About this report

This report examines the state of the NHS provider sector – the 223 hospital, mental health, community and ambulance trusts in England. It examines how they are performing, the challenges they face, how they are responding and the support they need to consistently deliver outstanding patient care.


It combines our own analysis and commentary, published data and the views of 131 chairs and chief executives from 121 NHS trusts that responded to our survey in June and July 2019. The responses cover more than half (54%) of all trusts, with all regions and trust types well represented.


In light of the long term plan published earlier in 2019 we revised the report’s four themes to:

  • quality and performance
  • workforce
  • funding and finances
  • system working, transformation and integration.

We also considered how the challenges and opportunities trusts are grappling with are affecting patients and service users, and how individual trusts and systems are responding to the challenges highlighted.

We would like to thank Helen Crump, Cogency Ltd director, for her contribution to drafting this year’s publication on our behalf.