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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.

Marina Strange, 90, was impressed that an ambulance reached her within two hours after she had a heart attack
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Marina Strange, 90, was impressed that an ambulance reached her within two hours after she had a heart attack

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”.

Dr Omar Mafousi has been a consultant in emergency medicine for 15 years
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Dr Omar Mafousi has been a consultant in emergency medicine for 15 years

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.

Colin Waters has been at Royal Berkshire for ten days, after a car ran him over, dislocating his ankle and fracturing his leg
Image:
Colin Waters had been at Royal Berkshire for ten days when we spoke to him, after a car ran him over, dislocating his ankle and fracturing his leg

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.

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UK officially recognises Palestine as a state

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UK officially recognises Palestine as a state

Sir Keir Starmer has announced the UK has officially recognised Palestine as a state.

“Today, to revive the hope of peace for the Palestinians and Israelis, and a two state solution, the United Kingdom formally recognises the State of Palestine,” the prime minister said on X, alongside a longer video statement.

“In the face of the growing horror in the Middle East, we are acting to keep alive the possibility of peace and a two-state solution.

“That means a safe and secure Israel alongside a viable Palestinian state. At the moment, we have neither.”

Follow latest: Palestine recognised as a state by three countries

Canada and Australia also officially recognised Palestinian statehood on Sunday, ahead of a conference of the UN General Assembly in New York this week.

It is a significant moment in the history of Britain’s involvement in the region, and comes as the death toll from the Israeli war on Gaza continues to rise and conditions for the people trapped become even more desperate.

An updated map of the region the Foreign, Commonwealth & Development Office website
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An updated map of the region the Foreign, Commonwealth & Development Office website

Sir Keir said in July that the government would recognise Palestine unless Israel met certain conditions, including agreeing to a ceasefire and allowing the UN to restart the supply of aid.

In recognising Palestine as a state, the UK does so based on 1967 borders to be finalised as part of future negotiations. It would be led by a “reformed Palestinian Authority”.

The UK also acknowledges “all legal rights and obligations of statehood” for Palestine.

An updated map on the UK’s Foreign, Commonwealth & Development Office website now has the West Bank and Gaza labelled as ‘Palestine’ rather than the ‘Occupied Palestinian Territories’. This change has been rolled out across the website.

Protesters in Tel Aviv calling for the release of hostages. Pic: AP
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Protesters in Tel Aviv calling for the release of hostages. Pic: AP

Sir Keir calls on Hamas to release the hostages

The prime minister repeated his calls for the the Israeli hostages – held in captivity since the brutal attacks on Israel on 7 October, 2023 – to be released by Hamas.

“I have met British families of the hostages. I see the torture that they endure each and every day. Pain that strikes deep in people’s hearts across Israel and here in the United Kingdom.

“The hostages must be released immediately and we will keep fighting to bring them home.”

Sir Keir was also clear to emphasise that recognition of Palestine was “not a reward for Hamas”, saying that the terror group “can have no future, no role in government, no role in security” in a future state.

“I have directed work to sanction other Hamas figures in the coming weeks,” he added.

Read more:
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Why Starmer’s move to recognise Palestine is a major shift

Huge amounts of Gaza have been razed to the ground. Pic: Reuters
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Huge amounts of Gaza have been razed to the ground. Pic: Reuters


Starmer calls on Israel to end Gaza offensives

Sir Keir also repeated his criticism of Israel, which for nearly two years has waged a brutal war on the densely-populated Gaza Strip.

“The Israeli government’s relentless and increasing bombardment of Gaza, the offensive of recent weeks, the starvation and devastation are utterly intolerable.”

The death toll in Gaza since the IDF launched its offensive following the 7 October attacks has now risen above 65,000 people, according to Hamas-run health authorities.

“This death and destruction horrifies all of us. It must end,” he said.

A pro-Palestinian march in London earlier this year. Pic: PA
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A pro-Palestinian march in London earlier this year. Pic: PA

British people ‘desperately want to see’ peace

Sir Keir also said: “Ordinary people, Israeli and Palestinian, deserve to live in peace. To try to rebuild their lives free from violence and suffering.

“That’s what the British people desperately want to see.”

But he warned that the possibility of a Palestinian state was in danger of vanishing forever.

“With the actions of Hamas, the Israeli government escalating the conflict, and settlement building being accelerated in the West Bank, the hope of a two-state solution is fading, but we cannot let that light go out.

“That is why we are building consensus with leaders in the region and beyond, around our framework for peace.”

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What changed in UK’s Gaza policy?

Sir Keir said this is a “practical plan” to bring people together behind a “common vision” that moves from a ceasefire in Gaza to negotiations on a two-state solution.

“We will keep driving this forward,” he pledged.

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What will the UK’s recognition of Palestine achieve?

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What will the UK's recognition of Palestine achieve?

Today, Sir Keir Starmer will deliver on his pledge to recognise a Palestinian state – after setting out a series of conditions in July which there was little prospect Israel could meet, including agreeing a ceasefire with Hamas. 

The prime minister will say it recognises the “inalienable right” of the Palestinian people and what he feels is a moral responsibility to keep a two-state solution alive, amid the devastation of the war and concern about settlement expansion in the West Bank.

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This will be formally put forward by the British government at a conference of the UN General Assembly in New York this week, after a diplomatic push led by Emmanuel Macron. Canada and Australia are also expected to recognise it, although may call for Hamas to disarm.

But Labour has always said it’s a move they would make as part of a peace process, which looks further away than ever.

What does it mean?

