A report from The King’s Fund argues that the government and public will need to be realistic about the extent to which current services can be improved in the short term.
As finances tighten, NHS are cutting services such as patient transport, holding down workforce costs by freezing recruitment and reducing agency staffing, and reducing investments in public health services such as health visiting and school nurses.
Researchers from The King’s Fund health and care charity have spoken to NHS leaders in England to understand the decisions being driven by tight finances and published a study on the reality of an NHS living within its financial means.
Despite sustained real-terms increases in the NHS budget, rising demand for care and treatment driven by a sicker population have left the health service. An additional £22.6 billion in NHS funding was announced in the 2024 Autumn Budget, yet the first iteration of financial plans for 2025/26 showed a significant financial deficit of £6.6 billion for NHS systems.
At the same time, as Healthcare Today reported in January, NHS England’s maintenance backlog has increased to around £800 million a year.
“Our research shows how challenging it is to keep running high-quality services when budgets can’t keep pace with demand. It underlines just how difficult it will be to deliver much-needed reforms while also expecting rapid improvements to current services, said Siva Anandaciva, director of policy at The King’s Fund.
A time for realism
With the NHS unlikely to get a major funding boost in the current economic context, the report authors conclude that it will not be possible for the health service to do everything that might be asked or expected of it. The researchers argue that the government and public will need to be realistic about the extent to which current services can be improved in the short term while also delivering fundamental reforms that would make for a sustainable health service in the long term.
“The government’s ambition to deliver major reform for the NHS has never been more needed. To achieve that goal, ministers have previously said they will need to make tough trade-offs. Now is the time for realism about what can be achieved in the current financial envelope, and clarity about how the NHS should prioritise funding to deliver reforms versus maintaining the services people are currently using every day,” said Anandaciva.
The authors recommend that NHS trusts are set multi-year budgets instead of the current annual approach. They argue that greater funding certainty would help NHS leaders mitigate the risk of in-year financial pressures adversely impacting patient care.
