Nearly two-thirds of NHS organisations expect to cut or reduce services this year, with more than half also planning to slash clinical staff, according to a stark new survey that points to a deepening financial crisis across the health service.
The poll, conducted by the NHS Alliance – the body formed from the merger of NHS Providers and the NHS Confederation and officially launched in April 2026 – surveyed 187 leaders of NHS trusts and integrated care boards (ICBs). It found that 64 per cent anticipate service cuts and 57 per cent expect to reduce clinical staff numbers. Three-quarters (75 per cent) believe financial pressures will worsen in the 2026/27 financial year, with the NHS Alliance warning that the health service’s “hard-won gains” are now at risk.
The survey also revealed deep unease about the impact on patients and staff. Some 64 per cent of leaders said they were concerned about patient experience, while 83 per cent expressed worry about the effect of financial measures on planned care. More than nine in ten (93 per cent) said they were concerned about staff morale. In a separate poll of 48 GP leaders, almost all (96 per cent) said they were worried about the impact of financial measures on day-to-day patient access. The NHS Alliance also carried out 65 interviews with trust finance directors over the past year.
The findings come against a backdrop that NHS Providers chief executive Sir Julian Hartley described in September 2024 as the “longest and deepest squeeze in NHS financial history”. Imperial College Healthcare NHS Trust noted in April 2025 that an additional £22 billion allocated nationally had been largely absorbed by pay awards and inflation, forcing trusts to cut spending by 1 per cent and increase productivity by 4 per cent. The government’s Spring Budget 2024 announced a £3.4 billion investment in technology from 2025/26, with the aim of achieving £35 billion in cumulative productivity savings by 2029/30.
Despite those efforts, Sir Ciaran Devane, chief executive of the NHS Alliance, said that while the NHS had pulled off a “remarkable double” – improving performance while balancing budgets and meeting key waiting time targets – the focus on targets and delivering record efficiency savings had come at a cost. “Many hard-won gains are now at risk,” he said, pointing to likely service closures and job cuts as well as deteriorating staff morale.
One trust chief executive told the survey: “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” and warned that “at some point there will be consequences that will be felt by patients and their families”.
Sir Ciaran also highlighted external pressures threatening to worsen the situation. He said inflationary pressures caused by conflict in the Middle East, as well as the threat of strikes, “will only make matters worse”. NHS England chief executive Sir Jim Mackey has separately warned that escalating conflict, particularly involving Iran, could trigger a significant financial shock for the NHS due to disruption to global supply chains and rising costs for medicines, equipment and energy – around 75 per cent of medicines used in the UK are imported.
The survey was released after the government and NHS England met a key target on waiting times for treatment. Hours later, Wes Streeting resigned as Health Secretary and was replaced by James Murray, formerly Chief Secretary to the Treasury, who has said he intends to continue Streeting’s “brilliant work”.
Industrial action continues to loom. The British Medical Association (BMA) has begun balloting senior doctors – consultants and SAS doctors – on industrial action over pay and conditions. The BMA says consultants’ pay has fallen by around 26 per cent in real terms since 2008/09, and SAS doctors have seen a 23.4 per cent real-terms pay cut over the same period, with the recent 3.5 per cent pay award for 2026/27 considered insufficient to reverse the trend. The union is calling for more protected time for consultants to focus on innovation and teaching, a reduction in standard hours, and better recognition for out-of-hours work. Resident doctors also currently have a mandate to strike until August.
Sir Ciaran called for greater support for local NHS leaders. “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,” he said. “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.” He added that political and national leaders could help by being clear and consistent about what the NHS needs to achieve this year: balancing financial imperatives, improving performance, and transforming care. He also warned that the government’s well-supported ambitions to move more care into the community would be derailed if short-term measures are prioritised and cash savings are not recycled into funding reform.
A Department of Health and Social Care spokesperson acknowledged the challenges but said the government had supported the health service with “record investment, boosted productivity, and driven improvements in tech”. They pointed to waiting lists being at their lowest level in more than three years, with over half a million fewer people waiting for treatment since July 2024. They also highlighted the expansion of community diagnostics, surgical hubs and GP appointments to get patients seen faster.
NHS England is focusing on technology and digital innovation to drive productivity gains, aiming for annual improvements of 2 per cent funded through the current Spending Review settlement. Evidence suggests that providers fully connected to core NHS App services have seen a 2.5–3 per cent improvement in waiting list performance. Electronic patient record (EPR) systems are also seen as a key driver: Imperial College Healthcare NHS Trust, for example, reported an 80 per cent reduction in paper-based outpatient records after implementing an EPR system.
On diagnostics, the government has allocated £237 million for new and expanded Community Diagnostic Centres (CDCs), with four new centres set to open in Gorton, Luton, Boston and Bideford, and 32 existing centres being expanded. However, the Society of Radiographers has raised concerns about the availability of staff to operate these new facilities, emphasising the need for a comprehensive workforce plan.
The NHS met its March 2026 referral-to-treatment (RTT) target, with 65.3 per cent of patients seen within 18 weeks – the first time since November 2021 that the 65 per cent threshold has been reached. The overall waiting list has shrunk by more than half a million since July 2024, falling to its lowest point since summer 2022. Interim targets for cancer care and A&E waiting times have not been fully met, and the long-term goal is to restore the RTT target to 92 per cent of patients seen within 18 weeks by 2029.
The DHSC spokesperson said the government would “continue working closely with system leaders to improve productivity, cut waste and reinvest in frontline care so patients benefit from faster, higher-quality services”.