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Workforce accounts for two-thirds of the cost of the NHS. Its effective management is fundamental to productivity improvement and delivery of challenging cost improvement targets. This briefing draws together the minimum expectations of NHS England as they relate to establishment and workforce cost control while providing case studies of good and bad practice drawn from across the United Kingdom. In a look to the future the briefing explores aspects of electronic patient record systems currently being developed that have the potential to enhance workforce cost management while improving patient safety and quality. This briefing sets out: the control objectives that the regulator expects to be in place a practical guide to the controls that need to be in place to cover the setting of establishment, recruitment, temporary staff usage and reporting case studies of good and bad practice the impact that next generation electronic patient record (EPR) systems might have on rostering.

In January 2025, the Republican majority in the House of Representatives’ Budget Committee offered a list of possible spending reductions to offset revenue losses from proposed tax cuts. In May, the Committee advanced a bill incorporating several reductions on the list. The Committee estimated that the 6 largest potential Medicaid cuts (for example, work requirements for some Medicaid enrollees) would each reduce the federal government’s Medicaid outlays by at least $100 billion over 10 years. On the basis of the Committee’s estimates of savings; Congressional Budget Office analyses; and peer-reviewed studies of the coverage, financial, and health impacts of past Medicaid expansions and contractions, the authors project the likely effects of each option and of the House bill advanced by the Budget Committee in May. Each option individually would reduce federal Medicaid outlays by between $100 billion and $900 billion over a decade, increase the ranks of the uninsured by between 600 000 and 3 900 000 and the annual number of persons forgoing needed medical care by 129 060 to 838 890, and result in 651 to 12 626 medically preventable deaths annually. Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate. These figures exclude harms from lowering provider payments and shrinking benefits, as well as possible repercussions from states increasing taxes or shifting expenditures from other needs to make up for shortfalls in federal Medicaid funding. Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans.

In the US, women die at a greater rate in pregnancy and during the postpartum period than in any other high-income country, and this rate has been increasing. Even if some of the apparent increase is attributable to changes in reporting, the fact remains that in the US, mortality rates are rising rather than falling, while disparities are widening.1Yet despite recent efforts to prioritise women’s health research, pregnancy research remains woefully underfunded. Much of the existing funding for pregnancy research focuses not on the health of pregnant individuals themselves; rather, they are considered hosts whose social, intrinsic biological, and environmental determinants affect fetal and child development: an important perspective, but not the only one. A recent report by the National Academies of Sciences, Engineering, and Medicine noted that National Institutes of Health (NIH) spending on women’s health research in the past decade has averaged only 8.8% of its total budget, of which only a fraction went to study pregnancy. Despite progress in the form of new initiatives—such as the NIH Implementing a Maternal Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative—funding for research regarding preconception, pregnant, and postpartum individuals remains a small proportion of the NIH portfolio.

On the 28 March 2025, the Trump administration notified Congress that it planned to shut down USAID (United States Agency for International Development) by 1 July 2025. The State Department would assume responsibility for “certain USAID functions” that align with the administration’s priorities and discontinue the rest. Two weeks earlier, in a post on X, Secretary of State Marco Rubio said that the programmes being cut (including efforts to address emerging infectious diseases, famines, natural disasters, maternal and child mortality, HIV, and tuberculosis) “spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States.” To date, however, neither Rubio nor the State Department has elaborated on how these cuts and the reduction of USAID’s staff (from about 10 000 employees to 15) will affect the health of people around the world—or in the US itself. Initial reports on the direct effects of the cuts have come from different sources. A leaked USAID document projected that if programmes were permanently halted, the world would see an additional 12.5 million to 17.9 million malaria cases and 71 000 to 166 000 additional malaria deaths annually. If US foreign aid is not restored before the end of 2025, it is estimated that at least 62 000 additional people would die of tuberculosis. Enormous harms to children are also expected because USAID spending has played a pivotal role cutting child mortality rates in half since 2000.

The Health Foundation has published new analysis estimating the funding needed for social care in England over the next 10 years. They have analysed the latest data on social care spending, which compares public spending levels over time and analyses if current spending is enough to meet pressures on the system. The analysis estimates that an extra £3.4bn would be needed in 2028/29 to prevent further deterioration of services - rising to £9.1bn in 2034/35. To go further and improve people’s access to care and boost care workers’ pay, we estimate an additional £8.7bn would be needed in 2028/29, rising to £15.4bn in 2034/35.  

