The state of health care and adult social care in England 2025/26

Bed occupancy and its impact on people

The NHS 2023/24 priorities and operational planning guidance recommends that no more than 92% of beds should be full at any one time to ensure that people are able to get the care they need and can be admitted to hospital when they need to be. The Royal College of Emergency Medicine (RCEM) thinks this should be lower, recommending that no more than 85% of beds are full at any one time, and that hospitals should justify why they exceed this level. Over the last 3 years, the average occupancy levels of general and acute beds have continued to stay at a high of 93%.

The average number of general and acute beds that are available has steadily increased year-on-year since 2021/22 until 2024/25 and was broadly level in 2025/26. However, the increase in the number of beds has not kept pace with the size of the population, as the number of beds per 100,000 people decreased by 0.9% from 174 per 100,000 in 2024/25 to 172 per 100,000 in 2025/26. This data is supported by a recent analysis from the King’s Fund, which shows that the number of acute and general beds has not grown in line with the number of admissions from emergency departments since 2011/12.

As we highlight in the section on Ongoing issues with discharge, challenges in the wider system and hospital processes can additionally affect patient flow through the hospital.

Pressure on the system and a lack of bed capacity can lead to people being cared for in settings that cannot provide safe and effective care. This is an ongoing concern from last year’s report, where we discussed the impact of providing care in inappropriate spaces. We reiterate to trusts that the use of inappropriate, non-clinical spaces is not acceptable. We recognise that the use of risk-assessed, short-term temporary spaces may be necessary to relieve pressure across the urgent and emergency care pathway. However, patients must receive safe and effective care in an environment that allows their privacy and dignity to be protected, and ‘corridor care’ must never become normalised.

As well as experiencing long waits in emergency departments and receiving care in inappropriate spaces, some respondents to the Adult inpatient survey described instances of being moved from ward to ward without warning multiple times, and often during the night. This caused stress and disturbed people as they were not sure what was going on.

Although moving people might help hospitals to manage the flow of patients in a constrained system, having multiple points of transition can reduce the continuity of specialised care and increases the risk harm, for example people’s notes being incomplete or going missing. Through our annual engagement with chief pharmacists in NHS trusts, we heard that having multiple points of transfer was a particular risk for medicines, with documentation on people’s medicines not being thorough or well-recorded if medicines reconciliation was not robust at the start of their admission.

Having multiple points of transition can also affect the quality of communication between patients, their families and staff. We heard this sentiment from people we spoke with in our patient pathway tracking interviews, who told us that communication was weaker at points of transition. Some respondents to the 2024 Adult inpatient survey also felt that a lack of continuity was a problem, and they did not appreciate having to repeatedly explain their requirements to new or different members of staff.

Impact of poor ward environments

Once on a ward, people have reported concerns with the environment. For example, respondents to the 2024 Adult inpatient survey reported concerns including that:

• the wards were very busy and overcrowded
• the temperature on wards was not always optimal – either too hot or cold
• they felt wards and/or toilets could be cleaned more frequently as they were often dirty.

The proportion of people saying their hospital room or ward was very clean has decreased from 74% in 2021 to 69% in 2025.

Free text responses from the 2024 Adult inpatient survey described some concerns about privacy on the wards, which could have an impact on people’s dignity. For example, some patients reported that they were in full view of other people when being treated or being changed:

There was a real lack of privacy on the ward as my bed was in a make-shift cubicle. The doctor and my partner had to set up the screens rather than ward staff. I had enough support from nurses and doctors but other people on the ward did not.

(Respondent to the 2024 Adult inpatient survey)

As we have reiterated to trusts on the use of inappropriate spaces, people should receive safe and effective care in an environment that protects their privacy and dignity. As the feedback above illustrates, creating additional bed spaces to accommodate patients can have an impact on the quality of people’s care, as well as compromising their safety.

In the 2025 Adult inpatient survey, the majority of people felt they had enough privacy when being examined. However, results also showed that only 37% of respondents felt they were able to sleep on the ward. Factors that prevented people from sleeping included:

• noise from other patients (36%)
• discomfort from pain (24%)
• noise from medical equipment (18%)
• hospital lighting (17%)
• noise from staff (17%)
• room temperature (10%)
• something else (7%).

This reflects similar findings from the 2024 Adult inpatient survey, where respondents reported that the wards were often noisy at night, as night staff were chatting with each other or on their phones. There was also often noise when staff were moving equipment or furniture around the ward. Other concerns included noise when new patients were admitted, disturbances from equipment, excessive light on the ward and noise from visiting relatives.

…my only problem was not being able to sleep well at night due to noise, but obviously this could not be prevented due to the necessity of machines and medical alerts during the night.