The move has been heavily criticised and leaves a number of questions not only about what it will achieve – but about whether it will have the opposite effect on the conflict.

David Lammy as foreign secretary conceded when the pledge was announced that “it will not change the position on the ground” which can only come through negotiations.

After all, 147 of the 193 member states of the United Nations recognise it already. Palestine has permanent observer status at the UN – speaking rights, but not voting rights – where it’s represented by the Palestinian Authority. Any move to full status would have to be agreed by the Security Council where the US has a veto.

Sir Keir has made clear he doesn’t accept Hamas – which he calls a “brutal terrorist organisation” – as a government in Gaza. The borders of such a state, wrangled over for decades during multiple rounds of negotiations between Israel and the Palestinians, are also not agreed.

Read more about what the decision means

Criticism

Recognition is opposed by the Trump administration, as the US president made clear in London last week. US secretary of state Marco Rubio has said it would “embolden Hamas” and be symbolic only.

In Britain there is cynicism too. Kemi Badenoch, the Conservative leader, has accused the prime minister of a “desperate and insincere attempt to placate his backbenchers”. He heads to the party’s conference in Liverpool next week with a further slump in his approval ratings to -42%, around where Rishi Sunak’s was after his D-Day blunder.

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Could recognition of Palestine change the West Bank?

Over a third of Labour MPs wrote to Sir Keir before his pledge in July, calling for recognition of a Palestinian state. It is not clear this symbolic move will placate them, with some already calling for tougher measures including on arms sales to Israel – especially after a UN Commission of Inquiry claimed Israel had committed genocide.

Other Labour MPs oppose the recognition move. The Labour Friends of Israel group has said: “It is important to recognise that Israel is not the only party to this conflict… Hamas could end this conflict tomorrow by releasing the hostages and laying down its arms.”

The move is also opposed by the families of the hostages in Gaza, of which 20 are believed to be alive – for not imposing their release as a condition on Hamas.

Ilay David, the brother of Evyatar David, who recently appeared emaciated in a Hamas video, said: “We want to meet with Starmer but he refuses to meet with us… Giving this recognition is like saying to Hamas: ‘It is OK you can keep starving the hostages, you can keep using them as human shields’. This kind of recognition gives Hamas power to be stubborn in negotiations. That is the last thing we need right now.”

Sir Ephraim Mirvis, the UK’s Chief Rabbi has said the “unconditional” recognition of the state “is not contingent upon a functioning or democratic Palestinian government, nor even upon the most basic commitment to a peaceful future”.

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Sir Keir Starmer welcomed Mahmoud Abbas, president of the Palestinian Authority, to 10 Downing Street earlier this month
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Sir Keir Starmer welcomed Mahmoud Abbas, president of the Palestinian Authority, to 10 Downing Street earlier this month

What happens next?

Sir Keir met 89-year-old Mahmoud Abbas, the president of the Palestinian Authority, in London this month and they agreed Hamas should not be involved in the governance of Gaza.

Efforts to set up a transitional government have been discussed between the US and Gulf states. But Mike Huckabee, the US ambassador to Israel, said last week there was nothing “ready for signature”.

The UK government is expected to announce further sanctions on Hamas figures this week. But the Israeli government has already responded with fury to the prospect of recognition and it’s reported that retaliation could include further annexations in the West Bank.

The UK government sees this as an important diplomatic move with allies, when nothing else is moving the dial. But it can only be made once, and even supporters in government acknowledge that on the ground in Gaza it won’t immediately change very much.

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British fighter jets defend Polish skies after Russian drone incursion

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British fighter jets defend Polish skies after Russian drone incursion

Two British fighter jets have flown their first defence mission over Poland after a Russian drone incursion into the country’s skies.

The flight was part of NATO‘s operation “Eastern Sentry”, launched to bolster Europe’s eastern flank after Poland shot down Russian drones earlier this month.

A Russian drone was intercepted flying over Romania days later, while three Russian jets entered Estonian airspace without permission for 12 minutes on Friday.

One of three Russian MiG-31 fighter jets in images shared by Sweden's armed forces. Pic: Swedish Armed Forces
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One of three Russian MiG-31 fighter jets in images shared by Sweden’s armed forces. Pic: Swedish Armed Forces

The three incursions into NATO airspace fuelled concerns about the potential expansion of Russia‘s three-year war in Ukraine and have been seen as an attempt by Moscow to test the military alliance’s response.

The incident over Poland prompted its prime minister, Donald Tusk, to warn that his country was the closest to “open conflict” it had been since the Second World War, while the UK announced it would provide Warsaw with extra air cover.

Two RAF Typhoons, supported by an RAF Voyager air-to-air refuelling plane, took off from RAF Coningsby, in Lincolnshire, on Friday night to defend Poland’s skies before returning safely early on Saturday morning.

A Gerbera drone landed in a field in the Olesno region of Poland
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A Gerbera drone landed in a field in the Olesno region of Poland

Defence Secretary John Healey said the mission sends a clear signal that “NATO airspace will be defended”.

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“I’m proud of the outstanding British pilots and air crew who took part in this successful operation to defend our allies from reckless Russian aggression.”

He said the mission was “especially poignant” coming as the UK marks the 85th anniversary of the Battle of Britain – when Polish pilots came to the aid of the UK – this weekend.

The head of the RAF, Air Chief Marshal Harv Smyth, said: “This sortie marks the RAF’s first operational mission on Eastern Sentry, reinforcing the UK’s steadfast commitment to NATO and its allies.

“We remain agile, integrated, and ready to project airpower at range.”

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