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The NHS is facing challenges in several key areas, including problems with emergency response times, waiting times and staff numbers. In this State of the NHS guide, the issues are broken down into the categories of Ambulances, Backlogs, Care, and Doctors & Dentists.
The main measure of performance for ambulances is their response time from the point when someone has dialled the emergency services. The request for an ambulance is then sorted into one of four categories, depending on the urgency of the situation. Each category has its own target for ideal response time.
Therefore, the ideal response time varies widely depending on the urgency of the call. This is measured both by the average response time and the 90% target for Categories 1 and 2, and just the 90% target for Categories 3 and 4.
Ambulance response times have improved from the worst levels seen during the pandemic, but performance reported by the government remains below the national standards for some categories. In January 2026, the average Category 1 response time was 8 minutes and 8 seconds, compared with the seven-minute target, whilst Category 2 calls had an average response time of 35 minutes and 4 seconds, almost double the 18-minute standard.
The longer waits were particularly pronounced for less urgent calls. For Category 3 incidents, 90% of patients were reached within 5 hours and 2 minutes, compared with the two-hour target. For Category 4, the 90th-percentile response time was 6 hours and 38 minutes. When compared against the three-hour target for Category 4, this shows how there are severe delays for emergencies that are both urgent and not.
There are several reasons why ambulance response targets have been missed.
To address this, the government’s 2025/26 Urgent and Emergency Care Plan was backed by almost £450 million, including funding for urgent treatment centres, same-day emergency care and ambulance improvements. The plan aimed to reduce average Category 2 response times to 30 minutes and ensure that patients are transferred from ambulances to hospital staff within 45 minutes.
One factor contributing to longer ambulance response times is the backlog of patients waiting for treatment across the NHS. Although the COVID-19 pandemic initially reduced the number of people on waiting lists as elective procedures were postponed, waiting lists began to rise sharply from 2020 onwards.
The backlog has since started to fall but remains substantial. In January 2026, around 7.25 million treatment pathways were waiting to start in England, representing approximately 6.13 million individual patients. This was a reduction of more than 370,000 pathways since June 2024, but waiting times remain a significant challenge.
The ‘four-hour A&E standard’ aims for patients to be admitted, transferred or discharged within four hours of arrival.
In January 2026, England recorded approximately 2.32 million A&E attendances, one of the busiest Januarys on record. The median total time spent in A&E was 2 hours and 47 minutes, whilst 4.8% of patients left before receiving treatment.
For patients requiring admission, delays can be particularly lengthy. Long waits in emergency departments also contribute to ambulance handover delays and reduce the availability of hospital beds.
The target time period for a cancer patient being referred from a GP to seeing a consultant is two weeks. 90% of patients should be seen by a consultant in this time. Furthermore, 90% of patients should be receiving treatment following a GP referral.
In December 2025, 77.4% of patients were told whether they had cancer, or had cancer ruled out, within 28 days of an urgent referral. This was above the 75% standard.
However, meeting the faster diagnosis standard does not necessarily mean treatment has started. The NHS also has targets of no more than 2 months’ wait between a cancer referral and the start of treatment, and no more than 1 month between a treatment plan being agreed upon and the start of treatment.
The care sector is a crucial component of the NHS. It includes all roles that support people who require specialised assistance to live their daily lives. This can include the elderly, young families and those with mental illnesses, or people who suffer from addictions such as drug or alcohol dependency.
As such, the care sector plays an important role in ensuring that people with either physical or mental health issues are supported in the community before they require the support of hospitals, GPs or emergency services.
Staffing shortages remain a significant challenge, and adult social care in England had around 111,000 vacant posts in 2024/25, representing a vacancy rate of 7%. The sector employed approximately 1.6 million people, but it is estimated that around 470,000 additional posts may be needed by 2040 to meet rising demand.
Recruitment and retention are also ongoing concerns. The number of international recruits entering adult social care in England fell from 105,000 in 2023/24 to 50,000 in 2024/25, and in May 2025, the government announced that it was ending overseas recruitment entirely. These pressures make it harder for care providers to deliver consistent support and meet growing demand.
There has been some improvement in retention, and the turnover rate in the independent sector fell from 25.8% in 2023/24 to 24.7% in 2024/25. However, turnover remains high enough to create ongoing recruitment pressures.
While the NHS workforce has grown in some areas, access to primary care remains a challenge. In June 2026, England had 50,440 GPs by headcount, 3.7% higher than the previous year. However, growth has not been consistent across the wider GP workforce, and England had approximately 16,697 full-time nurses, which was 0.1% lower than last year. Workforce figures also don’t show the differences in workload or appointment availability, meaning that an increase in staff numbers doesn’t always mean faster appointments.
Access to NHS dentistry is another concern, although activity has increased in recent years. In 2025/26, England recorded 37.6 million courses of NHS dental treatment, up 6.2% on the previous year, whilst 25,419 dentists provided NHS treatment, an increase of 3.1%.
The 2025 GP Patient Survey also found differences in people’s ability to access NHS dentistry. Only 78% of respondents who had tried to get an NHS dental appointment were successful, with people in some regions, like the South West, having much greater difficulty. This shows that patient access is still unequal across the UK and hasn’t been rectified by the increased workforce.
If you study Medicine in the UK, it is likely that you will go on to work for the NHS after graduating. Therefore it’s important that how understand how the NHS works and the issues it currently has.
Medical School interviewers will expect you to have some knowledge of the realities of working in the NHS and the challenges that Doctor face.
You can find over 100 example interview questions and answer guides in our Interview Question Bank.
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