Thread by @HSJnews

Amanda Pritchard, chief executive of NHS England, is about to give evidence at the Covid Inquiry on the impact of the pandemic on healthcare systems

Ms Pritchard said there is "no doubt" that smaller organisations such as those in primary care struggled in the pandemic and therefore may have moved towards larger-scale structures "more quickly" due to pandemic pressures

Asked if we are in any better position now were there to be a pandemic in the next few months compared to 2019, Ms Pritchard said there are "some things that put us in a stronger position" such as a "much more sophisticated data infrastructure"

Jacqueline Carey KC, Counsel to the Inquiry, asked if NHSE is on track to deliver six of the new hospitals in the NHP by 2025.

Ms Pritchard did not answer the question but said the government have had to review the programme "a number of times"

"There are service interruptions every day because bits of the NHS estate fail," Ms Pritchard said

In a letter sent to NHS staff on 29 April 2020, NHSE urged the restarting of some non-urgent elective care

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Some organizations "had really struggled to maintain those non-urgent services", Ms Pritchard said, because "they didn't have the resilience, particularly in staffing, to be able to run multiple things at once, and had had to put all their effort into responding to Covid"

A further letter in July 2020 asked NHS staff to re-establish in September at least 80% of last year’s activity for both overnight electives and for outpatient/daycase procedures, rising to 90% in October

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Jacqueline Carey KC said @NHSConfed described the letter as being extremely challenging, naive, unachievable and ultimately demotivating

@NHSConfed Ms Pritchard said that while it is "really important" to recognise the pressure that staff were under, "the NHS is fundamentally here for patients"

@NHSConfed In July 2020, NHSE sought 10,000 non-temporary beds to deal with recovery and potential future surges.

The request was rejected by the Treasury and Boris Johnson's private office

@NHSConfed Ms Pritchard said this was "very disappointing" and that "we could be in a very different position now on elective recovery" if the NHS had had that extra capacity

The NHS was "very close" to running out of beds in particular hospitals and regions during wave two of the pandemic, Ms Pritchard said, adding that the peak of demand and level of pressure was "completely terrifying" at times

The total cost of the Nightingale hospitals was £358,457,185, though they were "very little used" to treat Covid patients, Ms Carey KC said.

But Ms Pritchard said the hospitals were a useful resource that was available to the NHS

There is still no central inventory of how many ventilators the NHS has, Ms Pritchard said, adding that there are "plans to create one"