A “deadly mix” of nurse shortages and soaring patient demand is putting lives at risk across the National Health Service, nursing leaders will warn as thousands of frontline staff gather in the north of England this week.
New evidence from the Royal College of Nursing, which will be released as its annual Congress opens in Liverpool today, shows nurses fear patients are increasingly being harmed because wards and community services are dangerously understaffed. In a major survey of more than 13,000 nursing staff, almost a quarter said staffing levels on their last shift were so dangerously low there was a “high risk” of harm to patients and staff.
The stark findings come amid mounting alarm over corridor care, record A&E delays and excess deaths associated with overcrowded hospitals. Although the NHS waiting list in England has fallen to 7.11 million treatments – down by more than half a million since July 2024 – the backlog remains far above pre-pandemic levels, when around 4.6 million people were waiting for treatment.
And nurses say hospitals and community services are now overwhelmed by older and sicker patients with increasingly complex conditions, while too few staff are left trying to keep patients safe. One emergency department nurse in England described the terrifying pressure on a recent shift, saying: “The shift was completely unsafe, and it felt a miracle that avoidable harm was not caused. I’m 11 years into nursing and have never felt so awful about my work."
Her concerns echo those of doctors and patient safety experts across the UK who have repeatedly warned patients are being harmed and dying because of overcrowding and long delays. The Royal College of Emergency Medicine estimates there were 16,644 excess deaths in 2024 associated with patients waiting 12 hours or more in A&E before admission to a hospital bed – equivalent to around 320 deaths every week.
Emergency medicine experts say the risk of death begins rising sharply after patients wait more than five hours in A&E. Meanwhile, corridor care has become an increasingly visible symbol of the NHS crisis, with patients treated on trolleys in corridors, waiting rooms, cupboards and other makeshift areas because of bed shortages.
An All-Party Parliamentary Group on Emergency Care report backed by emergency medicine experts warned corridor care had become a “defining feature” of the NHS crisis. RCEM analysis also found more than 1.15 million people aged 60 and over endured waits of 12 hours or more in England’s A&Es in 2024.
Against that backdrop, RCN General Secretary and Chief Executive Professor Nicola Ranger will tell more than 3,000 frontline nursing staff in Liverpool ministers are failing in their “most basic task” of keeping patients safe. She will say: “Widespread vacancies of registered nurses are always unsafe, but the risk is being compounded by the demands of delivering ever more complex care to an ageing, sicker population with multiple conditions.
Nurse shortages and patient demand is putting lives at risk
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"It is a deadly mix. It is a Government’s first priority to keep its citizens safe, but our analysis and the testimony of nursing staff show ministers are too often failing in this most basic task."
The RCN survey found 79 per cent of nursing staff said clinical complexity had increased over the past two years. Only one in ten said staffing levels were right for patient needs, while more than two-thirds – 69 per cent – said they were being forced to make difficult decisions about which patients to prioritise.
Almost two in three said registered nurse staffing levels were either “below” or “well below” what was needed on their last shift. One nurse working on an acute adult ward in England said: “The ‘care’ has disappeared in nursing – now it’s just about trying to stay safe, to get through the shift without any harm being done... It’s very, very sad.”
A second nurse on an older people’s ward warned: “Managing high-risk fall patients who require 1:1 supervision is simply not achievable with current staffing levels, despite what policy suggests. This gap between theoretical expectations and practical reality places both patients and staff at risk.”
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The NHS backlog remains far above pre-pandemic levels
| PAA third nurse said: “There is no understanding, insight or awareness of how significantly the dependency, frailty and medical instability of our patient group have changed and increased.”
The RCN also warned growth in the nursing workforce has slumped to its slowest level in eight years. Its analysis found nurse numbers in NHS hospital and community services in England rose by just 6,127 last year.
Over the last decade, the nurse workforce grew by 31 per cent compared with 47 per cent for doctors. The union says if nurse numbers had grown at the same pace as doctors, there would now be around 45,100 more registered nurses in England – enough to fill NHS vacancies twice over.
Community nursing services were also described as buckling under pressure, with one district nurse saying: “District nursing is going under with the complexities of care required. We cannot sustain the levels of pressures faced since COVID.”
Another community nurse added: “Community nursing is on its knees.”
The crisis is also taking a major toll on exhausted staff. More than three-quarters – 76 per cent – said they felt emotionally exhausted on their last shift.
Professor Ranger said: “No matter how far we push ourselves beyond our limits, we can't make up for having too few staff. That can feel like our failure, and we carry that pain home with us long after our shifts have ended.
"It's not our failure. It's nursing set up to fail."
She also warned about rising violence and abuse against nursing staff and criticised anti-immigration rhetoric, which she said risked driving overseas nurses out of Britain.
“The truth of the matter is, if we don’t make nursing staff feel welcome here, we shouldn’t be surprised if they decide to leave,” she said.
A Department of Health and Social Care spokesperson said: “Nurses are the backbone of our NHS, and support patients both physically and emotionally in their most vulnerable moments. It is vital that they are equipped with the tools and resources they need to deliver world class care to those who need it.
“We have recruited 16,000 more nurses and health visitors since we were elected in July 2024, and our upcoming 10 Year Workforce Plan will set out a clear roadmap to improve working lives in the NHS, including better treatment of staff, higher-quality training, and more fulfilling roles.
“We expect NHS organisations to ensure their staff have the conditions they need to thrive, including well-being support, and our introduction of robust standards will improve staff experience and retention by tackling the issues that really matter to them.”
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