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NHS pressures – future trends

The NHS came under unprecedented pressure during the 2017/18 winter, with A&E attendances, waiting times and admissions rising to alarming levels. Concerns that seasonal pressures have now begun to adversely affect trusts well beyond the winter period led the BMA to forecast how the NHS was likely to perform during the traditionally less pressurized summer months.

We predicted that the summer was likely to resemble winters from recent years in terms of comparable levels of pressure, with the warmest months of the year seeing performance against key-targets not unlike those seen during much colder, more demanding periods in recent years. The analysis below clarifies this in further detail and shows that our predictions proved largely accurate.


What pressures did we think the NHS would be under during the summer of 2018?

Based on recent and historic trends, our assessment during early 2018 was that rather than experiencing the customary fall in pressures during the summer, the NHS would experience similar levels of demand and activity during the summer as it did in the winter of just two or three years ago. Our assessment of the issues was picked up by national media.

The table below shows the range of our projections, along with the actual figures from the 2018 summer.

  Best-case scenario  Worst-case scenario Actual figures
Attendances 5,887,000 6,214,000 6,176,000
People waiting over four hours at A&E 613,000 774,000  660,000 
Percentage of patients seen, admitted or discharged within four hours 89.6%   87.5%  89.3%   
Emergency admissions 1,513,000   1,571,000  1,559,000 
Trolley waits of four or more hours 127,000  147,000  125,000 
Comparable winter 2015  2016  An amalgamation of the winters of 2015 & 2016


What did the summer look like?

The summer of 2018 was, as expected, a busy one. Attendances and admissions equaled or outstripped even our worst-case projections, with the former increasing by 4.2% compared with the previous summer, and the latter increasing by 5.7%.

Despite a notable increase in demand, the NHS proved arguably more resilient than expected, with the 0.8% deterioration in the four-hour wait and an increase of 8,500 trolley waits closest to the ‘best-case’ scenario as projected by the BMA.

However, that best-case scenario still represented a problematic period for the NHS, one in which performance as measured by key indicators was broadly similar to winters of just 2 or 3 years ago.

With no summer respite, it’s increasingly difficult to see how the NHS can be expected to recover from intensely pressurised winters. Though A&Es are often extremely busy during the summer months, generally patient flow is smoother as unplanned admissions fall and it becomes easier to discharge patients from beds, but now staff and patients face the same kind of difficulties (bed shortages, long waits) that are more traditionally associated with much colder months.



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