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A Brighton GP surgery is under threat despite providing excellent services and strong links to the local community. This decision flies in the face of the proven 'social value' being delivered and potentially puts patients at risk. The reasons are presented in this excellent article which exposes the continued 'race to the bottom' due to an apparently unnecessary tendering exercise, a decision made behind closed doors and a failure to consult. Quote from Polly Toynbee's article in the Guardian: "Here’s the puzzle. Andrew Lansley’s calamitous system that opened the NHS to “any willing provider” to compete for contracts was supposedly swept away in 2022, replaced with ICBs that strove for cooperation across all NHS and social services in England. Yet some ICBs still apply the old competitive impulse to NHS services, even though they now have an obligation to ensure that tenders help to reduce inequalities."

This report from the Partnership for Change explores one of the most persistent challenges patients face: poor care co-ordination. It draws on insight from across the health charity sector to offer a clear and practical vision for improving how care is delivered and experienced in the NHS. The Partnership for Change is a collaboration of ten leading patient groups brought together and funded by Pfizer.  The report outlines a set of recommendations to help the NHS, and wider health systems, put patients at the centre of co-ordinated care. The report recommendations are to: Measure patient experience and act on the data. Make communication between healthcare, professionals and patients simpler, quicker, and more efficient. Proactively build a culture of collaboration. Take a holistic approach to care for long-term conditions. Related reading on the hub: How the Patients Association helpline can help you navigate your care Care co-ordination for people with long-term conditions: Patient Safety Learning’s response to HSSIB investigation #NavigatingHealth—Enabling every patient, every time, system-wide The challenges of navigating the healthcare system

Jacqueline Anne Potter, known as Anne, was a 54 year old teacher who died by suicide following a decline in her mental health. Anne died during overnight leave from an acute psychiatric unit in Somerset, where she was being looked after because of mental health issues exacerbated by menopause. In this report, the coroner raises concerns about her care and the lack of importance given to menopausal care in the NHS. Coroner's matters of concern Overnight leave arrangements When Anne was sent on her first overnight leave there was no codified ‘risk’ and ‘safety planning’ document. While in Anne’s case the report notes that it was widely accepted that her husband was well versed and knowledgeable about his wife’s risks and the measures that might be necessary to help keep her safe whilst she was at home, the Coroner noted that this may not apply in other cases. The report said that whilst families are not mental health practitioners and are not expected to adopt that role within the community there appears to be an opportunity to supply families with a short, codified document dealing with salient points of risks and safety planning when a patient goes for their first overnight leave since being detained. The Coroner suggests that this could help equip families with the knowledge to spot signs of declining mental presentation and/or risk and provide them with the knowledge and/or tools to take appropriate steps to assist in safeguarding their loved ones while they are in the community. Internet access in mental health settings The report notes that it found that if an in-patient (detained or voluntary) accesses the secure unit Wi-Fi there are no algorithms or ‘search detection features’ to prevent access to websites pertaining to self harm and so these can be readily accessed by a group who are already vulnerable due to their acute mental health presentation with some element of inherent risk of suicide. The Coroner noted that workplace organisations do have the ability to block sites if they deem it undesirable for their workforce to access (such as sites relating to gambling, sexually inappropriate content, etc). The report states that by allowing an already vulnerable group to have unfettered access to websites dedicated to self harm creates a risk of further deaths. Menopausal care The Coroner noted several areas of concern about menopausal care available on the NHS: Menopausal training is not mandatory in any area of clinical practice or specialism. The Coroner expressed concerns that there is no requirement to undertake essential compulsory menopausal training for those working in ‘relevant’ clinical practices such as mental health practice, obstetrics and gynaecology, and oncology, or even general as a general GP. The Coroner noted that she was told that the Trust has just one ‘menopause specialist’ (a GP) who covers the entire Trust operations. Not all GP surgeries have a menopause specialist practitioner (or access to one) despite a GP usually being the first port of call for women in the community when seeking primary care. Those GP surgeries who do have a practitioner who acts as a ‘specialist’ is often a GP with a personal interest who has taken the initiative to go on courses and broaden their learning and understanding, rather than any mandatory requirement for a surgery [or group with multiple surgeries] to have an available community ‘front-line’ specialist. She also noted that: “I was told during a previous PFD Response relating to menopausal knowledge and care within the NHS that “It is important to ensure that women understand common symptoms such as anxiety, stress and depression which they might experience during the menopause and where and when to seek help. The NHS website has resources….” This emphasises my concerns entirely; the lack of importance given to menopausal symptoms. If someone has concerns about heart disease, a worrying lump, a broken bone etc they expect to be able to consult a medically qualified professional who has a knowledge and understanding of their condition or presentation and can diagnose and treat accordingly; not just [and I paraphrase] ‘have a look at a website to help’.” Concluding, the Coroner referenced being told in a response to a previous Prevention of Future Deaths report where she raised similar concerns about a roll-out of specialist menopausal care and upskilling of GPs. She stated that from reviewing this case there was little evidence that this has happened/is happening and said that women continue to approach and navigate the menopause without the support of expert clinicians or practitioners who understand and can treat the symptoms they are experiencing.