(Respondent to the 2024 Adult inpatient survey)

Ongoing issues with discharge from hospital

As highlighted by the Health Foundation, delayed discharges from hospital are bad for patients, increasing the risk of infection, loss of mobility and worse mental health. Delayed discharges refer to people who remain in hospital despite being ready to leave. This means that people are staying in hospital longer than is medically necessary. This can affect patient flow through the hospital as beds remain occupied, limiting capacity for incoming patients and creating knock-on effects throughout the system. As with other areas of hospital care, we continue to see ongoing challenges with delays to discharge.

In 2025/26, a daily average of 13,000 people remained in hospital who were medically fit to be discharged, which equates to 13.8% of adult general and acute hospital beds. This is up from 2024/25 when an average of 12,700 people were delayed, occupying 13.4% of beds.

NHS England publishes data on the reasons for delayed discharges for longer stay patients (people who have been in hospital for 14 or more days), which provides some insight into why people are staying in hospital longer than necessary. In 2025/26, the most common reasons for delays for longer stay patients were:

• a lack of capacity or delays in completing transfers to rehabilitation, reablement or recovery services (24.6%)
• a lack of capacity or delays in completing transfers to social care services (24.1%)
• hospital process, including waiting for reviews, medicines and other discharge information (18.5%).

This is supported by evidence from our analysis of information gathered from our patient pathway tracking interviews, part of our inspections of emergency departments and medical wards over winter 2025/26. This highlighted issues including delays in arranging packages of care in the home environment, and patients waiting for discharge letters or patient transport services, as the following experience shows:

Dad’s going home with a package of care. The process was started yesterday morning. We were moved here (to Discharge Assessment Unit) this morning. We’re still waiting. I’ve asked what will happen if it gets to tonight and the carers aren’t ready, and they’ve said he’ll stay here in bed. It’s frustrating, my in-laws were here last year and my husband hates the discharge unit.

(Patient pathway tracking interview)

In addition, many respondents to the 2024 Adult inpatient survey reported that delays in discharge were because medicines were not available:

The amount of time it takes for medication once discharged, i.e. sent to pharmacy approximately 10.30am, [but] not ready until approximately 17.30. Total waste of hospital bed could a prescription be given to collect from own pharmacy.

(Respondent to the 2024 Adult inpatient survey)

People raised the problem of poor communication around discharge in our pathway tracking interviews, as some people and families felt the information they were given was inadequate. Results from the 2025 Adult inpatient survey found that:

• only 49% of respondents said they definitely had enough notice about when they were going to leave hospital
• 77% of respondents were given information about what they should or should not do after leaving the hospital, of these, 70% understood the information very well and 28% fairly well
• only 48% of respondents said their family or carers were given all the information they needed to care for them at home.

Effective communication and planning between hospitals, patients and other agencies is an important factor in allowing a safe and successful discharge from hospital and gives people a better chance of remaining out of hospital.

Challenges with discharge and readmission

To maintain sufficient bed capacity and improve the flow of patients from the emergency departments, wards can be under pressure to discharge patients without delay. However, as highlighted above, making sure that timely discharge happens safely requires co-ordination with community support services as well as a high level of clinical expertise.

Where there is a lack of appropriate community support or when people are discharged before being medically fit can lead to them being readmitted to hospital. The risk of readmission to hospital is higher for people aged 75 and over, with a rate 17.8%. People living in the most deprived areas of England are also more likely to be readmitted to a hospital within 30 days compared with the national average.

Some respondents to the 2024 Adult inpatient survey felt they were discharged before they were ready. Furthermore, only 47% of respondents to the 2025 Adult inpatient survey who said they needed support from health or social care after leaving hospital said they definitely got the help they needed.

This is supported by findings of our analysis of information from our patient pathway tracking interviews, which noted cases of patients being discharged when they did not feel ready to go home.

Mr X felt there was lack of communication with regards to discharge, and feels he was discharged too early on his last admission, which is why he had become unwell again.

(Patient pathway tracking interview)

At other locations, patients and their families told us about incidents where they were discharged from hospital, but then had to return or be readmitted within a short period (typically within 30 days).

… the patient developed a cough and shortness of breath on exertion. The patient’s daughter phoned 999, and the patient was taken to hospital by ambulance but was subsequently discharged home. Following this, community nurses visited to assess the patient and determined that the patient was not fit to remain at home, advising an immediate return to A&E. The patient’s husband then transported the patient back to the emergency department.

(Patient pathway tracking interview)

At one of these locations, a patient had reportedly been admitted multiple times for the same condition, including being admitted on 3 separate occasions within less than 2 weeks.

[The patient] has had multiple admission with chest problems last year. Currently on second admission this year. Previously discharged … with pneumonia and heart failure… However, presented to A&E 5 days later … to A&E and was discharged… [readmitted 4 days later] … after wife called the ambulance.

