Summary
The NHS faces unprecedented financial pressure, requiring the identification of cash-releasing interventions (CRIs). To support evaluation of this, the authors of this study established five criteria based on relevant frameworks. They conducted an evidence review of published and grey literature (2019–2025), identifying and evaluating CRIs aligned with NHS England’s ʻthree shifts’.
Content
This literature review confirms the hypothesis that there have been no published interventions found in the UK healthcare literature published over 7 years (2019–2025) that meet the authors rigorous criteria for cash release: direct budget reduction; explicit removal mechanisms; clear baselines, in-year realisation with sustainability; and absence of cost-shifting or harm.
332 interventions demonstrated either gains in cost-effectiveness or efficiency: reduced resource consumption, superior outcomes with fewer inputs, or care delivery in lower-cost settings. However, none achieved full cash release. This highlights structural and operational challenges in expecting cash to be released through isolated changes within a system characterised by fixed costs, absorbed capacity and persistent demand pressure. It also reflects fundamental features of healthcare economics including supplier-induced demand, capacity absorption and organisational behaviours that prioritise service expansion over budget contraction.
The NHS can benefit from reallocating resources into more cost-effective interventions within its largely fixed budget. That means that financial sustainability will be achieved not through one-off cash savings, but through sustained value-based decision-making, supported by explicit disinvestment, service reconfiguration and rebasing of activity and budgets. Cash release should therefore be a means to the objective of improving value for populations rather an end in itself.
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