Hard-won NHS gains at risk amid growing concerns of cuts to services

NHS leaders have called for political backing to make difficult decisions in the year ahead in order protect and build on recent progress amid growing financial pressures.

This follows a demanding year for the NHS which has delivered hard-won gains on many fronts including cutting waiting times, meeting tough efficiency targets and improving public satisfaction - all during a turbulent year culminating in the appointment of a new secretary of state for health and social care.

A new report by The NHS Alliance, based on extensive survey and interview feedback from local NHS leaders, highlights major improvements in the past year despite rising demand for healthcare, constrained finances and industrial action.

But despite NHS organisations continuing to improve productivity and cut waste while meeting rising demand (particularly for mental health services), the report highlights widespread concerns about the need to make further efficiency savings. NHS leaders are worried about the impact this will have on patient care, staff morale and knock on risks to the ambition to deliver more care outside of hospitals and in the community.

Local NHS leaders are warning of difficult trade-offs and choices which will be needed this year, and they fear further industrial action and rising inflation levels could exacerbate the challenges further.  
Key findings from the survey include:

•           76% of trust and ICB respondents said finances would be even tougher this year (2026/27) than last year.
•           64% said they expected to cut or reduce services this year.
•           57% expected to reduce clinical staffing this year.
•           64% said that they were concerned about patient experience this year. 
•           83% were worried about the impact of financial measures this year on planned care, and 78% were worried about the effect on emergency care.
•           93% said they were worried about staff morale this year.

Responses from GP leaders showed similar concerns, confirming growing pressure for cuts in clinical staff services. Nearly all (96%) GP respondents were worried about the impact of financial measures this year on on-the-day access, with a growing proportion (91%) expressing concerns over routine and proactive care, and 91% worried about staff morale.

There are also concerns that the focus on financial balance and hitting key waiting time targets will continue to impede progress when it comes to delivering more care outside of hospitals, increasing community based, preventative mental healthcare and building capacity in primary care. 

One trust chief executive said: "The overriding focus on finance at the expense of patients and particularly staff will have repercussions."
Another said: "NHS services are being asked to make deep cuts across the board. At some point there will be consequences that will be felt by patients and their families."

The NHS Alliance, formed from the recent merger of NHS Providers and the NHS Confederation, brings together leaders from across the health and care system. Its chief executive Sir Ciarán Devane said:

 "In the last year the NHS has pulled off a remarkable double – improving performance at a time of growing demand, and balancing budgets in the face of relentless and often unpredictable pressures such as strike action. 

"In many ways, the NHS is starting to turn a corner. Not only are key waiting time targets starting to be met, but public satisfaction is climbing after a long period of decline. We know we have a long way to go but these are significant achievements given all the challenges NHS staff have faced.

 "But our survey and interviews also show that the focus on targets and delivering record efficiency savings have come at a cost, with many hard-won gains now at risk. Local NHS leaders point to likely service closures and job cuts this year, as well as deteriorating staff morale.

"They are also concerned that the government's well supported ambitions to move more care into the community will be derailed if short-term measures are prioritised and cash savings are not recycled into funding reform.

"The threat of continued industrial action and the prospect of inflationary pressures caused by conflict in the Middle East will only make matters worse.

"Local NHS leaders are determined to achieve the goals of the 10-Year Health Plan, but they want political backing to make difficult decisions, particularly when it comes to reconfiguring local services where there may be opposition from the public to some much-needed changes. If the NHS is to continue to make inroads in improving services and slashing waiting lists, they are adamant that the government’s support for local autonomy and ministerial restraint, including the shift away from bureaucratic micromanagement of the NHS, must not be lost.

"NHS leaders across the system need financial support to mitigate the impact of additional pressures such as rising inflation and industrial action – costs that are not factored into the 2026/27 budget. Finally, they believe political and national leaders can help by being clear and consistent about what the NHS needs to achieve this year - balancing financial imperatives, improving performance, and transforming the way care is delivered."