NHS crisis: What you need to know

Accident and Emergency departments have suffered their worst week on record while more than a dozen hospitals have been forced to bring in "major incident" emergency plans.

At least 15 hospitals in England have had to cancel operations, call in extra staff or limit A&E services to the severely ill.

While the Government blames the drastic decline in performance on growing numbers of frail, older patients, charities supporting the elderly said that cuts to council care budgets were now having a knock-on effect upon the NHS.

Key figures

92.6%

Latest figures showed that just 92.6 per cent of patients were seen in four hours at England’s A&Es from October to December – below the 95 per cent target and the worst performance in a decade.

83.1%

Only 83.1 per cent of patients were seen in four hours at major A&Es in the week before Christmas – the worst week on record.

15

Twelve hospitals in England declared major incidents, and three others significant incidents, because of pressures on A&E and bed capacity.

The crisis points

Ageing population

Underlying the pressures on the NHS is the simple fact that it must care for an ever-growing and increasingly aged population. Eleven million of us are now over the age of 65, a group which has been growing.

Elderly people are more likely to fall ill, and more likely to require both urgent and routine healthcare.

Winter illnesses

Every year, the workload of the NHS peaks in winter. Cases of flu, chest infections, winter vomiting and other bugs increase during the colder months - although levels this year have not been notably high.

Cuts to social care

Cuts to social care services for basic care to elderly people has had a knock on effect. Once they are in hospital they are likely to have to stay for a while. Because care provision outside hospitals has been cut, it is taking longer to find long-term alternatives, once they are better.

Longer waits to see a GP

Many GPs are retiring or leaving the NHS to work overseas, creating a staffing crisis, and last year recruitment into the profession was at its lowest levels in a decade - another knock-on effect for hospitals.

NHS 111

The NHS’s telephone triage service is thought to be sending more people to A&E or calling out an ambulance more often than before. In October, the latest month for which figures are available, 17 per cent of 111 calls led to an ambulance call out or a recommendation to go to A&E.

What has been said?

NHS England’s director for acute episodes Professor Keith Willett said. He added that delays might be attributed to availability of care home places or social care packages.

Obviously social care services have taken a substantial reduction in funding whereas the NHS, albeit not having any growth in funding, has had its core budget protected.

• Prof Willett

Jeremy Hunt, the Health Secretary, paid tribute to NHS staff who were “busting a gut”, and said that the number of frail elderly patients requiring hospital care was the “key problem” facing the NHS.

If you’re over 80 and you turn up at an A&E department, the chances are you won’t go home, you’ll be admitted to the hospital and you’ll probably stay in the hospital for a very long time… across the country [people] are saying that is the key problem because many of those people would be better looked after at home.

• Jeremy Hunt

Shadow Health Secretary, Andy Burnham said budget cuts imposed on local councils by the Coalition had created “a crisis in social care” that was “dragging down the NHS”.

We have record numbers of older people trapped in hospital who can’t go home because the nursing home places aren’t there or care in the home isn’t there.

Because wards are staying full, A&E can’t admit to the ward, pressure is backing up through A&E and ambulance services can’t hand over patients at A&E.

• Andy Burnham

Caroline Abrahams, director of Age UK, said social care services were “overwhelmed”, meaning older people were more likely to end up in A&E and stay in hospital.

Politicians must recognise that there can be no long-term solution to the NHS winter crisis until Government investment in social care – in the form of its central grant to councils – significantly rises.

• Caroline Abrahams

More: Everything you need to know about the 'radical cure' for the NHS

Comment: Stretchers lining the corridors and unbearable crowding - The reality of life working on the front line of the NHS

More: NHS reforms and six other policies the coalition might regret