Last winter the NHS came under more pressure than ever before, with then Health Secretary Jeremy Hunt admitting it was "probably the worst ever".
And there is no sign that demand is going down. Urgent and emergency services are as busy as ever, mainly due to the growing and complex needs of our ageing population.
On Tuesday, Dame Donna Kinnair, of the Royal College of Nursing, said hospitals were facing a shortage of both beds and staff - with images of "patients waiting on trolleys in corridors" becoming all too common.
The NHS in England responded by saying it was committed to improving waiting times.
The government has brought forward £145m of funding for hospitals in England to upgrade emergency departments and wards.
Here in the North West, a huge amount of work has been done to try to improve "patient flow" through our hospitals.
What is 'patient flow'?
This describes a patient's journey through the system.
It can begin in A&E where he or she is seen by a doctor, being admitted to a ward, treated, and finally discharged.
Rather like a road network, a problem at any stage can cause the whole system to snarl up.
So for example, a shortage of GPs will see people, frustrated at not being able to get an appointment, flooding into their nearest A&E.
At the other end of the "journey", any problem with securing elderly patients the right social care package means they have to stay in hospital longer.
This obviously means that another patient cannot occupy that bed. This keeps them in A&E longer, causing pressures on waiting times there.
It means ambulance staff waste hours waiting for patients to be admitted.
A range of new ideas are being adopted around the North West.
In Southport, contractors are putting the finishing touches to a £1.25m Emergency Department upgrade which they hope will make bottlenecks less likely.
There's a new row of beds for patients arriving by ambulance, whose care can quickly be taken over by the hospital.
Another room, with eight beds, takes patients waiting for vital test results.
Both initiatives are designed to free space in the main emergency area.
Trust matron Jane Lawson said it had already transformed the way they work.
"There's an unbelievable difference - if you'd seen us 12 months ago you wouldn't have believed that we could achieve this in such a short space of time."
Over in East Cheshire, managers are block-booking beds in nursing homes for patients who, while no longer needing acute hospital care, are not yet well enough to go home.
The scheme will free up beds at Macclesfield General, which last winter was often completely full.
"I think it's a win-win for everybody," said Paul Bowen, chair of the local clinical commissioning group, which pays for healthcare there.
"People get to stay close to their own communities and it provides less pressure on the hospital."
But while bed space remains a challenge in most hospitals, the number one concern for nearly all is staffing - particularly nursing staff, where the shortage is becoming worse.
At the Royal Albert Edward Infirmary in Wigan they run a number of innovative schemes to train local nurses, including apprenticeships and paying for healthcare assistants to go to university.
The trust which runs that hospital also carries out regular recruitment drives in India, on behalf of the NHS across the whole of Greater Manchester.
Trust chief executive Andrew Foster said the situation was putting huge pressure on his existing "fantastic" staff.
"It's been getting more serious as this year has gone on," he said. "We're now talking about a picture nationally of at least 50,000 nurse vacancies and one that's set to get worse over the next few years as well."
In Wigan, as in the whole of the North West of England, they have been preparing for this winter like never before.
It remains to be seen whether that is enough.
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