1/21 Parliament votes on the new tiered restctions on Tuesday. A lot of comment in today’s papers on what’s happening in the hospital sector. Important questions on NHS capacity, demand, preparedness, Nightingales etc. Thread below sets out NHS hospital trust perspective.

2/21 Have deliberately concentrated in thread on hospitals as this is where current public debate ahead of Tuesday’s vote is. But many of same issues apply to community, mental health and ambulance trusts, all of whom are under the same current level of pressure as hospitals.

3/21 Running a hospital at the moment is much more complex & difficult than normal due to COVID-19. That often doesn’t show up in usual national data that some are currently quoting (e.g. NHS capacity levels below last year / not under real pressure so where's the problem?)

4/21 Remember pre-covid starting context. NHS already had large demand supply mismatch. Insufficient hospital beds. 100,000 staff vacancies. Despite frontline efforts, worst A&E/elective surgery performance in a decade. Huge overstretch in winter (late Dec-Feb) for last 5 yrs.

5/21 COVID-19 then made task massively more difficult in number of ways. Need to treat three sets of patients - COVID-19; planned care with urgent/important backlog cases from first phase of covid that simply can’t wait any longer; and usual emergency patients needing treatment.