Our new report, Mapping the NHS winter, highlights the scale of pressures faced by NHS trusts and front line staff through the toughest winter on record.

The report reveals that the number of people coming in to A & E over winter period, between December 2017 and March 2018, rose to more than 5.8 million, equivalent to ten times the population of Liverpool. 160,000 more patients were admitted, transferred or discharged within the four hour target compared to the previous winter – equivalent to every man, woman and child in the city of Oxford.

It also shows how, despite extensive preparations and extraordinary commitment from front line staff resulting in record numbers of patients being treated, services were unable keep up with demand. Finally, the report sets out what must be done to ensure the health service is ready next time.

The report comes as NHS England prepares to publish performance figures which are widely expected to confirm continuing difficulties for the health service in meeting standards set out in the NHS constitution.

Based on an analysis of official NHS data, the report shows: 

• A&E attendances over the year rose to nearly 24 million – equivalent to almost half the population of England
• there was a 261,000 increase in attendances during winter – broadly the same as the population of Plymouth
• there were 1.52 million emergency admissions over the winter, up 85,000 compared to the previous year – roughly equal to the number of people who live in Halifax
• over winter there were 1.3 million arrivals by ambulance, a similar figure to the number of people who live in Birmingham
• the number delayed more than 15 minutes (the official limit) in handing patients over to hospital was 600,000 – the same as the population of Bristol.

The report highlights the impact of severe winter conditions right across the health and care system, encompassing hospitals, ambulances, mental health, primary care, community services and social care. The combined effect of repeated cold snaps, high flu rates and norovirus, on top of the additional demands from long term demographic pressures, left services overstretched.

This was a watershed moment for the NHS as performance targets established to ensure safe, good quality care moved beyond reach.

The report says the experiences of frontline trusts should help shape the national review of winter which is being carried out by NHS England and NHS Improvement in preparing strategies at both a national and local level.

The report also calls for a new planning framework based on realistic demand projections, and a review of capacity right across the health and care system in good time for next winter.

Phillippa Hentsch, NHS Providers head of analysis, said:

"The unprecedented demand for care last winter exposed the vulnerability of health and care services which – despite heroic efforts - lacked the resources to ensure the standards of care that patients have a right to expect, and that trusts and their staff want to provide.

"Setting out the challenges by comparison to populations of some of our towns and cities provides a compelling perspective of the difficulties they faced.

"This was a watershed moment for the NHS as performance targets established to ensure safe, good quality care moved beyond reach.

"We must learn from last winter’s experiences to ensure services are safe and resilient next time."