The context in which NHS trusts are entering this winter is more difficult than last year following significant operational challenges during the heatwave over the summer, growing pressures on the health and care workforce and a period of sustained, financial constraint. One manifestation of the current pressures is the size of the elective care waiting list which is the biggest it has been since data collection began.

Work is currently underway to design the long-term NHS plan which will address the future direction for the provider sector around planning, efficiencies, performance targets, and service transformation. The long-term settlement provides a welcome £20.5bn (3.4%) additional funding for the NHS over the next five years.

However, set against experts’ estimates that 3.3% would be required just for the NHS to stand still, it poses big questions about future priorities, which will have to be addressed in the long term plan.

Yet, against this backdrop, we continue to see encouraging progress to integrate services, with a number of projects set up under the new care models programme starting to deliver better prevention and improved care for patients closer to home. The development of sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) is maintaining and building on this momentum.

Ahead of this winter, trusts are steeling themselves to juggle day-to-day operations, and to plan with system partners what they can do differently to prioritise patient safety  in the face of unsustainable demand for care.