What’s in store for health and care in 2026?

In one sense, this blog is easy to write, as there’s a lot on the health and care agenda for the coming year. Last year’s suite of big-ticket strategies and financial settlements, most notably the 10 Year Health Plan and the Comprehensive Spending Review, coupled with the decision to abolish NHS England and a whole host of other changes to the architecture of the health service in England, need operationalising. 2026 will be packed with measures to turn strategy plans and ambitious restructuring into reality.

Likewise, there’s plenty else happening across government that will impact health and care. The latest immigration measures, for example, will almost certainly put more pressure on an already depleted social care workforce in the near term. And a review to address the rising numbers of people not in education, training or work (NEET) is likely to make recommendations that span health. However, over and above the busyness of an administration attempting to get the levers of government moving faster, there are a couple of foundational questions: what does all this change add up to and will it be enough to turn the tide on a nation’s distressed health?

Public satisfaction with the NHS and social care is at its lowest recorded levels. One or two recent data points, including the latest GP and maternity surveys, show the first green shoots of improvement. Is the government’s focus on bringing down elective waits and making it easier for people to access primary care working (quickly enough), and is the public noticing?

The other big question is how much can our health and care system realistically deliver? Last year’s national conversation which preceded publication of the 10 Year Health Plan dodged this question. In an era of unprecedented medical advances and rising costs, we need a proper conversation – even if challenging – about what a taxpayer funded, free at the point of use system can realistically cover. We are nowhere near having a genuine national debate about the ability of our health and care system to meet all the demands placed on it. Instead, difficult financial decisions about the extent and quality of services provided, and to whom, are increasingly pushed down to local systems, which brings into question the national in NHS.

My previous new year blogs have begun with a paragraph about winter, and it would be remiss not to highlight the pressure our emergency departments continue to face. An early surge in flu cases meant hospitals were exceptionally busy pre-Christmas. The Royal College of Emergency Medicine, in its now annual distress call, has signalled the difficulties of continuing to manage with high bed occupancy, congested hospital flow and a continuation of corridor care. The solutions lie in more fundamental changes to the health of the population and include tackling social care reform, which I will come to.

Rewiring our health and care system

But first the business of rewiring our health and care system. This work is well underway and will continue in earnest in 2026. The big-ticket item is a new Health Bill, expected to be laid before parliament relatively early this year. This will formally abolish NHS England, making way for the transfer of functions to the Department of Health and Social Care, and cover off a range of other things such as granting new Foundation Trust powers and abolishing Healthwatch England and local Healthwatch, as detailed in previous government announcements and the Dash Review.

The government wants to move at pace, not least to help meet its own deadline of abolishing NHS England by April 2027. It also wants the legislation to be enabling and simplifying, keeping the primary legislation light and dealing with more detailed changes in secondary measures. History shows this approach may be harder to achieve in practice. Health legislation of a general nature will be pored over by parliamentarians, and they won’t appreciate attempts to use Henry VIII powers (clauses in a bill that enable ministers to amend or repeal provisions in an Act of Parliament using secondary legislation which is subject to less scrutiny) for much of the substance. There is a big risk that the bill creates a contradictory narrative to the one the government has been trying to cede. Legislation that gives the Secretary of State more direct powers and disbands the organisations currently charged with collecting independent patient feedback sounds at odds with an ambition to empower patients and end micromanagement of the NHS from Whitehall.

Meanwhile, reorganisation is already happening, with agreement at the Budget to re-profile health spending allowing local health systems to fund the redundancy pay offs created by Integrated Care Board mergers and cuts. The opportunity cost of large-scale reorganisation is not clear, but neither is it negligible, as staff are naturally anxious about their jobs and spending many hours re-wiring services, fatigued by previous changes. The hope of health leaders is that we end up with a genuinely leaner centre and more efficient local health system leadership.

Elsewhere, work is well underway to bring 10 Year Health Plan ambitions to life. Watch out for an impact assessment, sorely lacking at time of publication, that more clearly sets out the economic and policy effects of the plan. A raft of documents are due for publication to help bring headline measures to life, including a Model Neighbourhood Framework, an Integrated Health Organisation blueprint, Foundation Trust framework and an AI procurement framework. Payment reform, a key lever to shift resources and delivery of care, will be taken forward with a new urgent and emergency care payment model and best practice tariffs introduced for 2026/7 onwards. New GP contracts, for single and multiple neighbourhood providers, are expected to be rolled out this year too.

