I have been working in intensive care for over 20 years, including a decade as a consultant, and facing winter pressures has always been the norm. However, the past 18 months have been something else.

During the winter peak of the covid-19 pandemic in the UK, intensive care units (ICUs) in many regions were managing double the number of beds compared to their normal baseline.

To do this safely, the intensive care community massively increased their working hours by reducing leave, staying late, and working on rest days.

This was supported by uplifts in the acute medical specialties whose contribution has been invaluable.

This was not enough, and hospital trusts were forced to delay non-elective work so that non-ICU staff could be redeployed to provide support.

This still was not enough, so available beds in alternative and occasionally distant hospital trusts were used flexibly with the introduction of mutual aid and regional transfer services.

The whole country also ground to a halt, reducing the transmission of COVID-19 and the number of hospitalisations.

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