We will always have pressures, but the important thing is how we deal with them

NHS Chief Executive Nigel Crisp

Already a massive vaccination programme has begun, aimed particularly at the elderly and infirm.

"We do have 8.5 million vaccines out there, we don't necessarily always have them in the right place but we will get them in the right place," said Mr Crisp.

He has asked health authorities to devise comprehensive plans for coping with the extra burden of winter illnesses.

"We need more capacity. I am the first chief executive to come in and say we need more beds and this is a serious commitment we are making," he said.

"We could always have more money in the system, we will always have pressures, but the important thing is how we deal with them."

Cancelled operations

Several hospitals were forced to postpone operations during the worst periods of the flu epidemic last winter.

Already some health authorities are preparing by booking patients in for private surgery to free up space in NHS wards.

Mr Crisp thinks this is a wise precaution.

More nurses required to cope

"It is sensible and practical for us to use the private sector where that will take a bit of pressure off the system and staff," he said

Staffing problems could also prove to be a critical problem for several hospitals. A recruitment drive for nurses has improved, but not solved the situation.

The Royal College of Nursing acknowledges the efforts made to ease pressure on staff, but says it is monitoring the situation closely.

A hotline has been set up for nurses to report particular problems with stress and intolerable workloads.

Mr Crisp believes his role is to oversee the modernisation of the NHS. He pointed to improved cancer care as evidence of the achievements already made.

But he warned that the basic vulnerability of large parts of the NHS could still be exposed if circumstances deteriorated in the next few months.