(Updated version 14/7)
The NHS Alliance whose report has revealed the threat of brutal cuts to come in the current financial year (2026/27) is the result of a merger.
The NHS Confederation, representing ICBs, trusts, primary care, ‘independent’ and voluntary sector partners in England Wales and Northern Ireland) has merged with the more narrowly focused (and at one time relatively radical) NHS Providers (representing NHS hospital, mental health, community, and ambulance trusts in England).
The major report from the NHS Alliance, Targets and trade-offs, seems to break with recent NHS conventions of evasion and diversion by explicitly talking about the imminent issue of cuts in services. But it turns out the new organisation has brought together the most timid elements of each merging partner.
This was made clear in the limp press release (headlined ‘Hard-won NHS gains at risk amid growing concerns of cuts to services’) that was issued to promote the report. Both the release and report (published in the aftermath of Wes Streeting’s resignation and replacement as Health and Social Care Secretary) were ignored by all of the mainstream media and health sector trade press. The only prominent take-up was by the Nursing Times, which headlined on staff morale rather than the looming threat of cuts.
The lack of impact may be because the press release undermines the impact of its main revelations by cherry picking statistics that seem to show some improvements from the really poor state the NHS was left in by the Tories back in July 2024, rather than emphasising the risk of cuts to come.
But the impact of the Alliance survey is also limited by the lack of any concrete details that could really grab the attention of patients, the wider public or politicians by translating the generic talk of cuts into concrete plans and actions. It is as vague and abstract as the board papers of trusts and ICBs have been for the past several years.
What services have already been cut back or closed, and where? No details are given, even in the most general terms – leaving the obvious question of how the billions in cuts/savings have been delivered.
Have last year’s cuts put the system back into some form of balance? Obviously, the answer to that is ‘No,’ because almost twice as many trusts and ICBs (64%) now say they are expecting to make more, similar cuts this year. So more cuts are coming.
When does the wider public get to know what services have already been cut, and what more is at risk? We may have a long wait before even partial facts emerge. The NHS Alliance clearly lacks either the courage to ask for details, or the bottle to publish any findings they might uncover.
Indeed, it seems from its first report that if the Alliance and its member bodies have their way, we will never know what has gone, what is threatened … and what other “difficult” decisions may be in the pipeline.
Of course, this makes life easier for NHS leaders. If local people (and the staff involved) don’t know what services are affected, they cannot challenge cash-driven decisions, and may well not be aware as gaps in services and inequalities in access to health care widen and deepen.
The Lowdown has flagged up the lack of detail in the published board papers of trusts and Integrated Care Boards, warned that the planned mergers of trusts and ICBs into even larger bodies as proposed in the NHS Modernisation Bill will make the situation worse.
We have raised the alarm over the implications of abolishing Healthwatch bodies locally and nationally (leaving the NHS to mark its own homework and decide which complaints, if any, to respond to) and flagged up concerns on the amount of once-published information that is now concealed from view in closed-door “private” sessions of trust boards and ICBs.
The lack of any information explains why so many services could have been cut so far without public resistance on the scale we have seen in days gone by. The facts have been kept secret, because an ignorant public has no chance to fight back.
Staff and their unions have not been informed of cuts until the last minute; Healthwatch local bodies have been confined to collecting “patients’ experiences;” local councillors and MPs have been kept at arm’s length and fobbed off with bland press releases pointing to minuscule percentage improvements in selective issues – and the system is set to become even more secretive.
GP services – which have never published local plans in the same way as trusts and commissioners once did – seem set to go the same way.
There are other warning signs, indicating skewed priorities. The report shows Trust and ICB respondents are more concerned about delays in planned (waiting list) services (83%) than delays in emergency care (78%) – even though the delays treating the most serious (Type 1) emergency patients have been getting vastly worse.
(Please note this section has been updated and amended on June 15. We apologise for inadvertent errors in the previous version)
Updated Lowdown analysis of NHS figures each May since just before Labour took office in 2024, shows the treatment of patients with the greatest needs has been failing to keep pace with demand.
