Patients may be at risk from a shortage of beds, staff and money that threatens to undermine the most extensive preparation ever undertaken by the NHS, hospital trusts have warned.
With the health service entering its busiest three months of the year, the body that represents hospital, ambulance and mental health trusts says its members will be sorely tested this winter despite months of planning.
NHS Providers say hospitals are already severely stretched, with bed occupancy in some trusts running at 98%, and significant delays in transferring patients out of hospital reducing the capacity for new admissions.
Among the measures the NHS and local hospitals have taken to try and ensure safe, high-quality care are:
:: Contingency plans to support trusts facing the greatest pressure
:: Extending the number of GPs streaming patients in A&E to reduce strain on emergency departments
:: Local resilience plans involving co-operation between health and social care organisations
:: Work to improve the flow of patients through hospitals
While trusts are hopeful these plans will help mitigate some of the issues the health service will face this winter, they say major challenges remain.
Many hospitals privately admit that they have been unable to meet targets to free up bed capacity by discharging more patients ahead of the winter peak, a plan that was supposed to provide an additional 3,700 beds across England.
This increases the prospect of a repeat of last year’s difficult winter, when some A&E departments were forced to turn patients away.
The Government provided an additional £350m in the Budget to help the NHS cope with winter, but many believe the money was committed too late to be effectively spent.
Speaking to Sky News at Newham University Hospital, the Chief Medical Officer of Barts Health Alistair Chesser said local co-operation was helping them cope with demand.
He said: Winter has definitely arrived, we’ve noticed that. We had 530 attendances here in Newham on Monday, our normal rate is about 430, so you can see that the numbers are going up.
But we saw 97% of people within four hours yesterday which is a terrific performance by this hospital, so we are coping.
We’ve now got a system wide plan which involves not just the hospitals in the area but also social services, community services, metal health and primary care. So we’ve got one big system working together for patients.
The chief executive of NHS Providers, Chris Hopson, said: Our report highlights the range of measures trusts have put in place to improve resilience and provide safe, timely care for patients.
But we have to recognise we are not where we would want to be as we head into winter.
The NHS is already under severe pressure, and while the additional funding in the recent Budget is welcome, it has come very late to be used to maximum effect.
The warning comes as NHS England publishes its first winter pressure situation reports, figures that will reveal the volume of patients attending A&E departments across the country in the first few days of December.
In previous years they have also included the number of A&E departments under pressure, defined as those that have activated the two highest level of escalation plans.
The NHS uses four Operational Pressure Escalation Levels, known as OPEL 1-4, in response to extreme stress.
OPEL 3 is declared when major pressure compromises patient flow, and OPEL 4 when pressure means hospitals cannot deliver comprehensive care, and there is the potential for patient care and safety to be compromised.
Sources have suggested those figures will be withheld this winter, but NHS England said it was unable to clarify what statistics will be included ahead of publication.