Despite a challenging context, NHS providers are exceeding pre-pandemic levels of activity in a number of areas. Trusts are delivering more cancer tests and treatments than ever. They have delivered record numbers of diagnostic tests this year well above prepandemic levels, and there is increasing confidence that trusts will virtually eliminate 52-week waits by March 2025. Urgent community response services are making a key contribution to UEC pathways as ambulance trusts respond to ever higher numbers of calls. The NHS is striving to offer more mental health care provision in community settings, offering treatment to more people.

However, activity gains vary geographically and while the national policy focus often highlights elective and urgent and emergency care, there is concern about unmet need and whether there is sufficient resourcing to tackle care backlogs in mental health and community services, to invest in prevention and to reduce health inequalities.

In the face of major operational and financial challenges, trusts are doing all they can to improve activity levels and reduce costs, including local initiatives to improve staff wellbeing, joint working across pathways, and employing alternative delivery models like virtual wards. Provider collaboratives are also playing a meaningful role in developing constructive, material solutions to the productivity problem.

However, while some of the barriers to improving operational performance and productivity growth are within trusts’ gift to improve, there are additional factors relating to staff morale, bed availability, patient acuity and social care capacity that require collaboration, support and funding from government and system partners to address.

Indeed, while trust leaders recognise the need to utilise their existing capacity and staffing base to increase activity, this is difficult to do in a sustainable way while burnout and vacancy rates remain so high. In line with the ambitions recently set out in the long term workforce plan, supporting staff wellbeing and improving retention will be key. As the plan itself highlights, recovering productivity is categorically not about staff working harder.

In the long term, it will be vital to provide more care closer to home enabled by significant investment and reform of the social care system.

Finally, the government must adopt a step change in capital investment to enable the NHS to expand bed capacity and community provision, deliver digital transformation, provide safe and therapeutic environments and offer care effectively in the right settings.