It is clear that the media did not highlight the difficulties the NHS faced last winter as it did in previous years despite the sector facing comparable – or in some ways even more severe - performance challenges. The NHS long term plan, clinical review of access standards and NHS interim people plan have all been published at a time when the public and politicians are divided. A national preoccupation with Brexit has diverted considerable political attention away from other key challenges, not least those we face across health and care services.

It is critical that the ambitions set out in the long term plan are balanced against recovering performance to a standard that is best for patients and reflects evolving clinical practice. The current operational model and pressure on NHS staff can not be normalised by simply moving the goal posts.

It is important to review quality standards which have been in place for some time to ensure their continued relevance. However it is also important the review of clinical standards is done with enough time to test the proposals, but also that we return to knowing a clear trajectory for recovery of performance that’s transparent to the public and providers. The ‘ask’ of the provider sector from the centre should be stretching but feasible.

We know that trusts and staff have become better at managing seasonal spikes and are adopting quality improvement methodologies to adapt services. However the underlying issue persists - without filling vacancies and better supporting our workforce, securing an injection of capital investment to repair estates, and funding to mitigate the growing mismatch between demand for services, and capacity to deliver, the service will remain in a vulnerable position.

We must be transparent about the problem so the NHS continues to hold the trust and support of the public and its staff, and deliver a service that meets expectations that are balanced against the existing levels of funding.

We must work together and build a consensus across clinicians, trust leaders, health and care partners, politicians, and crucially we must engage with the public, to win engagement and support for the ambitions set out in the long term plan.

We look forward to continuing to work with colleagues in the Department of Health and Social Care, and the national bodies to support trusts to plan as effectively as possible for spikes in demand in the winter months, and to input constructively to the clinical standards review.