A new report from the Nuffield Trust highlights the challenges NHS providers are facing as they aim to close the £22bn gap by 2020, as set out in the Five year forward view. The briefing suggests that tough choices will need to be made by both commissioners and providers, and the impact of Brexit adds another layer of uncertainty.

Commenting on the briefing, Chris Hopson, chief executive of NHS Providers, said:

“This report shows that NHS trusts are now in an unsustainable position. Trust chief executives tell us they are doing all they can to deliver what is being asked of them, including greater efficiencies, but there is now a clear and widening gap between what they are being expected to deliver and the funding they are receiving. It’s time to acknowledge this gap and stop pretending that it doesn’t exist.

"We urgently need an honest and realistic plan for how the NHS will manage on the much lower funding increases the service will receive over the next few years. Increases which mean a real terms funding cut, given our growing population and growing demand. We need to be honest with the public about the consequences of the longest and deepest financial squeeze in NHS history: the NHS will be performing heroically well to just maintain existing standards of care. As the Nuffield Trust report points out, it will be particularly important to manage the expectations of a public led to believe that, post Brexit, the NHS would receive new additional investment when, in reality, we will be doing well to just preserve the standards of care we currently have.

“This report is the latest in a growing number of important, independent, pieces of evidence which show that it is systemic issues, not issues of management in individual trusts, that are driving the unprecedented number and size of NHS trust deficits. This systemic pressure, coupled with spiralling demand, rising costs and the growing gap between the money that trusts are paid to provide services and the actual costs incurred, mean that trusts are having to strain every sinew to just stay afloat.”