NHS chiefs are calling for an urgent £3 billion injection to cover unexpected costs and have warned ministers that without it, patients will wait longer for treatment and hospitals will begin to ration care.
Their move poses a new challenge for Chancellor Rachel Reeves as she tries to find ways to fill the expected amount of debt. £30 billion hole in the country's finances in its budget next month.
Hospital chiefs have said that unless they receive more money they will have to cancel weekend and evening surgery sessions, giving patients stuck on a huge NHS waiting list faster care.
They also threatened to stop performing “low clinical effectiveness” procedures, such as removing painful lumps that can limit mobility, because they are not an efficient use of limited resources.
The £3 billion demand is needed to cover the costs of NHS layoffs, doctors' strikes and rising drug prices, and is likely to cause consternation within a cash-strapped government. The NHS is already set to receive £196 billion of this amount. £211 billion health budget for England this year.
Health service chiefs say all three price issues they expect the Treasury to cover were unexpected and emerged after the 2025/26 funding deal was finalized.
Labour's promise to cut NHS waiting lists will become even more difficult to deliver without £3 billion, according to the NHS Confederation and NHS providers representing health trusts, which ministers are likely to see as a thinly veiled threat to undo a key promise to voters.
The waiting list for people needing non-urgent care within 18 weeks remains stubbornly high. When the Labor Party came to power in July 2024, it stood at 7.6 million procedures and appointments. After falling for six months, it has risen again in each of the last three months to 7.4 million, despite Labour's claim that it has made 4 million additional appointments to the NHS during its time in office.
The unprecedented joint call by NHS bodies will add to already serious tensions and fighting in Whitehall over who should foot the bill for the expected double whammy of layoffs and rising drug prices.
42 NHS Integrated Care Boards (ICBs) in England were to replenish 12,500 of 25,000 employees have been laid off by the end of the year as a result of cuts in health care costs, and Donald Trump's desire to reduce prices in the US It is expected that this will lead to an inevitable increase in the cost of medicines.
Reeves recently declined the request Wes StreetingThe Health Secretary has received £1.3 billion in extra funding this year so that cuts to ICB staff, which were due to be completed by Christmas, can finally begin, according to NHS sources. She offered him only half that amount, £650 million, and even that was on the condition that his Department of Health and Social Care (DHSC) agreed to cover rising drug prices.
The Chancellor and Streeting are locked in what one senior NHS figure described as a standoff over £1.3 billion. But the unknown cost of what higher drug prices would mean for the NHS is a “curve” that complicates negotiations, they added. Whitehall's behind-the-scenes row over NHS funding is “in complete disarray at the moment and needs to be resolved”, the same source said.
The two NHS organizations say the £3 billion they are seeking includes more than £1 billion to cover the cost of ICB cuts. five-day strike by resident doctors cost £300 million in July, and that higher drug prices could lead to the NHS having to pay a further £2.5 billion for life-saving drugs.
Matthew Taylor, chief executive of the NHS Confederation, said: “The threat of unbudgeted cuts, higher drug prices and renewed strikes risks undermining progress on key waiting time targets and the wider reforms needed to get the NHS back on track.”
The chief executive of one NHS trust said extra operating room listings “are the easiest thing to stop when money is tight, but they have an immediate impact on waiting times.” Hospitals will also perform fewer “procedures that affect quality of life but are not life-saving,” they said. Although the bumps are very painful for those affected, they are not a life-or-death problem, they added.
ICB shake is key radical reorganization of the National Health Service which Keir Starmer announced in March, including the abolition of the NHS in England, despite Streeting explicitly ruling out restructuring the health service before last year's general election.
Richard Sloggett, a former special adviser to the DHSC, said: “This £3bn demand from NHS chiefs is a dramatic intervention that leaves health ministers exposed. The hasty decision in March to announce a major overhaul of the NHS – with no clear funding or plans for it implementation has brought us to this point. Add strikes and rising drug prices and the government faces a real storm of challenges to its number one priority of public services.”
Daniel Elkeles, chief executive of NHS Providers, backed the £3 billion demand. “As the government prepares its budget, now is the time for an honest assessment and debate about what the NHS can actually achieve this year in these challenging financial circumstances, and what is 'doable' to meet ministers' ambitions in their 10-year health plan,” he said.
Conservatives criticized Streeting for stalled ICB reform. Last week in the House of Commons, Shadow Health Secretary Stuart Andrew told the deputies that Streeting “is very good at making promises, but the facts are that he is presiding over a reorganization that has stalled, creating uncertainty for staff.”
When Andrew challenged Streeting to indicate how many NHS staff would lose their jobs as a result of the restructure, the Health Secretary said only that he was aware of “a number of expressions of interest in voluntary redundancy across my department, NHS England and the ICB”.
A DHSC spokesman said: “The Government has invested a record £29 billion into our NHS (including up to £10 billion for digital and technology transformation and £750 million for an urgent overhaul), demonstrating our unwavering commitment to properly funding the health services we all rely on we rely.
“We know that unnecessary strikes will divert money, time and resources away from the front line. That's why the Health Secretary has called on the BMA to stop being selfish and start putting patients first.”
“But investment alone is not enough – it must go hand in hand with reform. That's why we are doing things differently: not just rebuilding the NHS, but pushing it forward through our efforts.” change plan. And it's already working. We have taken over 200,000 people off waiting lists, provided 5 million more appointments and GP satisfaction has finally increased.”
