Tight budgets and tough choices: the reality of an NHS living within its financial means (18 May 2025)

Summary

The NHS has faced financial pressure for more than a decade, but the signals of financial distress across the NHS have grown in recent years, and the current financial pressure on the NHS appears to be different. This matters because financial pressure can have a direct impact on patients and their care.

In this long read, The King's Fund explores the decisions leaders are making locally to mitigate financial pressures, and the impact these tough decisions will have on patients. It focuses on NHS trusts as they have responsibility for the majority of spending in the NHS. It draws on analysis of secondary data sources, such as NHS England and the Department of Health and Social Care accounts, and six anonymous semi-structured interviews with chief executives and chief finance officers from a range of NHS trusts. The interviews took place between March and April 2025.

It makes the case for a more open, intentional approach to how the NHS can live within its means, and clarity about how this will impact the public it serves. This will be important for setting foundations for the reforms outlined in the upcoming NHS 10 Year Plan, which will inevitably have ramifications for the direction and prioritisation of NHS finances.