This briefing sets out the challenges providers currently face and what they need from politicians over the next parliament, focusing on key issues including finances, workforce, quality, mental health, demand and integration.

The NHS is at the forefront of world class care, leading research and innovation, and generating jobs and economic growth across the country. NHS foundation trusts and trusts account for £65 billion of the £110 billion spent by the NHS. They employ more than 1.1 million of its 1.2 million staff. They interact with more than 5 million patients and service users a week. They are, in short, the backbone of the NHS, providing the vast majority of its care. The success of the NHS is significantly defined by the success of the provider sector.

The current state of the NHS provider sector

Continuing the success of the NHS means investing in its services as well as reshaping them to meet 21st century needs. If we do not, the impact will be felt most keenly by patients, service users and staff on the frontline in terms of increased distress, worsening conditions and a tired and demoralised workforce. Providers will also struggle to deliver ongoing service improvement. There are clear signs that we need to renew our approach to supporting and investing in the NHS:

• Trusts are facing large increases in demand for their services as a result of demographic factors, pressures on primary and social care, and rising public expectations. At the same time, patients have greater and more complex needs.
  
  
• The NHS is seven years into the longest and deepest financial squeeze in its history. A record two thirds of trusts were in deficit at the end of 2015/16 with deficits spreading beyond hospitals into mental health, community and ambulance trusts.
  
  
• Trusts are running at capacity levels well beyond the recommended and accepted levels seen in other advanced western countries. Safety and quality of care are becoming compromised, with winter pressures lasting throughout the year, bringing with them deteriorating performance against the four-hour A&E target, increasing trolley waits, more cancelled urgent operations, growing waiting lists and worse than ever levels of delayed discharges.
  
  
• Providers are struggling to meet a series of workforce challenges, particularly around recruitment and retention caused by staff shortages, rising pressure on staff, a prolonged period of pay restraint, and the early impact of Brexit.
  
  
• The repercussions of lack of capacity in primary and social care are being felt by hospital, ambulance, community and mental health trusts as patients and service users are transferred between the sectors.
  
  
• At a time of high operational pressure, the NHS is also being asked to undertake complex transformation projects and deliver new and innovative models of care at a much faster rate than the international evidence suggests is possible.

What NHS foundation trusts and trusts need from politicians over the next parliament

The NHS in England is striving to serve the rapidly growing healthcare needs of today and tomorrow on a constrained budget. The next five years are critical. The future of NHS care depends on politicians agreeing to invest in the NHS’s continuing success through:

1. A realistic approach to funding and performance
   
   
2. Support for the million-strong NHS workforce
   
   
3. A fair footing for mental health care
   
   
4. Investment in a sustainable social care system
   
   
5. A commitment to locally-led, nationally supported, health and social care integration
   
   
6. Serving future generations by taking a long-term view of demand
   
   
7. Investing in the NHS as an investment in the UK

Download the briefing for full details.