Jean is 80, works full-time as a building manager and has idiopathic pulmonary fibrosis – a condition that makes any respiratory infection potentially life-threatening. For her, A&E should feel like a refuge. Instead, walking into a busy waiting room fills her with paralysing anxiety. The place designed to help her could be the thing that harms her most. She's also my auntie and watching her fear is what drives my concern about the coming winter.

Recent research, Covid lessons and the reality of winter in A&E

Jean isn't alone. A recent poll revealed that 71% of older adults and 81% of their carers feel significant anxiety about attending A&E during winter – driven by fears of long waits, catching illnesses and concerns about an overstretched system. Last winter, this anxiety resulted in one in five (18%) older adults avoiding A&E altogether. These aren't irrational concerns. They're decisions about safety based on what people have witnessed in recent years following the Covid pandemic.

As a senior nurse in emergency care and lead advanced clinical practitioner, I've watched this anxiety take shape from the frontline. During the pandemic, I saw the system swing from an extreme caution – that impacted wellbeing – to worrying levels of complacency. In 2020, a lonely elderly woman I cared for, who came to A&E for company, was asked to stop visiting. She ended up in palliative care within months. Without Covid, I believe she would have had many good years left. These hard pandemic lessons seem increasingly forgotten as the 2026 winter season approaches.

There is no doubt this winter will be very difficult. Patient numbers are already in line with winter levels. And every year presents steeper challenges: funding hasn't kept pace, the elderly population is growing and increasingly frail, and social care capacity is dangerously inadequate.

The diagnostic challenge

Every winter, the NHS comes under intense pressure from respiratory viruses, with older and vulnerable people at greatest risk. One critical tool to manage this pressure is accurate diagnosis. However, across the UK, diagnostic approaches remain fragmented with the increasing use of tests that aren't intended as a first line of defence in emergency settings and inconsistently aligned to NICE best practice.

Lateral flow tests and rapid molecular point-of-care testing are fundamentally different tools, each with distinct roles. Lateral flow tests have a place perhaps better used in the community – they're quick, accessible and useful for early indication. But in emergency departments, they fall short. When a lateral flow result is unclear, clinicians may be required to order confirmatory molecular tests that take hours to process. During those hours, patients like Jean remain in limbo, waiting in mixed cohorts of coughing patients, exposed to the very health risk she's trying to avoid.

NICE-recommended rapid molecular point-of-care testing is the gold standard for timely, accurate diagnosis of respiratory infections in emergency settings. It delivers reliable answers in as little as five minutes, allowing clinicians to make confident decisions about patient placement and flow.

This fragmentation has a direct downstream consequence: slower decision-making and a delay in isolating patient cohorts. When clinicians lack certainty about a diagnosis, they can't move patients confidently through the system. Beds remain occupied for longer and patients are held in inappropriate waiting areas. The result is avoidable bed blocking and rising corridor care. It is no coincidence that recent figures show hospitals in England cared for 3,000 patients in corridors every day, during just one calendar month.

The solution

Jean puts it simply: ‘When it's flu and Covid season, I can't control what's happening in a hospital waiting room.' She does everything right – takes precautions, follows guidance and manages her condition as best she can. The one thing she can't control is what environment she enters into.

Access to reliable rapid diagnostics means an earlier opportunity to confidently detect and isolate patients. In inpatient settings, if a patient becomes unwell and symptomatic, a quicker, accurate diagnosis means clinicians can continue to rule in or rule out, reducing the risk of further outbreaks in inpatient areas. It means less risk of virus contact, which can ultimately close wards and contribute to corridor care if the virus develops.

When diagnostic accuracy and speed improve, control and clinician confidence improves. When clinicians are confident – from the most senior nurse to the newest advanced clinical practitioner – they can make informed decisions based on medical need, not on how much uncertainty they can tolerate.

My call for NHS leadership

NHS leadership need to act now. Planning needs to be ongoing, and decisions made now will determine whether we face another winter defined by corridors rather than care.

Firstly: align diagnostic practice across all emergency departments to NICE best practice. Make rapid molecular point-of-care testing the consistent, first-line standard for respiratory infection diagnosis in emergency and inpatient settings.

Secondly: invest in community diagnostics. Shifting accurate diagnostic capability into GP surgeries and walk-in centres would catch infections earlier, prevent unnecessary A&E attendance and allow vulnerable people like Jean to receive treatment in safer environments. We need to find opportunities to divert appropriate patients away from hospital entrances.

Thirdly: leadership needs to measure what matters. They must look beyond waiting times as the only signal of success, and consider diagnostic certainty, patient flow and bed management in their decision-making.

Accurate diagnosis isn't a luxury – it's essential to patient safety, system flow and restoring confidence in emergency care. The question now is whether leadership will act.