Insulin prescribing in the UK has tripled in the past decade, in particular due to an increase in use among those living with type 2 diabetes, now the largest group of insulin users. As a result, nurses in general practice and the community are increasingly expected to be skilled in supporting people living with type 2 diabetes with insulin therapy and associated glucose monitoring. The management of insulin therapy requires knowledge of the type of diabetes it is being used for and appropriate dosing, as well as correct injection technique, to prevent complications and medication errors. Diabetes nursing specialist Debbie Hicks shares key points on the management of insulin therapy for nurses in primary care.

Primary care is often referred to as the backbone of the NHS – the place where patients show up and rely on those professionals to help them; the place where relationships and continuity make all the difference, the place that connects problems to solutions; the place that works within its means – and we know that high-performing primary care is key to improving health outcomes.  As we look ahead to a new ten-year plan for the NHS, this is a moment of both challenge and opportunity. The world around us is changing: patients’ needs are evolving, and their expectations are rising, while the wider economic position – much of which is beyond our control – is looming large on what we do and how we do it.  This collection of essays from primary care clinical leaders in England is not a roadmap; it is a view of what the future could look like, written by those leading and working in primary care. It is intended to support both national thinking on the content of the ten-year health plan and inspire primary care leaders to recognise the opportunities that exist if they are willing to embrace them. 

