The government has instructed strategic health authorities to ensure trusts focus on reducing ambulance to hospital handover waits as part of planning for winter pressures.

NHS director general of finance, performance and operations David Flory and national director of NHS flu resilience Ian Dalton wrote to SHAs last week emphasising the need to keep the Department of Health updated on operational problems via the daily situation reporting system for winter and swine flu pressures.

The majority of the year has been one huge pressure - making us dread any extra over the winter

The letter tells SHAs they should work with trusts that report any problems and make sure local preparations are in place on routine winter risk areas.

“In particular, we are looking for reductions in ambulance to handover waits, especially where there have been problems previously… We are keen to understand the action being taken now,” the letter states.

It says where performance is projected to be below the operational standard, SHAs must ensure trusts are “fully focused and have actions agreed with their local primary care trust to maximise performance for the remaining months during the winter period and beyond”.

In a letter sent earlier this month Mr Dalton told chief executives that, while data indicated the swine flu pandemic may peak at a lower rate than first predicted, the coming months were still expected to be tough.

“We are still seeing a number of deaths from swine flu, we are also beginning to see increased pressure within the system, particularly on accident and emergency and ambulance services,” he said.

He added: “We are well placed to manage them due to the plans we have in place, but we are reminded of the need to continue to remain prepared for what will potentially be a tough winter for the NHS.”

However, a survey by HSJ’s sister title Nursing Times suggests staff shortages and high bed occupancy levels are already increasing pressure on the NHS to unexpected levels - even before the onset of cold weather.

Around three quarters of the 1,000 respondents - 72 per cent of hospital nurses and 77 per cent of primary care nurses - said the service they work in is under greater pressure than this time last year.

Sixty per cent of hospital nurses said this pressure is greater than planned for.

One respondent said: “The majority of the year has been one huge pressure - making us dread any extra over the winter.”