Winter has once again exposed the pressures that sit just beneath the surface of the NHS. Since mid‑December, the familiar combination of flu, Covid, norovirus and cold weather has collided with workforce shortages and industrial action. None of this is unexpected, but this year the impact feels sharper.

Winter Viruses: A Predictable Bounce‑Back, But Still a Blow

Just after Christmas, winter viruses surged. Flu hospitalisations rose by 9%, reaching 2,924 patients after two weeks of decline. Covid and norovirus admissions also increased, and overall bed occupancy jumped to just under 92% in a single week. GP flu consultations rose from 11.2 to 14.6 per 100,000 patients.

Anyone who has worked in or around the NHS will recognise the pattern. Winter doesn’t create new problems — it magnifies the ones already there. This year’s mix of viruses, cold weather and workforce pressures has made the system even more fragile. NHS leaders have been clear that the “worst is far from over”.

Doctors’ Strikes: Disruption, Yes — But the NHS Held Up

The December resident‑doctor (junior doctor) strike landed right in the middle of winter pressures. Despite this, the NHS still delivered 95% of planned hospital appointments. That reflects the commitment of staff who remained on duty and the planning that went on behind the scenes.

Even so, the disruption was significant:

• 3,167 inpatient procedures rescheduled
• More than 30,000 outpatient appointments affected

In Scotland, a more constructive approach has been taken. A planned January strike was called off after the government offered a two‑year pay deal worth 8.16% by 2026–27. The BMA is now consulting members — progress that England has not yet matched.

Why the BMA Is Balloting Again in England

The BMA has been clear about why resident doctors are being balloted again. Their position is that this dispute should have been resolved months ago with a responsible deal on pay and job security.

Their core arguments include:

• Pay erosion over more than a decade
• Limited training posts
• Newly qualified doctors struggling to secure stable roles
• Insufficient engagement from Government

The tone is one of frustration and determination. The BMA argues that no doctor should be worth less than they were 17 years ago, and that balloting is now the only meaningful leverage left. Coordinated action with consultants and SAS doctors remains a possibility.

As I’ve said before, many professions feel undervalued — but expecting salaries to return to 2008 levels in one step is not realistic in the current climate.

Winter Pressures: The Same Story, Only Sharper

Hospitals have been running hot. Ambulance handovers reached 101,177 in the week including New Year’s Eve — 5,100 more than the same week last year.

The King’s Fund described the start of 2026 as “frosty”, with winter viruses rebounding and cold weather adding strain, even though flu admissions remain below last year’s peak.

The familiar issues remain:

• High bed occupancy
• Slow discharges
• A&E overcrowding
• Staff firefighting on all fronts

What’s different this year is the combination of viruses, industrial action and a cold snap all landing at once.

Other Developments Worth Noting

AI forecasting in A&E

The NHS has begun using AI tools to predict A&E pressures using admissions data and weather forecasts. It’s a sensible step, but unless discharge delays are addressed, bed blocking will continue. Social care remains the missing link.

Vaccination reminders

Parents of at‑risk children are being reminded to book flu vaccinations as part of the winter response.

Cold weather impact

The “bitingly cold” conditions are expected to increase admissions for heart attacks, strokes and falls — a pattern we see every winter.

My Take

None of this is surprising, but it is sobering. The NHS is still carrying the long tail of Covid, the backlog, and long‑standing workforce issues. Winter simply exposes the cracks.

What stands out is this: even under enormous pressure, the NHS still delivered 95% of care during a strike. That says everything about the commitment of NHS staff — and everything about how stretched the system has become.

Scotland has shown that compromise is possible. England could do with the same clarity and urgency.

If this winter proves anything, it’s that goodwill and grit are not a long‑term plan. A sustainable settlement on pay, staffing and capacity is no longer optional — it’s overdue.

References

• NHS winter pressures reporting
• NHS strike impact reporting 
• BMA commentary on resident/junior doctor pay and ballots
• NHS winter planning and vaccination updates