NHS England has warned the health service is facing a “worst case scenario” December with a surge of “super flu”.

The warning comes as new figures revealed the number of people in hospital with flu have increased by more than half in just one week.

Catch up as it happened: NHS warns of ‘worst-case scenario’ as ‘super flu’ surges

Latest figures show:

• An average of 2,660 patients were in hospital per day with flu last week

• This is the highest ever for this time of year and up 55% on last week

• At this point last year the number stood at 1,861 patients, while in 2023 it was just 402

Health service bosses are warning the number of flu patients in hospital has already increased sharply since the week covered by this data – with no peak in sight.

Read more: Why is flu season worse this year?

Virus outbreaks coincide with doctors’ strikes

Weekly flu numbers in England peaked at 5,408 patients last winter and reached 5,441 over the winter of 2022/23, the highest level since the pandemic.

Alongside rocketing flu, the number of norovirus patients in hospital has also risen by 35%.

The NHS is now warning winter viruses are starting to “engulf hospitals”.

Demand for A&Es and ambulance services is also soaring.

New monthly figures show A&E attendances were a record for November at 2.35 million – more than 30,000 higher than November 2024.

In addition, there were 48,814 more ambulance incidents (802,525) compared with last year (753,711).

Some hospitals across the country have asked staff, patients and visitors to wear face masks to cut the spread of flu, while others have gone in and out of critical incident status due to the high number of people attending A&E.

The record-breaking demand on the NHS coincides with a resident doctors’ strike from 17 to 22 December over pay and jobs – sparking fears of major disruption for patients in the run up to Christmas.

People are being advised to attend any planned appointments scheduled during the strikes unless they have been contacted to reschedule.

Flu vaccinations on the up… who can get one?

The NHS is urging anyone eligible to get their flu vaccination to help prevent them getting seriously ill.

Latest figures show more than 17.4 million people have been vaccinated so far this year, more than 381,000 higher than last year.

You can get it if you:

• Are 65 or over in England, Scotland, Wales and Northern Ireland

• Are pregnant

• Live in a care home

• Are the main carer for an older or disabled person, or receive carer’s allowance

• Live with someone who has a weakened immune system

• Are a frontline health and social care worker

• Are of school age

• Have certain medical conditions (the NHS has a full list)

Wes Streeting, the health secretary, warned of a “tidal wave of flu tearing through our hospitals”.

“We are working with the NHS to make sure it is able to cope with this as best as possible,” he said.

Warning ‘extremely challenging few weeks ahead’

Professor Meghana Pandit, NHS national medical director, warned the health service faces “an extremely challenging few weeks ahead” with “staff being pushed to the limit”.

She said: “With record demand for A&E and ambulances and an impending resident doctors’ strike, this unprecedented wave of super flu is leaving the NHS facing a worst-case scenario for this time of year – with staff being pushed to the limit to keep providing the best possible care for patients.

“The numbers of patients in hospital with flu is extremely high for this time of year. Even worse, it continues to rise and the peak is not in sight yet, so the NHS faces an extremely challenging few weeks ahead.”

She added: “We have prepared earlier for winter than ever before, and stress-tested services to ensure people have a range of ways to get the help they need and avoid needing to go to A&E.

“For non-life-threatening care, people should call NHS 111 or use 111 online, which can direct you to the most appropriate place, and use A&E and 999 for life threatening conditions and serious injuries.”

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Mr Streeting has offered the British Medical Association (BMA) a last-minute deal in the hope doctors will call off the walkout, which starts next Wednesday.

The doctors’ union has agreed to put the offer to members over the coming day, and is expected to announced a decision on Monday, just two days before the planned strike.

The offer includes a fast expansion of specialist training posts as well as covering out-of-pocket expenses such as exam fees, but does not include extra pay.

The spread of subclade K, the super flu, is picking up – and it’s not looking good for the NHS.

An average of just under 2,700 hospital beds a day in England were occupied by patients with flu last week.

There are fears that could jump to somewhere between 5,000 and 8,000 by the end of this week.

That’s on top of COVID and RSV.

And with the possibility of a five-day strike by resident (junior) doctors next week, it’s a perfect storm for hospitals.

Christmas flu

Children are the super-spreaders of flu. It races around classrooms and some schools have temporarily shut because of the impact.

The Christmas holidays aren’t far off. They are likely to put the brakes on children passing around the virus.

But it’s also a time of year when families mix with elderly relatives, who are more likely to be hit hard by the infection – perhaps even needing hospital care.

So while the holidays may temporarily slow the overall rise in infections, the impact on hospitals could get much worse.

Subclade K

Flu is spreading so rapidly at the moment because immunity to subclade K from previous infections and vaccinations is low.

The virus – a variant of the H3N2 flu strain – suddenly acquired seven new mutations in late summer.

Every 100 people infected with seasonal flu would typically pass the virus on to 120 others.

With subclade K, it’s 140.

And that’s why cases are rising so quickly on the charts.

