Dozens of extra doctors and nurses will be working in A&E at the Norfolk and Norwich University Hospital this winter to try and cope with the anticipated demand.

Health chiefs said they were prepared for the health impacts of another long cold winter, despite warnings from unions that the NHS will be placed under huge strain in the coming months.

Last winter resulted in long queues of ambulances outside A&E departments and an emergency tent being put up on Easter Monday outside the Norfolk and Norwich University Hospital as a result of huge demand.

However, hospital bosses insisted that they were prepared and had plans in place to meet the winter demand with the region being on cold weather alert since the beginning of November.

An extra 70 front-line staff are joining the N&N following the creation of an Immediate Assessment Unit (IAU) to improve patient handover times from ambulance to A&E and a new Clinical Decision Unit (CDU) to help prevent admissions and reduce length of stays.

A pilot Urgent Care Centre will be also run at the Colney hospital over two days in December where patients who are not emergency cases being referred to a pharmacist, nurse or GP.

Anna Dugdale, chief executive of the N&N, said the hospital was better prepared this winter. She added that only one ambulance had waited more than an hour outside A&E since the IAU was established in June, despite a 20pc increase in ambulance arrivals and 7pc overall increase in attendances in the first half of 2013/14.

Mrs Dugdale said the hospital was working closely with Clinical Commissioning Groups and a three day trial of the Urgent Care Centre in October and November had been a big success.

'We are just one little wheel in a big machine and we can not work on our own and a big part is building the relationships with the new organisations. In the middle of our most difficult period, the whole landscape was changing with new organisations getting to grips with what they are doing,' she said.

Two consultants are joining the A&E department at the N&N next month and 18 qualified nurses and 22 healthcare assistants have been recruited to work in the IAU. The hospital is also recruiting two consultants, 13 nurses and 15 healthcare assistants to work in the CDU.

A spokesman added that capacity at the James Paget University Hospital was also being boosted at A&E. Hospital chiefs pledged to invest £1.4m this year to expand the department to improve ambulance handover times.

'Over the winter period we can expect additional demand on our A&E services due to the impact of bad weather and seasonal illnesses. Therefore the focus of the plan has been on ensuring we have the right level of support in A&E for patients to be treated that do not need to stay in hospital and having sufficient beds available for those patients who do,' the spokesman said.

Union officials have spoken of their concern about the impact of another tough winter on the NHS.

Karen Webb, regional director of the Royal College of Nursing, said an increase in nurses and healthcare assistants was welcome. However: 'The truth is that winter pressures are no longer confined to winter and all the hospitals in our region have experienced real pressures on their services throughout the year.

'The real difficulty is that local healthcare systems haven't really changed. The numbers of people choosing to attend A&E continues to rise rapidly and community NHS services are still not geared up to try and move that type of demand away from emergency departments. Avoiding admissions to hospitals and early discharges from hospitals will still be difficult because, as a general rule, the community services are not there to provide an extensive 24/7 service for those patients.'