NHS A&E Crisis Intensifies with Record 12-Hour Waits Amid Falling Treatment Backlog
Newly released figures from NHS England paint a stark picture of contrasting fortunes within the healthcare system, revealing a sharp escalation in Accident and Emergency department delays even as the overall waiting list for treatments continues its gradual decline.
Record-Breaking A&E Delays Signal Mounting Pressure
The data for January shows an alarming surge in patients enduring excessively long waits for hospital admission. A staggering 71,517 individuals waited more than 12 hours for a bed following a decision to admit them, marking a dramatic increase from 50,775 in December. This represents the highest monthly figure since records began in August 2010, underscoring a deepening crisis in emergency care provision.
Furthermore, the number of patients waiting at least four hours from admission decision to actual admission reached 161,141 last month, up from 137,763 in December. This stands as the second highest figure ever recorded, indicating widespread systemic strain. Currently, only 72.5% of patients in England are being seen within the four-hour target, falling significantly short of the March 2026 goal of 78%.
Treatment Waiting List Shows Modest Improvement
In contrast to the emergency department turmoil, the overall NHS waiting list for planned treatments has decreased for the second consecutive month. An estimated 7.29 million treatments were awaiting completion at the end of December 2025, relating to 6.17 million patients. This represents a slight reduction from 7.31 million treatments at the end of November, while the patient figure remained stable at 6.17 million.
The waiting list had previously peaked at a record high in September 2023, with 7.77 million treatments and 6.50 million patients. NHS England reported that staff delivered a historic high of 18.4 million treatments and operations throughout 2025, an increase from 18 million in 2024. December alone saw 1.43 million treatments delivered, representing an increase of 91,775 compared to the previous year, despite five days of strikes by resident doctors.
Concerns Raised Over "List Cleaning" Practices
Some healthcare experts have expressed concerns about the methods behind the waiting list reduction, pointing to the practice of "list cleaning" as a significant factor. The Nuffield Trust has argued that the balance between treatment referrals and actual deliveries has not substantially changed, suggesting that a considerable proportion of waiting list reductions stem from administrative processes rather than increased treatment capacity.
List cleaning occurs for various reasons, including when patients no longer require treatment, choose not to proceed, experience improvement in their condition, or have died while on the waiting list. Government figures reveal that NHS England paid NHS trusts £18,818,566 for "validation exercises" – essentially list cleaning – from April to September 2025.
Chris Roebuck, head of profession for statistics at NHS England, defended the practice, stating: "Unreported removals have accounted for around 15% of patients who come off the waiting list for decades – they are actually lower now than before the pandemic. It is the record level of operations, tests and scans being delivered by NHS staff that is now getting the waiting list down."
Healthcare Leaders Express Divergent Views
Health and Social Care Secretary Wes Streeting praised the NHS's efforts, stating: "Despite having to deal with flu and industrial action, the NHS has managed to continue cutting waiting lists, thanks to a Herculean effort this winter. This Government has cut waiting lists by more than 330,000, with hundreds of thousands more people treated within 18 weeks."
However, medical professionals sounded alarms about the deteriorating situation in emergency departments. Dr Vicky Price, president of the Society for Acute Medicine, warned: "These are people unwell enough to need admission, often older and frail with complex needs, who are at the greatest risk of harm when care is being delivered in corridors and hospitals are operating beyond safe limits."
Tim Gardner, assistant director of policy at the Health Foundation, summarized the mixed picture: "Today's data paints a picture of very mixed fortunes for the NHS. While it is positive to see a reduction in the overall waiting list, A&E departments continue to remain overwhelmed, with far too many patients facing unacceptably long waits."
Sarah Scobie, deputy director of research at the Nuffield Trust, noted the pressure to meet March targets, stating: "A 6% improvement by spring may not sound like much, but the NHS has struggled to make even tiny incremental improvements in recent months, despite staff working flat out." She expressed hope that future waiting list reductions would come "from extra treatment rather than other things like administrative processes."
The data also revealed some positive developments, showing that the Government is meeting its 28-day target for cancer diagnosis, with slight improvements in timely cancer treatment. However, with A&E attendances reaching a record high of 2,320,266 in January – 4.6% higher than January 2025 – and winter performance at 73.5% for the four-hour target, the challenges facing the NHS remain substantial and multifaceted.
