The coming winter is likely to be even more difficult than the last for NHS trusts, staff and patients, a new report has warned.

NHS Providers, the body that represents trusts, says several factors, including A&E waiting times and staff shortages, suggest problems for hospitals in the months ahead.

At Dartford and Gravesham NHS Trust, A&E waiting times are already slightly worse than last year.

Between April and September, 54,416 people attended an emergency department, with 87% being admitted, transferred or discharged within four hours. The government target is 95%.

That figure is lower than the same period in 2017, when 88% of patients were seen within four hours.

Across England, the percentage of people dealt with within the time limit dropped by 1% since last year, to 84% in 2018.

NHS Providers believes this indicates the coming winter is likely to put more strain on trusts than the last.

Deputy chief executive, Saffron Cordery, said: “Trusts and their staff put in extraordinary efforts last year to meet record demand - demand which continues to grow every winter.”

A spokesman for the Department of Health and Social Care said: “We recognise winter can be challenging, but as the report itself notes, the NHS will benefit from a second year of better, enhanced, national level winter planning, as well as £420 million to redevelop A&Es.”