Foreword: a view from Richard Meddings CBE, Chair

The 2022/23 financial year was my second in the NHS and marked the NHS’ 75^th.

In those 75 years the NHS has proven again and again that it can adapt and change to meet the needs of patients and the public, and I have once again been humbled by the hard work and innovation of staff during a challenging year. The NHS remains at its heart focused primarily on the patient, and whilst demand is rising in some areas very significantly, the NHS works hugely hard to serve society’s health needs and continues to do that with true commitment but also innovation.

But there are huge challenges. December 2022 saw the start of an unprecedented run of industrial action which to date has seen over one million elective appointments postponed, which inevitably also had a knock-on financial impact on trusts.

Staff faced their busiest winter on record – with 8.3 million A&E attendances between December and March 2023 – 40,000 more than the previous high – while teams in GP practices delivered half a million more appointments every week than before the pandemic. Over 10% of the population have a GP appointment every single week.

This reflects an ageing population – with a 30% increase in the over 70s since 2010 – and an over 60% increase since 2010 in over 70s who have multiple conditions, making the care we need to offer more complex.

This rise in people coming for care is welcome after we saw a drop off in people accessing the NHS during the pandemic.

But it obviously also adds pressure on capacity. The NHS has around 133,000 staff vacancies and has one third of the number of hospital beds they have in Germany and less than half the average OECD diagnostic capacity.

This makes the progress of staff over these 12 months all the more impressive.

On mental health we have a world-leading talking therapies programme and have rolled out mental health support teams in schools ahead of schedule. We are experiencing huge growth in the numbers of people presenting with mental health conditions, often severe. The growth in demand is particularly evident amongst the young.

The 62-day cancer backlog fell, while the number of patients waiting more than 18 months for elective treatment fell to just 10,737 – down by more than 90% from 124,911 in September 2021. The NHS is now referring over 25% more patients for cancer tests than pre the pandemic and has rolled out greater testing and screening, for instance for lung cancer and bowel cancer. Our war on cancer remains a key priority.

Progress on the backlog has continued apace since, with the backlog falling overall during October and November. The waiting lists remain a huge challenge, but we have reduced longer period waits and I am confident, absent industrial action, that we can make substantial further progress in reducing the lists further. Over 80% of the list does not require surgery but rather diagnostic tests or screening or other outpatient engagement.

These achievements have been a result of hard work but are also a result of NHS innovation. The NHS has to keep adapting, putting in place building blocks for the future.

Over 100 community diagnostic centres now exist across England, offering people easy and convenient access to tests, checks and scans.

We’re also beginning to see the potential of AI cancer checks that will not only speed up care but save clinical time and money.

While just a few years ago patients would have had to go to a GP to pick up their prescription, now patients can access these at a touch of a button on the NHS app.

And extensive work, engagement and negotiation over 2022/23 meant that in July 2023, we were able to publish the first NHS Long Term Workforce Plan, with government backing, to plug the staffing gaps we have but also meet the needs of a growing and changing population.

These are just a small sample of the progress the NHS has made.

The NHS is dealing with exponential demand growth from population increases and ageing, and from our brilliant academic medical researchers identifying ever more ways the human condition can go wrong and the ways to treat them. This demand growth is met by a system with insufficient capacity whether workforce or beds or diagnostics. And yet the sheer scale of healthcare provision by the NHS is truly amazing and the range and depth of what is provided today would have been unthinkable ten or fifteen years ago, never mind in 1948. But what is frequently missed is the level of innovation in medicines and drugs, in medtech, in technology and data. The NHS today innovates continuously but has so much more to do in so many areas. The NHS remains one of the most efficient health services but also needs continuously to improve. The pressures are huge, and the system sometimes falls short of what both the public and our colleagues expect of it, but the commitment to serve remains clear across and throughout the NHS.

So, I would like to thank all NHS staff for their hard work and courage over the past year. Not only have they managed unprecedented levels of demand, but they have also made improvements in the way the NHS works.

Richard Meddings CBE, Chair of NHS England.