Briefing on Statement by the Cabinet Secretary for Health and Social Care: NHS winter pressures

Current pressures and mitigations
 

• Demand: In recent weeks, most NHS organisations in Wales have been operating at the highest or highest but one escalation status, with demand prevalent across the entire system, causing long waits for services.
• The latest Public Health Wales data showed there were more than 900 patients in hospital beds in Wales with either flu, Covid or RSV – a 50% increase on this time last year.
• In addition, hospitals screen hundreds of patients attending hospital each week - regardless of symptoms – and found 30% of patients had flu compared to 10% the same time last year. RSV have already peaked, while Covid numbers remain "stable", but that flu numbers were expected to rise further, with rates higher compared to a similar period last year.
• Bed capacity: The high levels of infections in our communities means the likes of flu, Covid RSV and norovirus are also circulating within healthcare settings. This limits the number of beds available due to the inability to admit further patients onto a highly infectious ward or having to temporarily close beds/wards for thorough cleaning. In one health board, for example, there are currently around 100 beds closed due to flu.
• Delayed transfers of care: Capacity issues have been exacerbated by persistent numbers of medically fit patients in hospitals awaiting some form of support at home before they can be discharged, which is further affecting patient flow. Health boards are working closely with local authority colleagues to address these delays and help patients who no longer require hospital care to return to their own homes.
• Infection prevention and control measures: Several health boards (Aneurin Bevan UHB, Betsi Cadwaladr UHB, Cwm Taf Morgannwg UHB, Hywel Dda UHB and Swansea Bay UHB) have introduced more stringent infection prevention control measures to protect patients and staff. This includes reintroducing mask wearing in hospitals and asking people not to visit loved ones in hospital if they are feeling unwell.
• Staff absence: Health boards are experiencing lots of staff off with respiratory infections, further reducing capacity.
• Vaccination uptake: Vaccination is the single most important intervention that can protect people, individuals, families, and communities. Flu vaccination uptake amongst those over the age of 65 is between 65 and 70% across various health boards of Wales. At the comparable time last year, it was around 73%. Similarly, in healthcare workers, uptake this year has been around 27% compared to around 33% last year.
• Welsh Ambulance Service critical incident: On Monday 31 December 2025, the Welsh Ambulance Service declared a critical incident. This decision was made due to the 340-call backlog alongside roughly half of their ambulances waiting to hand over patients outside hospitals. Although the critical incident has now been stood down, it does not mean the pressures on the NHS are any less sustained. In one 7-day period over Christmas, the Welsh Ambulance Service received 1,716 immediately life-threatening calls, compared to 1,213 for the same period last year. This shows how intense pressures are on the frontline.
• The Welsh Ambulance Service has introduced a number of measures this winter to improve patient safety and quality of care. These include rapid clinical screening, a mental health response vehicle, community welfare responders and advanced paramedic practitioners (APPs). Data show that around 70% fewer people need to be taken to hospital when responded to by an APP, compared to a traditional ambulance crew.
• Other proactive mitigations include more widespread use of virtual wards (so some patients don’t need to come into hospital) and the use of Same Day Emergency Care services.
• These periods of intense pressure on frontline services can have a knock-on effect on the NHS’s ability to tackle waiting lists for non-urgent care, as those in life-threatening situations must be prioritised.

The health system is currently under significant pressure, and we all have a part to play in ensuring that we protect our precious resources for those who need them most. With the cold snap putting further pressure on all health and care services, the ask is for the public to take all reasonable precautions such as taking care when travelling or outside in icy conditions, stocking up on prescription medicines in advance of them running out, as well as first aid kit essentials to treat common ailments at home, like coughs, sore throats, and diarrhoea. If you can, check in on elderly or vulnerable loved ones (unless you have viral symptoms) and make sure you thoroughly wash your hands. 

