In recent years we have established an annual survey of trusts which has become the authoritative voice on the challenges facing the sector. Each year the survey looks at the past year’s policy developments and provides commentary on the sector’s contributions.

This year, the survey included some tracker questions from previous annual surveys, as well as a focus on winter 2021/22, mandatory vaccinations and environmental sustainability. This survey asked for trust leaders’ views across several areas such as capacity to meet rising demand, quality of care, workforce priorities, NHS funding and system working. We reflected trust leaders’ views on proposals to make COVID-19 and flu vaccination mandatory for NHS staff in our recent consultation response.  We discuss the findings around environmental sustainability in this blog.


The survey was open during September and was sent to all chairs and executive directors of trust boards. 172 trust leaders from 114 unique trusts responded to the survey, accounting for 54% of the provider sector. All regions and trust types were represented in the survey.


This briefing sets out the results of the survey which highlight concerns about winter and rising demand for services and staffing challenges including shortages and burnout. The results emphasise the strong sense amongst NHS leaders that the health and care system is entering an unpredictable time in which colleagues will need to navigate seasonal winter pressures, COVID-19, workforce burnout and staff shortages.