More than 80% of trust leaders are extremely or moderately concerned about winter, according to a new report by NHS Providers.
Only 1% of trusts were not at all concerned, and 16% were ‘slightly’ concerned.
The State of the Provider Sector 2025 report also found that 67% of trust leaders are also expecting winter to be worse than last year.
The report surveyed 172 trust leaders from 106 trusts, which accounts for around 52% of the provider sector, on their views around operational performance and resilience, financial stability and productivity, and workforce challenges and morale.
Respondents raised concerns of a combination of systemic, financial, capacity and workforce pressures this winter.
A chief executive of an acute trust that responded to the survey said: ‘We go into the winter with less resilience than in previous years. We have been holding posts and delaying recruitment and the financial pressures have been impacting on morale. This is not a good start point for the winter.’
One acute trust director added: ‘Despite proactive measures like virtual wards and urgent response teams, systemic fragility remains. Strategic mitigation through integrated planning, workforce support, and discharge coordination is essential to maintain patient safety and service resilience.’
Warnings have already come of a ‘long and drawn out winter’ for the health service due to the early arrival of the flu season.
How concerned are you about the impact of seasonal pressures over winter on your trust and system(s)?
Extremely concerned – 44%
Moderately concerned – 39%
Slightly concerned – 16%
Not at all concerned – 1%
Don’t know – 1%
Reforms to the NHS
The report also found that leaders are ‘generally split’ on the impact of structural changes to NHS England, with 52% extremely to moderately concerned and 48% with slight to no concern.
However, there was uncertainty over timelines, loss of capacity and expertise and disruption to both leadership and morale.
‘This level of uncertainty and change at time when we need to perform better than we ever have, as an NHS, to recover core operating standards is very unsettling and morale is low,’ said one director of an acute trust.
In a question on what three things trusts were prioritising to deliver the 10 year plan, 72% said digital transformation and 70% said neighbourhood health. Only 17% said workforce as an answer to this question.
To support the delivery of the 10-year health plan, what three things are you currently prioritising?
Digital transformation – 72%
Neighbourhood health – 70%
Financial and operational performance – 38%
Care delivery – 31%
Collaboration and system working – 27%
Productivity and strategic change – 23%
Prevention – 21%
Workforce – 17%
However, trust leaders also reported concerns over finance and capital in terms of delivering the 10 year plan, with 80% suggesting this was a concern. Over a third of leaders also reported integration of sectors and external partners as a concern (41%), and workforce and staffing (38%).
Chief executive of NHS Providers Daniel Elkeles said: ‘Trust leaders want to seize on the opportunities presented by neighbourhood working for a successful and sustainable NHS. But instead of going full throttle shifting care into the community, we’re moving at a glacial pace. We need to get a move on.
‘We see progress on productivity that’s being driven by digital transformation and bearing down on agency costs. There’s so much more that can be delivered through AI, too. We see the desire for a well-supported workforce, ready and able to provide the high quality care patients deserve. These are key ingredients to win back public trust in the NHS.’
He added that strikes would damage any progress in the NHS.
‘More strikes now could crush this fragile, hard-won progress, wiping out a once-in-a-generation opportunity to fix the health service. And just ahead of the budget, let’s remember strikes come at a financial cost. That’s money the NHS does not have,’ said Mr Elkeles.
‘We’re starting to shift the dial. Let’s all face forward together to build the better NHS that patients deserve.’
It comes as a BBC investigation has found that almost all hospital trusts in England are failing to meet the key NHS waiting time target for NHS cancer care. Just three trusts out of 121 in England were found to be treating cancer patients within the 62 day target, it found.
Resident doctors are due to go on strike at 7am on 14 November until 7am on 19 November following a ‘failure of the Government to offer a credible plan on jobs or pay’.
Systems have been preparing for winter pressures through increasing prevention and capacity, with concerns it could be busier than last year.
