When NHS Providers – the membership organisation that represents NHS trusts – starts using language like “unthinkable”, it’s time to sit up and take note. They chose the term in early May to characterise the scale of the cuts being forced upon NHS managers by Wes Streeting’s Department of Health and Social Care.
Using evidence gathered from 114 trusts – more than half the total number in England – NHS Providers revealed the “eye-watering” array of local services that face being scaled back or completely shut down: diabetes care for young people, rehabilitation centres, talking therapies, even – incredibly – palliative care beds. Meanwhile, nearly every trust surveyed said they were planning to cut – or had already begun cutting – up to 1,500 posts each to save money. Crucially, these include clinical roles such as doctors and nurses.
How have we arrived at this brave new world in which the route to “an NHS fit for the future… with world-class care for the many, not just the few” (Streeting at last year’s party conference) is through slashing clinical services upon which the health, well-being and dignity of patients so manifestly depend?
The role of Jim Mackey, Streeting’s choice to lead the NHS in England, is key. In March, Mackey ordered trusts to comply with a “financial reset” – code for unprecedented budget savings during 2025-26 to avoid a projected £6.6bn NHS deficit in England. The government, like its Conservative predecessors, insisted cuts required could occur harmlessly, through “efficiency savings” alone. Needless to say, savings of up to 12 per cent of entire trusts’ budgets cannot possibly be achieved without cutting services.
Perhaps Mackey and Streeting hoped that so long as they had a target-driven story to tell the press about falling waiting lists, no one would care very much about the less headline-grabbing forms of NHS care such as rehabilitation after serious injuries or humane deathbed care. It is no coincidence that services for people with disabilities, mental health conditions and terminal illnesses are on the line; certain patients have long been deprioritised by those in power. As one anonymous finance director told NHS Providers: “Health inequalities [are] a real issue when streamlining services. We need investment to reach the most vulnerable and excluded populations, not disinvestment.”
What happens now? In a speech at the Medical Journalists’ Association on 9 May, Mackey gave short shrift to the prospect of additional funding: the government, he said, was “maxed out on what’s affordable”. Meanwhile, a Department of Health and Social Care spokesperson doubled down on the fiction that reducing red tape could square the circle: “We have underlined the need for trusts to cut bureaucracy to invest even further in the front line.”
Easy for them to say. Less so for the doctor forced to have deathbed conversations with patients on trolleys in corridors (me, with increasing frequency these days). From a patient perspective, the impasse is painfully familiar. In his conference speech, Streeting rightly slammed 14 years of underinvestment as a legacy of “Conservative neglect”. He explicitly stated, the day after the general election, that: “The policy of this department is that the NHS is broken.” For NHS staff, this radical candour was more than a relief – it felt exhilarating. At last, it seemed, we had a health secretary willing to be honest about the scale of the task required to rebuild an NHS to be proud of.
Less than one year later, Streeting appears to be the first Labour health secretary willing to countenance the cutting back of end-of-life care on his watch. For me – a palliative care doctor who entered my specialty precisely to advocate for the patients that so many in power overlook – the only thing that’s “maxed out” right now is incredulity and disgust.
Rachel Clarke’s “The Story of a Heart” has been shortlisted for this year’s Women’s Prize for Non-Fiction
[See also: The public doesn’t like Brexit. Has anyone told the media?]
Content from our partners
Related
This article appears in the 04 Jun 2025 issue of the New Statesman, The Housing Trap