Looking ahead, 2026 is set to be another tough year. 

At the time of writing there looked little sign of a breakthrough in the damaging dispute between Government and resident doctors. While the two sides seem to be close to agreement on jobs they remain miles apart on pay. 

With the BMA's strike mandate coming to an end this month, members are being re-balloted over further action but early signs suggest there is no mood for compromise with turnout up during the walkout in December and the ballot result expected in February. 

Meanwhile, some NHS trusts are showing increasing strain in attempting to balance the books with jobs and beds being cut in a bid to reduce deficits. 

There will be no time for breath as the Government strives to meet targets for elective care in March 2026 and NHS abolition in April 2027. 

In addition, social care remains in urgent need of attention as we await the first findings of the Casey Commission this year. 

All this raises the stakes for solutions in the forthcoming NHS workforce plan to help progress the three shifts: hospital to community; analogue to digital; and sickness to prevention. 

Shifting funding flows leftwards through carrot and, if necessary, a bit of stick will be essential to speeding up the transfer from a doom loop to a virtuous cycle.