A NEW report has warned of a difficult winter for NHS trusts, staff and patients.

NHS Providers, the body that represents trusts, says several factors, including A&E waiting times and staff shortages, suggest problems for hospitals in the months ahead.

At Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) which includes the Bradford Royal Infirmary, A&E waiting times are already worse than last year.

Between April and September, 62,735 people attended an emergency department, with 83 per cent being admitted, transferred or discharged within four hours. The government target is 95 per cent.

That figure is lower than the same period in 2017, when 86 per cent of patients were seen within four hours.

Waiting times are also worse at Airedale NHS Foundation Trust (ANHST).

Figures show 30,076 people attended an emergency department between April and September, with 90 per cent being admitted, transferred or discharged within four hours.

That figure stood at 94 per cent for the same period in 2017.

Saffron Cordery, deputy chief executive at NHS Providers, said: "Trusts and their staff put in extraordinary efforts last year to meet record demand - demand which continues to grow every winter.

"Despite measures to prioritise emergency care, it was clear that in many places the quality of care for patients feels short of what the public rightly expects.

"As attention turns to what this winter will bring, there are many improvements which have been put in place to welcome."

However, she said there are "clear warning signs", with performance in a worse position going into this winter than the last.

She pointed to growth in staff shortages putting additional strain on an overstretched workforce.

Both trusts are carrying vacancies. In March 2018, the most recent period for which data is available, for BTHFT shows there were vacancies equivalent to 95 full-time jobs, compared with 67 in April 2017. Of those, 26 were nurses and seven were other medical staff.

At ANHST, for the same period, there were vacancies equivalent to 37 full-time jobs, compared with 51 in April last year.

NHS Digital warned that the number of nurse vacancies was likely to be higher, as the figures show the minimum number of jobs advertised, and many trusts have rolling adverts for nurses.

Donna Kinnair, acting chief executive and general secretary of the Royal College of Nursing, said staff are doing all they can, but demand is outstripping supply.

She warned winter 2018 could be the one "that brings services to a standstill".

The NHS Providers report calls on NHS national bodies to acknowledge and plan for the scale of extra, more complex demand that health and care services face.

A Department of Health and Social Care spokesman said the NHS will benefit from a second year of "better, enhanced, national level winter planning" and £420m to redevelop A&Es. The spokesman said nearly 2,000 more patients a day were seen within four hours in September, compared to the same month in 2017.

Last week it was announced Bradford will receive nearly £2.3m to help local authorities alleviate winter pressures on the NHS. 

Shaun Milburn, Assistant Director of Operations for unplanned care at ANHST said: “After successful recruitment events this year we have welcomed many new nurses to the trust recently. We are continually seeking to strengthen our workforce to ensure we can provide high quality, safe and effective patient care, especially over winter which can be the busiest time across hospitals nationwide.

“We are in a stronger position going into winter this year as our new acute assessment unit opened six months ago. The new unit allows for better patient flow from emergency admissions into onward care, which means we’re able to treat patients more quickly.”

A spokesperson for BTHFT said: “Our A&E waiting times reflect challenging conditions which we and other trusts faced this year due to a long, hot summer which significantly increased attendances. This included older people experiencing flare-ups of chronic conditions made worse by the heat, such as breathing difficulties, and people who had suffered a stroke.

“This rise in attendances has continued with frequently more than 400 patients being seen at Bradford’s A&E department each day.

“To meet this increasing and constant demand we have a detailed urgent care improvement programme in place and this winter we have secured additional funding for some key schemes focusing on alternative care pathways to avoid admissions from A&E. We have filled almost all our nursing vacancies in A&E, with 17 new staff nurses and four healthcare assistants joining the team.

“And we have announced the development of a Command Centre at Bradford Royal Infirmary – the first of its kind in Europe, which will open early next year. This will provide a clear, instant and real-time overview across our hospitals to cut waiting times, treat more patients and improve their experience, as well as reducing pressure on staff.

“We would always urge people to only come to A&E if it is a medical emergency. If you don’t have an obvious life-threatening illness or injury please consider accessing advice and treatment from your local pharmacy or GP surgery, NHS 111 or online advice from www.nhs.uk."