Hospitals should free up beds to prepare for “extensive disruption” caused by strikes by ambulance staff in England, NHS bosses have urged.
They said patients would need to be discharged safely where possible ahead of a “very challenging” period.
Ambulance staff are set to walk out on December 21 and 28 over a pay dispute.
Business Secretary Grant Shapps said the pay rises for ambulance and nursing staff had been decided by independent pay review bodies.
The coordinated walkout in England and Wales by the three main paramedic unions – Unison, GMB and Unite – will only affect non-life-threatening calls.
Unison, Unite and GMB are taking action on 21 December. GMB union members will go on strike again on December 28.
Rescue workers, as well as dispatch workers and auxiliary workers, will be involved in the trips.
In a letter to hospital chiefs, NHS England bosses called for patients who complete emergency medical care to be moved out of emergency departments.
This may include the creation of “observation areas” and additional beds elsewhere in the hospital, Sir David Sloman, chief operating officer of NHS England, wrote in a letter co-signed by the national medical director for England, Professor Sir Stephen Powis, and England’s chief nursing officer, Dame Ruth May.
The aim is to free up beds to ease the movement of people through A&E and allow paramedics to get back on the road more quickly.
Some outpatient appointments could also be shortened to allow older medical staff to be moved to the emergency department. But NHS bosses say “every effort” should be made to keep cancer diagnosis or cancer treatment urgent, with rescheduling seen as a last resort.
Measures should be put in place to ensure patients arriving at hospitals in ambulances are taken to A&E in less than 15 minutes, they said.
Ambulance handover delays in England have hit a new high, according to recent NHS figures. Last week, one in six patients waited more than an hour before being handed over to A&E teams.
However, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said that although he supported the request in the letter, it would be difficult to achieve.
“We don’t hold up ambulances for fun,” he told Radio 4 Today. “It’s really difficult. We always want to get ambulances back on the front lines as quickly as possible and we’ve been trying to do that for the last three years.”
When asked what the solution was, he replied that it was not just about providing social care that would allow the elderly to be discharged from the hospital.
“We run our hospitals very tight compared to our European peers,” he said, adding: “It’s not just about social care, it’s about making sure our hospitals are big enough to handle it.”
The December 21 ambulance strike comes a day after a strike by nurses.
“It’s something that makes everyone who works in the sector quite nervous,” Dr Boyle said
Interim chief executive of NHS Providers Saffron Cordery also said reducing handover delays would be “incredibly difficult to implement” due to factors such as staff absences and rising flu cases.
Ms Cordery said: “We understand why emergency workers have voted for industrial action, but it is vital that the Government and unions act urgently to find a way to prevent this and further strikes.”
The letter, sent to NHS trusts and integrated care councils, said bosses should create and coordinate plans to deal with strike days by December 19.
Staff have been offered an average rise of 4.75% with a guaranteed minimum of £1,400 – but unions have asked for a pay rise above inflation.
Asked on Radio 4’s Today how the Government could afford to increase state pensions in line with inflation but not NHS staff pay, Mr Shapps said: “Nurses and ambulance workers would get a pay rise which has been independently recommended, which I think is right way. do this.”