NHS leaders warn of longer waiting times if demand for extra £3bn not met | NHS

NHS bosses are calling for an emergency £3bn injection to cover unexpected costs and have warned ministers that without it patients will wait longer for treatment and hospitals will start rationing care.

Their decision poses a new problem for Rachel Reeves, the chancellor, as she tries to find ways to plug an estimated £30bn hole in the country’s finances in her Budget next month.

Hospital chiefs have said that if they do not receive extra money they will have to cancel weekend and evening surgery sessions, allowing patients stuck on the massive NHS waiting list to receive care more quickly.

They also threatened to stop procedures of “low clinical effectiveness,” such as the removal of painful bunions, which can restrict mobility, because they are not a good use of limited resources.

The £3 billion demand is needed to cover the cost of NHS staff layoffs, doctors’ strikes and rising drug prices, and is likely to cause consternation within a government desperately short of cash. The NHS is already set to receive £196 billion of England’s £211 billion health budget this year.

Health service leaders say the three cost pressures they want the Treasury to cover were unexpected and have arisen since finalizing their funding deal for 2025/26.

Labour’s pledge to reduce NHS waiting lists will become even harder to deliver without the £3 billion, according to the NHS Confederation and NHS Providers, which represents health trusts, in what ministers are likely to see as a thinly veiled threat to sabotage a key promise to voters.

The waiting list for people requiring non-urgent care within 18 weeks remains stubbornly high. It stood at 7.6 million procedures and appointments when Labor took power in July 2024. After falling for six months, it has risen again in each of the last three months and stands at 7.4 million, despite Labor’s claim that it delivered 4 million more appointments to the NHS during its term.

The unprecedented joint plea from NHS bodies will intensify already serious tensions and infighting in Whitehall over who should foot the bill for an expected double whammy of redundancy payouts and rising drug costs.

The NHS’s 42 integrated care boards (ICBs) in England were expected to lay off up to 12,500 of their 25,000 staff by the end of the year due to falling health service costs, and Donald Trump’s drive to cut prices in the US is expected to lead to an imminent rise in the cost of medicines.

Reeves recently rejected a request from Wes Streeting, the health secretary, for £1.3 billion in extra funding for this year so that ICB redundancies, which were due to be completed by Christmas, could finally begin, according to NHS sources. She only offered him half that, £650 million, and even that was conditional on his Department of Health and Social Care (DHSC) agreeing to absorb the rising cost of drugs.

The chancellor and Streeting are engaged in what a senior NHS official called a standoff over the £1.3 billion. But the unknown cost of what rising drug prices would mean for the NHS is the “curve” that complicates negotiations, they added. The behind-the-scenes row in Whitehall over NHS funding “is a mess at the moment and needs to be resolved”, the same source said.

The two NHS organizations say the £3bn they are seeking includes more than £1bn to cover ICB redundancy costs, that the five-day strike by resident doctors in July cost £300m and that higher drug prices could lead to the NHS having to pay up to £2.5bn extra for life-saving drugs.

Matthew Taylor, chief executive of the NHS Confederation, said: “The threat of unbudgeted redundancy pay, rising drug prices and renewed industrial action risks derailing progress on key waiting time targets and wider reforms that are essential to getting the NHS back on track. »

An NHS Trust chief executive said extra operating theater lists “are the easiest things to stop when money is tight, but they have an immediate impact on waiting times”. Hospitals would also perform fewer “procedures that impact quality of life but are not life-saving,” they said. Although bunions are very painful for those affected, they are not a life-or-death problem, they added.

The ICB shake-up is a key part of the radical reorganization of the NHS announced by Keir Starmer in March, including the abolition of NHS England, although Streeting explicitly ruled out restructuring the health service before last year’s general election.

Richard Sloggett, a former special adviser to the DHSC, said: “This £3 billion demand from NHS leaders is a dramatic intervention that leaves health ministers exposed. The rushed decision in March to announce a massive reorganization of the NHS – without clear funding or plans to achieve it – has led us to this point. Add in strikes and rising drug prices and the government faces a perfect storm of problems over its number one public service priority.”

Daniel Elkeles, chief executive of NHS Providers, defended the £3bn demand. “As the Government prepares its Budget, it is time for an honest assessment and discussion about what the NHS can actually achieve this year in these difficult financial circumstances, and what is ‘achievable’ to meet ministers’ ambitions in their 10-year health plan,” he said.

Conservatives have criticized Streeting for stalling the ICB overhaul. In the House of Commons last week, shadow health secretary Stuart Andrew told MPs that Streeting “is very good at making promises, but the facts are he is presiding over a reorganization which has stalled, creating uncertainty for staff”.

When Andrew challenged Streeting to specify how many NHS staff would lose their jobs as a result of the reorganization, the Health Secretary said only that he was aware of “a number of expressions of interest in voluntary redundancy within my department, NHS England and the ICBs”.

A DHSC spokesperson said: “This Government has made a record £29 billion investment in our NHS – including up to £10 billion for digital and technology transformation and £750 million for urgent repairs – demonstrating our unwavering commitment to properly funding the health service we all rely on.

“We know that unnecessary strikes will divert money, time and resources away from the frontline, which is why the Health Secretary has urged the BMA to stop being selfish and start putting patients first.

“However, investment alone is not enough – it must go hand in hand with reform. That’s why we’re doing things differently: not just fixing the NHS, but driving it forward with our plan for change. And it’s already working. We’ve taken over 200,000 people off waiting lists, delivered 5 million more appointments and GP satisfaction is finally rising.”