NHS going into Winter 'on the back foot' after heatwave summer, warns RCN

Trolley waits in summer have more than doubled in five years, RCN analysis shows

Press Release 20/11/2018

College warns bed numbers unlikely to increase this winter without extra nurses

Significantly increased pressures on the NHS in England this summer mean that the health service is going into this winter 'on the back foot', the Royal College of Nursing warns today.  This increased strain on services, coupled with increasing numbers of nurse vacancies, mean that the Health Secretary's recently announced ambition for 900 extra beds this winter is unlikely to be met, the College says.

In a new analysis, the College looked at some of the main indicators of pressure on the NHS this summer and compared them with those in the previous four1.This year England experienced record-breaking temperatures in June and July2 and frontline RCN members had reported increased numbers of patients attending A&E departments and GP surgeries with heat-related problems - many common long-term conditions such as heart, respiratory and renal problems and diabetes are exacerbated by high temperatures, with older and socially isolated people most at risk.  Nursing staff were concerned that this increased activity over the summer would make it more difficult to tackle the challenges of the forthcoming winter – at the same time as nursing shortages continue to increase relentlessly.  The College calculates that the number of nursing vacancies will reach 48,000 in five years if no action is taken to increase nurse numbers3.


The RCN therefore examined, over the course of the last five summers, three important indicators measuring demand for NHS services – performance against the A&E four hour standard, so-called ‘trolley waits’ in hospitals, and the number of overnight beds available in hospitals.   The findings paint a picture of increased pressure on NHS hospitals this summer, which the RCN warns are likely to have a knock-on effect on how quickly patients can receive care this winter, despite careful winter planning by Trusts. 


The analysis shows that:

  • The number of patients waiting more than four hours for a hospital bed after a decision was made to admit them from A&E (so-called ‘trolley waits’) topped 150,000 this summer, an increase of 137 per cent on the figure for summer 2014 (summer 2014: 64,898; summer 2018: 153,895).  These patients represent the most seriously ill of those who attend A&E.


  • The number of patients waiting more than 12 hours for a bed after the decision to admit them increased from just 32 in summer 2014 to 508 in summer 2018.  Although these numbers are small, trolley waits of more than 12 hours are not supposed to happen.


  • The figures above are absolute numbers, and it is important to note that hospitals in England have experienced increased demand over the five summers, in the form of increased numbers of admissions.  However, even when expressed as a proportion of the total number of patients admitted to hospital (so reflecting increased numbers of admissions over this period), the percentage of patients who had to wait more than four hours for a bed has more than doubled over the last five summers, from 4.85 per cent in summer 2014 to 9.8 per cent in summer 2018.


  • The number of available overnight beds in the first half of summer 2018 was the lowest for five summers, at 128,448 – the figure has fallen steadily since summer 2014, when 135,754 were available, despite increasing numbers of patient admissions4.


  • Only 90 per cent of people attending A&E were seen within the four-hour target time this summer, the lowest performance against the target over the five years.  In summer 2014, the figure was 95.13 per cent, and in summer 2015, 94 per cent.

The increased strain on hospital emergency departments this summer comes on top of a backlog of patients waiting for planned operations at the start of summer.  In April 2018, 500,068 patients had been waiting more than the 18 week target time for planned surgery, an increase of more than 30 per cent on the same time last year, and the highest figure for the last ten years5.

Commenting on the findings of the analysis, Dame Donna Kinnair, RCN Acting Chief Executive and General Secretary, said:

“We’ve all sadly become used to seeing TV pictures of patients waiting on trolleys in corridors in the cold winter months.  But what our analysis demonstrates is that trolley waits have now become a summer problem too, with over 150,000 patients waiting more than four hours for a hospital bed this summer once staff had said they needed to be admitted.  These waits are an important indicator of the level of pressure hospitals were under this summer during the record-breaking temperatures.

“This increased strain on the Health Service this summer will inevitably have a knock-on effect on services this winter, and means that the NHS is going into winter on the back foot.  This, coupled with the relentless rise in the number of nursing vacancies, means that it’s unlikely that an extra 900 beds can be freed up this winter as the Government wants, as additional beds can only be opened when there are more nurses to staff them – beds are more likely to be cut than created this winter”.




Notes to Editors

  1. On the Back Foot: An Analysis of NHS Performance in England in Recent SummersRCN, November 2018.

  2. Summer 2018 was the joint hottest on record: https://www.metoffice.gov.uk/news/releases/2018/end-of-summer-stats [Joint with 2006, 2003 and 1976]

  3. The RCN calculates that the number of nursing vacancies in England will reach 47,970 by 2023, based on analysis undertaken by the College of the following data sources: NHSI Digital workforce data on vacancies; Nursing and Midwifery Council registrant data on leavers and joiners; Universities and College Admission Service 28 days after A level results day undergraduate data, Higher Education Statistics Agency data on postgraduate student numbers; and Health Education England and Department of Health and Social Care data regarding nursing associates and nursing degree apprenticeships.

  4. Data for this indicator were only available for the first part of the summer, ie April, May and June (quarter 1 of 2018/19), as the figures for the second quarter are not published until later today.  The analysis therefore looks at the relevant figure for beds for the same time period over each of the five summers.

  5. 'NHS England: Consultant-led Referral to Treatment Waiting Times Data 2018-19'

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