(Patient pathway tracking interview)

Waits for hospital care

More people waiting for diagnostic tests

We know that prompt diagnosis can save lives, saves time and money, and can prevent conditions from getting worse. In last year’s State of Care, we highlighted the ongoing rise in the numbers of diagnostic tests carried out. This trend has continued in 2025/26, with the monthly average of scheduled and unscheduled diagnostic tests and procedures carried out increasing by 78,000 from 2,419,000 to 2,497,000. However, at the same time, the average number of people who are waiting for a diagnostic test has risen by almost 140,000 to nearly 1.8 million people.

This suggests that demand is exceeding capacity.

The NHS Constitution states that people should wait less than 6 weeks from the point at which the referral is made, but performance against this standard has worsened with the increasing demand.

There were, on average, 390,000 people on the waiting list for more than 6 weeks in 2025/26, which is 40,000 more than the previous year.

On average, nationally 77.8% of people had their diagnostic test within 6 weeks in 2025/26. However, performance varies. As at March 2026, 95% of tests were carried out within 6 weeks in the best performing integrated care board areas, while 55% were carried out within 6 weeks in the worst performing areas.

In line with the NHS 10-year health plan to move care away from hospitals into the community, in April 2026 the government announced it was investing £237 million in new community diagnostic centres (CDCs) to boost NHS diagnostic capacity and deliver more care in local communities.

Slight improvements in waits for elective care

Waiting times for routine hospital care are a key measure of NHS performance. As well as having a big impact on patients’ experiences, they consistently rank as one of the public’s main concerns with the NHS. The 2025 Adult inpatient survey found that 43% of respondents felt their health deteriorated while waiting to be admitted to hospital – the same proportion as the previous survey.

Data from NHS England shows that although the numbers of people waiting for elective treatment have fallen, they still remain high. The average number of people waiting for planned care reduced from 7.5 million in 2024/25 to 7.3 million in 2025/26. As at March 2026, 7.1 million people were waiting for care following a referral for treatment.

In January 2025, NHS England set out its plans for reforming elective care. This set the target that by 2029, 92% of patients should wait 18 weeks or less for care. As part of its plans, NHS England set an interim target of 65% to be achieved by March 2026.

Over 2025/26, performance against the interim target has improved, with 61.7% of patients waiting 18 weeks or less compared with 58.9% in 2024/25. While the average annual figures are short of the 65% target, monthly figures show that the target was met in March 2026, with 65.3% of patients waiting 18 weeks or less. Performance has also improved at integrated care board level, with 21 integrated care board areas meeting the target, and an additional 11 being within 2% of it, in March 2026.

The proportion of waits for care of 18 weeks or less has improved, with an average of 61.7% in 2025/26, compared with 58.9% in 2024/25. Monthly figures for 2025/26 show that while performance largely ranged between 61% and 62% in the year, it increased over the last 2 months, reaching 65.3% in March 2026, meeting the 65% interim target. Performance has also improved at integrated care board level, with 21 integrated care board areas meeting the target, and an additional 11 being within 2% of it, in March 2026.

However, while this improvement is encouraging, the response from Healthwatch to the March publication of waiting times stated that this still leaves an unacceptably high number of people stuck in limbo, which can take a toll on people’s health, work, and family life. Evidence from our analysis of NHS data shows that some people continue to be at risk of longer waits than others. The Waiting List Minimum Dataset (WLMDS) shows that between June 2025 and March 2026, people in the most deprived areas of England had longer waits for treatment than those in the least deprived areas, with 59.7% of people in most deprived areas waiting less than 18 weeks compared with 61.3% in the least deprived areas. WLMDS data also shows that, where ethnicity is recorded, people of Mixed and Asian ethnicities had longer waits for treatment, with an average of 59.3% of people waiting under 18 weeks, compared with people whose ethnicity is White (60.7%).

In its recent analysis of NHS England’s Waiting List Minimum Data Set, the Health Foundation highlighted some improvement in inequalities in waiting list times, with the proportion of people waiting for less than 52 weeks narrowing substantially between the most and least deprived areas. However, it notes how progress has been uneven across the country, with a small number of integrated care board areas accounting for a large share of the reduction in inequalities for very long waits.

Findings from the 2024 Adult inpatient survey also highlight concerns when appointments for treatment, tests or clinics are cancelled – often at short notice and on multiple occasions. This included people having their surgery or treatment cancelled or delayed after they had already been admitted to hospital. Those affected told us that there was often little explanation or communication from staff as to why their treatment had been delayed or cancelled.

I had a lot of appointments cancelled at short notice since my op on 3 times. I was to see my consultant. She was not there so they got a physio to see me.

(Respondent to the 2024 Adult inpatient survey)

As highlighted in the Healthwatch response, alongside efforts to reduce the length of waits, people must be kept informed about their care, including being given information about the support available to them while they wait, so they feel confident that they have not been forgotten.