Thank you for joining our coverage from across the region of the work going on in our hospitals to prepare for winter.

Tune in now to BBC North West Tonight on BBC One or on iPlayer from 18:30 for more coverage.

Part of the response to rising pressures is a drive to get more people fully vaccinated against viruses like flu in time for Christmas, when many people will gather with friends and family.

There has been a drive to vaccinate the vulnerable after an early wave of flu. There were more than 300,000 vaccination appointments in the region last week.

Dr Gregory said: “The flu vaccine is one of the best ways you can protect yourself and your families this winter.

“If you’re eligible and not yet had your vaccine, please do book an appointment or find a walk-in site such as a community pharmacy as soon as possible.”

The NHS website explains that flu vaccines are available for everyone aged 65 and over, under 65s in clinical risk groups, pregnant women, care home residents and carers, close contacts of those who are immunosuppressed, frontline social care workers, and health and social care staff as well as children.

COVID-19 vaccinations are available to adults aged 75 and over, older adult care home residents, and people who are immunosuppressed.

We have been hearing lots from across the region about how hospitals are managing rising pressures.

The wider message across the region is for people to "use services wisely" as demand surges.

Dr Michael Gregory, Regional Medical Director for NHS England in the North West, said: “We’re asking the public to help us by only accessing the most appropriate service for their needs.

“We need to ensure people are only using A&E for genuine emergencies and life-threatening situations and using NHS 111 online for less urgent health advice.

"People can use primary care and pharmacies for anything else.

“Remember that pharmacists can provide expert advice and treatment for many common conditions without the need for an appointment.”

Image source, PA Media

Roger Johnson
Presenter, BBC North West Tonight

It’s always confusing to go into someone else’s workplace.

You don’t know the systems, you can’t understand the acronyms, but my first introduction to life behind-the-scenes at Whiston Hospital was a real head-spinner.

The morning bed meeting sees all departments report their numbers: how many patients have arrived, how many are staying, how many could go home.

If they can’t get a flow through the departments, the whole system gets jammed.

So, as much as medicine, hospitals are about logistics. Porters moving patients about; cleaners making sure infections are avoided; catering staff delivering meals; pharmacists ordering and delivering medication.

The on-site pharmacy has to be seen to be believed. Everything relies on IT.

From the moment a doctor prescribes medication, it barely touches a human hand, until it gets back to the patient.

There are 200 staff working here alone, yet all the day’s 1,500 prescriptions are picked by a robot. It works 24 hours-a-day, even re-stocking its own shelves at night when the humans have gone home.

Diane Stafford, who is the Deputy Divisional Director of Operations, told me “everybody who works in this hospital comes to this place because it’s where their families come to as well.

"So you know we want to make it the best it can be because this is where our family would come to if they were ill.”

"I used to login at 8 o'clock in the morning and there was like 50 to 60 people waiting in a call queue, and we had to decide whether they were urgent," Gemma Ronald, a receptionist at Buckshaw Village Health Centre said.

But under the triage system, those enquiries are going direct to GPs like Dr Chris Scales.

He said most patients contact them online over anything from coughs, colds, minor injuries, complications from recent treatment, or to request prescription drugs.

The British Medical Association did have concerns that this "unfettered access" could lead to GPs being overwhelmed and affect the quality of our work, Dr Scales said.

"But we are finding that isn't the case and we are able to manage very well."

Many of you will have experienced the 8am rush to get a GP appointment, either on the phone or stood outside the surgery waiting for it to open to be first in the cue.

Last month the NHS moved to a ‘total triage’ system where all requests for appointments online or by phone are immediately assessed by GPs or nurses.

The system has been in place at Buckshaw Village Health Centre in Lancashire.

Julie Southern, Digital Transformation Lead, Buckshaw Village Health Centre, said before the change they would have had an early morning rush over the phone or at the reception desk trying to get appointments.

But since the change in system "that has completely fallen away, that has changed totally," she said.

Teams at the centre log each online request, phone call and walk in made some of the 12,500 patients registered there, and then direct them to two GPs, who check and assess each inquiry.

Mat Trewern
BBC Radio Manchester

With the Accident & Emergency Department currently full, the hope is that some patients can be triaged and moved to the Same Day Emergency Care (SDEC) unit.

The idea is that patients who need urgent care but don’t necessarily need to be in A&E can get quickly treated without needing to take up a much-needed bed on a ward.

In many cases they can safely go home on the same day.

Consultant Andy Fagan, clinical lead at Wythenshawe’s SDEC said patients they typically see will have “chest pains, severe headaches or possible DVT”.

He said: “We realise people don’t like spending long times at A&E. We’re here to offer an alternative.

"You may still be here quite a few hours, but it’s directive treatment during that time, rather than spending four hours on a trolley in an A&E corridor.

“We’re busy but we like being busy.”

Ellie Browning
BBC Radio Lancashire

Jo Connolly, divisional nursing director at the Royal Preston Hospital spoke to BBC Radio Lancashire about the work done around Christmas time for child patients.

She said: "It’s fantastic to work with children, but of course there’s highs and lows like any job.

“As we approach Christmas, we've got a lot of activity planned. We'll be having some fun there. I think we've got some naughty elves coming to visit the wards and things like that.

"We'll have people coming in to give the children gifts and visits and things like that so we can try and make it as pleasant as possible.

"Because for those that need to be in hospital, they need to be here, so we just wrap everything around them to improve your experience.”

