We considered whether officials were planning on the basis of realistic assessments of future demand for healthcare or whether they were being too optimistic. NHSE&I told us that there was lots of risk and uncertainty in the NHS at present because of missing patients and the rate at which they might return but it agreed to do all it could to plan realistically.48 But it also focused mostly on optimistic scenarios for the future. It told us that if demand was “at the better end of the spectrum” and it “did not have disruptions like those we are going to potentially have in the next few weeks” then the NHS would have “a really good run” at reducing waiting lists.49 We asked whether enough long-term resilience was being put in place to deal with known and unexpected risks. NHSE&I told us that one of the biggest known risks was annual winter disruption to elective care and that it was working to address this in the current planning process. Longer-term resilience would be underpinned by a workforce of the right size, the right estate and capital support, and digital transformation, as well as necessary reforms to social care.50