NHS Winter Pressures: Can the NHS Change the Ending This Winter?

Planning early for NHS winter pressures

For Dr Layla McKay, Director of Policy at the NHS Confederation, the biggest lesson from recent winters is that preparation must begin far earlier. While recent winters have prompted emergency funding announcements, these often arrive too late to support meaningful planning.

“Last year we warned of the need to act fast when it comes to unlocking funding for winter pressure,” she explains. “Adult social care discharge funding arrived in the middle of the winter crisis. Funding like this needs to be released well before winter, so leaders can prepare services properly rather than scramble to spend during the peak of demand.”

In July 2023, national plans were announced to support winter preparedness, including care ‘traffic control’ centres to speed up discharge, additional ambulance hours and extra beds. While welcome, these measures sit against a backdrop of long-term underinvestment. A maintenance backlog of more than £10 billion continues to affect estates, digital infrastructure and medical equipment. Without addressing this, efforts to reduce waiting lists and improve productivity risk being undermined – particularly during winter, when system resilience is already stretched.

Creating Capacity by Adapting and Expanding the Estate

To cope with predictable winter surges, Trusts are increasingly adapting existing space and introducing new capacity through modular solutions. In 2021, Health Spaces worked with Peterborough City Hospital to deliver a modular, 24-hour Urgent Care Centre alongside the existing A&E department. The approach allowed additional capacity to be brought on stream quickly while minimising disruption to live hospital operations.

John Watkins, Contracts Manager at North West Anglia NHS Foundation Trust, says uncertainty around the timing and scale of winter funding remains a challenge, but longer-term planning is helping to build resilience. Across the Trust, schemes include a new 20-bed externally located modular ward and the expansion of the ambulance receiving rapid assessment centre by repurposing internal space. These projects are designed not only to increase bed numbers but to improve patient flow at critical pressure points.

Making Better Use of Existing Space

Finding space for additional beds and clinical areas remains difficult on constrained hospital sites. However, changes in working patterns are opening up new possibilities. The shift towards hybrid and remote working has freed up administrative areas that were previously unavailable for clinical use. While this creates opportunity, conversion is not straightforward. Clinical environments require appropriate ventilation, infection control measures and digital infrastructure, all of which must be carefully planned and funded. Nonetheless, adapting existing space is becoming an increasingly important part of how Trusts respond to NHS winter pressures without relying solely on new builds.

Virtual Wards and Care Closer to Home

Another way to cope with winter pressures on hospitals is to treat more people at home. According to Tara Donnelly, former Chief Digital Officer at NHS England and founder of Digital Care Limited, almost £500 million has been invested in virtual wards over two years. As a result, around 10,000 patients every fortnight who would previously have been admitted to hospital are now supported at home. Virtual wards were initially focused on acute conditions, reflecting the NHS’s relatively low bed base compared with international peers. Increasingly, however, they are being integrated into urgent care pathways and community services. At Hertfordshire Community NHS Trust, virtual wards operate alongside community response teams. Staff attending rapid response calls are equipped with digital monitoring kits, allowing treatment and observation to take place in patients’ homes. There is also growing interest in extending these models to paramedic services, enabling more patients to be monitored safely at home rather than facing a binary decision between admission and discharge.

Long-term conditions represent a significant opportunity. Conditions such as Chronic Obstructive Pulmonary Disease (COPD) are highly seasonal and contribute disproportionately to winter pressures. This can be managed at home with relatively simple technology, “Some of the best sites in the country are halving admission rates for patients supported at home,” Donnelly notes. With long-term conditions accounting for around 70% of hospital bed use, scaling these models could fundamentally change how winter feels inside hospitals. “If we can stabilise bed occupancy to healthier levels,” she says, “we protect elective care, reduce cancellations and improve staff experience.” Crucially, patients support the shift. Feedback from virtual ward users consistently highlights convenience, reassurance and a strong sense of trust in NHS services. The challenge now is not proof of concept, but investment at scale, particularly at Integrated Care System (ICS) level, where digital tools can deliver long-term returns.

Can AI Help Predict and Manage Winter Demand?

Artificial Intelligence (AI) is increasingly being used to help systems anticipate winter pressures rather than simply respond to them. The Government has invested £123 million in AI technologies supporting diagnosis, screening and home-based care, with further funding available for Trusts to deploy tools that speed up diagnosis and improve patient flow.

In Bristol, North Somerset and South Gloucestershire ICS, new intelligent care traffic control centres are being developed to bring together live data from across the system, including ambulance services, NHS 111, acute providers, virtual wards, social care, GPs and mental health services. Deborah El-Sayed, Director of Transformation and Chief Digital Officer for BNSSG ICS, explains that this system-wide view allows leaders to understand capacity, demand and risk in real time, supporting more proactive management of patient flow and discharge. The work is being delivered in partnership with Faculty, whose operational AI tools are already in use across the NHS. At University Hospitals of North Midlands NHS Trust, AI-assisted monitoring reduced admissions by up to 50% among patients with moderate to high frailty by identifying early signs of deterioration.