At 10.45am on 23 November 2024, Peter Anzani sadly died from a pulmonary embolism in Birmingham Heartlands Hospital. He had been admitted to hospital the day before and was receiving treatment for a community acquired pneumonia when he suddenly and unexpectedly collapsed due to a pulmonary embolism. Peter had previously suffered a number of falls at home in August and September 2021 and was subsequently diagnosed with suffering a spontaneous infection of the cervical vertebral canal which caused a complete spinal cord injury and left him tetraplegic. This made him more vulnerable to chest infections and pulmonary embolisms which he experienced in the years that followed. There is no evidence of any human intervention that rendered his death unnatural.  Based on information from the Deceased’s treating clinicians the medical cause of death was determined to be:  1a Pulmonary Embolism 1b 1c 1d II Pneumonia Spinal cord injury resulting in Tetraplegia Matters of concern To The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust I considered evidence from a [REDACTED] who indicated at paragraphs 20-21 of his statement, “I did not see any record of his pulse, blood pressure or oxygen saturation. The normal practice is to complete these observations, and I would expect this to be done, especially with him presenting with chest issues. However, I am unable to comment why this was not recorded or confirm that these were carried out. (21) This is a learning point for the department, and I have taken steps to ensure this learning is taken forward by theTrust. I have alerted the Sister in charge of the Spinal Injuries Outpatients’ Department and requested that adequate measures are taken to ensure that all observations made are recorded in the outpatient forms…” It was unclear whether this was a single one-off event involving human error or indicative of a wider and systemic issue involving a lack of training. There was no evidence before the court that this “learning point” had been actioned or that any adequate steps had been taken to ensure proper and accurate recording of records by staff. There is a real risk of future deaths occurring where staff do not have adequate training and that patient records are not being properly completed. To NHS England / Department of Health and Social Care I heard evidence that The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (“The Trust”) have been experiencing difficulties with patient waiting lists – due to both an increase in the quantity of patients being treated and staffing shortages – which has led to patients waiting longer than is reasonable or necessary for reviews and treatments. As part of the inquest, there was evidence that Peter Anzani himself had been waiting for nearly a year for a follow-up review, which should have been carried out after no more than 6 months. I heard evidence from representatives of the Trust that they have repeatedly requested additional funds for workforce development and expansion to assist with cutting patient waiting lists and waiting times. I understand that an initial Workplace Funding Review was submitted in 2023 but was rejected by NHS England due to a funding shortage. I understand that a further Workplace Funding Review was submitted in the Autumn of 2024, but in February/March of this year, NHS England indicated that the same would again be rejected under a “no growth policy”. Whilst naturally I am aware of the pressures on the public purse and on the NHS generally, it is concerning to hear that the Trust do not appear to be being adequately supported financially by NHS England, and do not currently appear to be able to address their workplace staffing issues without additional financial support (which does not appear to be forthcoming). It is obvious that where patients are waiting for longer than is reasonable or necessary for treatment or reviews, there is a real risk of deaths occurring. No patient should be waiting longer than absolutely necessary for treatment. In light of HM Government’s decision on 13 March 2025 to abolish NHS England and for its role to be subsumed within the Department of Health and Social Care, this report is being sent to both Agencies to consider, as it relates to issues of both a local and national significance.

The US government’s decision to end programmes that treat and prevent communicable diseases will have serious consequences—not just for vulnerable communities that depend on this aid but also for public health in the US and beyond. Cutting funding to global health programmes isn’t just about withdrawing aid. It increases the risk of infectious disease outbreaks that could impact everyone. Without prevention and treatment efforts, diseases are more likely to spread unchecked, mutate and become harder to control. This creates a higher risk of future global health crises that could threaten lives worldwide. Investing in global health isn’t just humanitarian. It’s essential for protecting public health everywhere.

Brooke Nichols has launched online tracking tools that capture estimated increases in mortality and disease spread for HIV/AIDS, tuberculosis, malaria, and other diseases as a result of the near-total freeze in US foreign aid funding and programming.  Over the last two months, the Trump administration’s slashing of US foreign aid and systematic dismantling of the US Agency for International Development (USAID) have severely disrupted the lives of populations abroad who rely on this funding for disease detection and treatment, nutrition assistance, and other vital public health services. After pausing all foreign aid assistance by executive order on Inauguration Day, the administration permanently cancelled 83 percent of USAID’s global contracts just weeks later—a decision that public health experts warned would lead to preventable deaths and accelerate disease spread. If this foreign aid is not restored before the end of 2025, more than 176,000 additional adults and children around the world could die from HIV, according to excess death estimates from a new digital tracking initiative by Brooke Nichols, associate professor of global health. Her tracker also indicates that at least 62,000 additional people could die from tuberculosis (TB)—roughly one death every 7.7 minutes—if foreign aid does not resume by the end of the year, and these figures are steadily increasing. These estimates are listed on Impact Counter, a real-time digital tracking website that Nichols utilises to quantify the real-world human impact of the recent US policy changes on humanitarian aid. On the site’s dashboard, Nichols provides up-to-date calculations of increases in mortality, disease spread, and healthcare costs for HIV/AIDS, TB, malaria, pneumonia, diarrhea, neglected tropical diseases, and malnutrition.

US foreign aid plays a critical role in tackling poverty, hunger, and inequality worldwide, which is why the Trump administration’s recent cuts to foreign development assistance were met with public outrage and pushback from development and humanitarian organisations, including Oxfam. Despite widespread public support for US-funded foreign aid, Secretary of State Marco Rubio cut more than 80% of US Agency for International Development (USAID) programmes, which provide humanitarian and development assistance worldwide to people in some of the worst global crises. The effect of these cuts on people is dire: At least 23 million children stand to lose access to education, and as many as 95 million people would lose access to basic healthcare, potentially leading to more than 3 million preventable deaths per year. Oxfam has responded to the attacks on USAID by joining other humanitarian groups in a lawsuit to defend USAID and US foreign assistance, which is ongoing. So what does the Trump administration's decision to eliminate so much foreign aid mean, what impact could it have around the world, and why is it critical for the government to reverse this decision? Oxfam answers all of these questions and more.

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.