State of the provider sector

Operational performance and resilience: this winter and beyond

• Perceptions around high-quality care being provided both now (52%) and in future (2025: 47% in one years’ time, 48% in two years’ time) have increased since last year (2024: 41% currently, 33% in one years’ time, 35% in two years’ time). 
  
  
• Although trust leaders are less worried about having the capacity to meet demand than last year, worry remains high overall (2025: 63% worried, 2024: 79%).
  
  
• In mental health services specifically, only 9% of trust leaders feel the level of investment is proportionate to demand. Only a quarter (25%) feel they have the capacity and resources to bring mental health waiting times down and intervene earlier. 
  
  
• Over 80% of trust leaders are concerned about winter and 67% are expecting it to be worse than last year.
  
  
• Half of trust leaders (50%) do not think it's likely that the 18-week standard will be met in the next 5-years, with a further 15% feeling unsure. Meanwhile, only a quarter (24%) think it's unlikely that the 28-day faster diagnostic standard for cancer will be met. 

Financial sustainability and productivity

• Around half (52%) of those we surveyed were confident that their trust will deliver its financial plan for 2025/26. 20% were neither confident nor unconfident. 28% were not confident their trust would deliver its financial plan for 2025/26.
  
  
• While over half (54%) believe their trust’s planned efficiency savings rate is deliverable, 34% do not. These trusts tend to face higher required savings rates and larger gaps between what is required and what is forecasted.
  
  
• Trust leaders are taking widespread cost-saving actions; 97% told us their organisation is cutting agency and bank spend. 80% of those surveyed see this as having a major impact on increasing productivity within their organisation this year. 

Workforce challenges and morale

• Over 70% of trust leaders are highly concerned about staff burnout (79%), discrimination towards staff from patients and the public (77%), as well as staff morale (74%). 
  
  
• Heavy workloads (66%) alongside additional periods of industrial action (64%) are also prominent concerns for trust leaders.
  
  
• Trust leaders' confidence in the current skill mix and overall number of staff has increased from last year (2025: 53% confident, 2024: 40%), but this confidence declines as they look ahead to next year (39%) and beyond (33%). 

System reform and planning

• Whilst trust leaders generally feel clear on the role their trust will play in delivering the 10YP as part of their local system (67% confident), confidence is lower in the likelihood of tangible improvements to care over the next 3-years, especially in relation to IHOs and multi-neighbourhoods.
  
  
• Trust leaders are generally split on both the potential impact of structural changes to NHSE (52% extremely to moderately concerned vs 48% slight to no concern), as well as to whether league tables can provide fair representation of their trusts (44% agree, 41% disagree). 
  
  
• Over 80% of trust leaders cite finance and capital as a top concern for delivering the ambitions of the 10-year health plan.
  
  
• Over 70% of leaders are prioritising neighbourhood health (70%) and digital transformation (72%) to support delivery of 10-year health plan ambitions, and 80% told us that system integration and transformation is one of the top actions needed to shift care into the community meaningfully over the short to medium term.
  
  
• Trusts leaders highlight achievements that contribute to the ambitions of the 10-year health plan, particularly in integrated care and collaboration, neighbourhood health, digital transformation, and operational improvement and financial savings. Examples include reduced out-of-area placements and increased mental health collaboration leading to financial savings, virtual health hubs supporting care at home, AI-driven neighbourhood models reducing hospital admissions, expanded diagnostic and surgical services, and innovative workforce development initiatives that strengthen local partnerships and neighbourhood health for the future.