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.

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.

The man who killed Conservative MP Sir David Amess was released from the Prevent anti-terror programme “too quickly”, a review has found.

Sir David was stabbed to death by Islamic State (ISIS) supporter Ali Harbi Ali during a constituency surgery at a church hall in Leigh-on-Sea in October 2021.

The killer, who was given a whole-life sentence, had become radicalised by ISIS propaganda and had been referred to the anti-terror programme Prevent before the attack.

Politics latest: PM and Badenoch in rare agreement over judge’s decision on Gazan refugees

His case had been closed five years before, after just one meeting for coffee at a McDonald’s to deal with his interpretation of “haram” (forbidden under Islamic law), as well as texts and calls with an “intervention provider”.

Despite Prevent policy and guidance at the time being “mostly followed”, his case was “exited too quickly”, security minister Dan Jarvis told the House of Commons on Wednesday.

Following the publication of a review into Prevent’s handling of Southport child killer Axel Rudakubana earlier this month, Mr Jarvis said a Prevent learning review into Sir David’s killing would be released this week in a commitment to transparency over the anti-terror programme.

Matt Juke, head of counter-terrorism policing, said it is clear the management and handling of Ali’s case by Prevent “should have been better” and it is “critical” the review is acted on “so that other families are spared the pain felt by the loved ones of Sir David”.

The review found:

• Ali was referred to Prevent in 2014 by his school after teachers said his demeanour, appearance and behaviour changed from a previously “engaging student with a bright future” with aspirations to be a doctor to failing his A-levels and wanting to move to a “more Islamic state because he could no longer live among unbelievers”

• Prevent quickly took his case on and he was referred to Channel, part of the programme that aims to prevent involvement in extremism

• He was “exited from Prevent too quickly”, Mr Jarvis said, just five months later “after his terrorism risk was assessed as low”

• A review by police 12 months after he was released from Prevent “also found no terrorism concerns” and the case was closed. This was not uploaded for eight more months due to an “IT issue”

• People released from Prevent are meant to have a review at six and 12 months

• The assessment of Ali’s vulnerabilities “was problematic and outdated” as it did not follow the proper procedure, which led to “questionable decision-making and sub-optimal handling of the case”

• Ali’s symptoms were prioritised over addressing the underlying causes of his vulnerabilities – and support provided did not tackle those issues

• Record keeping of decisions, actions and rationale was “problematic, disjointed and lacked clarity”

• The rationale for certain decisions was “not explicit”

• Ali’s school was not involved in discussions to help determine risk and provide appropriate support – they were only called once to be told the “matter was being dealt with”

• A miscommunication led to only one intervention session being provided, instead of two.

Read more:
Sir David Amess’ daughter taking legal action

The review found most of the failures in Ali’s case would not be repeated today as the guidance and requirements are much clearer.

It said referrers, in Ali’s case his school, are kept informed and engaged, and different departments and agencies – not just police – have clear roles.

Which records need to be kept is now clear and guidance for detecting underlying vulnerabilities has changed and would have made a difference, the review added.

It said a Prevent “intervention provider” met Ali at a McDonald’s to deal with his understanding of “haram” (forbidden under Islamic law).

No risk assessment was made but they suggested one more meeting, however a breakdown in communication between the police and the provider meant there were no more meetings.

Training for providers is “substantially different” now and the review says this would not be repeated today, with the provider in question saying the process is “a completely different one today”.

However, the review said there are still problems – not just in Ali’s case – with the Vulnerability Assessment Form, an “incredibly complex document that is vital to Channel” and the progression of a case.

It also found a more recent decision by the College of Police to only hold Prevent case data for five years “may prove to be problematic” and if Ali’s case material had been deleted under that ruling “it would have been nigh on impossible to conduct this review”.

Sir David’s daughter, Katie Amess, 39, last week welcomed the announcement to publish a review into Ali’s case but said every victim failed by Prevent deserves an inquiry, not just the Southport victims.

“We potentially wouldn’t be in the same situation today with repeat failings of Prevent had somebody had just listened to me back when it [her father’s killing] happened and launched a full public inquiry,” she told LBC.

Ms Amess said she believes if the Southport attack had not happened, the review into Prevent’s handling of her father’s killer would never have been released into the public domain.

An NHS trust has been fined £1.6m after admitting it failed to provide safe care and treatment to three babies who died within days of their births.

The Care Quality Commission (CQC) had charged Nottingham University Hospitals (NUH) NHS Trust over the deaths, which all occurred in 2021.

The trust pleaded guilty to six charges of failing to provide safe care and treatment to the three children and their mothers at Nottingham Magistrates’ Court on Monday.

The charges were in connection to the deaths of Adele O’Sullivan, who was 26 minutes old when she died on 7 April 2021, four-day-old Kahlani Rawson, who died on 15 June 2021, and Quinn Parker, who was one day old when he died on 16 July 2021.

District Judge Grace Leong told the hearing, which was attended by the trust’s chief executive since September 2022 Anthony May, that the “catalogue of failures” in the trust’s maternity unit were “avoidable and should never have happened”.

Family members cried in the courtroom as the judge expressed her “deepest sympathy” to each of them and said the trust they put in NUH to deliver their babies safely had been broken.

“The death of a child is a tragedy beyond words, and where that loss is avoidable the pain is even more profound,” she said.