At the moment, 18 in every 100,000 patients in England are consulting their GP with flu-like symptoms. That’s still well short of the peak of around 50 in every 100,000 in 2017/18, the worst flu outbreak in recent years.

The grim reality of flu

Flu is a really unpleasant disease, nothing like a cold. I’ve had it twice in my life and it physically hurt to get out of bed. It’s grim.

Most people get over it with a few days’ rest and paracetamol to take the edge off the fever.

But vulnerable people can become seriously ill. In the outbreak of 2017/18, around 22,000 died.

Read more:
Nurses ‘deeply concerned about what lies ahead’
NHS braced for ‘toughest winter’ after record-breaking month

That’s why the NHS is urging people in certain groups – the over 65s, those with underlying health conditions, pregnant women, carers and children – to get the jab.

The vaccine isn’t a great match for subclade K, but still reduces the chance of hospital admission by 30-40% in adults.

It’s impossible to say when the spread will peak, but the latest figures suggest the outbreak is far from over.

Ramesh lives in fear every day. A police siren is enough to alarm him.

He’s one of up to 400,000 visa overstayers in the UK, one lawyer we spoke to believes.

It’s only an estimate because the Home Office has stopped collecting figures – which were unreliable in the first place.

Britain is being laughed at, one man told us, “because they know it’s a soft country”.

We meet Ramesh (not his real name) at a Gurdwara, a Sikh place of worship, where he goes for food and support.

He insists he can’t return to India where he claims he was involved in political activism.

Ramesh says he came to the UK on a student visa in 2023, but it was cancelled when he failed to continue his studies after being involved in a serious accident.

He tells us he is doing cash-in-hand work for people who he knows through the community where he is living and is currently working on a house extension where he gets paid as little as £50 for nine hours labouring.

“It’s very difficult for me to live in the UK without my Indian or Pakistani community – also because there are a lot of Pakistani people who give me work in their houses for cleaning and for household things,” he adds.

‘What will become of people like us?’

Anike has lived in limbo for 12 years.

Now living in Greater Manchester, she came to the UK from Nigeria when her sister Esther was diagnosed with a brain tumour – she had a multi-entry visa but was supposed to leave after three months.

Esther had serious complications from brain surgery and says she is reliant on her sister for care.

Immigration officials are in touch with her because she has to digitally sign in every month.

Anike has had seven failed applications for leave to remain on compassionate grounds refused but is now desperate to have her status settled – afraid of the shifting public mood over migration.

“Everybody is thinking ‘what will become of people like us?'” she adds.

‘It’s a shambles’

The government can’t say with any degree of accuracy how many visa overstayers there are in Britain – no data has been collated for five-and-a-half years.

But piecing together multiple accounts from community leaders and lawyers the picture we’ve built is stark.

Immigration lawyer Harjap Singh Bhangal told us he believed there could be several hundred thousand visa overstayers currently in Britain.

He says: “At this time, there’s definitely in excess of about 200,000 people overstaying in the UK. It might even be closer to 300,000, it could even be 400,000.”

Asked what evidence he has for this he replies: “Every day I see at least one overstayer, any immigration lawyers like me see overstayers and that is the bulk of the work for immigration lawyers.

“The Home Office doesn’t have any accurate data because we don’t have exit controls. It’s a shambles. It’s an institution where every wall in the building is cracked.”

The number of those who are overstaying visas and working cash in hand is also virtually impossible to measure.

‘They know Britain is a soft country’

“They’re laughing at us because they know Britain is a soft country, where you won’t be picked up easily,” says the local man we’ve arranged to meet as part of our investigation.

We’re in Kingsbury in northwest London – an area which people say has been transformed over the past five years as post-Brexit visa opportunities opened up for people coming from South Asia.

‘Mini-Mumbai’

The man we’re talking to lives in the community and helps with events here. He doesn’t want to be identified but raises serious questions about visa abuse.

“Since the last five years, a huge amount of people have come in this country on this visiting visa, and they come with one thing in mind – to overstay and work in cash,” he says.

“This area is easy to live in because they know they can survive. It looks like as if you are walking through mini-Mumbai.”

‘It’s taxpayers who are paying’

And he claims economic migrants are regularly arriving – who’ve paid strangers to pretend they’re a friend or relative in order to obtain a visitor visa to get to Britain.

He says: “I’ve come across so many people who have come this way into this country. It’s widespread. When I talk to these people, they literally tell me, ‘Oh, someone is coming tomorrow, day after tomorrow, someone is coming’.

“Because they’re hidden they may not be claiming benefits, but they can access emergency healthcare and their children can go to school.

“And who is paying for it? It’s the taxpayers who are paying for all this,” says the man we’ve met in north London.

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A Home Office spokesperson said: “We will not tolerate any abuse of our immigration system and anyone found to be breaking the rules will be liable to have enforcement action taken against them.

“In the first year of this government, we have returned 35,000 people with no right to be here – a 13% rise compared to the previous year.

“Arrests and raids for illegal working have soared to their highest levels since records began, up 63% and 51%.”