Executive Summary

Urgent and Emergency Care (UEC) is the frontline test of NHS resilience. For winter 2025/26, NHS England has set out a plan to stabilise UEC performance, reduce long waits, and improve patient flow. Yet translating this plan into operational reality within Integrated Care Systems (ICSs) and Trusts is fraught with challenges: workforce fragility, bed pressures, financial constraints, and social care bottlenecks. This blog examines the UEC plan, what must be in place by November, and how leaders can navigate the gap between ambition and delivery.

 

 

What the UEC Plan Requires

Key components of the 2025/26 UEC plan include:

• Expanding Same Day Emergency Care (SDEC): To reduce admissions and free up beds.
• Frailty front-doors: Early specialist intervention for older patients to avoid unnecessary admissions.
• Ambulance response improvements: Reducing handover delays and corridor care.
• Bed occupancy management: Targeting sustainable levels below 92%.
• Vaccination rollout: Timely flu and COVID protection to reduce demand surges.
• Discharge acceleration: Stronger integration with local authority and social care services.

These interventions are well-evidenced, but their success depends entirely on workforce and operational execution.

The Gap Between Policy and Reality

The frontline picture shows the fragility of delivery:

• SDEC units are often under-staffed or limited to office hours, reducing their impact.
• Frailty teams face shortages of geriatricians, therapists, and specialist nurses.
• Ambulance services remain overwhelmed, with handover delays leading to patients treated in car parks or left waiting at home.
• Bed occupancy is already above 90% in many Trusts, even before winter peaks.

Without urgent action, the UEC plan risks becoming another set of targets unachieved.

What ICSs and Providers Must Stand Up by November

1. Fully Functioning SDEC Units

Every acute Trust must ensure SDEC is resourced and staffed for extended hours, not just weekday working. Evidence shows this directly reduces admissions and length of stay.

2. Frailty Pathways That Work

Frailty assessment at the front door prevents avoidable admissions. This requires trained staff and close integration with community services.

3. Real-Time Command Centres

ICSs should operate command centres linking acute, ambulance, community, and social care partners. Real-time data and authority to act can prevent bottlenecks spiralling.

4. Discharge Capacity

System leaders must secure agreements with local authorities and care providers to accelerate discharges. Without this, beds will remain blocked.

5. Vaccination at Pace

Vaccination rollout must be prioritised and resourced early, to reduce seasonal admissions.

Workforce and Financial Constraints

Workforce remains the critical enabler:

• Shortages across emergency medicine, nursing, and paramedics/ambulance staff continue to undermine plans.
• Agency demand has been artificially suppressed to cut spend and force staff into banks, yet many bank shifts are now as costly, or more costly, than agency or substantive roles, leaving systems with less flexibility at the moment they most need resilience.
• The £6.6bn NHS deficit limits Trusts’ ability to expand services or staff SDEC/frailty adequately.

The uncomfortable truth: without workforce capacity and sustainable funding, UEC ambitions cannot be delivered and patients will continue to bear the consequences.

Political Responsibility

The Labour government under Wes Streeting has promised transformation but continues to pursue policies that erode resilience. Promises of reformed UEC pathways ring hollow when systems are asked to do more with fewer staff and tighter budgets. Corridor care persists, ambulances queue, and patients suffer. Without real investment in workforce and capacity, the UEC plan is destined to fail.

Final Word – Altin Biba, MBA, AMBA

Urgent and Emergency Care defines public trust in the NHS. The 2025/26 plan is right in principle: SDEC, frailty, discharge, and vaccination all matter. But principles don’t treat patients, staff do. By November, ICSs and providers must show tangible improvements, not just paper commitments. Government must face reality: without reinvesting in workforce and protecting the NHS’s shock absorber and safety net, UEC targets are fantasy. Winter 2025 will reveal who prepared with honesty and who relied on promises that were never deliverable. Winter 2025 will expose which leaders built resilience and which left patients with promises instead of care.

References

1. NHS England. Urgent and Emergency Care Plan 2025/26.
2. NHS Providers. UEC Briefing, 2025.
3. HSJ. SDEC and Frailty Pathways Impact on Winter Pressures.
4. NHS Staff Survey 2024. Emergency Medicine Workforce Findings.
5. King’s Fund. Urgent and Emergency Care: Policy and Practice.
6. Health Foundation. NHS Finances and System Pressures, 2025.