NHS managers got an early taste of winter pressure this week as prime minister Tony Blair admitted that some problems would be 'inevitable' over the coming months.

While the Department of Health, backed by Mr Blair, said that it had done everything it could in terms of spending and planning to avert problems, managers are still anxious.

Chief executive of Royal Liverpool and Broadgreen University Hospitals trust Pearse Butler said its share of the£300m winter pressures cash would be spent on 37 extra medical beds.

'We are under a lot of pressure, ' he said. 'A lot of demand is from elderly people, and we are doing a lot of extra surgery to meet targets. Pressure is created both by extra demand and the long-term need to increase capacity.'

Cambridgeshire health authority chief executive Alan Burns said government plans were 'broadly right'. But he echoed Mr Butler's concerns about the long-term outlook. 'We don't know how much money is recurring and that doesn't help long-term planning.'

Medical director of Epsom and St Helier trust Dr Peter Mitchell-Heggs said he had only just received winter cash allocations and this had made recruitment difficult.

'If only somebody had given us the cash a year ago. At this level to receive a cheque is great, but what the hell am I going to do with it?'

Chief executive of the Royal Group of Hospitals trust William McKee said Belfast was better prepared that in previous years. 'We have more critical care beds than in previous years. However, that doesn't mean that all patients will get what they deserve.'

At a press conference on Monday, Mr Blair said that last week's one-day census on bed availability within the NHS revealed that England had 445 more critical care beds than the same time last year, an increase of 18.8 per cent, and 1,358 more general and acute beds, a 1 per cent increase.

While flagging up examples of progress like Bradford (see picture caption), he warned that 'there is still a long way to go.'

Shadow health secretary Dr Liam Fox said Mr Blair had 'totally ignored the biggest problem facing the NHS this winter' - the dramatic loss of care homes for elderly people which would cause bed-blocking.

Two weeks ago West Surrey health authority was faced with 173 medically fit elderly patients blocking acute beds due to the closure of care homes.

Executive director of performance development David Smith said the HA took the 'balanced risk' of spending cash by preemptively opening up intermediate care wards before any new cash was allocated.

'Bed-blocking is now down to 128, and the£1m that we have been allocated for winter will allow us to pay for additional beds.'

And chief executive of the National Care Homes Association Sheila Scott said: 'New money needs to be targeted at people in receipt of long-term care, as the rate of care home closures still increasing.'

But NHS chief executive Nigel Crisp was confident the new arrangements would be an improvement on last winter:

'This year it will be far more systematic. We've got resources behind it and people in charge who are applying common sense.'

Mr Crisp said the NHS had been merely 'surviving' for too long.

'We have been struggling in terms of how we provide services. Now we are seeing the first signs of change, but that doesn't mean to say we have solved every problem, ' he said.

President of the Association of Directors of Social Services Moira Gibb agreed that collaboration was 'much better', but that there would be 'struggles'.

NHS Confederation chief executive Stephen Thornton, hoped that this short-term policy would force ministers to look at bed occupancy levels in the long term.

'It is accepted internationally that the ideal occupancy level is 85 per cent, but last year it was well into the 90s in the NHS.'