Tejal Somvanshi
The NHS faces cutting thousands of jobs and reducing patient services despite receiving a £22 billion funding increase over two years. A projected £6.6 billion deficit for 2025-26 has forced health leaders to demand “efficiency savings” of up to 12 % from all 215 NHS trusts in England.
A survey of 160 senior executives across 114 trusts reveals the scale of the problem. 36 % have already cut clinical posts, while 86 % are trimming non-clinical teams in areas like HR, finance, and digital services. More worryingly, over 25 % plan to close at least one patient service, with nearly half scaling back frontline care.
Saffron Cordery from NHS Providers has urged politicians to provide “air cover” for controversial service changes to shield trusts from public backlash.
Services now at risk include diabetes care for young people, hospital-at-home “virtual wards,” end-of-life beds, and mental health talking therapies. Some trusts are reviewing maternity unit locations and A&E services, changes that typically face strong community opposition.
The current crisis mirrors the “Nicholson challenge” of 2009-15, when the NHS was asked to find £20 billion in savings. Research later linked those cuts to poorer patient outcomes when implemented without proper service protections.
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Despite the funding boost, inflation, unfunded pay awards (notably 22 % for junior doctors), and rising costs for energy and medical supplies have eaten away at the money’s real value. The Institute for Fiscal Studies found a real-terms funding cut of 2.4 % for 2024-25.
The workforce situation adds more pressure. The NHS currently has around 121,000 vacant posts – an 8.4 % vacancy rate. Yet some large trusts now plan to cut up to 1,500 posts each to meet savings targets. Meanwhile, junior doctors are again considering strikes, with the British Medical Association opening a ballot that could lead to action from July 2025 to January 2026.
Adding to the uncertainty, Prime Minister Keir Starmer and Health Secretary Wes Streeting plan to dissolve NHS England itself, moving its functions into the Department of Health and Social Care. This reorganization could cut around 10,000 jobs with potential savings of £500 million for frontline care.
The impact on patients is already visible in the numbers. NHS England data shows 7.43 million people waiting for treatment, including 1.2 million clinically ready for admission. Despite small recent improvements, service cuts risk undoing this progress.
For NHS staff, the outlook is equally concerning. 94 % of trust leaders expect negative impacts on staff wellbeing. With morale already low after years of pressure, further cuts raise serious questions about the NHS’s ability to retain its workforce.
While health leaders work to maintain essential services during these cuts, the combined challenge of financial pressures, staffing shortages, and organizational change creates the most difficult operating environment the NHS has faced in recent memory.
