Price said. “This is a complex problem that has been growing for years, increasing tension both in hospitals and in the community. »

Record numbers of older people and advances in life-prolonging treatments have led to an increase in the overall need for care, she said.

NHS England’s ability to withstand winter pressures has also been compromised by the “reset” of the service’s finances for 2025-26 ordered by its chief executive, Sir Jim Mackey, she said.

“Many hospitals have seen their number of beds reduced to cope with the punishing financial pressures to which they are subject.

“It was predictable that any additional pressure would cause this effect. This is an extremely serious situation. For patients stuck in the emergency room, this results in significant mortality,” she said.

Late discharges cost the NHS in England around £200m a month, or around £2bn a year, the Health Service Journal estimated in October. This is a slight increase on the £1.7 billion that health think tank the King’s Fund calculated in 2023.

Mackey predicted recently that as many as 8,000 of the NHS’s 100,000 beds could soon be occupied by flu patients, given the severity of the outbreak.

Rory Deighton, director of acute and community care at the NHS Confederation, which represents NHS trusts, said: “Given the ever-increasing demand the NHS has seen over recent years – often from older patients or those with more complex conditions – it is unfortunately unsurprising to see this analysis highlight the ongoing impact of delayed discharges on services.

“Delayed discharges are a long-standing challenge for the NHS and can exacerbate winter pressures.

“A lack of social and community care can often lead to delays in the discharge of medically fit patients from hospital, which in turn can create bottlenecks in the urgent and emergency care system that result in longer ambulance transfers and waits in emergency and emergency rooms. »

Hospital bosses were also “very concerned that upcoming strikes by resident doctors would put even more pressure on the NHS and could put patient safety at risk”, he said.

The Department of Health and Social Care has been contacted for a response.