‘We are absolutely full’: This hospital is outperforming most – but it is still on its knees

Marina Strange is 90 and lives alone. She had a heart attack last week, her third in two years. It took two hours for an ambulance to reach her. Marina was impressed.

“I was surprised the ambulance came within two hours. I thought that was very good,” she told Sky News.

Marina also has an untreatable tumour, so she’s gotten to know the hospital well over the last few years, and this is the service she’s come to expect.

Marina was one of 7,678 patients to arrive at the care of Royal Berkshire NHS Trust by ambulance so far this winter, where Sky News has spent the past few months speaking to patients, consultants and those responsible for running the hospital.

Far from being an extreme example, the hospital is performing close to or even outperforming the national average in most measures. The experiences we’ve seen are normal for NHS patients in 2025.

On 9 January we were scheduled to come and film with the respiratory ward. It was too busy for us to come in.

We spoke to Chief Executive Steve McManus about it:

“Our ward occupancy at the moment is running around 99% of our beds, so we are absolutely full,” he said.

“Almost half of [our respiratory unit] has been given over for patients with flu – and we’ve got a lot of very unwell patients at the moment. Each morning over the last few days we’ve been starting the day with another 20-30 patients in the emergency department waiting for beds, so the pressures are really significant.”

Flu and other viruses, like norovirus and now also COVID, tend to peak around the winter months when people spend more time indoors in close proximity to one another.

This year’s surge was particularly bad. It’s on the decline again now, but peaked in early January at a level almost twice as high as last winter.

Bed occupancy in Royal Berkshire has averaged 94.7% this winter.

Again, far from being an outlier, this is only slightly worse than the average across England of 93.6%. The recommended maximum to achieve efficient operations and transfer between emergency care and other hospital departments is 92%, so at least 8% of beds should be free at any one time.

That has only been achieved on ten days out of 60 this winter across England. All of those days were between 21 December and New Year’s Day, so for the entire rest of winter the service has been over capacity.

We came back to Royal Berkshire the next day – 10 January – and spoke to Dr Omar Mafousi, the clinical lead at the hospital. He explained how a lack of beds in the main hospital affects the emergency care his team can provide.

“We say every year it gets a little worse. This year has felt worse than any other year that I remember and I’ve been a consultant for 15 years in emergency medicine.

“We can’t [have patients in A&E long term]. We’ve only got 20 major cubicles but 25 waiting for a bed. Some are on chairs, some are in the waiting room, but we have no space to bring patients off an ambulance to see and examine them.”

“Almost every single bay is full, there’s just one free at the moment. There are patients waiting to be transferred to the wards, and while we’ve been here in the last couple of minutes two more patients have been brought in by ambulance. Things in the emergency department change very very quickly”.

Accident and emergency

We’d first spoken to Dr Mafousi in the emergency department on Wednesday 4 December. It was at the beginning of winter and the number of flu cases had yet to really spike.

At 1pm 191 patients had already come through. Dr Mafousi says these kind of numbers are the “new norm”.

“We probably see about 480-500 patients a day on busy days, sometimes over 500 on really busy days. That’s becoming more and more frequent.

“Attendances are going up and up and up year-on-year and we are struggling. We are trying to cope as best we can and give patients the best care we can, but that’s not always possible.”

In 2010 NHS England set a standard of no more than 5% of patients waiting more than four hours to be admitted, transferred or discharged.

That target hasn’t been met in a decade. Every winter since COVID it’s gotten higher than 20% – four times higher than the target.

In December it was 28.9%. At major A&Es (not speciality centres or minor injuries units), it was 44.7%, almost one in two.

Again Royal Berkshire is fairly normal – 5,293 of the 11,972 patients at the major A&E (44.2%) waited longer than four hours.

At the time we were there, 14 patients had been waiting over 15 hours.

“Without a doubt that is too long,” said Dr Mafousi. “That’s not what anyone wants. No one in this Trust wants that to happen.”

There used to be a bit of respite in summers, when more beds were free from winter virus patients and people could flow more quickly and easily through the system.

Waits in the middle of summer now are worse than even the most dangerous winter peaks of years gone by.

The Royal College of Emergency Medicine estimated that waits longer than four hours at A&E had contributed to 23,000 excess deaths in 2022.

Ambulance handover delays

A&E delays don’t just affect the patients who are at hospital, they also make it more difficult to treat new patients. Part of the reason it takes so long to get ambulances out to people like Marina when they have heart attacks is because of “handover delays”.

The NHS guidance allows a standard of 15 minutes from the ambulance’s time of arrival at A&E to having handed over care of the patient to A&E staff.

If A&Es are full, ambulances can’t offload their patients, so they aren’t available to get out to see new patients.

At Royal Berkshire this winter the average has been 25 minutes. That’s not far off double the time it should take, but again that’s better than average. In England as a whole it’s 40 minutes, up from 32 minutes over the same dates last year.

One in seven ambulance handovers now takes over an hour. That figure has more than trebled in just the last four years.

As well as meaning potentially worse care for the patient in the ambulance, handover delays ultimately contribute to delayed response times as well.

Ambulance calls are of course categorised by seriousness, with the most serious life-threatening cases put into Category 1 – usually for people that aren’t breathing.

People experiencing heart attacks, like Marina, should usually go into Category 2 – emergency cases. The target is that an ambulance should arrive for these patients within 18 minutes.

In December the average wait across England for these patients was over 47 mins, almost three times as long. That was slightly worse than last year, but in fact better than December 2022 and 2021. In 2022 it peaked at a scarcely believable 1 hour and 32 minute average.