The Nuffield Trust and The King’s Fund join forces each year to analyse and present findings from the gold-standard survey of public attitudes and opinions towards the NHS and social care, as surveyed by NatCen. The 2024 survey results show that the British public are deeply unhappy with the way the NHS runs – just 1 in 5 people said they were satisfied. Key findings Satisfaction with the NHS In 2024, just one in five British adults (21%) were ‘very’ or ‘quite’ satisfied with the way in which the NHS runs. This is the lowest level of satisfaction recorded since the survey began in 1983 and shows a steep decline of 39 percentage points since 2019. Only 2% of respondents were ‘very’ satisfied with the NHS, down from 4% in 2023. The percentage of people who were ‘very’ or ‘quite’ dissatisfied with the NHS rose to 59% in 2024, from 52% in 2023. This represents a statistically significant 7-percentage-point increase from the year before, which already had the highest dissatisfaction seen in 40 years of the British Social Attitudes survey. A higher proportion of people in Wales (72%) were dissatisfied with the NHS compared to the survey average and compared to people in England (59%). Supporters of the Reform party were less likely to be satisfied (13%) than the survey average and this was significant after controlling for other variables like age and income. There is a divide between generations, with satisfaction lower and falling in younger age groups. While the proportion of people who were satisfied rose slightly for those aged 65 and over, from 25% to 27%, among those under 65 it fell significantly, from 24% to 19%. Satisfaction with social care In 2024, only 13% of respondents said they were ‘very’ or ‘quite’ satisfied with social care (the same figure as 2023). 53% of respondents were ‘very’ or ‘quite’ dissatisfied. Respondents in Wales (69%) were again significantly more likely to be dissatisfied than the survey average. Satisfaction with different NHS services Public satisfaction with A&E services has fallen sharply, from 31% to just 19%, and dissatisfaction has risen from 37% to 52%. These are the worst figures on record by a large margin and make A&E the service with lowest satisfaction levels for the first time. Satisfaction with NHS dentistry has continued to collapse. As recently as 2019 this was at 60%, but it has now fallen to a record low of 20%. Dissatisfaction levels (55%) are the highest for any specific NHS service asked about. Satisfaction with GP services continued to fall, mirroring the trend over the last few years. 31% of respondents said they were satisfied with GP services, compared with 34% in 2023. Inpatient and outpatient hospital care is the part of the NHS with the highest levels of satisfaction, with 32% saying they were satisfied and only 28% dissatisfied. Attitudes to standards of care, staffing and efficiency The majority of the public (51%) said they were satisfied with the quality of NHS care. People aged 65 and over were more likely to be satisfied (68%) with the quality of NHS care than those under 65 (47%). Dissatisfaction with waiting times and the ability to get an appointment is widespread, and is consistent across respondents from all ages and UK countries: 62% of all respondents were dissatisfied with the time it takes to get a GP appointment. 23% were satisfied. 65% of respondents said they were dissatisfied with the length of time it takes to get hospital care. 14% said they were satisfied. Dissatisfaction levels are highest regarding the length of time it takes to be seen in A&E. 69% of respondents said they were dissatisfied, while just 12% said they were satisfied. Only 11% agreed that ‘there are enough staff in the NHS these days’. 72% disagreed. NHS funding, principles and priorities 8% of respondents said that the government spent too much or far too much money on the NHS; 21% said that it spent about the right amount, and 69% said that it spent too little or far too little. When asked about government choices on tax and spending on the NHS, the public would narrowly choose increasing taxes and raising NHS spend (46%) over keeping them the same (41%). Only 8% would prefer tax reductions and lower NHS spending. Only 14% of respondents agreed that ‘the NHS spends the money it has efficiently’. 51% disagreed with this statement. Respondents felt the most important priorities for the NHS should be making it easier to get a GP appointment (51%) and improving A&E waiting times (49%), with increases in staff (48%) and better hospital waiting times close behind (also 48%). A&E has now slightly overtaken staffing as a priority, reflecting the sharp fall in satisfaction described above. People under 65 were more likely to prioritise improving mental health services (34%) than those aged 65 and over (21%). As in previous years, a strong majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply in 2024: that the NHS should be free of charge when you need to use it (90%); the NHS should primarily be funded through taxes (80%); and the NHS should be available to everyone (77%). The percentage of people saying that the NHS should ‘definitely’ be available to everyone decreased from 67% in 2023 to 56% in 2024. This is the only statistically significant change year-on-year across all three principles. Supporters of the Reform party (20%) were significantly less likely to say that the NHS should ‘definitely’ be available to everyone than the survey average.

Since 2022, general practice has shifted from responding to the challenges of Covid-19 to restoring full services using a hybrid of remote, digital and in-person care. This BJGP study aimed to examine how quality domains are addressed in contemporary UK general practice. The authors found that: quality efforts in UK general practice occur in the context of combined impacts of financial austerity, loss of resilience, increasingly complex patterns of illness and need, a diverse and fragmented workforce, material and digital infrastructure that is unfit for purpose and physically distant and asynchronous ways of working. providing the human elements of traditional general practice, such as relationship-based care, compassion and support, is difficult and sometimes even impossible. systems designed to increase efficiency have introduced new forms of inefficiency and have compromised other quality domains such as accessibility, patient-centredness, and equity. long-term condition management varies in quality. measures to mitigate digital exclusion such as digital navigators are welcome but do not compensate for extremes of structural disadvantage. many staff are stressed and demoralised.

Research suggests that insights from patient narratives—stories about care experiences in patients' own words—contain information that can be used to improve care. However, assessments of narratives reported by clinical personnel have been mixed. This US study aimed to systematically measure how useful staff in primary care perceive patient narratives to be. The authors surveyed 276 clinical and administrative personnel in nine primary care clinics in a large health system in the USA. We found that perceived usefulness of patient narratives is generally high, but varies by individual characteristics such as level of burnout and professional role, and with organisational characteristics such as a clinic's learning orientation and history of using patient feedback to improve quality. These findings imply that narratives can be useful for improving primary care and that their perceived usefulness is greater when organisational practices facilitate learning from patients' narrative feedback.

A comprehensive infographic with expert information from Dr Charles Shepherd (Honorary Medical Adviser to the ME Association) to help primary healthcare professionals with diagnosing ME/CFS. It contains vital information regarding suspecting ME/CFS, diagnosis, differential diagnoses, key symptoms, investigations, and information relating to NHS specialist referrals.

