Briefing on the financial challenges facing NHS trusts

In May 2024, we surveyed trust chief executives and finance directors, asking for their views on a variety of financial and operational challenges in 2024/25. We received responses from 114 different trusts, accounting for over half (55%) of the provider sector (209 trusts), from all regions and trust type in England.

Key findings include:

1. Over half (51%) of respondents were extremely concerned about delivering operational priorities within their organisation’s 2024/25 financial allocation.
2. Almost all respondents (97%) said it would be extremely difficult (72%) or difficult (25%) for their ICS to reach financial balance over 2024/25.
3. Over nine in ten respondents (92%) felt that the scale of the efficiency challenge in 2024/25 is more challenging than 2023/24.
4. 44% of respondents forecast their trust’s financial position for 2024/25 as a deficit, 45% forecast their position as breakeven and 11% forecast their position as a surplus. This survey was conducted before the planning round was completed and so may not reflect final planning submissions made by trusts.
5. 32% of respondents felt that it was very likely (25%) or likely (7%) that their trust will require additional national support to manage cash flow pressures over 2024/25.
6. In regard to physical health services, almost a third of respondents (32%) were confident that their system will deliver its recovery targets to reduce waits in 2024/25 (2% very confident, 30% confident).
7. Fewer respondents were confident with their system’s ability to deliver its recovery targets to reduce long waits in mental health services compared to physical health. Only 8% said they were confident, a slight increase from 5% in 2023/24.
8. Of the respondents who deliver A&E services, nearly half (46%) said it is likely that their trust will meet the new target of seeing 78% of A&E attendees within four hours by March 2025. 28% of respondents said it is unlikely (20%) or very unlikely (8%) that their trust will meet this target.