Hospitals in England face dangerous overcrowding this winter because even more patients than last year are “stranded” in a bed, according to an analysis of NHS figures.
The findings come as the health service struggles to cope with the early onset of its usual winter crisis driven by a crippling “flu-nami” and the NHS in England is bracing itself for a five-day strike by resident doctors starting on Wednesday.
Hospitals will have fewer beds available this winter than usual because “delayed discharges” – beds occupied by people who are medically fit to leave, but have nowhere to go – have been even worse in the run-up to the cold season that they were last year, research by the Health Foundation has found.
Senior doctors and NHS leaders said the lack of beds identified by the thinktank would make an already “truly shocking” situation this winter harder still for hospitals. They said it would lead to ambulance queues building up outside A&E departments, patients facing long waits to be seen, widespread “corridor care”, an increased spread of the flu virus – and even greater risk that seriously ill patients would die because of delays in finding them a bed.
The Health Foundation analysed the delayed discharges in hospitals in England from July to September last year and the same period this year. It found that:
The percentage of bed days used by patients whose discharge was delayed rose from 10.1% in 2024 to 11% this year, an increase of 9% or 19,000 bed days.
That rise was driven by an 8% year-on-year rise in the number of discharges, equivalent to about 3,800 patients a month.
The number of the NHS’s overall stock of about 100,000 general and acute beds occupied last winter by delayed discharge patients hit a peak of 14%, but it is likely to be even higher this winter.
“Winter has already begun but the NHS is already under intense strain, with an unprecedented surge in flu cases for the time of year,” said Francesca Cavallaro, the foundation’s senior analytical manager, who undertook the analysis.
“The mounting pressures are compounded by the rising number of patients stranded in hospital beds despite being medically fit to be discharged compared with last year.
“Our new analysis shows that 19,000 more hospital bed days were lost due to delays in discharging patients during July-September compared with the same period last year. These delays harm patients and increase pressures on overstretched A&E departments.
“Last winter saw a record number of patients forced to wait for 12 hours or more in A&E, so this suggests this winter could be even more gruelling than the last.”
Cash-strapped local councils’ inability to put in place the right social care package for patients who are medically fit to leave hospital is a key reason for the growing numbers of delayed discharges, but doctors and NHS leaders says the ageing population and advances in medical science that keep people alive for longer are also significant factors.
The president of the Society of Acute Medicine, Dr Vicky Price, said chronic bed shortages this winter would lead to patients dying. The Royal College of Emergency Medicine estimates that 16,600 people died avoidably last winter as a result of delays in getting A&E care or a bed.
“These findings fit with our clinical experience and if anything underestimate the problem,” Price said. “This is a complex problem which has been escalating for years, increasing the strain both in hospitals and in the community.”
Record numbers of older people and life-prolonging treatment breakthroughs have led to an increase in the overall need for care, she explained.
NHS England’s ability to withstand winter pressures has also been compromised by the cost-cutting “reset” of the service’s finances for 2025-26 ordered by its chief executive, Sir Jim Mackey, she said.
“Many hospitals have had the number of beds reduced in order to comply with the penalising financial pressures they are placed under.
“It was predictable that any additional strain would cause this effect. This is an extremely serious situation. For patients stranded in the emergency department, there is a significant mortality associated with this,” she said.
Delayed discharges cost the NHS in England about £200m a month, or about £2bn a year, the Health Service Journal estimated in October. That was a small increase on the £1.7bn that the King’s Fund health thinktank calculated the cost to be in 2023.
Mackey predicted recently that as many as 8,000 of the NHS’s 100,000 beds could soon be filled with flu patients, given the severity of the outbreak.
Rory Deighton, the acute and community care director at the NHS Confederation, which represents NHS trusts, said: “Given the ever-increasing demand that the NHS has seen over the last few years – often from patients who are older or have more complex conditions – it is sadly not surprising to see this analysis highlighting the continued impact delayed discharges are putting on services.
“Delayed discharges have been a longstanding challenge for the NHS and can exacerbate winter pressures.
“A lack of social and community care can often result in delays getting medically fit patients out of hospital, which in turn can create bottlenecks in the urgent and emergency care system that result in longer ambulance handovers and A&E waits.”
Hospital bosses were also “very concerned the upcoming resident doctor strikes will pile yet more pressure on to the NHS and could put patient safety at risk”, he said.
The Department of Health and Social Care was approached for a response.