Numbers of Type 1 A&E patients in England have averaged 1.47m, and numbers of emergency admissions have decreased by 0.5% since May 2024: but the numbers of 12-hour plus trolley waits from decision to admit have increased by 18% – to just over 50,000 in May 2026. And figures showing delays from time of arrival show consistently more than one in four emergency admissions waited over 12 hours, rising to almost 28% in May 2026. The Royal College of Emergency Medicine (RCEM) calculates that:
“the number of patients waiting 12 or more hours in A&E before being transferred, admitted or discharged is the highest of any May on record – at 147,957.”
The RCEM has also warned of another emerging phenomenon: “over a whole year, nearly half a million people (489,138) waited 24 hours or more in EDs.”
The report goes on to warn of the impact on morale (and in too many cases on the mental health) of staff working short-handed, with inadequate resources, clapped out equipment in crumbling buildings.
So when the Alliance report goes on to explore ‘What NHS leaders need in 2026/27’ (p17) it comes as a huge disappointment to find that they are not seeking any reconsideration of policies that are doing long-term damage to the NHS and its staff.
Instead trust and ICB respondents “want backing to make difficult decisions” (i.e. deeper and more visible cuts):
“particularly when it comes to reconfiguring local services where there is likely to be opposition from the public.”
This brings us back to the surprisingly low profile of a report which years ago would have hit media headlines with its warnings over cuts. One explanation is that much of the media seems to have tacitly bought into the idea of a constant funding squeeze on the NHS, and dismissing the concerns and fears of NHS leaders: another is that the journalists have been left as much in the dark on the real situation as the wider public.
The only people who have not come to terms with continued NHS decline is the wider population. They have been systematically starved of the information that would in previous periods have galvanised communities into action – such as previous prolonged campaigns
The NHS Alliance, to live up to the promise of its name, should be not be calling in ministerial reinforcements to drive through more “difficult decisions”, but calling for public support and working with local councillors and MPs, to persuade the government to change course and take action to avert the continued decline of the NHS.
To do that would mean going the extra step to fully admit to the public in every affected area what the consequences of further cutbacks will be: which services, and which staff, and what safety measures are set to be cut to save money … by NHS local leaders who know it is wrong, but lack the courage to say so or take a stand.
__________________
* If Lowdown readers have any information on local planned cuts and their impact, please share with us, if need be on a confidential basis, so we can help to publicise the situation and forewarn health workers, patients and the public.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
(Updated version 14/7)
The NHS Alliance whose report has revealed the threat of brutal cuts to come in the current financial year (2026/27) is the result of a merger.
The NHS Confederation, representing ICBs, trusts, primary care, ‘independent’ and voluntary sector partners in England Wales and Northern Ireland) has merged with the more narrowly focused (and at one time relatively radical) NHS Providers (representing NHS hospital, mental health, community, and ambulance trusts in England).
The major report from the NHS Alliance, Targets and trade-offs, seems to break with recent NHS conventions of evasion and diversion by explicitly talking about the imminent issue of cuts in services. But it turns out the new organisation has brought together the most timid elements of each merging partner.
This was made clear in the limp press release (headlined ‘Hard-won NHS gains at risk amid growing concerns of cuts to services’) that was issued to promote the report. Both the release and report (published in the aftermath of Wes Streeting’s resignation and replacement as Health and Social Care Secretary) were ignored by all of the mainstream media and health sector trade press. The only prominent take-up was by the Nursing Times, which headlined on staff morale rather than the looming threat of cuts.
The lack of impact may be because the press release undermines the impact of its main revelations by cherry picking statistics that seem to show some improvements from the really poor state the NHS was left in by the Tories back in July 2024, rather than emphasising the risk of cuts to come.
But the impact of the Alliance survey is also limited by the lack of any concrete details that could really grab the attention of patients, the wider public or politicians by translating the generic talk of cuts into concrete plans and actions. It is as vague and abstract as the board papers of trusts and ICBs have been for the past several years.
What services have already been cut back or closed, and where? No details are given, even in the most general terms – leaving the obvious question of how the billions in cuts/savings have been delivered.
Have last year’s cuts put the system back into some form of balance? Obviously, the answer to that is ‘No,’ because almost twice as many trusts and ICBs (64%) now say they are expecting to make more, similar cuts this year. So more cuts are coming.
When does the wider public get to know what services have already been cut, and what more is at risk? We may have a long wait before even partial facts emerge. The NHS Alliance clearly lacks either the courage to ask for details, or the bottle to publish any findings they might uncover.