You can hear more from Jenny Beynon chat with BBC Radio Manchester below.

Mat Trewern
BBC Radio Manchester

Jenny Beynon has been a consultant at Wythenshawe Hospital for 14 years. She is now head of medicine.

“It’s been much busier than the last few years. We’ve done what we can to prepare for the winter period but sometimes there’s just lots of people and we just have to do the best we can.

"At the moment, I’ve got 17 patients waiting in the Emergency Department for a bed elsewhere in the hospital.

"There are quite a few specific viruses flying around that are not the flu we’ve been vaccinated against.

"We are noticing people coming in sick with bugs which are quite vile and they’re knocking people sideways for quite a few days.”

Jenny tells us the job can be tough sometimes but says she works with an “amazing team of doctors, nurses and operational staff.”

“It’s never easy talking to someone who is very unwell or speaking to their relatives and having those challenging conversations about whether they will or won’t get better.

"But that’s what we’re here for.”

BBC North West Tonight is going behind the scenes later at 18:30 for a look at what our region's hospitals are doing to cope with demand.

That includes a look inside Whiston Hospital's new service, which you can watch below.

Lily Hiley is one of the staff working on the urgent community response team at Whiston Hospital.

She said they get referrals for ailments that are "not really for hospital".

"But more often than not we can help in some way".

As we know, this is the busiest time for A&E departments across the North West.

It often leads to many patients being treated on corridors because there is simply no room.

Three years ago, Whiston Hospital in Knowsley Merseyside launched a service, which diverts people away, whilst still being cared for.

It serves parts of Knowsley, Halton, parts of Warrington, St Helens and Liverpool

If a GP or paramedic sees a patient but thinks hospital isn't right place for them, they can call the hospital's urgent community response team.

They will guarantee to have a patient assessed in their own home in two hours.

The team has been dealing with patients who have suffered issues like falls at home or struggles with an infection, while they can also be referred to go and see residents in care homes.

Peter Becconsall volunteers on ward 23 twice a week at the Royal Preston Hospital, helping out the nurses with food and being a runner so that the health care assistants can stay on the ward.

He told us he decided to volunteer after his late wife's experience on the ward at the end of her life.

“My wife was carefully looked after here for 18 months of her life," he said.

"She was really quite ill on ward 23 and they looked after her so well, and probably for selfish reasons, after she died, I rang up and said 'I'd like to give something back to these guys'.

"Because they did such a good job for my wife, but they do and continue to do a bloody good job for all the patients on the ward.

"So I volunteered and here I am."

Earlier this month resident doctors walked out for five days as part of an ongoing row over pay and limited training opportunities.

Health Secretary Wes Streeting said the strikes were "needless", but Madjda Bougherira, a doctor in psychiatry in Manchester, said pay was 21% down on 2008 levels and this was affecting staff retention while leading to a shortage of workers.

Dr Bougherira, the chair of the British Medical Association (BMA) North West regional resident doctors committee, said she sees the impact of this every day.

Leanne Harper
BBC Radio Merseyside

A hospital cannot function without food, and that's where Clare Reynolds and Pat Kershaw come in.

They are part of the catering team at Southport Hospital, and work to make sure there are enough meals and drinks for patients, staff, and visitors.

At Christmas, they will help serve up 3,000 festive dinners, including 170 kilos of sprouts and 32 litres of gravy.

As winter sets in and temperatures drop, BBC Radio Lancashire has been reporting from the Royal Preston Hospital.

Data for last month shows that over a third of patients in Lancashire and South Cumbria waited more than four hours in A&E, before they were admitted to hospital or treated and discharged.

It comes at a difficult time for the health service and here at the Royal Preston. You can hear more from Deputy Chief Executive and Chief Nursing Officer Sarah Morrison.

A record number of people in the region have waited 12 hours or longer to be admitted to hospital from A&E in the region this September, 9% higher than in the previous year.

Emergency departments have also seen a spike in attendances, which, coupled with the demand for beds and rising cases of flu, has led the region's NHS to urge people to "use services wisely.

It has given the following advice for 'self-care' to help people avoid unnecessary trips to the GP or hospital:

• Keep a well-stocked medicine cabinet
• Got to a pharmacists who can offer advice for many common conditions without the need for an appointment
• They can also prescribe medicines for seven conditions, which are sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections,
• Those who need less urgent health advice are urged to use NHS 111, available online at 111.nhs.uk, on the NHS App and by calling 111.

Mat Trewern
BBC Radio Manchester

The nurses at Wythenshawe’s Accident & Emergency Department have told me the unit is currently full.

It’s been a steady but not particularly busy morning and yet there is no more space for new patients at the moment.

Staff have seen lots of people come in with flu and shortness of breath, including poorly children suffering from flu. There’s also been quite a few older patients with hip fractures, some caused by falls at home.

In the A&E waiting area, an electronic display board with red scrolling writing is telling patients the current waiting time is approx. seven hours.

There’s around 25 people waiting for treatment here at the moment.

One of them, Keith Berry from Chorlton said he has been waiting two hours so far.

“The waiting time doesn’t bother me because I know how busy the staff are.

"The NHS is brilliant and I’ll never slag it off. It doesn’t matter how long I have to wait.”

Last month the NHS moved to a ‘total triage’ system where all requests for appointments online or by phone are immediately assessed by GPs or nurses.

BBC North West Tonight visited a GP practice in Lancashire to see how the system is going.