John McIntyre: "Health Secretary Frank Dobson concedes that this winter won't be easy"

More than three-quarters of the 67 hospital trusts that responded said they thought it was very likely there would be delays in finding beds for people in accident and emergency.

This could mean people being left on trolleys in casualty departments - as has occurred in previous years.

And 67% said they thought waiting lists in some specialisms would rise.

Alan Milburn and Stephen Thornton on the impending crisis

The government has made great stock of its pledge to reduce waiting lists and, after months of increases following the general election, the numbers have just begun to fall since the summer.

Pay demands

The NHS Confederation, which organised the survey of NHS trusts and health authorities, said that, while good working practices had been set in place to deal with the problems, there were still likely to be difficulties.

It said people might have "huge expectations" because of the government's announcement of a £21bn cash injection for the health service earlier this year.

Stephen Thornton: extra £21bn has created huge expectations of the NHS

Stephen Thornton, chief executive of the confederation, said the money would not come on stream until next April.

"We have to get through this winter before we can get the money. Let's hope this is the last winter when there are these problems," he said.

He added: "People will be treated in an emergency. What will happen is that a number of people will not get the quality of care they expect. Many may have to wait on trolleys and some may end up on the wrong ward."

Stephen Thornton on winter pressures

Last year, a crisis was avoided, but many health officials believe that this was because there were no major epidemics and the weather was mild.

The survey showed that most trusts feared they would have real difficulty in an average British winter and would need extra cash to cope.

Pressures

Richard Hannaford reports on one hospital's preparations for the winter

At the Kent and Canterbury district hospital, beds are already at 98% occupancy and doctors fear they will not be able to cope with a severe winter.

Dr Robin Witherington said: "Pressures are increasing with increasing admissions. This year they have gone up by 15%. We are expecting more pressures this winter."

The hospital admits between 12 and 46 patients a day and this number is likely to go up with a severe winter.

Chief executive Jim Smith said: "Any additional pressures will give us real problems. We sometimes have to cancel day lists as we cannot cope. We do cope with waiting list targets, but it is not easy."

Extra money

The government poured an extra £300m into tackling the winter crisis last year.

A similar sum is being injected this year. Health Secretary Frank Dobson says that, in all, £1.2bn of additional cash is being pumped into the NHS this year.

He also believes new measures for dealing with winter pressures, such as better working partnerships between health and social services, will have a positive impact.

He said: "Last winter, at my request, the NHS introduced new procedures to make sure they planned better than ever before and worked with social services better than ever before.

"As a result, for the first time in years, they avoided a winter crisis in the NHS and coped successfully.

"For this winter, the confederation's own survey shows that nine out of 10 managers said they have either kept the same arrangements as last year or put in place even better arrangements."

Speaking on BBC radio's Today programme, Health Minister Alan Milburn said: "The NHS is better prepared than it has ever been before for the challenge of the winter months."