Hospitals in England are cutting staff, closing services and planning to ration care in order to make “eye-watering” savings demanded by NHS bosses.
Rehabilitation centres face being shut, talking therapies services cut and beds for end-of-life care reduced as part of efforts by England’s 215 NHS trusts to comply with a “financial reset”.
Sir Jim Mackey,NHSEngland’s new chief executive, has ordered them to make unprecedented savings during 2025-26 to avoid a projected £6.6bn deficit becoming a reality.
But trust bosses are warning that delivering what for some equates to 12% of their entire budget in “efficiency savings” will affect patients and waiting times.
“These [savings targets] are at eye-wateringly high levels”, said Saffron Cordery, the interim chief executive of NHS Providers, which represents trusts. “It’s going to be extremely challenging.”
Trusts have to make, in some cases, deep cuts in order to stay in the black this year, despite the government having given the NHS an extra £22bn for last year and this one.
A survey it conducted among trust leaders found that diabetes services for young people and hospital at-home-style “virtual wards” were among the areas of care likely to be scaled back.
Trusts are planning to shrink their workforce by up to 1,500 posts each to save money, even though they fear that could damage the quality or safety of care provided.
Cordery said the looming cuts were so significant that the prime minister, Keir Starmer, and health secretary, Wes Streeting, may not be able to fulfil promises to revive the NHS, such as pledges to improve waiting times for diagnostic tests, surgery and A&E care.
“We’ve got the narrative of the ‘three shifts’ … and those are driving the decisions that the government is making, alongside the imminent delivery of the [NHS] 10-year plan and pressures on transforming the NHS for the future,” she said.
“But we’ve got to question whether those are compatible with the needs of delivering the financial recovery and for trusts to really meet the operational challenges they face.”
Ministers would have to explain to the public that trusts were having to make potentially unpopular decisions about staff numbers and what services they provided as a result of Mackey’s financial “reset”, and defend their decisions, Cordery added.
“Politicians are going to have to give trusts air cover locally and nationally when they need to make some changes, because even if trusts aren’t cuttings services or closing services, they may well be moving services.”
The survey of 160 senior figures from 114 trusts found that:
47% were cutting services and another 43% were considering doing so.
37% were cutting clinical posts and a further 40% may follow suit.
26% were closing some services and 55% more may do so.
“These findings show that trust leaders are having to think the previously unthinkable in terms of cutting posts. These include clinical roles,” said Cordery.
“We are already seeing cutbacks in temporary and ‘bank’ staff, including doctors, nurses, healthcare support workers and allied health professionals that could include physios and other types of therapists.”
In a recent update to staff, the boss of the Barking, Havering and Redbridge trust in east London, Matthew Trainer, warned that making £61m of savings this year – double last year’s £30m total – would be “painful”, especially given the rising demand for care and need to improve waiting times.
The trust is cutting 115 posts in corporate services to save £7.5m and slashing the number of shifts it gives “bank” and agency staff by more than a third as part of an attempt to cut its wage bill by £40m.
Having fewer staff on duty could have “adverse effects on patients”, Trainer acknowledged. “We will mitigate any risks to patients as best we can and ensure we continue to have properly skilled clinical staff delivering good quality care to the patients that need it”, he said.
A second trust chief executive, who has to save £16m this year, said: “At the moment I don’t know how I’m going to do it.”
A third echoed Trainer’s concern that staff cuts could endanger patients. “Last year the [NHS’s] combined deficit was £200m. I recognise that this is unaffordable and cannot continue. But it’s really difficult to find a way to protect safe care to patients … and to [also] deliver the financial efficiencies.”
A Department of Health and Social Care spokesperson said: “We invested an extra £26bn to fix the broken health and care system we inherited, and through our plan for change, are determined to tackle inefficiencies and drive up productivity in the NHS.
“We have underlined the need for trusts to cut bureaucracy to invest even further in the frontline, so we can support hard-working staff and deliver a better service for patients and taxpayers’ money.”