In this blog, Sarah Clark, Research Communications Manager at THIS Institute, looks at the ongoing challenge of trying to improve access to GP services for patients. She reflects on analysis by THIS Institute and the Health Foundation which identified what we called a “zombie solution”—where some options are revisited time and time again even though they never seem to make a real difference for patients. She looks at the issue and how to move beyond this pattern.

Patient-Reported Indicator Surveys initiative (PaRIS) was set up by the Organisation for Economic Co-operation and Development (OECD) to allow countries to work together on developing, standardising and implementing a new generation of indicators that measure the outcomes and experiences of healthcare that matter most to people. The PaRIS survey aims to fill a critical gap in primary healthcare by asking about aspects like quality of life, physical functioning, psychological well-being and experiences of healthcare. This website explains how PaRIS works and provides access to research outputs.

The growing pressure of workload and staff shortages – and the decline in patient satisfaction in primary care in the UK – is a topic that’s generating a lot of discussion in healthcare.  Host Kristina Wanyonyi-Kay and guests Patrick Burch, Georgia Black, and Sean Manzi discuss:  How might increasing access to NHS care and changing how pathways are navigated impact a patient’s experiences of the healthcare system?  The power of multidisciplinary teams in tackling complex problems by defining the right pathway  How does a busy GP make a judgment call when they’re balancing the pressures of time, capacity, and urgent patient needs?  What is the system level approach, and what trade-offs have to be made? 

The purpose of this guide is to share guidance about developing and sustaining state-based cooperatives that aim to strengthen the capacity of healthcare systems, other healthcare organisations, and clinicians to deliver evidence-based whole-person care.  The guide includes effective approaches, lessons learned, and example materials from the Agency for Healthcare Research and Quality (AHRQ) initiatives designed to provide external quality improvement (QI) support for primary care practices. This guide draws mainly from the experiences of AHRQ’s EvidenceNOW: Building State Capacity initiative, but also reflects other AHRQ and primary care/healthcare extension efforts. This guide will be useful to groups planning or developing similar infrastructure, including healthcare extension programs with a focus broader than primary care.

The World Health Organization has released a new report, Compassion and primary health care, which explores the vital role compassion plays in primary health care (PHC). The document synthesises findings from a five-year exploration. Compassion – characterised by awareness, empathy and action – is identified as a transformative force for primary health care, driving quality care and health system transformation. The document connects compassion to the WHO-UNICEF Operational Framework for Primary Health Care, describing its relevance across both strategic and operational levers. Drawing from insights gathered through twelve Global Health Compassion Rounds, it highlights the relationship between compassion and various healthcare themes. This foundational resource provides actionable insights for health leaders and practitioners on how to harness compassion to improve population health. The report argues that compassion is not only essential to the core of primary health care but also serves as a catalyst for systemic change. The report outlines three strategic approaches to ensure compassion remains embedded at the heart of PHC efforts: Integrated health services Services designed and delivered with compassion address the needs of people. This requires compassion to be embedded in the full continuum of essential health services, from health promotion to disease prevention, treatment, rehabilitation and palliative care. Awareness of and empathy for human suffering across the life-course can drive action that optimises health services for individuals and populations. Integrating public health services and primary care enables compassion to guide decision-making and subsequent action that enhances overall population health, including in public health emergencies. Empowered people and communities Compassion enables people to see other people more fully, listen deeply and resonate with their humanity. From within this shared space of genuine connection and trust, co-developed community solutions and organisational policies can emerge in the health sector and beyond. Compassion empowers individuals, families and communities to optimise their health. Multisectoral policy and action Compassion demands collaboration across sectors to comprehensively address the health and well-being of the whole person and whole community. Whether in interdisciplinary partnership in a health system or allied efforts among multiple ministries, compassion urges people to work collectively and consistently for the well-being of all, to attend to suffering and to take action on broader determinants of health.

