19 September 2025
The NHS winter planning letter is a missed chance to make good on promises to prioritise Emergency Care, and to curb dangerous long waits for patients, says the Royal College of Emergency Medicine (RCEM).
Today (19 September 2025), NHS England published its ‘Winter Letter’, entitled ‘Building on our progress in the second half of 2025/26’.
Written by NHSE Chief Executive Sir James Mackey, the letter has been sent to all Integrated Care Boards as well as to Trust CEOs and chairs, and has been published online.
RCEM supports the focus on vaccinations for staff and at-risk members of the public. We also welcome the aims contained in the letter, such as bringing down bed occupancy rates to below 80% ahead of the Christmas period and reducing delayed discharges. These are measures that RCEM has argued should be in place throughout the year.
The scale of the problem we face all year is immense and RCEM is concerned that there has not been enough detail on how they will be fixed. We are also sceptical about encouraging providers to chase temporary targets which will have little to no long-term benefit.
Meanwhile, a focus on improving the number of people being admitted, discharged or transferred within four hours ignores the fact that there are still far too many people waiting much longer than that, and these are the ones who come to the greatest harm.
Recent RCEM analysis showed that around one in every 11 patients are enduring waits of more than 12 hours. Thousands of people are being treated in corridors, or in the back of ambulances, due to a lack of hospital capacity.
Today’s letter is far-reaching, with asks of the system to include ensuring primary care access over Christmas, having specific paediatric plans in place for respiratory viruses, implementing targeted reducing bed occupancy reductions ahead of the holiday period – all while maintaining a continued focus on reducing elective waiting times.
Dr Ian Higginson, RCEM President, said:
“I welcome the recognition of the importance of valuing NHS staff in England, as detailed in today’s letter.
“However, it’s hard to read it without feeling some cynicism, since we see something similar every year and they have yet to make a difference.
“Whilst the letter talks about improvements in NHS performance, this isn’t being felt on the ground in most Emergency Departments where patients continue to languish in corridors and where staff feel they and their patients are expected to simply put up with it.
“Today’s letter was a chance for system leaders to make good on promises to prioritise Emergency Care – and to give some proper detail on how we can dig ourselves out of the situation we are in.
“That chance was missed, and we call on NHSE to address that by putting into place thorough, detailed, long-term plans to tackle long and dangerous waits in EDs.
“The suggestion to focus on reducing occupancy rates ahead of the festive break is tacit acknowledgement of how system slow down over this critical period has such a harmful effect on patient care.
“However, what we want to see is occupancy levels reduced all year around, rather than once a year. Safe hospitals should be for life, not just for Christmas.
“We know this is going to be an extremely challenging winter, with potentially record numbers of people suffering avoidable harm because they could not be treated in time.
“Although I would love to say otherwise, I see nothing in this letter to suggest anything will be different from what has become normal. Winter seems to come as a surprise each year, leaving our members and their patients to deal with a recurrent crisis which could have been prevented.”