During winter acute trusts tend to experience a rise in the number of unplanned hospital admissions, with more patients admitted to hospital via A&E, walk-in centres and ambulances. Limited physical capacity (beds, surgeries) means trusts are required to prioritise unplanned urgent activity, at the expense of planned elective care. In fact, last winter the NEPP recommended pausing non-urgent elective surgery until the end of January 2018. Last winter NHS Improvement estimated around 22,800 elective admissions were postponed or cancelled during winter, although this is likely to be a conservative estimate.

Compounding matters further was the £338m withheld by commissioners via the marginal rate emergency tariff (MRET) rule (up £70m on the previous year). This is money that leaves providers out of pocket simply because of the unprecedented level of demand they faced during winter. 

Taken together these represent a significant loss of income for acute trusts. Last winter many trusts continued to carry out elective operations notwithstanding the advice from NEPP. They will hope to minimise the loss of elective work in the months ahead.