NHS Providers is warning that the NHS could be facing its worst winter crises yet and says an immediate emergency cash injection is essential to help it manage the risk to patient safety.

The group, which represents 97 percent of hospital, mental health, community and ambulance service trusts in England, is calling for funds of between £200 and £350 million to improve the NHS’ “state of readiness” for this winter.

Failure to make this investment will fuel lengthening waiting times in A&E and other services “and will also put the safety of patients at risk as local trusts have insufficient capacity to meet extra expected demand”, it warns.

On the positive side, its assessment has found that planning and support for “what is currently heading for a worse winter than last year” is “considerably more developed” than last year and emergency care performance has been given greater priority.

Also, extra cash for social care is helping to expand capacity in about a third of local areas which should help reduce the delays faced by some patients unable to leave hospital because of a lack of available support in the community.

However, any improvements are being “outweighed by a combination of increasing risks”, NHS Providers warns, including key staff shortages and greater financial pressures than last year.

NHS trusts are not consistently benefitting from the government’s extra £1 billion of social care investment announced in the spring Budget, as planned, and so delayed transfers of care for patients remain stubbornly high. Added to which, demand for emergency care is continuing on its upward trajectory, while performance against the four hour A&E standard has not improved compared to last year, it says.

“The overwhelming view of NHS trusts is that without immediate extra funding they will not have sufficient capacity to manage this winter safely,” said the group’s chief executive Chris Hopson. Patients will be “put at greater risk as local trusts won’t have the extra beds, staff and services they need to meet the extra demand they will face.”

Also commenting on the status quo, Nick Hulme, chief executive of Colchester Hospital University Foundation NHS Trust, said the first quarter of this year “has been as challenging as any I can remember – there has been no let up.

“Acuity, attendances and admissions have all stayed high. The planning meetings we have had through our A&E delivery board have been dominated by firefighting rather than looking ahead to the winter. Our major concern going into this winter is staffing – going into August we are 50 junior doctors short on our rotas across the hospital. Every day is a constant struggle for junior doctors and registered nurses.”

Niall Dickson, chief executive of the NHS Confederation, said the NHS managed incredibly well last year “but we cannot continue just to rely on a hope that viruses will not wreak havoc, that the weather will be clement and that staff commitment will get us through.

“We will continue to push the Government for a comprehensive review looking at which services are needed, where they are needed, how much they will cost, and how they will be funded.”