NHS leaders are calling for clear political backing to help them make increasingly difficult decisions in the year ahead, as growing financial pressures threaten to stall – or reverse – recent progress across the health service.
The warning follows a demanding year for the NHS, which has nevertheless delivered hard‑won improvements on multiple fronts. These include reducing waiting times, meeting stringent efficiency targets and improving public satisfaction, all against a backdrop of rising demand, industrial action and political change, culminating in the appointment of a new Secretary of State for Health and Social Care.
A new report from The NHS Alliance, drawing on extensive survey responses and in‑depth interviews with local NHS leaders, highlights the scale of progress made over the past year despite constrained finances and sustained operational pressure.
However, the report also underlines growing concern about what lies ahead. While NHS organisations have continued to improve productivity and reduce waste while meeting rising demand, particularly in mental health services, leaders warn that the requirement to deliver further record efficiency savings risks undermining patient care and staff wellbeing.
Many leaders fear the impact of additional savings on:
- Patient experience
- Staff morale
- The ambition to shift care out of hospitals and into the community
There is also concern that continued focus on financial balance and headline waiting time targets may slow progress on preventative care, community mental health services and capacity in primary care.
Local leaders warn that the year ahead will require difficult trade‑offs, with risks compounded by the potential for further industrial action and persistently high inflation.
The NHS Alliance survey paints a stark picture of sentiment across trusts and Integrated Care Boards (ICBs):
- 76% of trust and ICB respondents said finances would be even tougher in 2026/27 than the previous year
- 64% expected to cut or reduce services this year
- 57% anticipated reducing clinical staffing
- 64% said they were concerned about patient experience
- 83% were worried about the impact of financial measures on planned care, and 78% on emergency care
- 93% said they were worried about staff morale
Responses from GP leaders echoed these concerns. Almost all GP respondents (96%) said they were worried about the impact of financial measures on same‑day access, while 91% expressed concern about routine and proactive care, and the same proportion about staff morale.
Sir Ciarán Devane, Chief Executive of the NHS Alliance, 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 need support. 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.
"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. And, 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."
Taken together, the findings underline a growing consensus among NHS leaders that continued progress will be difficult without political support for tough, sometimes unpopular decisions.
Leaders are clear that the NHS can continue to improve productivity and modernise care delivery – but warn that without realistic financial settlements and political cover, the risks to staff, patients and long‑term reform are rising.
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