“Three-and-a-half years have gone by, yet for the families no doubt their grief remains as raw as ever and a constant presence in their lives that is woven into every moment.

“The grief of a baby is not just about the past, it is about the future that is stolen. It is a lifetime of missing first words, first steps, first days of school, missing memories that should have been made.

“It is very difficult, if not impossible, to move on from the failures of the trust and its maternity unit.

“The weight of what should have been done differently will linger indefinitely.”

‘Systematic failures’

District Judge Leong highlighted concerns over a lack of escalation of care, an inadequate communications system and a failure to provide “clear and complete” information sharing.

She said: “I accept there were systems in place but there were so many procedures where guidance was not followed or adhered to.

“The failures in combination amounted to systematic failures in the provision of care and treatment.”

The trust has an average turnover of £612m, but District Judge Leong said she was “acutely aware” that all its funds as a publicly funded body were accounted for and that the trust is currently operating at a deficit of around £100m.

“I can’t ignore the negative impact this will have… but the significant financial penalty has to be fixed to mark the gravity of these offences and hold the trust to account for their failings,” the judge said.

Read more:
Wrexham player in car crash after cup game
Man charged with murder of ‘much-loved’ mum
RuPaul’s Drag Race star died of ‘unnatural’ cause

The £1.6m fine was broken down into £700,000 related to the death of Quinn Parker, £300,000 each for the deaths of Adele O’Sullivan and Kahlani Rawson, and three amounts of £100,000 related to the care provided to each of the mothers.

Lawyers acting on behalf of the trust told the families in court they offered their “profound apologies and regrets” and that improvements have been made, including hiring more midwives and providing further training to staff.

‘Contemptuous and inhumane’

The court was told that one of the pregnant women, Emmie Studencki, went to the hospital four times suffering bleeding before her son Quinn was born.

On the final occasion before Quinn was born, Ms Studencki called an ambulance at around 6.15am on 14 July 2021 with paramedics estimating she had lost around 1.2 litres of blood both at home and in the ambulance on the way to City Hospital.

Despite this, the paramedics’ observations did not “find its way into the hospital’s notes”, with staff only recording a 200ml blood loss.

Quinn was “pale and floppy” when he was born via emergency Caesarean section that evening, and despite several blood transfusions, he was pronounced dead after suffering multiple organ failure and lack of oxygen to the brain.

An inquest concluded it was a “possibility” he would have survived had a Caesarean section been carried out earlier.

In a statement, Ms Studencki said the trust’s treatment of her, her son, and her partner Ryan Parker had been “contemptuous and inhumane”.

‘We lost our beautiful daughter’

Adele O’Sullivan died 26 minutes after being born following an emergency Caesarean at 29 weeks in April 2021, the court also heard.

Her mother Daniela had noticed bleeding and suffered abdominal pain but in a victim impact statement said she was left “screaming in pain” with no painkillers. Despite having a high-risk pregnancy, she was not examined for eight hours before Adele was born.

Adele was born in “poor condition” and a decision was made to withdraw care, with a post-mortem examination finding she died as a result of severe intrapartum hypoxia.

Daniela said: “People who were supposed to help me did not help but harmed me mentally and physically forever.

“We lost our beautiful daughter. Instead of bringing her home I had to leave the labour suite empty-handed in a lot of physical and mental pain.”

The trust also admitted liability in another case involving mother Ellise Rawson, who had reported abdominal pain and reduced foetal movements. She was delayed in receiving an emergency Caesarean section in June 2021. Her son Kahlani suffered a brain injury and died four days later.

Kahlani’s grandmother Amy Rawson told the court that her grandson’s death was a “preventable tragedy” that had left the family “devastated, broken and numb”.

This case is the second time the CQC has prosecuted the trust over failures in maternity care.

It was fined £800,000 for a “catalogue of failings and errors” that led to the death of a baby 23 minutes after she was born at the Queen’s Medical Centre in Nottingham in September 2019.

NUH is also at the centre of the largest maternity inquiry in NHS history, with midwife Donna Ockenden leading the investigation.

In February she confirmed the number of families taking part has increased to 2,032 – forcing a delay to her report’s publication until June 2026.

‘We fully accept the findings’

In a statement released after the hearing, NUH chief executive, Mr May said: “The mothers and families of these babies have had to endure things that no family should after the care provided by our hospitals failed them, and for that I am truly sorry.

“Today’s judgment is against the trust, and I also apologise to staff who we let down when it came to providing the right environment and processes to enable them to do their jobs safely.

“We fully accept the findings in court today and have already implemented changes to help prevent incidences like this from this happening again.”

He added that a CQC report published in September 2023 showed there had been an improvement in the overall rating for the trust’s maternity services.

Helen Rawlings, CQC’s director of operations in the Midlands, said in a statement after the sentencing: “The care that these mothers received, and the death of these three babies is an absolute tragedy and my thoughts are with their families and all those grieving their loss under such sad circumstances.

“All mothers have a right to safe care and treatment when having a baby, so it’s unacceptable that their safety was not well managed by Nottingham University Hospitals NHS Trust.

“The vast majority of people receive good care when they attend hospital, but whenever a registered health care provider puts people in its care at risk of harm, we seek to take action to hold it to account and protect people.

“This is the second time we have prosecuted the trust for not providing safe care and treatment in its maternity services, and we will continue to monitor the trust closely to ensure they are making and embedding improvements so that women and babies receive the safe care they deserve.”