Introduction

In 2025/26 the NHS in England faced its biggest financial savings challenge. System leaders were required to meet efficiency targets of £11 billion, with integrated care board (ICB) leaders asked to halve operating costs by December 2025 and general practice needing to fund new triage systems from already-stretched budgets. 

Alongside these financial asks, the 2025/26 planning guidance set out ambitious operational priorities to improve access to care and reduce waiting times. Further challenging requirements were placed on trusts and ICBs in the medium-term planning framework for 2026-29.

Rising to the challenge, the health service made significant improvements across a range of key performance indicators, including A&E waits, GP access, waiting lists for elective care and ambulance response times. But it did so at a cost. 

As the independent membership body for the organisations responsible for delivering these targets, we surveyed members to gain a deeper understanding of the demands of navigating 2025/26, how local NHS leaders plan to make progress in 2026/27 and the support they need. 

Ahead of financial year-end, we surveyed ICBs, NHS trusts and foundation trusts, and general practice providers to build a broad understanding of experiences across the NHS. Two surveys were issued (one for ICBs, foundation trusts and trusts and the other for GP leaders) and ran from 4 March to 30 March 2026. We received 235 responses: 187 from trust and ICB leaders and 48 from GP leaders. [1] All responses were anonymous. We supplemented the surveys with interviews with 65 trust finance directors over the course of 2025/26, as well as conversations with ICB leaders over the same period. 

The findings reveal the progress made in the last year despite ongoing challenges from industrial action, rising demand and constrained finances. They also reveal the difficult trade-offs required – and those still ahead – to improve financial sustainability and operational performance. The research highlights that the measures taken to meet financial plans have come at a cost, impacting efforts to build a more prevention and community-focused model of care and staff morale.