Winter Pressures on the NHS: What It Means for Negligence Claims

Every winter, the headlines are familiar: overstretched A&E departments, delayed operations, staff shortages, and patients waiting hours on trolleys. The so-called “winter crisis” in the NHS is not a new phenomenon, but its impact is becoming more acute.

For patients, winter pressures can mean delayed treatment, cancelled surgeries, and overcrowded wards. For solicitors and expert witnesses, these same pressures often surface later in the form of clinical negligence claims. Understanding the link between systemic strain and litigation is essential in today’s medico-legal landscape.

Why Winter Pressures Arise

The NHS faces increased demand every winter due to a combination of factors:

• Seasonal illnesses: Influenza, RSV, and norovirus lead to surges in hospital admissions.

• Respiratory conditions: Cold weather exacerbates chronic conditions like asthma and COPD.

• Staff shortages: Higher rates of staff sickness and burnout intensify workforce gaps.

• Bed pressures: Limited capacity means patients often face “bed blocking” or boarding in corridors.

• Delayed discharges: Social care shortages keep medically fit patients in hospital, reducing available beds.

The result is an overstretched system operating at or beyond capacity.

How Winter Pressures Affect Patient Care

When systems are stretched, patient safety risks increase. Common issues include:

• Long waits in A&E: Extended delays before assessment, triage, or treatment.

• Ambulance delays: Crews waiting outside hospitals instead of responding to new emergencies.

• Cancelled or postponed elective surgeries: Prolonging suffering and, in some cases, worsening prognosis.

• Overcrowding on wards: Increased risk of hospital-acquired infections, pressure ulcers, or falls.

• Reduced staffing ratios: Nurses and doctors managing more patients than is safe.

Each of these problems has the potential to create the conditions for clinical negligence.

Negligence Claims in the Context of Winter Pressures

The law is clear: systemic strain does not lower the standard of care owed to patients.

Courts assess negligence using the Bolam test (was care in line with a responsible body of medical opinion?) and Bolitho (is that opinion logical and defensible?). Montgomery applies in cases involving informed consent.

Even if pressures are well known, individual lapses, such as failing to escalate deteriorating patients or not following sepsis protocols, may still amount to breach of duty.

Examples of Claims That May Arise:

1. Delayed diagnosis: Long waits in A&E leading to missed sepsis, strokes, or heart attacks.

2. Failure to monitor: Understaffed wards where deteriorating patients are not observed or escalated.

3. Cancelled surgery: Worsening of a condition (e.g., cancer progression) due to excessive delays.

4. Pressure sores: Arising from inadequate care in overcrowded wards.

5. Infections: Outbreaks linked to poor infection control in stretched facilities.

   
   

Causation Challenges

One of the most complex aspects in winter-pressure negligence cases is causation. Claimants must show not only that there was a breach but also that it caused harm.

For example:

• Did a delay of several hours in A&E materially affect the outcome?

• Would earlier treatment have avoided complications?

• Did overcrowding increase the risk of infection in a way that can be causally linked?

These questions require careful expert analysis.

The Role of Expert Witnesses

Expert witnesses are pivotal in these cases. Depending on the allegations, courts may hear from:

• Emergency medicine experts (A&E triage, delays).

• Nurses (monitoring and staffing standards).

• Intensivists (ICU admission and escalation).

• Specialists in the underlying condition (cardiology, oncology, respiratory medicine).

Experts assess:

• Whether standards of care fell below what was reasonable.

• Whether systemic pressures were relevant but not determinative.

• Whether harm could have been avoided with timely intervention.

For example, in a sepsis case, an expert may examine whether delays in antibiotics materially worsened the prognosis, even if the hospital was overwhelmed.

Systemic vs Individual Negligence

Courts distinguish between systemic failures and individual negligence. While resource shortages are acknowledged, staff must still work within guidelines and escalate concerns.

Hospitals may argue “systemic resource constraints” as context, but this rarely absolves them of liability where clear clinical standards were breached.

For solicitors, this means building cases carefully: separating unavoidable system strain from lapses in care that fall below professional standards.

Implications for Solicitors

For claimant solicitors:

• Gather complete disclosure, including staffing rotas, escalation logs, and internal winter pressure policies.

• Use expert evidence to link delays directly to harm.

• Prepare clients for challenges around causation.

For defendant solicitors:

• Emphasise systemic pressures and national context.

• Scrutinise whether harm was truly avoidable even with earlier intervention.

• Highlight staff efforts to maintain standards in difficult conditions.

Wider Policy Context

The rise in winter-pressure claims reflects broader issues in NHS capacity, workforce planning, and funding. Policy discussions continue about:

• Expanding urgent care capacity.

• Strengthening social care to free up hospital beds.

• Recruiting and retaining staff.

• Investing in community services to reduce admissions.

Until systemic reforms ease pressure, litigation linked to winter strain is likely to continue.

Final Thoughts

Winter pressures on the NHS are an annual challenge, but their consequences extend into the courtroom as well as the hospital ward.

For patients, delays and overcrowding can have devastating consequences. For solicitors and expert witnesses, these cases demand careful analysis of breach and causation in a complex context.

The legal system does not excuse substandard care because of systemic strain. Instead, it asks whether clinicians acted reasonably, whether escalation protocols were followed, and whether harm could have been avoided.

For the medico-legal community, winter pressures highlight the importance of expert evidence, detailed disclosure, and a nuanced understanding of how systemic and individual factors intersect.

At Apex Experts, our panel of clinicians and medico-legal specialists provide impartial, CPR-compliant reports to support both claimant and defendant cases. We help solicitors navigate the evidential challenges of winter-pressure claims, ensuring that justice is based on clear, reasoned medical opinion.