The cost of living increase has been caused by inflation, which reached 10.1% in August, outpacing rises in household incomes. Our survey of 160 trust leaders, representing 54% of the trust sector, shows a high level of concern about the effect this is having on NHS staff and patients alike. Many trusts are putting in place support for people and staff, but there are concerns about long-term sustainability of these schemes, and there is a need for national, coordinated response to the pressures people are facing.

Our report sets out the key findings of the survey, including:

• All respondents (100%) said they were concerned about the mental, physical and financial wellbeing of staff as a result of cost of living pressures, and the majority (61%) reported a rise in mental health sickness absence. Trusts also reported staff struggling to afford to come to work: almost three quarters (71%) said this was having a significant or severe impact on their trust.
• More than three quarters (78%) of trust leaders are extremely concerned about the mental wellbeing of staff.
• Trusts say the rising cost of living is causing staff to look for roles elsewhere: two thirds (68%) report a significant or severe impact from staff leaving the trust for other sectors, such as hospitality or retail, where employers are able to offer competitive terms.
• The vast majority of trust leaders (95%) said that the cost of living increases had either significantly or severely worsened health inequalities in their local area. As rising housing, energy and food costs put more people in the position of making difficult choices about heating or eating, trust leaders expect to see more people pushed into poverty and its health consequences.
• Trusts are increasingly working in partnership and providing additional community outreach services. Some are offering widened access to digital initiatives for remote services, or providing referrals to local foodbanks, debt advice services, and other services which support people in financial difficulty. Alongside this, trusts are stepping up support for staff. Three quarters (72%) offer financial advice and education, with 10% more planning to introduce this service. Others are offering direct support, including food banks (27% offering, with 19% planning to do so).
• Trusts are keen to do as much as they can to mitigate the financial pressures people are facing. However some expressed concern at how sustainable it will be to cover the costs of many of these schemes on an ongoing basis, particularly given additional cost pressures on existing budgets alongside the lack of dedicated funding to provide these schemes. Trust leaders are also conscious of the need to ensure equity of access for those most in need, while avoiding stigma or inadvertently creating division between staff groups.

The briefing sets out recommendations for a coordinated national response to the rising costs of living, that addresses the wider determinants of health, offers a long-term plan to bolster the NHS workforce, and invests in prevention and health inequalities in the longer term. As the cost of living crisis progresses, including in light of recent government announcements, governors will no doubt wish to continue seeking assurance from their boards on how their trust is meeting the needs of patients and staff within their available resources, and how they plan to tackle key capacity issues alongside staff shortages and increasing demand.