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“We have lost this winter already. This ship has already sailed,” a well regarded hospital figure said during a discussion at the HSJ annual summit in Manchester this week.

A pessimistic forecast it may be, but it was one shared by a number of hospital bosses from different parts of the country in the session, all of whom had many years of experience to draw on.

HSJ’s annual November gathering of NHS leaders is always a good place to gauge the mood at all levels of the system ahead of winter. The consensus that winter will be bad – and most likely worse than last year – was perhaps unsurprising, given recent national performance data and rising demand. (Type one performance is worse by one percentage point this October than last, but the number of 12 hour waits in July had nearly doubled year on year).

But the depth of the concern was tangible. Worries last year were often batted away by national leaders, who parroted the line that the NHS was “the best prepared” it had ever been for winter. But not so this year, and little wonder.

The local views also suggest NHS England will likely have some explaining to do to ministers after pledging in its 2018-19 planning guidance the system would hit the four hour target in 2018 and the 18 week position would have improved by March 2019, compared to March 2018.

Indeed, some even questioned if the headline statutory targets – should they all exist following a major review of targets as part of the NHS long-term plan – will be hit in 2019-20 unless a major slug of the additional funding is directed towards meeting the existing performance deficits instead of new ambitions.

Health and social care secretary Matt Hancock’s decision to use an HSJ interview broadcasted exclusively at the summit (a written report is here) to really drive home his desire to make the NHS a leading global digital health service also prompted some interesting reactions.

Mr Hancock’s desire to ensure technology is viewed as part of the day job by hospital chief executives and all NHS leaders is hugely encouraging for the future, should he be in the job long enough in these politically uncertain times to see it through.

Only this way will the NHS get close to dragging the health service from the age of the fax machine into the age of artificial intelligence and algorithms.

But the dominance of the topic in his messaging to the sector was questioned.

As another seasoned NHS chief executive told me, Mr Hancock also needs to start talking more about “patients and patient safety [in the here and now and how they will be protected in winter] and not just about fancy technology which will transform services in the future soon or else he’s in for a shock over winter”.

Asking for positive views about winter drew wry smiles. But there were some. Some cited their sustainability and transformation partnerships as the drivers of conversations which had led to more integrated work between different local organisations.

The move to allow decisions around cancelling elective work to be locally driven rather than issue national level diktats as happened last winter has also been well received, with the caveat that the centre must support those providers forced into cancellations if they face a backlash.

The early indications are also that flu should not be as big a problem this winter as it was last year and a central drive to vaccinate more staff has also been well received.

Largely, however, the system’s fate this winter remains out of its hands, and trust bosses remain concerned they will be the ones to feel the heat as the demand cranks up and the temperature drops.