The combined effects of worsening population health, increasing staff shortages, and inflationary cost pressures will add to the challenges of managing winter pressures and meeting important targets for care backlog recovery. Three quarters (72%) of trusts are extremely concerned about the impact of the cost of living on their ability to manage winter pressures across the system, and half (50%) are extremely concerned about its effects on their ability to reduce care backlogs and meet national targets.

Figure 9

Level of concern over spiralling costs impacting trusts' abilities to:

Despite the many initiatives trusts are putting in place, there is a limit to how far they can mitigate the impacts of the increased cost of living for their employees or patients. Some trust leaders expressed concern at how sustainable it will be to cover the costs of many of these schemes on an ongoing basis, particularly given growing cost pressures on existing NHS budgets alongside the lack of a dedicated national fund to support 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.

Trusts have a tight financial envelope and there are limits to the extent we can plug the gap for staff when the fundamental issue is that their earnings are not keeping pace with inflation. It is difficult to target support because the extent of the impact is very specific to people's lifestyles and personal circumstances.

Ambulance trust    

There are challenges in making sure what is on offer is fair, is accessible to those most in need, and actually meet the need, as an ill thought response can increase staff morale problems.

Community trust, South East    

We've already tried to implement a food bank but staff told us they would not want to be seen accessing such support on site so for all the things we are offering/planning to offer we need to find a way to make sure it is done with dignity.

Acute trust, Midlands    

Trusts would welcome more national-level coordination on support for staff and patients, including more sharing of good practice. But trust leaders also stress the need for any national framework to remain fleet-of-foot allowing them flexibility to respond to the diversity of local needs and the changing nature of the issue. Trust leaders remain keen to avoid inadvertently competing for staff via the support they are offering.

This is a national problem, so it would be helpful for a steer on best practice. it needs to be co-ordinated at integrated care system level so we don't give unequal access in [our area] for those most in need.

Community trust, South East