“We start planning for winter at the beginning of the year. We probably start as winter ends.”
Those are the words of Shaun Curran, director of operations at Wrightington, Wigan and Leigh NHS Foundation Trust, who wants to make sure everything runs smoothly in the borough’s hospitals in the coming months.
While there is demand for treatment all year round, the pressures faced by hospitals up and down the country certainly increase in the winter.
Wigan Infirmary struggled to cope with the demand last winter, with its A&E waiting times plummeting to the second worst in the country in January and wards closing due to outbreaks of flu and norovirus.
But hospital bosses hope it will be different this time, after months of preparations, new initiatives and reviews of what did and did not work previously.
There are many reasons why the NHS faces so much more pressure in winter than at other times of the year.
These include more patients with seasonal illnesses such as flu, the deterioration of existing health conditions and falls.
More complicated conditions can mean people need to stay in hospital for longer, while staffing levels can be affected by sickness too.
Mary Fleming, the trust’s chief operating officer, said: “While we still see the same volume of patients over the summer, they tend to be people we can treat very quickly and get back out again.
“In winter, they tend to be a higher acuity of patients, both young and old, and they tend to require more medical input.”
Mr Curran said: “There are higher incidences of certain conditions, whether it is flu, respiratory conditions and other things that affect our patients’ health over that period, which is why it’s so important that people have the flu jab if they can. There are so many frail and elderly patients who may suddenly deteriorate over the winter months.”
The A&E department is the first place many patients go, but there can be a long wait, particularly for people whose condition is not life-threatening.
Now, the two-thirds of people who make their own way there are assessed on arrival and may be told to go to the urgent treatment centre, located in neighbouring Christopher Home, if their condition is less serious.
This frees up A&E staff and ensures there is more space in the department to care for the most poorly patients.
Changes have been made to the waiting area and work has been done to ensure ambulatory patients are seen, so they can be discharged as soon as possible.
Around one-third of patients are taken to A&E by ambulance and there have previously been issues with paramedics having to wait to hand them over, preventing them responding to other 999 calls.
But efforts have been made to address this, with a new area where patients can be assessed when they arrive by ambulance.
More changes are afoot, with plans for significant building work to remodel the front of A&E, which will provide more space and allow for more streaming of patients.
There are also plans to extend the services on offer at the urgent care centre, which could take more patients away from A&E.
But it is not just A&E where work is done to ensure patients are treated as quickly as possible.
For example, there need to be enough beds on the wards for the people who need them, so they are not stuck waiting in A&E. Mr Curran said: “We don’t have a massive bad base like other hospitals have. We don’t have massive flexibility like other hospitals have. We have to be efficient and innovative in our approaches.”
Every patient is reviewed on a daily basis to make sure something is happening to them and ensure they can be ready for discharge as soon as possible.
The trust has an integrated discharge team, where hospital staff work alongside members of other organisations, such as social services, to overcome any obstacles to discharging patients once they are medically ready.
There can be many reasons for delays, with the team seeing increasingly complex needs among patients young and old. One of the issues they faced last winter was delays in moving people into nursing homes, particularly at weekends.
Now there are trusted assessors, who are hospital staff trusted by nursing homes to assess people before they move.
It has cut the time taken by three days and means staff do not have to leave the homes to carry out assessments.
But sometimes other factors can come into play, such as care homes having to shut due to outbreaks of flu, leaving people struggling to find somewhere to go.
The trust has dedicated ward co-ordinators, who have magnetic boards next to each patient’s bed to provide information, and multi-disciplinary team meetings look at how to get people home safely.
The team is also looking at pathways to intermediate care facilities and hopes that switching to paperless referrals next month will see this cut from six to two hours.
Work is being done to improve links with authorities outside Wigan, to help patients from Chorley, West Lancashire and other areas get home as soon as possible.
While the trust did struggle last winter, Ms Fleming is hopeful that all the changes will make a difference.
She said: “We had a very difficult start to the year with our A&E performance and didn’t recovery as quickly as we normally do. We normally recover by March but didn’t this year.
“We were really confident that we had a set of projects in the background - the development of the urgent treatment centre, the transfer of the minor injuries unit, the ambulatory model and the ambulance service handovers. We have got a series of fantastic projects around managing patient flow which is why we were really confident.
“All these different ways of delivering that care have come about from learning lessons last year and the year before.”
With everything being done to improve the flow of patients through the hospital, bosses hope people will play their part by only going to A&E if they really are seriously ill or injured.
Mr Curran said: “I think it’s about making people aware of the alternatives. There are more convenient alternatives that can quite successfully tend to health needs locally. There are pharmacists, GP extended access, the walk-in centre.”
Alternative sources of medical help include Leigh walk-in centre, GPs, pharmacies and dialling NHS 111.