• Trusts ask to prepare for seeking ‘top quartile performance in productivity’
  • Must ‘mobilise all available surge capacity’ as covid rises ‘almost everywhere’
  • More staff redeployment on the cards
  • Covid vaccines should be targeted at most at-risk NHS staff
  • ’Relentless pressure has taken its toll on staff’

New planning guidance asks local NHS organisations to prepare for a major waiting-list catch-up by seeking “top quartile performance in productivity”, but also to “safely mobilise all… available surge capacity over the coming weeks” as the service battles rising covid levels “in almost all parts of the country”. 

An end-of-year planning letter was issued by NHS England to local NHS chief executives last night.

It warns: “With covid-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, you should continue to plan on the basis that we will remain in a level 4 incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of their available surge capacity over the coming weeks.

“This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity.”

It is unclear precisely what this requires, as most Nightingale hospitals currently remain out of use; and many trusts have not yet opened full surge intensive care beds.

The letter, from chief operating officer Amanda Pritchard and chief finance officer Julian Kelly, says: “Support for staff over this period will need to remain at the heart of our response, particularly as flexible redeployment may again be required.”

It says 2020 has “arguably been the most challenging in the NHS’s 72-year history”, and says: “We know that this relentless pressure has taken a toll on our people. Staff have gone the extra mile again and again. But we have lost colleagues as well as family and friends to the virus; others have been seriously unwell and some continue to experience long-term health effects.

“The response of the NHS to this unprecedented event has been magnificent. We thank you and your teams unreservedly for everything that you have given and achieved and the support you continue to give each other.”

The letter also encourages more work to speed up discharges from hospitals.


The letter says the NHS should prepare to step up the major covid vaccination effort further in the new year. It asks for NHS staff vaccinations to be targeted at high risk staff, saying: “Healthcare providers have been undertaking staff risk assessments throughout the pandemic to identify these individuals and it remains important that this is organised across the local healthcare system to ensure equitable access.”

There have been numerous individual reports in recent days of covid vaccines being made available to NHS staff, and even non-staff, on a more ad hoc basis, to avoid wastage where vaccinating sites say they cannot reach over-80s or care homes.

There have also been complaints from staff at trusts which have not received any that they do not have access. The letter says government priority rules from the joint committee on vaccination and immunisation must be followed.

It also says: “All NHS trusts should be ready to vaccinate their local health and social care workforce very early in the new year, as soon as we get authorisation and delivery of further vaccine.”


The letter says a major priority in the next financial year will be to “recover non-covid services, in a way that reduces variation in access and outcomes between different parts of the country”.

NHSE will therefore “set an aspiration that all systems aim for top quartile performance in productivity” in ophthalmology, cardiac services and MSK/orthopaedics. Systems will be given “goals for productivity and outpatient transformation” in the new year, but “in the meantime we are asking you to begin preparatory work for this important task now, through the appointment of a board-level executive lead per trust and per system for elective recovery”.


Budgets for local NHS services are normally published at this time of year for the forthcoming financial year, but for 2021-22 will not be available until closer to April, when government will agree what funding is needed to recognise ongoing covid pressures.

The guidance does, however, say that, on top of previously planned budgets for 2021-22, “there will be additional funding to offset some of the efficiency and financial improvements that systems were unable to make in 2020-21”.

It also asks local managers to “start to develop plans for how covid-19 costs can be reduced and eliminated once we start to exit the pandemic”.