Conclusion

This report reveals the significant progress the NHS has made in the last 
year despite ongoing challenges from industrial action, rising demand and constrained finances. But it also reveals the difficult trade-offs that have, and will continue to be, made to improve financial sustainability and operational performance – and at what cost. 

The findings make it clear that the financial and performance ask in 2026/27 is likely to be even harder than last year. There are widespread concerns about patient experience, service reductions and staff morale that need  to be managed, as well as the ongoing threat from industrial action.

The report also shows that progress on the government’s three shifts, which are widely supported, will continue to be impeded if the primary focus remains on recovering services and meeting financial targets. 

There are grounds for optimism given the progress the NHS has made 
during the last year, but there are clear risks ahead. In these challenging 
circumstances, national and political leaders can help by being clear and 
consistent about what the NHS needs to prioritise and achieve, support local leaders publicly, back local leaders to make difficult decisions, and ensure regulatory intervention adds value rather than being a burden.