Summary and analysis of NHS England’s 2025/26 priorities and operational planning guidance. Key points On 30 January 2025, NHS England published its operational planning guidance for 2025/26, outlining the priority areas and objectives for the service. This is the first planning guidance since the government was elected in July 2024. The 2025/26 NHS Planning Guidance sets out clear priorities to: (1) continue to reduce elective care waiting times, with 65% of patients waiting less than 18 weeks; (2) improve ambulance response and A&E waiting times, with a minimum of 78% patients seen within four hours, (3) improve patients’ access to general practice (GP) and urgent dental care access, including 700,000 additional urgent dental appointments; and (4) accelerate patient flow in mental health crisis and outpatient care pathways. It sets a path for reform through development of neighbourhood health services models to prevent admissions and improve access to care. It also asks systems to improve productivity to balance system budgets and improve quality and safety of services, particularly maternity and neonatal services. Fewer national priorities – just 18 headline targets (excluding other ‘requirements’), down from 31 last year and 133 as recently as 2022/23 – gives welcome focus and clarity. More funding and decision-making is devolved to systems, letting local leaders lead. Lifting most ring-fences will give them agency to innovate and use scarce resources to best effect. NHS England and the government commit to back local leaders to make difficult decisions, including reducing or stopping lower-value activity. The finances remain very difficult and will be incredibly stretching. Despite a 4% spending uplift at the budget, this will feel more like 2% real-terms increase for most systems once particular cost pressures are accounted for. Crucially, to balance the books, providers are asked to make eye-watering 4% efficiency savings – before new local pressures are accounted for. This is almost double last year’s 2.2% target and more than four times the NHS’s historical rate of productivity growth at 0.9%. Systems will have to make tough and unpopular decisions over service provision, closing some relatively lower value services to balance the books. Balancing reform and recovery will be key. The guidance is more about recovery than reform, but putting the NHS on sustainable path will require more radical reform and transformation to deliver the three shifts. The ten-year health plan will need to work out how to do recovery and reform at the same time.

In line with the Government Mandate, the 2025/26 priorities and operational planning guidance sets out a focused, smaller number of national priorities for 2025/26 with an emphasis on improving access to timely care for patients, increasing productivity and living within allocated budgets, and driving reform. To support this, systems will have greater control and flexibility over how they use local funding to best meet the needs of their local population. The national priorities to improve patient outcomes in 2025/26 are: Reduce the time people wait for elective care, improving the percentage of patients waiting no longer than 18 weeks for elective treatment to 65% nationally by March 2026, with every trust expected to deliver a minimum 5% point improvement. Systems are expected to continue to improve performance against the cancer 62-day and 28-day Faster Diagnosis Standard (FDS) to 75% and 80% respectively by March 2026. Improve A&E waiting times and ambulance response times compared to 2024/25, with a minimum of 78% of patients seen within 4 hours in March 2026. Category 2 ambulance response times should average no more than 30 minutes across 2025/26. Improve patients’ access to general practice, improving patient experience, and improve access to urgent dental care, providing 700,000 additional urgent dental appointments. Improve patient flow through mental health crisis and acute pathways, reducing average length of stay in adult acute beds, and improve access to children and young people’s (CYP) mental health services, to achieve the national ambition for 345,000 additional CYP aged 0 to 25 compared to 2019. In delivering on these priorities for patients and service users, ICBs and providers must work together, with support from NHS England, to: Drive the reform that will support delivery of our immediate priorities and ensure the NHS is fit for the future. For 2025/26 we ask ICBs and providers to focus on: Reducing demand through developing Neighbourhood Health Service models with an immediate focus on preventing long and costly admissions to hospital and improving timely access to urgent and emergency care. Making full use of digital tools to drive the shift from analogue to digital. Addressing inequalities and shift towards secondary prevention. Live within the budget allocated, reducing waste and improving productivity. ICBs, trusts and primary care providers must work together to plan and deliver a balanced net system financial position in collaboration with other integrated care system (ICS) partners. This will require prioritisation of resources and stopping lower-value activity. Maintain our collective focus on the overall quality and safety of our services, paying particular attention to challenged and fragile services including maternity and neonatal services, delivering the key actions of ‘Three year delivery plan’, and continue to address variation in access, experience and outcomes.

