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Marking 100 days since her appointment, the NHS England chief executive began her comment piece on HSJ yesterday on a largely positive note.

The vaccination programme continued at pace, there had just been a record day for top-up jabs and diagnostic tests were up, too, said Amanda Pritchard.

But then she added: “We all know that the next 100 days are likely to be significantly more challenging and I want every member of NHS staff to know that I recognise how difficult the coming winter is going to be. I am concerned by how stretched we – and our colleagues in social care – are, before we have even reached what are traditionally the busiest winter months.

“We cannot know how many of those who, understandably, held back from seeking treatment earlier in the pandemic will now come forward for operations, procedures or other care.

“And although we are pulling out all the stops to vaccinate as many people as possible we cannot know the impact that covid, flu or other respiratory diseases will have on the health and care sector in the coming weeks and months.”

It was this acknowledgment of the storm clouds that would no doubt have struck more of a chord than the good news with a respected NHS chief executive who phoned HSJ on Sunday. 

“We should all be rated inadequate,” he said.

His big, highly rated acute trust is facing record levels of emergency demand, and increasing elective referrals as exhausted staff turn down the extra shifts needed to reduce the growing backlog, and intensive care is once again seeing a steady flow of acutely ill covid patients.

The situation is far worse than in January, he told HSJ – when the service was able to bend every bit of discretionary effort towards combatting the Alpha covid wave and the vaccine roll out offered light at the end of the tunnel. “This time,” he said, “the vaccine hasn’t saved us.”

The chief executive had never seen anything like it in his long and distinguished career, writes our editor in his own comment piece. Despite his long track record of delivering exemplary performance and turning around services that had defeated many of his peers, he does not know where to turn.

No return to normal

Huge surges in 111 demand during normal working hours are linked to ‘challenges’ in primary care capacity, an ambulance trust has said.

Substantial increases in 111 demand, particularly on weekday mornings, have been noted by Yorkshire Ambulance Service – which says pre-pandemic norms are “unlikely to ever fully return”.

YAS said these increases are “reflective of primary care challenges linked to the wider system” and have made rotas more flexible in response.

An expert in urgent care has told HSJ these increases in 111 demand during ‘in hours’ on weekdays risk causing even further staffing challenges for the service.

Many 111 call handlers took on the job because they wanted to work the ‘unsociable’ hours on evenings and weekends. This could cause issues with recruitment and retention in 111 if more demand occurs within the normal working hours.