Indeed, it seems from its first report that if the Alliance and its member bodies have their way, we will never know what has gone, what is threatened … and what other “difficult” decisions may be in the pipeline.
Of course, this makes life easier for NHS leaders. If local people (and the staff involved) don’t know what services are affected, they cannot challenge cash-driven decisions, and may well not be aware as gaps in services and inequalities in access to health care widen and deepen.
The Lowdown has flagged up the lack of detail in the published board papers of trusts and Integrated Care Boards, warned that the planned mergers of trusts and ICBs into even larger bodies as proposed in the NHS Modernisation Bill will make the situation worse.
We have raised the alarm over the implications of abolishing Healthwatch bodies locally and nationally (leaving the NHS to mark its own homework and decide which complaints, if any, to respond to) and flagged up concerns on the amount of once-published information that is now concealed from view in closed-door “private” sessions of trust boards and ICBs.
The lack of any information explains why so many services could have been cut so far without public resistance on the scale we have seen in days gone by. The facts have been kept secret, because an ignorant public has no chance to fight back.
Staff and their unions have not been informed of cuts until the last minute; Healthwatch local bodies have been confined to collecting “patients’ experiences;” local councillors and MPs have been kept at arm’s length and fobbed off with bland press releases pointing to minuscule percentage improvements in selective issues – and the system is set to become even more secretive.
GP services – which have never published local plans in the same way as trusts and commissioners once did – seem set to go the same way.
There are other warning signs, indicating skewed priorities. The report shows Trust and ICB respondents are more concerned about delays in planned (waiting list) services (83%) than delays in emergency care (78%) – even though the delays treating the most serious (Type 1) emergency patients have been getting vastly worse.
(Please note this section has been updated and amended on June 15. We apologise for inadvertent errors in the previous version)
Updated Lowdown analysis of NHS figures each May since just before Labour took office in 2024, shows the treatment of patients with the greatest needs has been failing to keep pace with demand.
Numbers of Type 1 A&E patients in England have averaged 1.47m, and numbers of emergency admissions have decreased by 0.5% since May 2024: but the numbers of 12-hour plus trolley waits from decision to admit have increased by 18% – to just over 50,000 in May 2026. And figures showing delays from time of arrival show consistently more than one in four emergency admissions waited over 12 hours, rising to almost 28% in May 2026. The Royal College of Emergency Medicine (RCEM) calculates that:
“the number of patients waiting 12 or more hours in A&E before being transferred, admitted or discharged is the highest of any May on record – at 147,957.”
The RCEM has also warned of another emerging phenomenon: “over a whole year, nearly half a million people (489,138) waited 24 hours or more in EDs.”
The report goes on to warn of the impact on morale (and in too many cases on the mental health) of staff working short-handed, with inadequate resources, clapped out equipment in crumbling buildings.
So when the Alliance report goes on to explore ‘What NHS leaders need in 2026/27’ (p17) it comes as a huge disappointment to find that they are not seeking any reconsideration of policies that are doing long-term damage to the NHS and its staff.
Instead trust and ICB respondents “want backing to make difficult decisions” (i.e. deeper and more visible cuts):
“particularly when it comes to reconfiguring local services where there is likely to be opposition from the public.”
This brings us back to the surprisingly low profile of a report which years ago would have hit media headlines with its warnings over cuts. One explanation is that much of the media seems to have tacitly bought into the idea of a constant funding squeeze on the NHS, and dismissing the concerns and fears of NHS leaders: another is that the journalists have been left as much in the dark on the real situation as the wider public.
The only people who have not come to terms with continued NHS decline is the wider population. They have been systematically starved of the information that would in previous periods have galvanised communities into action – such as previous prolonged campaigns
The NHS Alliance, to live up to the promise of its name, should be not be calling in ministerial reinforcements to drive through more “difficult decisions”, but calling for public support and working with local councillors and MPs, to persuade the government to change course and take action to avert the continued decline of the NHS.
To do that would mean going the extra step to fully admit to the public in every affected area what the consequences of further cutbacks will be: which services, and which staff, and what safety measures are set to be cut to save money … by NHS local leaders who know it is wrong, but lack the courage to say so or take a stand.
__________________
* If Lowdown readers have any information on local planned cuts and their impact, please share with us, if need be on a confidential basis, so we can help to publicise the situation and forewarn health workers, patients and the public.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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