The number of people in hospital with flu has more than quadrupled compared with last year, new figures show as NHS leaders sounded the alarm over hospitals being “busier than ever” for this time of year.

Health leaders have warned that the service is facing a “quad-demic” of disease going into winter amid rising cases of flu, Covid-19, norovirus and respiratory syncytial virus (RSV).

It comes as the Government’s “plan for change” pledges that by July 2029, 92% of patients will be seen within 18 weeks for pre-planned care such as hip and knee replacements.

In a speech setting out the plan, Prime Minister Sir Keir Starmer said the NHS was “on its knees” and that meeting the waiting time target would be a “symbol” that the service is “back on its feet facing the future”.

But health commentators said there should be a “healthy dose of realism” about how quickly the NHS can deliver the target.

Leading nurses said there is a “barely a spare bed in the NHS” as they highlighted how staff and patients are “desperately worried” about the coming weeks and months.

It comes as a record number of people are occupying hospital beds for this time of year due to a variety of illness and injury.

An average of 96,587 hospital beds in England were occupied each day last week – more than have been recorded at this point in any other year.

This means that around 95% of hospital beds in England are full.

People who are eligible for a free flu jab have been urged to take up the offer “as soon as possible” as hospital admissions for flu rose to a three-year high for this time of year.

New figures for the NHS in England show that an average of 1,099 flu patients were in hospital beds each day last week, including 39 in critical care.

This is up sharply on the equivalent numbers for the same week in 2023, when the total was 243 with nine in critical care.

Concerns had initially been raised over a “tripledemic” of flu, RSV and Covid-19 heaping additional pressure on the health service.

But after an 86% rise in norovirus cases in hospital compared with the same week last year, the NHS’s top doctor has told the service to brace for a “quad-demic”.

The figures show that there were an average of 756 patients with norovirus in hospital beds each day last week, 1,390 patients with Covid and 142 children in hospital each day with RSV.

And the service is expected to get busier in the coming months.

The figures have been published by the NHS as part of its first weekly snapshot of the performance of hospitals in England this winter.

NHS national medical director Professor Sir Stephen Powis said: “The NHS is busier than it has ever been before heading into winter, with flu and norovirus numbers in hospital rising sharply – and we are still only at the start of December, so we expect pressure to increase and there is a long winter ahead of us.

“For a while there have been warnings of a ‘tripledemic’ of Covid, flu and RSV this winter, but with rising cases of norovirus this could fast become a ‘quad-demic’, so it’s important that if you haven’t had your Covid or flu jab to follow the lead of millions of others and come forward and get protected as soon as possible.

“Ambulances are also facing huge demand, with thousands of extra patients and other pressures having an impact on handover delays, which is why our robust plans, including services like urgent treatment centres and same-day emergency care, are so important this winter.

“As always, the public have an important part to play in helping NHS staff over winter by, as ever, calling 999 in an emergency and using the NHS 111 service through the NHS App, online or phone, for advice on how to access the right support for non-emergency health needs.”

Professor Susan Hopkins, chief medical adviser at the UK Health Security Agency added: “It’s clear that unless more eligible people come forward to receive their flu vaccine, we are likely to see more cases of flu, and more hospitalisations and deaths, than we saw last year.

“It is still early in the season, so there is still time to change the trajectory and reduce the impact of flu in our communities in time for Christmas, but time is running out.”

NHS staff have also been urged to take up the offer of a free flu jab as figures show that uptake among staff is lower than in recent years.

Commenting on the figures, Patricia Marquis, executive director for England for the Royal College of Nursing, said: “There is barely a spare bed in our NHS, with sky-high flu admissions and thousands stuck in hospital unable to be discharged due to a lack of capacity in social care.

“Before the cold weather hits, nursing staff and patients are desperately worried about what the coming weeks and months may bring.”

Saffron Cordery, interim chief executive of NHS Providers, said: “Services are already feeling the strain from a worrying spike in nasty winter bugs and bad weather.

“Flu, norovirus, RSV and Covid-19 are piling the pressure on already stretched services and staff, and this is likely to get worse as we head into the depths of winter.

“Delayed discharges also continue to be a worry for trust leaders, with nearly 12,000 patients stuck in hospital when they don’t need to be, with social care and community services also under relentless pressure.

“High bed occupancy compared to this time last year is also adding to the strain.”

On the Prime Minister’s pledge, she added: “Even with the welcome budget boost for the NHS, they are also calling for a healthy dose of realism about how quickly they can deliver the ‘milestone’ set out today given the backdrop of soaring patient demand, the impact of a decade of underinvestment, and major workforce challenges across every part of the health and care system.”

The latest figures for the NHS in England show that an estimated 7.57 million treatments were waiting to be carried out at the end of September, relating to 6.34 million patients.

Some 249,343 people had been waiting more than 52 weeks to start routine hospital treatment.

And 2,703 patients had been waiting more than 18 months for pre-planned care.

Meanwhile, new figures from the UK Health Security Agency (UKHSA) show tuberculosis (TB) levels in England increased by 11% last year.

There were 4,855 notifications of the disease in 2023, up from 4,380 in 2022.