THE surge of patients which has left hospitals struggling this winter could have been predicted and better planning is needed to stop it happening again, according to a leading expert.

Professor Derek Bell called for NHS Scotland to return to the days when systems were in place which saw hospitals and community services working together in a bid to solve the problem.

Professor Bell, who led official programmes to improve emergency care north and south of the Border, said more healthcare and social work staff should work over Christmas and New Year to prevent a backlog building up at a critical time for the service.

He added they could then get the time off in lieu later, when the NHS is less busy.

His comments follow serious concerns about the pressure on Scottish hospitals this week with nurses raising fears about patient safety in Glasgow and operations being cancelled around the country because of the shortage of hospital beds.

Kezia Dugdale, deputy leader of the Scottish Labour Party, told Holyrood yesterday(thurs) that the Victoria Infirmary in Glasgow was "using a Portakabin" to treat some patients and bosses at Aberdeen Royal Infirmary had been forced to cancel 80 operations this week.

Professor Bell, President of the Royal College of Physicians of Edinburgh and previously clinical lead for the Scottish Government's Unscheduled Care Collaborative, said: "If you look at the historic trend data over the last five years it was likely that we would see this sort of pressure again. To me, it was predictable. Therefore, we need to develop far more robust and realistic plans that engage and support the workforce."

He acknowledged there had been a lot of planning on paper, but said the work of the unscheduled care collaboratives which he led in Scotland and England were more pro-active about preparing for surges in demand, and the system has become more reactive since these projects were wound-up.

Waiting times in A&E were better five years ago when the programmes were in place, he said, but have been deteriorating since 2009. He dismissed the suggestion that this is the result of the growing elderly population and rising demand for beds. "By just saying it is around the demand we are missing the fact we need a whole systems approach," he said. "We need to co-ordinate what is happening in primary care and what is happening in social care and what is happening in hospital care, and we need to do that together.

"We are cutting social care budgets at a time when we need to maintain people in their home environment... There is a perfect storm of reductions in social care funding and trying to transfer care from hospitals into the community. We need a co-ordinated plan."

The number of patients who cannot go home from hospital because they are waiting for care packages to be put in place is often said to be part of the current problem. These patients are filling ward beds, leaving less room for the sick who need to come into hospital.

Regarding the reduction of health and care services, such as GP surgeries, for four days over both the Christmas and New Year, Professor Bell said: "I think we have to keep more services running."

He warned it would take time for the NHS to recover from this week's problems, and said: "Let's accept that this winter is going to be a tough one, but start planning for next winter and also recognise that it can be a 365 day phenomenon."

In an angry exchange at First Minister's Questions, First Minister Nicola Sturgeon accepted the health service was under pressure but said the situation would have been worse had Labour still been in control.

Ms Sturgeon said three times as many A&E consultants and 1,700 more nurses had been hired under the SNP, with the health budget rising by £3 billion. Two A&Es, which would have been closed by Labour, had been saved by the SNP, she added.

Ms Dugdale said: "Harking back to the Labour years might comfort her back benches, but it won't comfort anybody who slept on a trolley last night."

The Scottish Government said it has been working closely with health boards and stakeholders to prepare the NHS for this winter's challenges.

A spokesman added: "We continue to closely monitor the position across our NHS and provide assistance to boards wherever possible and necessary. We have made an additional £10 million fund available to boards for winter pressures as part of an extra £28 million we have invested to help the NHS cope this year.

"Winter brings extra pressures to A&E and a much greater proportion of patients require admission to hospital during these months. As is being seen across all UK countries, the growing proportion of sicker patients, in the context of an ageing population, increases these pressures."