On the surface, it appeared as though the NHS experienced a relatively quiet winter in 2018/19. Media and political commentary over the season have become instrumental in shaping the public, and political narrative around the NHS. But the usual media stories about performance against the four-hour A&E target, ambulance delays and patient experience, were noticeably absent or significantly reduced this winter. This was reflected in Westminster, with a reduction in the number of parliamentarians flagging pressures in their local hospitals and communities.

However, what were the real reasons for this reprieve and what was the real story of winter for trusts, their patients, and hard pressed frontline staff? During the winter months, NHS Providers monitored the weekly data and asked our members what they were experiencing on the frontline. We tracked what was happening each week in our NHS winter watch series. This briefing tells the real story of winter 2018/19 for the provider sector.


The reality is that media and political focus on Brexit diverted attention away from: the worst A&E performance since records began - people waiting longer than ever for cancer diagnosis and treatment, routine operation waiting list ballooning, delays for hundreds of thousands of diagnostic tests and the sustained increase in demand for an already overstretched system. The scale of this increase in demand over the winter in 2018/19 was somewhat unexpected. Much milder weather, with a less severe strain of flu and a significant reduction in the prevalence of norovirus, should, on the face of it, have meant a less stretched health service than last year. Despite the more benign external conditions, demand for emergency care services grew by 6% compared to the previous year, and when we take a longer view, emergency admissions have increased by nearly a fifth (18%) since 2014/15 – a staggering rise in activity in just four years. Once again, NHS staff showed remarkable resilience and commitment through the winter months in keeping services going, treating more patients than ever, and ensuring that the overwhelming majority received good care, often in the face of considerable pressures.

In parallel, proposals which could significantly change what the public should expect in terms of NHS access standards across a range of services have been published. Under the clinical review of access standards, which underpins the NHS long term plan, a number of trusts are now piloting different ways to measure performance in urgent and emergency care. The review also proposes new ways in which trusts measure standards in emergency care, cancer services, planned care and in mental health with the potential for significant changes to be rolled out as early as this autumn. With an ambitious NHS long term plan to deliver, a growing need for additional capital investment and severe workforce shortages, the provider sector is already busy preparing for winter 2019/20.