The winter you can already see coming
Every January, the NHS runs out of road. The decisions that can help prevent it need to be made months earlier. Here’s what the evidence says about where to start.
In the first week of January 2026, adult bed occupancy in England hit 95.7%. That’s above the NICE ceiling of 90% and the NHS operational planning limit of 92%. At that level, the consequences are predictable: longer A&E waits, patients treated in corridors, higher rates of hospital-acquired infection. None of this is a surprise. The same number surfaces every January.
What rarely gets said plainly is this: a meaningful share of that bed pressure is avoidable, and the window to avoid it is now, not November. Two things drive winter admissions that complex clinical homecare can address. First, stable patients receiving routine infusions in hospital chairs and day units, occupying clinical resource that Trusts will need for acute cases. Second, patients with chronic conditions whose disease isn’t controlled well enough to keep them out of A&E when the cold sets in.
This article sets out the evidence for both. Later articles in this series look at delivery in specific therapy areas: IBD, MS, and COPD.
The chairs that don’t need to be full
Walk into a mid-sized acute Trust’s infusion suite in November and the chairs are full, often with patients who are, by any clinical measure, well: stable, in remission, months or years into maintenance therapy, attending every few weeks because that is how the pathway was built. These patients are not taking up overnight beds. But they are taking up chairs, specialist nursing hours and day-unit estate – precisely the resources Trusts repurpose for escalation when winter arrives.
In inflammatory bowel disease, subcutaneous formulations of infliximab and vedolizumab are now well established. When Leeds Teaching Hospitals evaluated its own switching programme, 90% of maintenance patients were clinically eligible to switch from IV to subcutaneous administration, and 58% chose to do so. This suggests there is significant potential to move appropriate maintenance treatment away from hospital infusion settings, although patient choice and the support available around the transition remain important.
The Leeds experience shows the potential to move appropriate maintenance treatment away from infusion suites. Sciensus shows what delivering that shift at scale can look like.
The opportunity to move this activity out of hospital is already visible in the Sciensus services. Over the last 12 months, 12,300 patients with IBD received support at home, either to learn to self-administer their medicines or through ongoing nurse administration. Across 14,300 visits, this represented approximately 14,300 hours of treatment and support delivered outside the hospital setting.
For patients with MS, Sciensus supported 1,600 patients through 1,750 home visits over the same period, representing a further 1,750 hours of activity delivered outside hospital.
Together, these services show how appropriate treatment and support can be moved into the home at scale, reducing the amount of routine activity that needs to take place in hospital and creating more capacity for patients who need hospital-based care.
The admission that never happens
The second argument is different in kind. COPD causes around 130,000 emergency hospital admissions in England every year. Respiratory disease overall accounts for more than 700,000 hospital admissions and roughly six million inpatient bed days annually – the majority unplanned, and a leading driver of what gets called “winter pressure.”
Two things changed this year that make COPD a homecare story for the first time. In January 2026, NICE approved dupilumab as the first biologic for COPD – self-injected at home every two weeks. Around 30,000 people in England are eligible. In trials it reduced exacerbations by about 30%. In May, NICE followed with final draft guidance recommending mepolizumab for the same population. NHS England has published business-case guidance to support commissioning of both.
The significance for winter is direct. These patients are not an infusion-suite cohort – their treatment is, by design, delivered at home. But their exacerbations are exactly the admissions that fill medical wards in January. Realising the potential benefit of a home-administered biologic depends in part on patients being able to take their treatment as intended. That is where complex clinical homecare providers, and the adherence and monitoring infrastructure that comes with them, become critical parts of the care plan.
Sciensus clinical homecare can support patients to establish their treatment routine once care moves into the home. Patients can be trained to self-administer safely and confidently, while the Sciensus patient app can provide medication reminders and allow them to record injection sites. For people with COPD starting a home-administered biologic, this support can help them take their medicine as intended and maintain treatment consistently, supporting the wider aim of keeping their disease controlled and reducing the risk of exacerbations.
What the evidence shows
The strongest independent evidence comes from the ABPI’s July 2025 report, Bringing Healthcare Home, which for the first time paired patient-level outcome data with a survey of NHS professionals. Patients receiving clinical homecare had around half the rate of A&E attendances and hospital admissions of comparable patients who did not. In the accompanying survey, 92% of NHS professionals said homecare increases NHS capacity, 90% said it brings financial savings, and 57% reported better health outcomes for their patients.
Importantly, these findings come from an independent analysis commissioned by the ABPI, the industry body representing the pharmaceutical companies whose medicines are being delivered. That provides useful independent evidence for NHS teams considering the role clinical homecare could play in increasing capacity and improving outcomes.
The timing problem
Winter bed pressure is not, mostly, a winter problem. It is the visible failure mode of a system that already runs above its safe-occupancy thresholds for much of the year, climbing into the mid-90s at the peak with almost no reserve for a surge. Clinical homecare can create capacity by moving planned, stable and protocolised activity out of hospital, leaving more hospital resource available for acute, unplanned cases that cannot be managed elsewhere. It can also support people with chronic disease to stay well at home during the months when deterioration is more likely to result in urgent care or hospital admission.
Both effects take time to build. Neither can be switched on in December.
For Trusts preparing for winter, the starting point is understanding which planned activity could appropriately move out of hospital and which patient groups may benefit from additional support at home. Sciensus is already supporting thousands of patients with complex conditions in this way, helping move treatment and associated clinical activity beyond the hospital setting.
