Dealing with winter pressures now: strategies from a former NHS COO

Winter now arrives in September for the NHS. But what do you do when it’s already December and pressures continue to mount – testing urgent and emergency care services to their limits?

You know the pattern well, but how do you deal with rising demand, stretched capacity, and ambulance delays stacking up at the door?

“National standards have been under immense pressure and a huge dip in performance over winter months will result in a mountain to climb for Trusts trying to catch up on performance.” Explains Jez Tozer, Prism CEO and former NHS COO.

But these aren’t isolated problems. They cascade through the entire system—12-hour A&E waits become the norm, patients receive care in corridors, and elective procedures are cancelled, creating a ripple effect that impacts care quality for months to come.

“Trusts don’t want to be in a place where patient safety and ability to provide quality service diminishes rapidly.” Continues Jez.

The question isn’t whether winter will challenge your trust. It’s whether you’ll be ready to meet those challenges head-on

Beyond Firefighting: Building True Operational Resilience

Many trusts find themselves in perpetual firefighting mode each winter, applying temporary fixes that barely hold until spring. According to Jez, “demand on staff time increases and the ability to ‘do the job’ disappears” in winter. But what if winter pressures could become an opportunity—a catalyst for sustainable improvements that strengthen your operations year-round?

This is where strategic consultancy support makes the difference.

How the Right Consultancy Partner Transforms Winter Preparedness

Prism Improvement brings more than additional hands-on deck. We bring external expertise, proven methodologies, and the operational leadership that allows your permanent executives to focus on strategic priorities while we manage the immediate pressures.

Our approach delivers across five critical areas:

Operational Excellence
- Implementing same-day emergency care (SDEC) pathways that divert patients from unnecessary inpatient admission
- Redesigning patient flow processes to eliminate bottlenecks and reduce length of stay
- Creating sustainable systems, not temporary workarounds
Workforce Solutions
- Designing flexible staffing models that adapt to demand fluctuations
- Developing bank staff frameworks that ensure consistent quality of care
System Integration
- Establishing discharge-to-assess pathways that free up beds faster
- Implementing virtual ward models that extend capacity beyond your physical walls
Strategic Planning
- Conducting comprehensive winter preparedness assessments
- Developing resilience plans that anticipate pressure points before they become crises
Change Management
- Embedding cultural change that supports new ways of working
- Training staff in lean methodologies and continuous improvement
- Managing stakeholder engagement across complex health systems

What sets Prism apart? We don’t impose off-the-shelf solutions. We take what your UEC providers currently have and build operational resilience around it—driving plans forward despite the pressures, not in spite of them.

“At Prism, we support Trusts with external expertise – it’s not an admission of failure, but proactive supportive actions to see Trusts through tough periods.” Explains Jez.

The Operational Resilience Programme: Your Strategic Winter Partner

Our Operational Resilience Programme provides hospitals with senior executive and operational leadership support precisely when you need it most. This isn’t consultancy at arm’s length—it’s a comprehensive, hands-on intervention.

Core Components:

Experienced Leadership: Senior executives who hit the ground running, managing daily patient flow operations with proven expertise
Command and Control Structures: Bringing clarity and coordination during the most intense pressure periods
Implementation Support: Dedicated resources ensuring winter schemes translate from plans to action
Executive Enablement: Freeing your permanent leadership team to focus on strategic responsibilities

The programme is underpinned by robust governance structures that accelerate decision-making, ensure completion of critical actions, and enable rapid design of new processes to manage patient flow pressures across your organisation.

Prism Improvement Managing Director and former NHS COO, Peter Fry, explains “We’re always told on programmes that staff don’t have the capacity. One thing Prism does is not add to that capacity, but support staff with the tools they need to improve performance and relieve pressure on the Trust – not add to it.”

Proven Results: North West Anglia NHS Foundation Trust

The impact speaks for itself: 91% four-hour performance standard achieved—up from 77.1% baseline.

When North West Anglia NHS Foundation Trust partnered with Prism Improvement, they needed support improving the back section of their patient pathway. The results were transformative:

4-hour performance at programme start: 72%
4-hour performance at programme end: 91%
Performance improvements sustained after Prism’s team departed

Caroline Walker, Chief Executive Officer, captured the value perfectly:

“The team delivered what we needed by bringing additional capacity and holding us to account. The value of bringing in a team meant we were able to build in valuable additional elements such as the work on board rounds and the introduction of a clinical coalition. If possible, it would be great to run a similar model next winter.”

Phil Walmsley, Chief Operating Officer, added:

“The support and capacity the team were able to provide over the Winter period provided a solid foundation as we came out of Winter. Teams felt supported at a critical time and the structure that was created allowed for a daily rhythm which supported patient flow and early decision making at all levels. I joined NWAFT towards the end of PRISM’s involvement here and I was glad to see that they had done a lot of work in getting the trust in to having a strong daily rhythm. I have been impressed with where they have got us to and expect it to stand us in good stead going forward.”

These aren’t just winter survival stories—they’re examples of sustainable transformation that continues benefiting patient flow and operational performance long after the immediate pressures ease.

The Value of Time-Limited, Focused Partnership

Consultancies offer what stretched NHS resources often cannot: time-limited, laser-focused interventions that deliver rapid improvements precisely when they’re needed most.

We bring:

Cross-sector learning from successful implementations across multiple trusts
Specialised expertise in healthcare transformation
Scalable support that flexes up or down based on your needs
Additional capacity without long-term staffing commitments

Our Operational Resilience Programme demonstrates how bringing in additional capacity and accountability creates lasting cultural and operational improvements—establishing daily rhythms and governance structures that serve your trust well beyond winter.

Building Capability, Not Dependency

Success requires genuine partnership. We’re committed to knowledge transfer, ensuring your NHS staff develop the skills and confidence to sustain improvements independently. Our goal isn’t to create long-term dependency—it’s to build internal capability while providing crucial support during peak pressure periods.

When spring arrives, you shouldn’t just breathe a sigh of relief. You should have systems, processes, and a team culture that’s stronger than it was before winter began.

Ready to Transform Your Winter Preparedness?

Winter 2025/26 is here, but it’s not too late to get help. The pressures are predictable—but your response doesn’t have to be reactive.

Contact Prism Improvement today to discuss how our Operational Resilience Programme can help your trust:

Navigate winter pressures with confidence
Achieve sustainable performance improvements
Build operational resilience that lasts beyond the crisis
Support your teams during their most challenging period

Don’t just survive winter—use it as a springboard for lasting excellence.

About Jez Tozer

As the architect of much of the Prism Improvement approach, Jez Tozer founded the company in 2017 following his frustrations with existing performance consultancy firms in the market, who he felt did not always adequately deliver value against the needs of the organisations he worked with. More recently, Jez has also taken the reins of Four Eyes Insight, harnessing the power of their track record in data and analytics to enhance the change that can be delivered across the group.

Originally trained as a pharmacist, Jez then moved into operational management, working in all trust departments from radiology through to A&E, from divisional manager level through to the executive board, and ultimately COO.