Summary

  • A&E waits and ambulance response times have hit their worst levels on record across the UK

  • During a special day of coverage, we'll be reporting on the pressures faced by patients, doctors and nurses

  • We have teams stationed outside hospitals and in an A&E unit - and we'll bring you undercover insights from medics

  • Data released on Thursday shows more than 40% of people needing a hospital bed spent more than four hours waiting on trolleys

  • The NHS faces crises on multiple fronts this winter, with nurses and ambulance workers set to strike in the coming weeks

  • The government says the NHS will publish a recovery plan in the new year

  • Ministers have also pledged an extra £6.6bn over the next two years to improve urgent and emergency care

Live Reporting

Edited by Philippa Roxby and Michelle Roberts

  1. ‘Goodwill has concealed the cracks in the NHS’

    Gem O'Reilly
    Live reporter

    You heard earlier from Laura - the ear, nose and throat (ENT) surgeon.

    I also asked her about how A&E could be improved, and generally what she thought needed to change in the NHS.

    She replied: “It feels like you’re scooping out a sinking ship with an egg cup when you ask what needs to change.

    "This has been decades of slowly chipping away at an NHS that’s now bare bones. So when it has a stress, it’s feeling crippled."

    Laura said the public could help “relieve the burden” by exercising “personal health responsibility” and by only seeking medical care if it was really needed.

    I asked her about the recent announcement of nurses’ going on strike in a dispute over pay.

    She explained that you don’t go into medicine to earn huge amounts of money, but everyone has to live.

    In her words: “putting financial stress on top of an emotional and physically stressed out workforce is too much.”

    The core of the NHS is built on its staff. We go above and beyond, and it is goodwill that has concealed the cracks in the NHS. That goodwill has run dry now and things need to change.”

  2. What's the latest?

    If you're just joining us or need a recap after the latest NHS England data were released this morning, here's a reminder:

    New statistics

    • The data shows waiting lists hit a record number in November. Some 7.2 million people were waiting to start routine treatment at the end of October, up from 7.1 million in September
    • In emergency departments, just 68.9% of patients in England were seen within four hours last month, down from 69.3% in October - the worst performance on record
    • But, there have been improvements in NHS performance in some areas, with the number of people waiting more than 12 hours in A&E departments from a decision to admit to actually being admitted falling
    • The number waiting at least four hours from the decision to admit to admission also dropped from a record 150,922 in October to 143,949 in November
    • Ambulance response times outside of London were quicker by 30 seconds
    Chart showing waits for hospital bed at record high.

    On the ground: Burnout and wait times

    • A junior doctor, who works at a hospital in the East Midlands, says one of the worst things staff are dealing with is burnout and they cannot afford to lose any more staff. Another says they start work "knowing I’m going to do a rubbish job" due to lack of beds and waiting times
    • Ear, nose and throat (ENT) surgeon Laura works in A&E in the north Midlands and says there is little room to relieve pressure and it just gets "pushed somewhere else". She says: "Every winter they say it’s the worst winter for the NHS, but this year it feels like it actually is."
    • Covid is still having an impact on doctors, many of whom had worked in critical care for two years, leading to "massive burnout" and "unnecessarily long" waiting times for patients

    Is the NHS in crisis or not?

    • Chris Hopson, chief strategy officer for NHS England, says the health service has a clear plan to improve performance and denies it is in crisis. He tells Radio 4's Today programme, while the NHS is still feeling the pressures of Covid, it has a "very clear three-point plan"
    • First, recover and stabilise core services like A&E, ambulances and planned care waiting lists, he says. Second, deliver key ambitions in its long-term plan to improve health outcomes. Third, transform the NHS for the future
    • But Dr Ian Higginson, vice president of the Royal College of Emergency Medicine, says the emergency care system across the UK is in crisis with many staff "wondering if it is in a state of collapse"
    • He says it has been caused by cutting NHS beds over the last decade and a failure to plan a health and social care workforce to meet the needs of the population

  3. Hospital investing millions in bid to tackle pressures

    Matthew Hill
    Health correspondent reporting from Taunton

    Dr Charley Davies hopes up to 300 patients can be cared for in the community

    Dr Charley Davies hopes up to 300 patients can be cared for in the community

    Health bosses in Somerset are spending more than £6m to get patients out of hospital and back into the community in a bid to tackle the intense pressures and increased wait times .