In the last pre-pandemic year it was 27:57 in December and 20:55 in January – still over target but not to the same scale as now.

In total, more than 600,000 hours have been lost to ambulance handover delays this winter. The cost to the ambulance service of 600,000 hours of time is upwards of £100m.

Crumbling infrastructure

Part of the problem is capacity. Royal Berkshire opened in 1839 and parts of that original building are still in use to this day. Other parts can’t be used anymore because they’ve fallen in to disrepair.

One building hasn’t been in use for more than ten years. £2.5m has been spent to keep it from collapsing. £15m would need to be spent to make it useable. The Trust is now considering filling the building with concrete to make it safer.

A hospital that is running out of space and money has no alternative but to waste both.

Plans have been approved for a new hospital at a different site, to replace Royal Berkshire, as part of the previous government’s plan to deliver 40 new hospitals by 2030.

Labour have since branded those plans “uncosted and undeliverable”, and have said work can’t start at that site until 2037 at the earliest.

The estimated cost is already over £100m and could be four times higher by the time it’s ready.

But it’s not just the main hospital where space is short.

Colin Waters is another Royal Berkshire patient we spoke to. He’s been there ten days after a car ran him over, fracturing his leg and dislocating his ankle.

He’s stable now and doesn’t actually need to be on the acute ward anymore, but he still needs some care.

He’s due to be transferred to a community hospital where he can receive physiotherapy and start his rehabilitation, but no space has opened up.

There have been an average of over 200 patients a day across Buckinghamshire, Oxfordshire and Berkshire who are “fit to be discharged” but still occupying a hospital bed because no safe alternative care setting is available. It peaked on 25 January at over 300 patients.

Across the country it peaked on 1 February. There were a total of 13,894 patients remaining in hospital who no longer needed to be there. In many cases, like Colin’s, they will not be receiving the specialist care they actually need at that time.

All of those full beds contribute to patients not being able to flow through the system from A&E, which adds to the ambulance handover delays. But they also mean that people have to wait longer to book in operations they need.

The waiting list for routine operations currently stands at 7.5m – or more than one in eight people in the country. 221,889 people on that list have been waiting for treatment for over a year.

That number is 120 times higher than before the pandemic.

Among Royal Berkshire’s patients alone, there are more than 60,000 on the list and almost 3,000 of them have been waiting over a year.

The ailments people need operating on to fix don’t go away while the wait goes on. They affect quality of life at a minimum, and in many cases will require ongoing care from other NHS services, or could reach the level where it becomes an emergency that adds to the pressure on the ambulance service or A&E.

Simon Shurey, another patient we spoke to, is a classic example of someone with a multitude of complex and competing healthcare needs that affect him daily, but also occasionally extend to requiring emergency care.

He’s had asthma all his life. Five years ago he was diagnosed with COPD, a lung condition that makes breathing difficult. And six months ago he was put into a coma after developing sepsis following a kidney infection.

He says he’s waited up to two days for a ward bed on previous visits.

When we spoke to him on 19 December, he had been in hospital for five days, having been rushed in by an ambulance because of flu.

He had to be kept in a side room to stop his infection spreading to other patients. Like Marina, he’s also grateful to healthcare workers sensitive to the pressures on them, despite the multitude of health concerns he’s facing.

“Every time you come in – and I use the hospital a fair bit lately, sadly – it’s getting worse for them. There seems to be so much pressure on them.”

Health anxiety

One of the reasons for the increased pressure on healthcare workers in recent years – in addition to increased medical issues – is because people are more concerned and aware of their health, in a way in which they weren’t before the pandemic.

Dr Amrit Sharma runs four GP surgeries near Royal Berkshire. He says that since COVID there has been an increase in health anxiety, and people presenting with physical symptoms that extend from mental health issues.

“The level of appointments have changed significantly. That’s got to be around anxiety. That’s what we see every day. People are more fearful and anxious about their health.

“Some awareness [of personal health] is needed to catch things like cancers, but our concern is that we’re seeing young people coming in with self-limiting illnesses, or symptoms that are physical but related to mental health conditions, like chest pains or palpitations or breathing problems.”

More than a million people who tried to reach their GP in December couldn’t get through, despite there being more appointments than ever before.

There were 40m appointments in December 2024, compared with less than 30m in 2018.

Health anxiety is something that Dr Mafousi says also contributes to more pressure and longer waits in emergency care.

“I see people who don’t need to be here, I see people who need to be here but have come here a bit late, I’ve seen people who are just concerned, I see people sent by their friends because their friends are concerned, there’s a combination of all this.

“There’s a lot of anxiety after Covid and we’ve seen that. Young people with chest pain which they’ve had for a few minutes and are concerned they’ve had a heart attack. There’s a lot of little things which before would have been nothing but now are something.”

Whether it’s increased anxiety or increased illness, the demand on the NHS is at unprecedented levels and it simply isn’t able to cope. Targets are being missed in pretty much every department, and the ultimate result of missed targets is worse health or an increased chance of death for patients all over the country.

There are hundreds of other stories like Marina’s, Colin’s and Simon’s that could be told every day from all parts of the country.

We’ve spent time in just one hospital. And it’s a hospital that is performing in a fairly typical way, for England in 2025. Thousands of patients are seeking treatment every day in hospitals that are performing worse than this.

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The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open-source information. Through multimedia storytelling, we aim to better explain the world while also showing how our journalism is done.