Hospital leaders predict this winter will be worse than the last and warn their health economies are not coping well already.

Eighty per cent of those surveyed for the latest HSJ/Capsticks hospital chief executives barometer said that this winter would be worse than last year’s, when the NHS saw widespread breaches of waiting times targets.

Asked to rate how well their health economies were coping currently, hospital bosses gave an average score of 4.5 out of 10.

Data released last week showed that in the week ending 8 December, 94.8 per cent of accident and emergency patients were seen within four hours, against the national target of 95 per cent.

National A&E performance since the start of October has been below that of the same period last year, with hospitals and walk-in centres achieving 95.8 per cent, compared to 96.1 per cent in 2012.

Just over half of chief executives responding to the survey, which was conducted between 27 November and 11 December, said their trust had a plan in place to reduce the admission of frail elderly patients.

Of the remainder, half said they had no plan and the other half was still developing one.

When surveyed last winter, chief executives said a significant cause of problems in A&E was the difficulty in discharging patients to social care.

A&E attendance is generally lower in winter but patients are more acutely ill, with multiple comorbidities.

A Department of Health spokesman said: “We are tackling the short and long term problems: transforming out of hospital care by giving all elderly people a named GP, merging the health and social care system and backing health systems with £400m to prepare for this winter.” 

Hospital chief executives were also sceptical about whether their organisations could afford workforce reforms intended to increase patient safety.

Asked how affordable seven-day working plans were − which focus on increasing senior and specialist medical cover in the evenings and weekends − the survey average was 3.9 out of 10.

NHS Employers chief executive Dean Royles said: “Current [medical] contract negotiations are a once in a generation opportunity to change the way hospital doctors work.

“The contract negotiation heads of terms highlight more local control of increments − like we have for other staff − and more plain time working.”

Responding to the findings, a spokeswoman for the British Medical Association said: “We have to prioritise what services can and should be provided seven days a week within the current budget and workforce.

“The BMA believes that delivering the same high quality urgent, acute and emergency care throughout the week should be the priority.”

Trust bosses were also pessimistic about the costs of the current drive to increase nurse numbers, in the wake of the Francis inquiry.

The government’s response to the inquiry, which was published in November, said all organisations must review their nurse staffing levels twice a year against national guidance.

Although no mandatory minimum staffing level was imposed, increases in workforce are widely expected.

More than half of the 33 respondents to HSJ’s survey said their trust could not afford the extra nursing staff.

Mr Royles warned against using nurse numbers “as a proxy for the quality of care” and said: “If we are not careful we risk growing the number of hospital nurses at the expense of allied health professionals and more sustainable community solutions.”

However, chief executives were bullish about the hospital sector’s capacity to maintain or improve care quality.

They rated their confidence in maintaining the quality of care at 7.6 out of 10, up from 7.3 last year. Confidence in their ability to improve care quality was at 6.6 out of 10, up from 6.1 in 2012.

This winter will be worse than last, warn hospital chiefs