    NHS Somerset CEO Jonathan Higman believes supporting people in the community will also help them "live healthy lives for longer".

    Amongst the schemes being rolled out are "virtual wards" which provide care in people's own homes and a mobile GP service.

    Figures for October show 57% of patients had to wait more than four hours in the emergency department at Musgrove Park Hospital in Taunton before being discharged, but there had been a 10% improvement in November after many of these schemes started.

    Though it is early days, it is hoped these schemes could already be having an effect on the demand for hospital beds.

    You can read more about what NHS Somerset is doing here.

  4. 'The NHS can't improve unless social care gets better funding'

    We've been asking you to get in touch with us about your experiences of accident and emergency care in the NHS.

    A discharge facilitator at a large hospital in the West Midlands contacted us.

    The reader - who asked us not to use their name - told us they have about 200 medically fit patients waiting to be discharged from the hospital.

    They say it's a "perfect combination" of issues.

    There just aren't the care homes or care packages available in the community. Social care and continuing health care are stretched. Care workers are not paid enough leading to high staffing vacancies in care homes and domiciliary care. Our staffing within the team and wider hospital is stretched, with multiple people handing in their notice as they are burnt out.

    It's a vicious circle, elderly people wait 6 hours for an ambulance, then 18 hours on a trolley in A&E, they decondition and then need extra support to go home. The NHS can't improve and change unless community support and social care gets better funding.

    A discharge facilitator at a large West Midlands hospital

  5. Treatment centres able to tackle many urgent cases

    Rob Sissons
    East Midlands health correspondent, reporting from Derby

    Derby Urgent Treatment Centre

    The NHS can be a confusing maze of access points .

    This morning people were queuing before the doors opened at 8am at Derby's Urgent Treatment Centre which is designed to take some of the pressure of the city's A&E which is a couple of miles away.

    Livia Rodger who runs the Derby centre says people should use centres like this more: "We do what it says on the tin - we are here for urgent cases that are non-life threatening."They typically see between 100 and 200 patients a day and are open from 8am to 8pm. Some patients complain they are unable to see a GP so come to the centre, Livia says, adding that they have "scope to help and see more".

    Meanwhile at Derby's A&E unit staff are said to be working flat out. The hospital estimates around 20% of patients who show up could be seen appropriately elsewhere.

    Waits at the treatment centre are typically way less than A&E with most people through in one to two hours at the nurse-led facility.

    The message from Derby is if you're unsure which bit of the NHS in England you need to access call NHS 111 for advice.

  6. 'I spent 33 hours in A&E with my six-month-old baby'

    Hayley's baby in a hospital bedFamily submission

    Hayley and her baby were moved onto the paediatric ward last night

    Hayley from Ashford in Surrey got in touch to tell us about her experience of A&E with her sick baby which began last night.

    She says when her six-month-old became unwell she was able to get a GP appointment that day and was told to go straight to the nearest accident and emergency unit in Chertsey.

    St Peter’s Hospital A&E was totally rammed. We spent 33 hours in A&E waiting for a bed on the wards. They looked after my baby well and have some brilliant doctors and nurses. I didn’t have a bed though and had to sleep on the floor. The room we had was noisy, open and next to the waiting room, so we’ve not really slept for more than an hour.

    The staff tried their best to help us. We were moved to the paediatric ward last night at 10:30pm. I can’t complain about the care we’ve had as it’s been very good. The NHS is totally overwhelmed.

