The number of patients attending A&E departments in Greater Manchester has now hit the same levels as mid-winter before the pandemic hit.
As the long summer days draw to a close, the impending chill of winter - and the inevitable annual barrage of health emergencies that come with that - still lie firmly ahead.
Yet, and running alongside a rise in Covid hospitalisations, clinicians continue to report unseasonably high attendances at emergency departments.
READ MORE: Hospital staff say even a ‘firebreak lockdown’ won't get NHS out of trouble this winter
In August, according to NHS data, a total of 89,439 patients attended Greater Manchester’s A&E departments.
That compares to December of 2019, when there were 89,870 patients at A&E.
In many trusts, including Manchester NHS Foundation, Bolton, Stockport, Tameside and Wrightington, Wigan and Leigh, there were actually more patients than during that pre-pandemic December.
And clinicians are also reporting concerns around the length of time patients are waiting to be seen at A&E.
Nationally, last month the percentage of people waiting more than four hours to be admitted, transferred or discharged hit a new low - with 77 per cent of patients hitting the target.
A long way off the NHS goal to see 95pc of patients within four hours, this was the lowest percentage recorded since the data collection started.
However, in Greater Manchester, all trusts were below even this level, with Salford, for example, seeing just 57pc of patients within four hours, and Pennine Acute meeting the time limit with just 58pc of its patients.
The data supports the repeated warnings from senior clinicians at Greater Manchester trusts in recent weeks.
And it’s led Katherin Henderson, president of the Royal College of Emergency Medicine, to warn of ‘stark inequalities’ in health care between different regions in the country, with the cited comparison of the South East and North West.
Describing the figures as ‘appalling’, she added: “As part of levelling up, it’s vital that these inequalities are properly addressed and not overlooked, and that support is given to those areas and to those patients that need it most.”
Dr Henderson called for more comprehensive data, an improved 111 service, a renewed focus on the workforce and morale, as well as a recruitment drive, plus investment in alternative care pathways to ease pressure on A&E.
In a bulletin update, Greater Manchester Health and Social Care Partnership described hospitals as ‘very busy’, both for patients with higher and lower needs.
And although there had been concerns that many patients were attending A&E unnecessarily, the Partnership says the rate of growth in recent weeks has been greatest in those with ‘significant need’ - indicating the majority of patients are seeking urgent care appropriately.
There is also mention of the additional pressure to recover planned services like hip replacements, while a workforce deficit is exacerbating the challenge.
The Partnership says it is providing extra clinical support when patients ring 999 and 111, while a team of paramedics, nurses, advanced practitioners and GPS are directing people the right service and if needed, arrange a slot at A&E.
They are also ‘strengthening urgent community response’ for accidents like falls or for urgent equipment provision, in a bid to avoid hospital admission or readmission.
Meanwhile, calls to NHS 111 are around 30pc higher than ‘planned level’, resulting in periods of ‘sustained pressure’ on call answer times meaning some patients abandon their call or make repeated calls. A recruitment drive is ongoing.
It comes as North West Ambulance Service last week moved into ‘REAP 4’ - indicating ‘extreme pressure’.
Sarah Price, interim chief officer of Greater Manchester Health and Social Care Partnership, said: “We are continuing to see high levels of demand for all health and care services including in our emergency departments, across 111 and in primary care.
“We are continuing to restore elective (planned care and appointments) surgical activity and working hard to reduce the waiting list.
“This week has seen the announcement of the government’s Covid-19 Response: Autumn and Winter Plan, which included the details of Covid booster jabs and extending the offer of a vaccine to younger people aged 12-15.
“Our teams are preparing to implement this, but I’d also remind anyone yet to be vaccinated - the offer will always be there for you, please make sure you’re fully vaccinated to protect yourself and everyone you come in to contact with.
“Remember, the NHS will always be there for those that need support, but we all have a role to play in making sure that those who need help most urgently receive it quickly.
“Please always think about the best place to get care and support when you need it. If you are unsure call 111 or use the online service any time of day, to get urgent health advice.”