In recent years the NHS has become trapped in a recurring cycle of winter crises –  each one more severe than the last. Trusts believe that the forthcoming long term plan provides an opportunity to break this pattern.

However, in order to do this it is vital that national bodies acknowledge and plan for the true scale of extra, more complex demand that health and care services face.  Services across the entire range of health and care must be able to meet this demand rather than running 'permanently in the red zone'.

As trusts work to recover NHS constitutional performance standards they need will need adequate time and resources to get back on track.

They will also need urgent steps to address immediate workforce problems, and measures to provide a sustainable long term solution.

Finally, they need to see more investment and greater pace and consistency in moving to join up local health and care services and new ways of providing care, with a particular focus on helping to keep frail elderly patients in their own homes or local community when possible, rather than in their local acute hospital.