    Hayley, 34, from Surrey

    Hayley's baby lying in a hospital bedFamily submission

    Hayley has praised the "brilliant" doctors and nurses at St Peter's Hospital in Chertsey

  7. Watch: Managing A&E 'like massive game of Jenga'

    Managing A&E like 'massive game of Jenga'

    BBC News Northern Ireland is granted exclusive access to the emergency department at the Royal Victoria Hospital in Belfast.

    In one area, known as acute care, trolleys were lined up head-to-toe with staff having to squeeze between them in order to check patients and to deliver food.

    Michael Thompson, lead nurse in charge of patient flow between the department and wards, says: "It's like a massive game of Jenga.

    "There's just no flow going out. Our front door is massive but our back door is tiny and it just keeps shrinking."

    Read more here.

  8. Burnout is high, we can’t afford to lose more staff - junior doctor

    Sam Hancock
    Live reporter

    Let's bring you some more stories from people on the ground - those in hospital facing these pressures we keep talking about.

    One junior doctor, who works at a hospital in the East Midlands, has been telling me what it’s like to work in emergency medicine right now.

    Here’s some more from our conversation. Their name’s not being reported.

    A lot of the extra workload that my colleagues and I are facing isn’t due to people coming to A&E randomly or because their GP can’t see them. It’s people who genuinely need help… which makes it 10 times harder to disappoint them. Some of our staff – and at hospitals across the country, I’m sure – are off with illness at this time of year, so it’s kind of a perfect storm what with it being winter. Covid hasn’t helped either.

    On top of that, loads of staff are dealing with burnout – that’s the worst thing for us. I saw a British Medical Association (BMA) survey recently, which warned that something like 40% of junior doctors were considering leaving. If that happens, or even close to it, I don’t know what we’ll do. Something needs to change. It’s hard to pinpoint one thing that needs to be fixed, because there are so many issues.

    Where I work, for example, we’re really good at getting people off ambulances so our ambulance colleagues can go and help more people. But that doesn’t marry up with the issues inside the hospital. It’s all well and good getting someone off a vehicle and inside, but what then if we’re at capacity? The only way anything will change is if staff – both in hospitals and in other sectors like social care – feel they're being looked after properly and paid enough.

  9. Staff fear emergency care system in 'state of collapse'

    Ambulance outside an Accident and Emergency department, as it leaves a hospitalScience Photo Library

    The emergency care system across the UK is in crisis with many who work in it "wondering if it is in a state of collapse", says the vice president of the Royal College of Emergency Medicine.

    Dr Ian Higginson tells BBC Radio 5 Live's Nicky Campbell it is has been caused by cutting NHS beds over the last decade and a failure to plan a health and social care workforce to meet the needs of the population.

    "What that means is that are hospitals are full to bursting because there aren’t enough beds and there isn’t enough capacity in the social care system," he says.

    "When our hospitals are full, we can’t get patients out of our emergency departments.

    "That means emergency departments become overcrowded and we see patients waiting for long periods on uncomfortable trollies in corridors or other rubbish places."

    Dr Higginson says his colleagues are "very worried" and unable to deliver the care they would like to give to patients.

    I can’t deliver adequate care or safe care at times to patients who are in corridors or waiting in ambulances outside my emergency department. It’s just not possible. We can’t offer the patients the privacy and the dignity they need. We may not be able to examine then or get to them to treat them properly and so the quality of the care we’re providing is reducing."

    Dr Ian Higginson, Royal College of Emergency Medicine

  10. Nurse says she will put patients first rather than go on strike

    Jay Sneade
    reporting from Manchester

    Generic hospital ward imagePA Media

    A staff nurse from a hospital in Manchester has been telling me about the pressure nurses are facing.

    Their name is not being reported to protect their identity.

    "The problem is, for nurses especially, is that the wages haven't been great for the workload and pressure we take," they said.

    "All around the world, things are getting expensive. Petrol, bills, everything is getting higher and the salary doesn't match so people are struggling. Nurses are struggling."

    Despite this, the nurse says they will not be going on strike on 15 and 20 December and none of the hospitals in Greater Manchester are affected by the action taking place elsewhere in the country.

