Record numbers of patients will be stuck on trolleys in corridors or the back of ambulances this winter as hospitals run out of beds because of soaring demand and limited funding, the country’s leading A&E doctor has warned.

Hospitals will have to put more patients on trolleys, cancel more operations than ever before and turn away new admissions as they fail to meet the four-hour maximum patient waiting A&E target, amid unprecedented bed-blocking caused by fast growing demand, Dr Cliff Mann told the Observer.

“I’m concerned that this winter will be worse than last winter, and last winter was the worst winter we’ve ever had. It’ll be the worst winter most of us can remember. Many hospitals will struggle on a weekly and daily basis, particularly in January and February,” he said.

The NHS in England only narrowly avoided collapsing last winter, Mann said. But he is worried that the situation confronting the service could get “really bad” over coming months because “this year there’s been a further rise in A&E attendances and there’s no extra money in the system to tackle transfers of care.

“If you increase demand for beds but reduce the supply, you’re bound to end up with more people queuing in corridors and in the back of ambulances outside your A&E department. We will have so few available beds that the numbers of people waiting in A&E to be admitted to hospital will reach new records,” he said.

Usually only a few hospitals find they cannot cope in winter, but Mann, a senior consultant in the emergency department at Musgrove Park hospital in Taunton, Somerset, believes that this year for the first time most of them are likely to end up having to declare a “black alert” or “significant incident”. That is an emergency situation that can lead to patients being told to go elsewhere, asking neighbouring hospitals for help or discharging patients early to free beds.

The most recent NHS figures show that 80% of acute trusts are in deficit or are failing to meeting politically important NHS waiting time targets or both – the telltale predictors of which hospitals will struggle in winter – Mann said.

About 20 of England’s 160 acute trusts came under such strain that they declared a major incident last winter. “I’m not going to predict Armageddon, but the most likely thing is that many trusts will declare major incidents. In the past a large minority of hospitals have been in this predicament, but the challenged hospital is now really the norm rather than the exception,” said Mann.



“Sudden surges in demand will be widespread and difficult to handle. My prediction is that they’ll probably happen around January and February and are most likely to happen in trusts that are already struggling, both financially and in terms of [waiting time target] performance, because they have no leeway on which to call.”



More hospitals will miss a series of NHS targets, causing difficulties for patients, he expects. “I think we will have the worst four-hour [A&E] performance figures for 10 years, the worst 12-hour performance for probably about 10 years, more cancelled operations than for many years and more delayed transfers of care than previously,” Mann said.

The most recent official NHS figures show that A&E units based at hospitals have breached the target to treat 95% of patients within four hours every month this year and that their performance has been worse in every month compared to the same month in 2014.

The Department of Health responded to Mann’s remarks by accusing him of pre-winter “scaremongering, which is a disservice to our NHS staff who are working incredibly hard. The NHS is busy, but has been preparing for winter pressures for months and services are performing well, with the overwhelming majority of patients treated quickly.

“Enhanced, clinically led expert support is in place to support the systems under the most pressure,” a spokesman said. However, Justin Madders, the shadow health minister, said: “This stark warning from the country’s most senior A&E doctor should set alarm bells ringing in 10 Downing Street.

“There are now serious doubts over whether the NHS has the resources and staff it needs to cope with demand this winter. The NHS is on the brink of a deeply worrying crisis, and patients are already facing unacceptably long waits in A&E.”

Prof Jane Dacre, president of the Royal College of Physicians, which represents non-specialist hospital doctors in England, said: “I share the concern of our colleagues in A&E medicine that the NHS will struggle to cope again this winter. Last year the overwhelming pressure of acute admissions led so many hospitals to declare major incident status that, if we had also experienced bad weather and a flu epidemic, we would have been extremely close to an NHS collapse.”

When A&E units become overwhelmed, acute medical units, and ultimately entire hospitals, end up struggling to cope with the increased numbers of patients, said Dacre. “More physician time is needed for diagnosis, treatment and monitoring. This leads to cancelled outpatient clinics, reduced time for teaching and education sessions, longer working hours, and healthcare staff being asked to do overtime or come in on days off to cover.”

NHS England said it was taking action to improve the local delivery of healthcare to try to ease the pressures on A&E units. A spokesman said: “It’s also worth remembering that, despite the usual flow of negative predictions at this time of year, our services continue to admit or treat and discharge more than nine out of 10 patients within four hours, a higher standard than any major western nation.”