Health authorities and trusts have been given just four weeks to detail plans for dealing with this year's winter pressures.

Health secretary Frank Dobson sent a letter to NHS staff last week thanking them for 'the successful management of emergencies last winter' and outlining 'what must be done to achieve the same level of success this year'.

It said local plans for coping with emergency pressures should be signed off by chief executives and agreed at regional level by the end of the month. Accident and emergency departments must stay open, while waiting list targets are met and financial control is maintained.

Suzanne Tyler, deputy director of the Institute of Health Services Management, called for more time and warned Mr Dobson not to 'expect miracles' if the winter was hard. 'The health secretary must appreciate that the management agenda is already jam-packed with work,' she said.

A spokesperson for the NHS Confederation said it 'recognised the potential for problems'. It will hold a conference later this month to clarify outstanding winter issues.

The letter coincided with the second report of the Emergency Services Action Team.

Chair Christopher Bunch, medical director of Oxford's John Radcliffe Hospital, said stress levels were high across the NHS last winter. While many hospitals were working at 95 per cent occupancy, 'the system was not severely tested' and 'long spells of severe weather or a flu epidemic will pose serious problems.'

Managers and clinicians told ESAT they were worried about the rising number and dependency of patients, recruitment and long-term funding worries.

ESAT will continue for another year. Mr Dobson said it would carry forward its longer-term recommendations and provide 'additional help' this winter. It will also 'support systematic planning for the millennium holiday'.

Emergency Services Action Team, 1998 Report. Department of Health Stores, PO Box 410 Wetherby, LS23 7LN.

See Comment, page 15

ESAT recommendations:

Immediate action:

Round-the-clock bed management

'Chain of contact' between bed managers and senior executives

Trusts to work with social services and other agencies

Medium-term improvements:

Bed managers to be trained and new ideas reported to them

Discharge protocols to be established

Best practice to be spread by NHS Executive

Longer-term action:

Acute trusts to co-operate in large conurbations and develop 'coherent strategic response' to bed crises

Conferences, bulletins and other methods of spreading best practice to be developed.