    "I'm not taking part on the strike because I'm thinking, if we all go on strike, who's going to stay in the wards for the patients who need us?

    "We have that responsibility. Especially when we are registered with the Nursing and Midwifery Council. It is in our code of conduct to look after patients.

    "Health comes first.

    "Some people at our hospital will not be taking part. If we take part, how many surgeries will be cancelled and rescheduled? And we're already behind because of Covid."

    Clarification 22 December: This post was updated to include information that there were no strikes at hospitals in the Greater Manchester area.

  11. How does A&E work and what are your other options?

    Smitha Mundasad
    Health reporter

    Accident and emergency departments are set up to deal with “genuine, life-threatening” emergencies. That’s things like losing consciousness, fits that aren’t stopping, breathing difficulties, chest pain or severe bleeding. Burns, strokes, major trauma, self-harm and severe allergic reactions are also treated in A&E.

    Generally, the first assessment after a patient arrives is known as triage - where people with the most serious conditions are prioritised and some are directed to other parts of the department. A&Es often have separate sections for children, for example.

    Crucially, they aren’t designed to deal with every type of medical problem.

    People who have urgent - but not life threatening problems - are encouraged to head to urgent treatment centres, walk-in centres and minor injury units instead.

    This might include people who have suspected broken bones, cuts and grazes, minor scalds, some ear infections, skin infections or people who need emergency contraception.

    But it’s not always easy to know where the most suitable place to go is. NHS 111 can give advice on this. GPs and pharmacists may be able to offer advice too.

  12. NHS figures and delays explained

    We've been bringing you a whole stack of figures for how the NHS is doing in England.

    To help make clear what the various targets and metrics are, we've laid them out in graphic form.

    Graphic showing trolley waits and A&E admission times.

  13. 'My daughter cannot wait this long to see a doctor'

    Insaf Abbas
    Reporting from Hillingdon Hospital, west London

    Patients have been queuing for Hillingdon Hospital’s A&E department since early morning.

    Firoz Mohamed, 45, says he has been there since 4am, trying to get his nine-year-old daughter seen.

    But he says he will have to leave after staff told him it would be another six hours to wait.

    "She is a child, she can’t wait this long to see the doctor," he says.

    "We need more nurses and doctors to give better service."

    Another patient, who doesn’t want to be named, has been waiting with her baby since 3am.

    She says it is a common problem at the hospital, and also puts it down to a lack of staff.

    Hillingdon HospitalGetty Images

  14. What have we learned this morning?

    Thomas Mackintosh
    Live reporter

    We've been crunching the latest NHS England data since it was released at 09:30.

    Let's have a quick recap of the latest figures which chime with the stories and issues patients and NHS staff have been telling us about this morning:

    • NHS waiting lists have hit a record high and in November A&E departments experienced their worst performance on record against the four-hour target
    • Data shows 7.2 million people were waiting to start routine treatment at the end of October, up from 7.1 million in September
    • In emergency departments, just 68.9% of patients in England were seen within four hours last month, down from 69.3% in October - the worst performance on record
    • But, there have been some improvements in NHS performance in several areas, with the number of people waiting more than 12 hours in A&E departments from a decision to admit to actually being admitted falling
    • Some 37,837 people waited longer than 12 hours in November, down 14% from the record 43,792 in October but still the second-highest monthly total since records were first kept in August 2010
    • The number waiting at least four hours from the decision to admit to admission also dropped from a record 150,922 in October to 143,949 in November
    • Ambulance response times outside of London were quicker by 30 seconds
    Graphic showing hospital bed wait times.

  15. 'A&E experience in north-east London hospital was brutal'

    Victoria Bourne
    Reporting from King George Hospital, Ilford

    King George Hospital-A&E, Barley Lane, Ilford

    The A&E department at the King George Hospital in Ilford, north-east London, has recorded some of the worst waiting times in England.

    This morning, several ambulances have arrived and taken their patients straight into the building.

    But while the wait outside might not be long, it is a different picture for those who already inside.

