The Lowdown has, for some time, been asking questions about how plans to make savings have affected staff and services during 2025/6. Now, according to a recent report from the NHS Alliance, it seems an even tighter financial squeeze, with bigger and potentially more damaging cuts, is on the way in many areas for 26/27.
The report is largely based on a March survey of leaders of trusts, ICBs and GP services, of whom 235 responded (187 from trusts and ICBs, the remainder from General Practice).
It begins by reminding us of the huge cash savings target set by NHS bodies. Indeed, NHS England itself in May last year noted:
“Delivering against plans will be challenging. The Planning guidance sets ambitious productivity and performance goals for the NHS, but provides no additional funding to cover rising demand or activity. […] systems must collectively deliver £11.0 billion in efficiencies – 7.1% of total allocation – compared to the £8.7 billion achieved in 2024/25.”
The Alliance also points out that near the end of the financial year, more than a quarter (26%) of trusts and ICBs were “not at all confident” of meeting their targets for 2025/26.
Moreover, to make matters worse:
“many finance directors reported that a large portion of their savings targets were likely to be met via non-recurrent measures … with issues being deferred rather than resolved, exacerbating the challenge for 2026/27.”
The point is rubbed home with the near-unanimous finding that
“this year is likely to be even harder. 97 percent of trust and ICB respondents [and all of the replies from General Practice] said that the scale of the financial challenge would be at least the same as 2025/25, if not larger.”
86% thought it would be harder again this year to make further savings through ‘cost improvement plans’ (CIPs).
And there are particular concerns that mental health (for which demand is still growing rapidly) is not being sufficiently prioritised or realistically funded.
Apparently, more than a third (35%) of trust and ICB replies admitted that their organisation had reduced or closed services in 2025/26. This is in stark contrast to the near-universal denials from most NHS bodies last year that their large-scale cost-saving plans would impact patients.
Moreover, now almost twice as many (64 per cent) of trusts and ICBs say they expect to reduce or close services in 2026/27. And the survey warns:
“There is also a greater likelihood that services will be redesigned: 61 per cent redesigned services in 2025/26 but 87 per cent suggested it is likely for 2026/27.”
“Redesign” in many previous waves of austerity has too often been an evasive way of describing the centralisation and selective closure of services.
But it’s not just hospitals at risk. GP services are also being cut back more heavily this year. One in six (16%) of replies said GP services had been cut or closed last year: but more than twice as many (39%) said that more cuts are likely in 2026/27, while almost two-thirds (65%) say they would have to cut routine and proactive primary care.
The trusts, ICBs and GP leaders all know these cuts will hit patients. That’s why almost two-thirds (64%) of trust and ICB replies, and almost three-quarters (74%) of GP respondents say they are concerned about delivering a poorer patient experience this year.
One reason why the patient experience is likely to be worse is further reduction in staff numbers, with 57% of trusts and ICBs expecting to cut clinical staff, and a massive 88% expecting to axe non-clinical staff, the team who keep the ‘front line’ services rolling.
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