As winter 2025 approaches, concern is mounting across England’s National Health Service (NHS) as trust leaders warn of unprecedented challenges ahead. According to a new State of the Provider Sector 2025 report by NHS Providers, more than 80% of trust leaders say they are extremely or moderately concerned about the coming winter, with only 1% expressing no concern at all. A further 16% are ‘slightly’ concerned, painting a grim picture of the months ahead for England’s health system.
The report, which surveyed 172 leaders from 106 trusts—covering about 52% of the provider sector—found that 67% expect this winter to be even worse than the last. Trust leaders cited a perfect storm of systemic, financial, capacity, and workforce pressures. One chief executive of an acute trust told NHS Providers, “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.”
Despite attempts to bolster services through measures like virtual wards and urgent response teams, fragility remains. “Strategic mitigation through integrated planning, workforce support, and discharge coordination is essential to maintain patient safety and service resilience,” an acute trust director emphasized in the report. The early arrival of the flu season has only heightened concerns, with many bracing for what has been described as a “long and drawn out winter.”
These anxieties are compounded by ongoing structural reforms within NHS England. Trust leaders are split on the impact of these changes: 52% are extremely to moderately concerned, while 48% are only slightly or not at all worried. However, uncertainty over timelines, loss of capacity and expertise, and disruptions to leadership and morale have left many uneasy. “This level of uncertainty and change at a 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 another acute trust director.
As for the NHS’s 10-year plan, digital transformation and neighborhood health are the top priorities, cited by 72% and 70% of trusts respectively. Surprisingly, only 17% of trusts listed workforce as a primary focus, despite widespread concern about staffing shortages. Financial constraints loom large, with 80% of trust leaders worried about finance and capital, 41% about integration with external partners, and 38% about workforce and staffing.
Daniel Elkeles, chief executive of NHS Providers, highlighted the opportunities and risks ahead. “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,” he said. He also pointed to progress in productivity driven by digital transformation and efforts to cut agency costs, while stressing the potential of AI. “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.”
However, Elkeles warned that ongoing industrial action could jeopardize this fragile progress. “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,” he said. Resident doctors are scheduled to strike from 7am on November 14 to 7am on November 19, citing the government’s failure to offer a credible plan on jobs or pay.
Amid these broader pressures, a BBC investigation has revealed another urgent crisis: almost every hospital trust in England is failing to meet the key NHS waiting time target for cancer care. Just three out of 121 trusts are treating cancer patients within the 62-day target, according to BBC analysis covering September 2024 to August 2025. The consequences are dire—research led by Dr. Timothy Hanna shows that every four-week delay in treatment reduces patient survival by an average of 10%. “It’s not a few outliers. It’s the norm for trusts in England to not hit these waiting time targets and they are set for a reason—timely treatment can improve survival rates,” Dr. Hanna told the BBC.
The impact on patients is stark. Paul, a stage three colon cancer patient, shared his harrowing experience with the BBC: after his initial biopsy in January 2024, he received no further contact from cancer services until January 2025. By the time he underwent surgery in February, the cancer had spread to nearby lymph nodes. “The waiting was horrendous and now I think that if I had been treated properly and not had to wait so long it wouldn’t have progressed to stage three,” Paul said.
Hospitals attribute these delays to overwhelming demand, outdated equipment, and administrative mishaps. The Royal Free NHS Trust in London, for instance, ranks 109 out of 121 for 62-day wait times, though it is showing some improvement. One of its two radiotherapy machines is over a decade old, leading to frequent breakdowns and treatment delays. Despite submitting a business plan for a replacement earlier this year, the trust’s request for funding was turned down. “We can’t deliver the service we want to and it can cause delays to patient treatment. We need a newer machine—it delivers better treatment faster so means we can treat more people per hour,” said Claire Hartill, head of radiotherapy at the Royal Free.
Yet, there are glimmers of hope. The three trusts that consistently meet the 62-day target—Calderdale and Huddersfield, East and North Hertfordshire, and Bolton—credit their success to streamlined communication, modern equipment, and coordinated teamwork. At Lister Hospital in Stevenage, part of East and North Hertfordshire, patients like Paul (diagnosed with prostate cancer) benefit from same-day consultations with surgeons and oncologists, rapid scheduling, and robotic surgery that shortens hospital stays and recovery times. “He [the surgeon] got his diary out, flicked through a couple of pages and gave me a date. I said, that’s a Saturday. The surgeon said, yes, I work Saturdays,” Paul recounted to the BBC.
Innovations such as at-home chemotherapy are also helping ease capacity issues. Josephine Hoskins, who requires chemotherapy injections every three weeks, now administers them herself at home. “It’s revolutionised things for me,” she told the BBC, noting that this approach frees up hospital resources for patients needing more complex care.
The government insists it is determined to improve waiting times, with a new cancer strategy expected early next year. Following cancer’s designation as a core priority in the July 2025 NHS 10-year plan, the Department of Health has invested £70 million in new radiotherapy machines and is expanding community diagnostic centers with evening and weekend appointments. “Cancer care is a priority as we turn around more than a decade of neglect of our NHS. We’re working at pace to ensure patients get timely diagnoses and treatment,” a Department of Health spokeswoman told the BBC.
Still, health policy experts remain skeptical about whether these efforts will be enough. “The reality for the government is that it will be incredibly challenging to make meaningful progress on waiting times when finances are so tight,” warned Sarah Scobie of the Nuffield Trust.
The NHS stands at a crossroads this winter, facing both immediate operational pressures and long-term strategic challenges. As trust leaders, government officials, and frontline staff grapple with these issues, patients across England are left hoping for a health system that can deliver the timely, high-quality care they deserve.