Every winter, the NHS faces immense pressure, with poor standards of care becoming an expected part of the "winter crisis." The Patients Association, the Royal College of Emergency Medicine, the Royal College of General Practitioners, the College of Paramedics, the National Association of Primary Care, and the Association of Ambulance Chief Executives have joined together to propose practical solutions for meaningful, long-term improvement. The joint statement identifies four core issues at the heart of the crisis: Primary care does not have the capacity to meet its patient demand. We are not pro-actively looking after patients who are currently the most frequent users of urgent and emergency care to stop them getting so unwell. The urgent and emergency ‘system’ in the NHS remains fragmented and disjointed, making it hard to navigate patients to the right place to get their care. Emergency departments (EDs) have become hugely congested because of lack of flow into and out of hospital beds. Proposals to address these issues 1) Increasing primary care capacity by: In 2025/26 ensuring the uplift in funding promised by the government does translate into the ability of practices to employ more GPs. In subsequent years increase the share of NHS funding for general practice to match the increased workload involved in the planned shift of care from hospitals to the community. Freeing up GP time, so they have more time to spend with the patients who most need continuity by cutting bureaucratic red tape, supporting practices to improve triage systems to help navigate patients to the right part of primary care and the wider NHS. This could also contribute to freeing up capacity in 111. Introducing a national alert system to flag unsafe levels of workload and allow GP practices to access additional support. Every Integrated Care System (ICS) should be required to establish alert systems for general practice, similar to the ‘operational pressures escalation levels framework’ in hospitals. Beginning the implementation of integrated neighbourhood working by aligning community services to each primary care network so we can better use existing resources across the primary and community care sector to focus on prevention and keeping people well in their communities. Making the best use of the paramedic workforce to support primary care with home visiting and face to face services. 2) Improving care for the patient groups who are currently using urgent and emergency care the most by: Resource is needed to enable every older person in a high risk group to have a full health ‘MOT’ every year, including consideration of loneliness and isolation risks, a known driver of ill-health. These should be conducted by integrated neighbourhood health teams with multi-disciplinary team input particularly from primary, community and mental health colleagues. The resulting care plans should be readily accessible to all healthcare professionals with whom they come into contact. All people in residential and nursing homes should have the NHS delivered to them. This should be led by GP and community teams with the expectation that care is provided to them in their place of residence and the first point of contact for most urgent care episodes is those teams and not 999. All patients known to be on a palliative care pathway should have a care plan, accessible to clinicians across the emergency care pathway that is explicit about where the patient would like to die so that we can honour their last wishes. Identifying the highest users of urgent and emergency care in each ICS footprint, in order to agree a care plan for these individuals and to reduce their use of ED. Providing more support to patients in deprived communities by reviewing all funding streams (including primary care) to channel more spending to areas of greatest need. Identifying patients who are at high risk of emergency admissions (supported by AI) with a particular focus on adults with chronic breathing and cardiac conditions to create bespoke care plans (including using wearable devices) with pro-active monitoring to minimise the spikes in demand we see every winter. Consider making the flu vaccination available, subject to JCVI approval, to a much broader group than currently defined, and then making sure we maximise both the uptake and speed of vaccination. 3) Joining the urgent and emergency system back together by: Creating a single 24/7 service for each ED catchment area that is focused on caring for people in their normal place of residence that brings together the current urgent community response teams, virtual ward teams and ED teams into a single multi-disciplinary team. Supporting the development of the principle of senior clinical decision making in community as well as the ED environment. Making it an expectation that community-based clinicians and hospital staff routinely discuss their patients to ensure they get the right care, blurring the boundaries between hospital and community / primary care. Integrating urgent mental health services into ambulance, ED and 111 delivery and training many more clinicians with mental health skills for managing patients in mental health crisis. Allowing the ambulance service the time to do a fuller clinical assessment for all patients who call 999 who do not obviously need conveying to an ED. Having a patient’s medical record that is accessible by all providers who can read and update it and that patients can see themselves. Re-wiring the NHS financial flows to incentivise the system to work together and to reward providers who deliver the interventions in this paper. Creating a workforce strategy for the urgent and emergency care system looking at capacity needed for in and out of hours GP services, community nursing, mental health and paramedics, aligning training and careers together. Create an improvement culture in urgent and emergency care by routinely evaluating, learning and adapting initiatives. 4) Improving the flow through emergency departments: We have to improve flow in hospitals by beginning to resolve the bottlenecks that delayed discharges create, primarily because of insufficient bed capacity and lack of social care funding. Rather than rehearse the arguments that have been made in recent weeks, we endorse all the feedback being voiced by many, that the solutions for social care cannot wait until 2028 and we must begin to increase social care capacity before next winter. Implementing many of the recommendations from the Cavendish review from 2022 would be a good place to start. We also need to maximise opportunities to prevent deconditioning of our frail or elderly patients when they are inpatients through improved therapy and dietetic support.