Hospitals in England have been advised to halt elective surgery over Christmas to ensure enough beds are free for patients who need emergency treatment at the end of the year.

In a sign of the intense pressures on NHS resources over the winter months, the regulator NHS Improvement said all hospitals should make more beds available between now and mid-January.

Jim Mackey, the chief executive of NHS Improvement, said the focus needed to be on emergency patients at what he called a critical time for the health service. Many hospitals take steps to wind down the number of operations they perform over the Christmas period, but a letter obtained by the Health Service Journal states that operations may need to be postponed “beyond any current plans”.

In the letter to NHS trusts, the regulator says: “Given the level of risk facing the system, it is clear that having sufficient bed capacity going into Christmas is critical, and we know most organisations will already have this in hand as part of local planning arrangements.

“In preparing for managing winter pressures, it is recommended that all providers pace their elective work by introducing elective breaks where trusts cease most in-patient elective activity and focus on treating emergence activity and non-admitted patients.”

Highlighting how much spare capacity is thought to be necessary, hospitals are being advised to reduce their bed occupancy to 85%. The rate currently stands at 95% across NHS England.

Jon Ashworth, the shadow health secretary, said: “This leaked memo represents a damning indictment of Theresa May’s mismanagement of the NHS. The Tory failure to provide the NHS with the funding it needs means that hospitals are having to close operating theatres over Christmas just to get through the winter.

“This short-term fix is only going to store up problems for next year and leave more and more people stuck on waiting lists when already almost 4 million people are waiting for an operation.”



Admissions to hospital emergency departments tend to spike over the winter because of the cold weather and a rise in respiratory infections.



The NHS Providers chief executive, Chris Hopson, told the Health Service Journal that the guidance was “another classic example of how trusts are now caught between a rock and a hard place” of meeting surgical targets while coping with ever-rising emergency demands. “Trust chiefs tell us it’s increasingly difficult to deliver both,” he said.



“This guidance does go further than before, for example in specifying a target bed occupancy level as the holiday period starts, but it is in line with the direction of travel over the last few years,” Hopson added.



The letter, dated 9 December, came to light as the Nuffield Trust said pressure on beds in NHS England hospitals had become so intense that on any given day last winter the equivalent of more than five extra hospitals’ worth of beds had to be brought into service.



On the busiest day last winter, 26 January, hospitals had to find a record 4,390 extra beds, the equivalent to the capacity of seven hospitals. With the pressure on beds so acute, the Nuffield report said hospital managers would find it harder to deal with emergency patients within four hours of their arrival in A&E departments as targets required.



Beds have come under increasing pressure in the past few years as more people are referred to hospital and medically fit patients are not discharged on time. Delays in discharging patients stand at a record high, up 27% on last year, as do trolley waits, up 54% in the year to October. John Appleby, the Nuffield Trust’s chief economist, said: “It’s a big sign the system isn’t working that efficiently.”



He said the call on hospitals to free up more beds over Christmas showed a “tinge of anxiety” over the levels of bed occupancy in the NHS. “It’s a bit invidious,” he said. “But clearly emergencies must take priority.”

A spokesperson for NHS Improvement said: “NHS providers will be doing all they can to make sure their patients are able to receive quality care during the busy Christmas period. A reduction of elective hospital activity in the run-up to Christmas is standard practice, and well rehearsed by NHS providers.

“Many hospital trusts also routinely wind down elective activities in the run-up to the Christmas and new year period, as patients do not wish to be in hospital over the festive period and those who are medically fit for discharge want to return home. This also frees additional capacity.



“Cancellations should be kept to an absolute minimum and, in trusts where elective work does need restricting, then the decisions should always be taken using appropriate clinical reviews to ensure patient needs are met.”

