Health bosses say they have been developing new ways of easing pressures on services as a new report warns this winter is set to be even tougher than last year.
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 North Tees and Hartlepool NHS Foundation Trust, A&E waiting times are already worse than last year.
Between April and September, 21,987 people attended an emergency department, with 91% being admitted, transferred or discharged within four hours. The government target is 95%.
That figure is lower than the same period in 2017, when 93% of patients were seen within four hours.
NHS Providers believes this indicates the coming winter is likely to put more strain on trusts than the last.
It says the situation is compounded by a number of unfilled roles within the trust.
Latest figures for March 2018 show there were vacancies equivalent to 65 full time jobs.
That was fewer than in April 2017, when there 94 open jobs.
Saffron Cordery, deputy chief executive of NHS Providers, said: “As attention turns to what this winter will bring, there are many improvements which have been put in place to welcome.
“But there are clear warning signs. Performance is in a worse position going into this winter than last. Staff shortages are growing, putting additional strain on a workforce already overstretched during an exceptionally busy summer.”
But the trust says it has already seen patients being dealt with better with their new minor injuries units easing demand on its A&E, and have a ‘robust’ plan in place for this winter.
A spokesperson said “As a forward thinking provider of care, we have been developing new ways of working to ease pressures on our services this winter.
“By closely integrating the main hospital and minor injuries units at North Tees and Hartlepool sites we have already improved patient flow and are consistently amongst the top performers nationally against the four hour waiting standard for A&E.
“We have taken steps to reflect on last year’s performance to ensure we have a robust plan in place to continue to deliver the best standard of care for our patients.”