There are plans for improving patient pathways and services in gestation. I have written about the opportunity a new Cancer Plan presents, due for publication early this year. This will be accompanied by the first raft of new Modern Service Frameworks in CVD, mental health and sepsis. An updated Quality Strategy, informed by the Dash Review, and the revamped National Quality Board, is also due for publication in the first half of the year.

I will be watching particularly closely for the updated Workforce Plan. Expect a clear break from the past, where increased staff numbers were seen as key to recovery and revitalisation of the service. The mood music has shifted significantly. Ongoing concerns about productivity and affordability, as well as opportunities afforded by technology including AI, mean we can expect a different sort of plan, more focused on improving ‘the deal’ and working conditions of our 1.5 million health workers.

The obvious question surrounding many of the plans and implementation documents is what resource accompanies them, to drive delivery and do things differently? And if not new money, how can existing resource be re-purposed, something that’s notoriously difficult to release.

What’s likely to make the headlines?

Resident doctor industrial action made headlines at the close of 2025. With no end to the dispute in sight, and the BMA re-balloting members to cover the first half of this year, we can expect more strikes. Other healthcare professional groups, including nurses, will be watching closely. The independent maternity and neonatal investigation is expected to publish initial findings in February and a final report in the spring. Whether this review can tackle systemic issues leading to harrowing accounts of mothers ignored and avoidable baby deaths remains to be seen.

Reform of the SEND system, with plans to scale down legal rights of children with less severe needs, will garner plenty of media and political attention, with potential for a backbench rebellion as the government pursues changes to the current creaking system.

What should be making more headlines is the crisis occurring in our social care system. Tales of rationed care – leading to inadequate support for people in need and distress for loved ones navigating a bureaucratic system – are replacing access to primary care as the top concern I hear about from colleagues, friends and family. Just one particularly upsetting case I was told last week involves an older, doubly incontinent and confused man being told he has the ‘capacity’ to return home after a lengthy hospital stay which the family know is a non-starter. This is not an unfamiliar story and experiences like it are causing untold stress across the country. The changes to UK visa and settlement rules – including the proposed changes on the qualifying period for indefinite leave to remain – are expected to come into force this spring, don’t require an act of parliament, and will make the workforce situation in social care worse.

The Casey Commission is due to publish a Phase 1 report at some point this year. This will be important to sustain the confidence of a broad and complex social care sector and a public increasingly appalled at patchy provision and at times a cruel system. DHSC also published priorities for local authorities 2026-7 just before Christmas which should stabilise the situation, although as my colleague Simon Bottery argues, running an unfair system more effectively doesn’t make it a fair system.

There’s plenty on the parliamentary timetable too. The Assisted Dying Bill is stuck in the Lords and garnering strong representations on both sides. The Tobacco and Vapes Bill is similarly completing its parliamentary journey and remains the flagship public health measure of a government that’s had less to say on improving the health of the nation than many hoped. Having said that, the junk food restrictions on advertising to children came into effect earlier this week, and though delayed and slightly watered down, are welcome as part of the plan to tackle high levels of childhood obesity.

There are several cross-government changes that could begin to impact health and care in 2026. The two-child benefit limit will be removed in April. This will help reduce childhood poverty, a big driver of health inequalities and poor health in early years. The English Devolution and Community Empowerment Bill will introduce a new legal requirement for Strategic Health Authorities to ‘have regard’ to the need to improve the health of people and reduce health inequalities in their areas. It will be interesting to watch how health leaders use the shifting sands in local government and the NHS to drive health improvements on the ground.

Key takeaways

The government has made improving NHS performance, and the nation’s health, key to its success or otherwise. It can’t achieve all its ambitions (for example, all the measures cited in the medium-term planning framework) and there will have to be trade-offs. Many targets are extremely ambitious and progress towards them to date has been slow. Can the government demonstrate the strategy is beginning to work and public satisfaction with the NHS is ticking up? The government may also wish to focus on quicker wins and has signalled a focus on improving the NHS app as one of these. They would be wise to broaden this to tackle poor patient administration and better coordination of care too, something we believe contributes to patient experience and satisfaction. Together with colleagues at the Nuffield Trust, we will publish our annual analysis of the latest public satisfaction figures in March.

The May local elections will be key for the Prime Minister’s future, which looks increasingly uncertain. Ambitious cabinet ministers, Wes Streeting high on the list, will be keeping an eye on the big picture as they try to drive improvements in their departments.

And lastly, I want to be hopeful. As I’ve travelled the country the past year, visiting different health and care settings, I’ve witnessed fantastic innovation and commitment to deliver better joined up, compassionate, high quality care for all. I’m hopeful that the landscape helps, rather than hinders, skilled staff to do the jobs they came into the NHS and social care to do.