HOSPITAL bosses in Worcester may have to cancel non-urgent operations as they are told to prepare for a winter crisis.

Hospitals in England have been ordered to cut back non-urgent operations and cancel outpatient appointments in the run-up to Christmas in preparation for a possible winter crisis, official documents have disclosed.

The move comes as the Royal College of Nursing (RCN) warned of a "drastic shortage" of accident and emergency nurses, with departments across the country "buckling" under the pressure.

The Worcestershire Acute Hospitals NHS Trust which runs Worcestershire Royal Hospital in Worcester continues to struggle to meet its target to treat to admit, transfer or discharge at least 95 per cent of patients within four hours of arrival at A&E.

The winter months are considered far busier as flu and winter vomiting bugs like Norovirus are at their height.

For Worcestershire Acute Hospitals NHS Trust this figure was 76 per cent in June for type one cases, those which involve a consultant-led 24 hour service.

Of the total number of admissions (3,795), 823 waited more than four hours from the decision to admit to admission.

A spokesperson for Worcestershire Acute Hospitals NHS Trust said: “Like many other NHS trusts in the area, we are experiencing increasing pressure throughout the year and not just during the festive period.

“Despite this, we are continuing to work with our local health care partners to ensure that we plan for the winter and this includes elective surgery to ensure that patients can be seen and treated as quickly as possible.

“One key focus is to ensure that we make people it fully aware of all the health services available to them. Often people with minor injuries are not fully aware of the services available from the Minor Injury Units where they can often be seen and treated more quickly.

"Our planning has just commenced and as part of this we always aim to schedule our services to avoid cancellations.

However, unfortunately at times of extreme emergency pressure we need to see patients based on clinical need and this can lead to cancellations of elective patients.

"This is something which we want to avoid as recognise it is very distressing for patients."

A leading emergency doctor said the service nationally could be "poleaxed" in the event of a bad winter flu outbreak.

Details of the planning for a potential crisis like that which saw A&E departments overwhelmed by a flood of emergency admissions in the winter of 2014/15 are disclosed in written evidence to the Commons Health Committee.

In a joint submission, the Department of Health and NHS England said hospital trusts would be required to draw up "specific plans" for winter which would be "assured" by officials nationally.

Measures include reducing the number of "elective" procedures carried out in the period immediately before Christmas to create more "non-elective capacity" and cancelling some outpatient activity.

Trusts will also be required to produce "clear discharge plans" for inpatients prior to the holiday period to provide more beds and patients will be encouraged to make "appropriate choices" on using pharmacies, walk-in centres and GPs to reduce "inappropriate attendance" at A&E.

Dr Cliff Mann, president of the Royal College of Emergency Medicine, told the Daily Telegraph that the service could be in trouble in the event of another difficult winter.

"What is really worrying is that when you look at last winter, the NHS came under very heavy pressures despite mild weather and little flu. All it would take is a bad flu outbreak this winter and we would be poleaxed," he said.

In separate evidence to the committee, the RCN said it was "very concerned" about staffing levels in A&E departments in the face of rising admissions and budgetary constraints.

"There is a drastic shortage of nurses working in A&E departments," it said.

"The RCN is very concerned that A&E departments do not have the appropriate staffing levels, with the right skill mix, in place to deliver safe and appropriate care for patients.

"Across England, the acute sector is buckling under the strain of financial pressures and increased demand for services.

"It is clear that the pressure is affecting the whole system, however, A&E units are often the place where effects are most visible."

A spokesman for NHS England said: "The NHS again proved resilient this winter despite further increase in demand, with fewer trusts reporting serious operational issues and a significant reduction in trolley waits.

"We are already preparing for the upcoming winter with hospitals, GPs, social services and other health professionals coming together to work out the best way of responding in every area of the country."