    One young woman tells me she waited more than eight hours for her mother, who was having breathing difficulties, to be seen overnight.

    And she says there were other people who had been there several hours longer.

    Describing the experience as being “brutal”, she says there were not enough doctors or nurses.

    She felt bad for the nurses, she adds, as she saw them pleading with doctors after facing anger from patients due to the long waiting times.

  16. NHS facing perfect storm of pressures, says health boss

    NHS worker outside A&E entrance in LondonEPA

    Let's bring you some reaction to all of these figures from the national clinical director for urgent and emergency care.

    Prof Julian Redhead draws on current issues facing NHS staff which he describes as a "perfect storm of pressures" which he says includes flu hospitalisations, issues in social care and record numbers needing A&E treatment.

    "Staff have powered through to bring down some of our longest waits for care," he says.

    “We have already said we are dealing with a perfect storm of pressures this winter, including increased demand for emergency are, and today announced an expansion of mental health crisis services which will ensure people... get the help they need as quickly as possible, and reduce the chances of a patient needing to go to A&E."

  17. Analysis

    What's happening at A&Es in Scotland?

    Lisa Summers
    BBC Scotland Health Correspondent

    The latest A&E waiting time figures in Scotland are once again the worst on record.

    In the week ending 27 November just 61.9% of patients attending emergency departments were dealt with within the four-hour target.

    And the problem is far more acute at Scotland's busiest casualty units.

    The crisis in A&E shows what is happening across the whole system.

    Separately, the number of hospital beds occupied by people who are medically well enough to go home is also at a record high.

    This means patients can't get into hospital because there are no beds and they can't get out because there is not enough social care.

    The pressure this causes seeps into every single part of the system.

    Staff are stressed and burnt out while patients are at risk because they can't access the care they need.

    Read more here.

  18. Rate of patients waiting two years for hospital treatment down

    More on the latest data dump from NHS England.

    Not all of the new NHS figures are showing increases.

    It is estimated that the number of people waiting more than two years to start routine hospital treatment is down from 2,239 to 1,907.

    This is well below the peak of 23,778 in January 2022.

    The government and NHS England set the ambition to eliminate all waits of more than two years, except when it is the patient's choice or for complex cases requiring specialist treatment, by July this year.

    NHS under pressure graphic,

  19. Get in touch: Tell us what’s happening at A&E today

    Whether you’re a nurse, a paramedic, a patient or a loved one, get in touch.

    Get in touch image

    We want to show what is happening at A&E today.

    As part of our special day of coverage, we’re reporting on the pressures faced by patients, doctors and nurses.

    We have teams stationed outside hospitals and in an A&E unit - and we'll bring you undercover insights from medics.

    If you’re a you’re a nurse, a paramedic, a patient or a loved one, get in touch and tell us your experiences at A&E today.

    You can also get in touch in the following ways:

    In some cases a selection of your comments and questions will be published, displaying your name and location as you provide it unless you state otherwise. Your contact details will never be published.

  20. Analysis

    Latest figures show the strain on emergency care

    Nick Triggle
    Health Correspondent

    Data published in England today covering November shows, once again, huge pressures on the emergency care system.

    Ambulance response times for emergencies such as heart attacks and strokes are taking twice as long as they should, while three in 10 patients who arrive at A&E spend more than four hours waiting to get seen.

    The BBC has been looking at another part of the system as well – the wait the seriously ill and injured face when A&E staff decide they need to stay in hospital.

    Many of these are the elderly patients who will be on trolleys in corridors and in makeshift bays. In November, nearly 40% waited more than for hours for a bed to be found. Before the pandemic 25% did.

    It is why the Royal College of Emergency Medicine is warning patients are at risk of severe harm.

    But there are also some positive signs in the latest data - ambulance response times have shown a slight improvement on the month before.

    Some of the work to improve community support and tackle queuing outside hospitals may be helping a little.

    But with the worst of winter still to come no-one in the health service will be getting complacent.