999 and Emergency Departments are for emergencies only. Unless in a life-threatening emergency, the NHS 111 website should be the first port of call for advice, information, and next steps. Minor Injury Units are for things such as sprains, fractures, cuts, and minor wounds and those in life-threatening emergencies should go straight to their nearest Emergency Department for the timeliest treatment.

Long term

To assist in alleviating short-term pressures, we must also address long-term demand and capacity. This includes:

• Social care: The NHS and social care are intrinsically linked. Demand on and capacity on one has a huge knock-on effect on the other. Social care services play a crucial role in care pathways by keeping people well at home, preventing hospital admissions, and enabling faster, safer discharges home.
  - Delayed Transfers of Care: Such high levels of delayed discharges – or pathways of care delays – have knock on consequences for the wider health and care system. Because the back door to the NHS is effectively closed, there is no flow through the system and the front door increasingly becomes jammed.
  - Keeping people well at home: We know social care is essential to keeping people well at home and therefore reducing demand coming into the NHS (usually for urgent and emergency care or for GPs).

We must address system-wide challenges and stabilise the social care system through sustainable funding and resourcing, considering workforce pay and conditions, access to publicly funded care and transparency and consistency around the collection and reporting of social care data.

• Rising demand – shifting to prevention: Particularly since the pandemic, demand on health and care services has been. Both the complexity and acuity of demand has also increased. Addressing the wider determinants of health would help relieve pressure on the NHS in the longer term. One such key determinant is the quality of housing and the impact of cold homes, especially on respiratory conditions.

We need a cross-government strategy to improve health and wellbeing and reduce inequalities. This will shift the focus from simply treating illness to promoting health and wellbeing, reducing inequalities, and tackling the wider determinants of health, boosting economic growth and supporting people to be active partners in their own health and wellbeing.

• Workforce: A sustainable workforce is essential for a sustainable NHS.

We need investment in a Long-Term Plan for the NHS and social care workforce and their education. This will enable the implementation of multi-professional, digitally enabled, motivated, engaged and valued workforce across the NHS and social care.

• Waiting times and performance: Waiting lists in Wales continue to increase, with the most recent data from October showing there were around 620,300 individual patients waiting for treatment in Wales, the highest figure on record. Current winter pressures including the spike in flu cases, high levels of norovirus, RSV and Covid circulating in local communities, and increasing acuity and demand will have a significant impact on the NHS’s ability to make inroads and deliver on Welsh Government targets.

We need a joint health and social care performance and financial framework for seamless care and support. This framework should emphasise prevention, effective treatment, and timely support for individuals, and be measured consistently across health and social care, support joined up models of care and provide care closer to home.

• NHS estates and infrastructure: The current state of the NHS estates and infrastructure (including digital) mean to address the maintenance backlog alone the NHS needs hundreds of millions of pounds. This is hampering productivity and efficiency, undermining efforts to work towards sustainability and risking patient outcomes, with a less than desirable physical working environment for staff.

We need a long-term capital and infrastructure strategy which invests in the entire NHS and social care infrastructure, including buildings, equipment and digital infrastructure; but also leveraging technological and research advancements including genomics and AI.

Conclusion

The NHS is facing one of its most challenging winters on record due to record numbers of patients seeking care across all the breadth of health and care services (A&E, ambulances, GP, mental health) and increased pressure from respiratory illnesses, flu, and norovirus. This is being compounded by high numbers of medically fit patients unable to be discharged from hospital.

NHS organisations are taking steps to address the situation, but despite their efforts, significant challenges remain. To address short-term pressures, we must also address long-term demand and capacity. This includes addressing the stark challenges in social care for a more sustainable health and social care system for the future.

Further Information

If you would like further information on any of the issues raised in the briefing, please contact Haleema Khan on haleema.khan@welshconfed.org.

The Welsh NHS Confederation represents the seven Local Health Boards, three NHS Trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public Health Wales NHS Trust), and two Special Health Authorities (Digital Health and Care Wales and Health Education and Improvement Wales). The twelve organisations make up our members. We also host NHS Wales Employers.