Nearly two-thirds of NHS organisations in England expect to cut or reduce services this year, and more than half anticipate reducing clinical staff, according to a survey of health service leaders published this week. The results point to serious financial strain across the health system at a time when it is, by some measures, performing better than it has in years.

The survey was conducted by the NHS Alliance, formed from the merger of NHS Providers and the NHS Confederation. It gathered responses from 187 leaders of NHS trusts and integrated care boards, supplemented by interviews with 65 trust finance directors conducted over the past year. A parallel poll of 48 GP leaders was also carried out. The findings are among the most comprehensive gathered from health service leadership in recent years.

Sixty-four per cent of trust and integrated care board leaders said they expect to cut or reduce services during the current financial year. Fifty-seven per cent anticipate reducing clinical staffing levels. Three-quarters believe financial pressures will worsen in 2026/27. Eighty-three per cent said they were concerned about the impact of financial measures on planned care, and 93 per cent reported worrying about staff morale. Among GP leaders, 96 per cent expressed concern about the effect of financial constraints on day-to-day patient access.

Trust chief executives, speaking anonymously, described conditions that they say are becoming difficult to manage. One said that "the overriding focus on finance at the expense of patients and particularly staff will have repercussions." Another warned that NHS services "are being asked to make deep cuts across the board" and that "at some point there will be consequences that will be felt by patients and their families."

The survey arrives at a moment of genuine, if fragile, progress. The NHS recently met a key waiting time target, and public satisfaction has risen after a sustained period of decline. Sir Ciaran Devane, chief executive of the NHS Alliance, acknowledged that the health service had achieved "a remarkable double" over the past year, improving performance while balancing budgets under considerable pressure. He described the NHS as "starting to turn a corner." But he was equally clear that this progress carries a cost. "The focus on targets and delivering record efficiency savings have come at a cost, with many hard-won gains now at risk," he said. "Local NHS leaders point to likely service closures and job cuts this year, as well as deteriorating staff morale."

NHS leaders are asking for three things from government: political support to make unpopular but necessary decisions about reconfiguring local services, financial help to absorb costs from rising inflation and potential industrial action that were not accounted for in the 2026/27 budget, and greater consistency from national leadership about what the NHS is actually expected to prioritise this year. Sir Ciaran warned that the government's ambition to shift more care into community settings risks being undermined if short-term savings measures take precedence and funds are not reinvested into reform.

The industrial relations picture adds further pressure. The British Medical Association began balloting senior hospital doctors on strike action earlier this month. Resident doctors retain a mandate to strike until August. Both developments introduce costs and operational uncertainty that NHS finance directors say are not reflected in current budget assumptions.

The Department of Health and Social Care said the government "has supported the health service with record investment, boosted productivity, and driven improvements in tech," and acknowledged the challenges NHS leaders face.

The picture that emerges is one of a health service caught between short-term financial imperatives and longer-term reform ambitions. Performance is improving and waiting times are falling, but the leaders responsible for delivering those results say the current trajectory is not sustainable. Whether the government moves to address the structural funding gap, or continues to press for efficiency savings, will determine whether recent gains hold.