The trend of water resources and water consumption in the Haihe River Basin and three provinces (municipalities) of Beijing, Tianjin, and Hebei in the main receiving area along the middle route of the South-to-North Water Diversion Project from 2001 to 2023 was analyzed using the Mann-Kendall test. The Spearman’s rank order test was applied to analyze the correlation between the changes in agricultural, industrial, and domestic water consumption with indicators of industrial production, agricultural production, and social economy in the three provinces (municipalities) and to explore the main reasons for the changes in water consumption. The results show that the total water resources of the Haihe River Basin and the three provinces (municipalities) exhibit an upward trend from 2001 to 2023. The total water consumption of Hebei Province has a significant decreasing trend, while the total water consumption of Beijing City and Tianjin City has a significant increasing trend. Beijing’s agricultural and industrial water consumption has a significant reduction trend, with many industrial and agricultural production indicators showing a strong positive correlation, indicating that Beijing’s industrial and agricultural water consumption is mainly affected by industrial restructuring. In Tianjin, the agricultural water consumption has a significant decreasing trend and a certain positive correlation with milk production. The industrial water consumption in Tianjin shows no significant variation. In Hebei Province, the agricultural water consumption shows a significant trend of reduction and a strong positive correlation with the sown area of crops. The industrial water consumption in Hebei also shows a significant trend of reduction, which has a certain positive correlation with the proportion of GDP in the secondary industry, but the positive correlation with other indicators of industrial production is weak. The domestic water consumption in Beijing, Tianjin, and Hebei all show strong positive correlation with population size, per capita disposable income, construction output value, and GDP ratio of tertiary industry, indicating that the increase in domestic water consumption in Beijing, Tianjin, and Hebei mainly originates from the synchronized growth of population, construction, and tertiary industry.