The 2017 spring Budget made £100m available to 111 trusts to fund improvements in patient streaming in type 1 A&E services by introducing GPs into emergency departments. Although there was variation in the number of patients streamed under these new services, it is clear streaming was in place in 98.5% of services and shows how money can be spent broadly as intended the earlier it is announced.

Later in the year, in the 2017 autumn Budget, the chancellor announced an injection of £337m winter funding.

The money was primarily spent trying to increase the available workforce, as well as offering overtime incentives for existing staff. Trust leaders also converted more vacant senior posts to junior posts in order to create additional headcount.  However the NHS Improvement winter review concludes that because the money only arrived in November, trusts struggled to plan the most cost-effective staffing models (NHS Improvement, 2018)

Other acute providers purchased placements in community care homes for those patients fit for discharge but still awaiting a package of care, while others bought capacity from the independent sector.

These circumstances hit provider finances hard last winter. The sector recorded a £986m deficit at year end, with two thirds of acute trusts finishing the year in the red.