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The report says it would take little for departments to collapse under the weight of winter pressures this year.

"A prolonged period of cold, a rapid increase in the acuity of patients presenting in A&E or a lengthy norovirus would be all it would take to bring many departments to breaking point," it concludes.

It also said that the social care system, which should care for many vulnerable elderly people when they are ready to be discharged from hospital, is failing too many people because it is not available at weekends.

Senior managers interviewed for the report said: "The social care system is still largely available 4.5/5 days a week with limited support at weekend and out of hours. Bank holidays, especially Christmas, and new year, normally seee a lesser service."

The report said the service is "facing a grave financial challenge" with organisations likely to collapse as they struggle to cope with demands on them.

A review of emergency and urgent care by Prof Keith Willett, deputy medical director of NHS England, which is due to be published later this autumn will call for major changes to strengthen GP and pharmacy services, to relieve pressure on A&E departments.

Speaking on Saturday Prof Willetts said that almost one in three visits to casualty departments involved patients who would have been better treated elsewhere.

The report by the NHS Confederation says urgent action is needed to deal with rising numbers of frail elderly patients with multiple conditions, which they say is the most significant cause of growing pressures on the system.

The report says that the number of hospital admissions among those aged 85 and over has risen by more than one quarter in four years.