Classification: Official
Publication reference: PRN02323

To:

• Trust and integrated care board (ICB) chief executives and medical directors

cc.

• Trust and ICB chief operating officers
• Trust and ICB chief nurses
• Trust and ICB communications
• Directors
• NHS England regional directors

Dear colleagues,

Given that your teams will be incredibly busy over the coming weeks, I wanted to kick off the new year by saying a huge ‘thankyou’ for all of the work you have done over the festive period. The way you have all managed industrial action and then quickly had to prepare for the Christmas period was truly remarkable. The latest performance data shows that the NHS remains on course for delivering its strongest December performance in a number of years with some very dramatic improvements in ambulance response times and handover performance.

None of this has happened by accident. Much earlier and more rounded planning alongside the big focus on getting as many patients home for Christmas as possible, has seen over 5,000 fewer people in beds this Christmas when compared to last, which equates to under 80% of our standard bed base. The big push we all promised to deliver to create additional capacity and safely discharge patients, giving the NHS a better chance of delivering better care for people in the Christmas to New Year period, has made a huge difference. You should be really proud of that.

That performance is all the more impressive given what we have had to contend with during December with the latest round of industrial action by resident doctors, and the significant pressure of a widespread flu arriving early just before Christmas. It is remarkable that the NHS delivered 94.7% of elective activity across the 5 days of the most recent industrial action despite having the additional winter pressures to contend with.

This is a testament to your leadership and to the efforts of those staff who have been working flat out to deliver care for patients. We know that this has been especially hard for those covering the strike and then also digging in to work alongside their colleagues over the holiday period. This is hugely appreciated, and I know that you will be making this clear to colleagues locally. We must all remain focussed on looking after our staff and giving them the downtime they need when they can.

However, we also can’t let up. This next couple of weeks will be tricky for us all, as we look to get services fully powered up again and recover from the holiday period. Whilst flu levels have come down a bit, hospital cases still stand at 2,676 and the cold weather snap will inevitably mean that we have a spike of patients needing our care as a result.

You have shown throughout this last year that the NHS can step up and deliver and meet the challenges we face in to. We are all going to need keep that going as we look to get fully powered up over this next week or so, and then to end the financial year well.

Thank you for all you have done and continue to do. Please pass on my thanks to your teams also – this whole team effort is very much appreciated.

All the best for 2026 – we have much to do, but I hope you can continue to build on progress over this last year, and have greater confidence of delivering what we all want to in this coming year.

If you need anything this week, please shout.

Keep going…..

Sir James Mackey, Chief Executive, NHS England