Responding to the publication of the planning guidance by NHS England, which sets out the NHS priorities and ambitions for the coming year, the interim chief executive of NHS Providers, Saffron Cordery said:

"This year, the planning guidance serves as a stark reminder of the challenges facing the health service. Against a backdrop of severe operational pressures exacerbated by ongoing workforce shortages, care backlogs and soaring demand, trust leaders are bracing themselves for another tough year.

"Trusts will welcome NHS England's efforts to streamline priorities, clarify core aims for the service as it seeks to recover operational performance, deliver existing aspects of the long-term plan, and retain an eye to the future given the need to transform services over the longer term.

"They will also share NHS England's long-term aim of recovering the 95% A&E target – and will see next year's ask to improve A&E waiting times so at least 76% of patients wait no more than four hours – as proportionate and realistic given the unrelenting pressure across urgent and emergency care services.

"However, there are several areas where trusts will question whether they are equipped to deliver all the priorities and ambitions.

"It is unclear whether systems will be provided with additional funding if next year's pay settlement exceeds what has been budgeted. We must not see a repeat of this year, in which NHS England and trusts were forced to deprioritise investment in care improvements following the government's failure to fully fund the pay award. If the NHS is again forced to scale back transformational investment, this will limit the capacity for efficiencies, and will ultimately affect patient care.

"It is also vital that mental health and community services remain central priorities both for local systems and NHS England given the key role these services play for patients and service users, and as part of the solution to alleviate pressures on urgent and emergency care and other pathways.

"Trusts are being asked to reduce adult general and acute bed occupancy to 92% or below. While the renewed recognition that bed occupancy rates remain very high is welcome, it is clear much more needs to be done nationally to increase capacity across the health and care system if real progress is to be made in achieving this target alongside efforts to reduce delayed discharges. This applies to hospital settings but also across community and mental health services, and in social and step-down care.

"The major workforce challenges facing health and care continue to be laid bare, with a staggering 133,000 vacancies across trusts and an increasingly discontented NHS workforce with more strike action expected in the new year.

"Trust leaders and their frontline teams have done an incredible job bearing down on care backlogs. There is more to come in the drive to eliminate or minimise waits for elective care and cancer patients, to reduce pressure on urgent and emergency care pathways, and to meet soaring demand for mental health and community services. We know though, that providers are committed to improving performance and restoring underlying activity.

"However, given major workforce constraints, it is important staff do not become burned out in the drive to recover pre-pandemic levels of activity or that trusts that have to call upon agency staff to meet expected levels of performance are not unduly punished for workforce constraints outside of their control."