NHS leaders have been ordered to “prioritise patient safety” ahead of a key A&E target as hospital beds in England near full capacity.
Hospital bosses have been told to focus on patients with the greatest need above trying to meet key targets in emergency departments.
Government officials said there was a “critical” situation in emergency care as health leaders came together to discuss how to cope with the surge of demand over winter.
There is a national target for 95% of people who go to A&E to be admitted, transferred or sent home within four hours.
But concerns have been raised that the target can lead to medics seeing patients who they can get through quickly as a priority.
Health Secretary Wes Streeting has told NHS leaders to “put patients ahead of targets”.
It comes as a record number of people are occupying hospital beds for this time of year because of a variety of illnesses and injuries, with England’s NHS hospital beds around 95% full.
“Skyrocketing” cases of flu, coupled with rising levels of norovirus and other winter bugs are already heaping additional strain on the NHS, health leaders have said.
Mr Streeting said the NHS should improve emergency ambulance response times, address handover delays and tackle the longest waits in emergency departments.
“We inherited a broken NHS that saw annual winter crisis as the norm,” he said.
“This year, we’re seeing record pressures on services as we move into December.
“This winter, I want to see patient safety prioritised as we brace ourselves for the coming months.
“I’m asking trusts to focus on ambulance delays, handovers and the longest A&E waits.”
Amanda Pritchard, NHS England chief executive, said the service was “already seeing unprecedented demand going into winter”.
She added: “While staff have worked hard to prepare – including expanding virtual wards so more patients can receive hospital-style care at home and delivering over 27 million vaccinations since September – we know services are set to come under even more strain.”
Matthew Taylor, chief executive of the NHS Confederation, said: “Prioritising patient safety across the urgent and emergency care pathway is likely to result in elective operations being delayed or cancelled, so waiting lists could rise as a result.”
It comes a week after the Prime Minister Sir Keir Starmer pledged that by July 2029, 92% of patients would be seen within 18 weeks for pre-planned care such as hip and knee replacements.
Meanwhile, the number of people with flu needing hospital treatment continues to rise, with health leaders urging those eligible for a free flu jab to get vaccinated “now or never”.
Professor Sir Stephen Powis, national medical director for NHS England, said: “Flu cases are skyrocketing so it’s now or never for older people and children to get themselves jabbed and protected ahead of any family get-togethers they have planned over the festive period.
Flu cases are going up – book your vaccine as soon as possible to get protected and #GetWinterStrong. 💪https://t.co/U738tFN3Sc #FluVaccine #FightFlu pic.twitter.com/EngtevDS6R
— UK Health Security Agency (@UKHSA) December 5, 2024
“Every Christmas we see far too many older adults and children admitted to hospital because of flu, and the best way to avoid this situation is getting your flu jab if you are eligible.”
Saffron Cordery, interim chief executive at NHS Providers, told BBC Breakfast: “We’ve seen a real rise in, a spike in, the number of children who are suffering from flu in particular, and often that’s a predictor of a later wave coming in adults.
“So it’s likely that we might see rising demand in adults further down the line.
“So yes, we are bracing ourselves, I think, for a challenging winter ahead.”