In a move that has sent shockwaves through the diving medical community and patient advocacy groups alike, NHS England has announced plans to dramatically reduce its hyperbaric oxygen therapy (HBOT) infrastructure. The proposed restructuring would shrink the current network of eight contracted hyperbaric units down to just three—a reduction that critics warn could create dangerous gaps in emergency care coverage across the United Kingdom.
The Scope of the Cuts
According to the Undersea and Hyperbaric Medical Society’s Q4 2025 registry update, NHS England initially proposed reducing eight contracted units to six. However, subsequent developments have proven even more severe. As reported by DIVE Magazine and the Sub-Aqua Association, four additional chambers are scheduled to lose their NHS contracts effective October 1, 2025. The affected facilities include Hyperbaric Treatment and Training Services in Wirral, among others.
The new commissioning requirements demand that remaining units operate 24/7 and maintain capability for treating critically ill, ventilated patients inside the chamber. As of October 1, 2025, only three units met these stringent criteria—leaving vast geographic swaths of England without timely access to this life-saving therapy.
Why This Matters: Approved Indications at Risk
The NHS decision carries particularly weighty implications because England’s approved indications for HBOT under the national health service are already narrowly circumscribed. Unlike healthcare systems that reimburse HBOT for diabetic foot ulcers, radiation injuries, and other chronic conditions, NHS England currently approves hyperbaric treatment for only two indications: decompression sickness and arterial gas embolism.
Both conditions are time-critical emergencies. Decompression sickness—often called “the bends”—can strike divers who ascend too quickly, causing nitrogen bubbles to form in the bloodstream and tissues. Symptoms range from joint pain and skin rashes to paralysis, unconsciousness, and death. Arterial gas embolism, similarly, occurs when gas bubbles enter the arterial circulation, potentially causing strokes, heart attacks, or organ failure.
In these scenarios, the “golden hour” principle applies with particular force. Delayed treatment can mean the difference between full recovery and permanent neurological damage—or worse. With only three chambers remaining, patients in northern England, the Midlands, and other regions may face transport times measured in hours rather than minutes.
The Diver Community Sounds Alarms
The British Diving Safety Group (BDSG) and Sub-Aqua Association have been vocal in their opposition to the cuts. Their concerns extend beyond recreational scuba divers to commercial divers, military personnel, and even medical patients who might require emergency HBOT following certain surgical procedures or trauma.
The geographic concentration of remaining facilities raises particular concern. If only three units remain operational, entire regions could find themselves effectively uncovered. A diver experiencing decompression sickness off the coast of Northumberland or Cornwall might face multi-hour transfers to reach treatment—delays that could prove catastrophic.
A Global Context of Contraction
The NHS England cuts fit into a broader pattern of hyperbaric service reductions across developed healthcare systems. In the United States, rural hospitals have increasingly closed their hyperbaric units due to reimbursement pressures and staffing challenges. The American Hospital Association has documented dozens of such closures over the past decade, leaving “hyperbaric deserts” across the American heartland.
Yet the NHS approach is uniquely restrictive in its approved indications. While Medicare in the United States covers HBOT for diabetic foot ulcers, radiation tissue injury, carbon monoxide poisoning, and numerous other indications under National Coverage Determination 20.29, NHS England’s two-indication policy already represented one of the world’s most limited HBOT reimbursement schemes.
The Safety Imperative
The U.S. Food and Drug Administration, in its consumer guidance on hyperbaric oxygen therapy, emphasizes that HBOT is a proven, effective treatment for specific medical emergencies—including decompression sickness and air embolism. The FDA has not approved HBOT for many wellness and longevity applications that dominate popular discourse, but the agency maintains clear recognition of its value for these emergency indications.
The NHS cuts therefore represent a retreat from an evidence-based standard of care. Decompression sickness and arterial gas embolism are not speculative conditions requiring experimental treatment; they are well-characterized medical emergencies with established, effective interventions. Removing access to those interventions does not reflect scientific uncertainty about HBOT’s efficacy—it reflects budgetary pressures overriding clinical priorities.
What Comes Next
As the October 1, 2025 deadline approaches, stakeholders continue pressing for alternative arrangements. The affected chambers may seek private funding, charitable support, or local NHS trust partnerships to maintain operations outside the national commissioning framework. Whether such arrangements can materialize in time remains uncertain.
For divers and patients across England, the message is clear: know your nearest hyperbaric facility, understand that it may soon be farther away than it once was, and consider how emergency medical evacuation might work in a landscape of concentrated, distant resources.
The NHS has built its reputation on universal access to essential care. In reducing hyperbaric services to a skeletal network covering only two approved indications, that universal access promise faces a significant test—one that patients and providers will be watching closely as the autumn deadline approaches.
HBOToday Editorial provides independent coverage of hyperbaric medicine policy, research, and clinical developments. This article reports on publicly available information from NHS England, UHMS, and diving safety organizations.
Sources
- Q4 2025 Update from the Multicenter Registry for Hyperbaric Oxygen Therapy - UHMS
- NHS England to close four more hyperbaric chambers - DIVE Magazine
- Closure of UK Hyperbaric Chambers by NHS England - Sub-Aqua Association
- NHS England Service Specification: Hyperbaric Oxygen Therapy
- FDA - Hyperbaric Oxygen Therapy: Get the Facts