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NHS priorities for 2025/26: our expert insights

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The NHS has published its national planning guidance for 2025/26 – an annual suite of documents that set out the national priorities and targets for local systems, alongside funding and financial planning assumptions. Against the backdrop of an extremely tight financial settlement, the focus this year is on performance recovery – bringing down the hospital waiting list, cutting long A&E wait times, and enabling more people to access GPs.

Budgets are more stretched than ever. NHS service providers are being asked to increase productivity by 4%, with a 1% reduction in cost base, which will inevitably mean cuts to spending as there is little money to invest.

It was clear that tight budgets would mean tough trade-offs had to be made about health service priorities. That might explain why the documents have been published so late, less than nine weeks ahead of the start of the new financial year.

This year’s guidance sees the number of targets slashed from 32 to 18, with casualties including dementia care, vaccinations and community waiting lists. On the positive side, this could free up local areas to focus on what matters to patients and communities in their area. But given the financial position, it is more likely that local areas will be forced to make difficult decisions about deprioritising the services that will cause least harm.

There seems little space to focus on the three big shifts that the health service needs – towards prevention, care in the community and enabling digital.

Below, our experts at The King’s Fund set out what the document tells us about NHS priorities in a range of areas and what it might mean.

NHS performance recovery

Charlotte Wickens

Charlotte Wickens photo

Following the government’s manifesto commitment and the recent elective reform plan, there are no prizes for guessing that reducing elective waits is prioritised in the planning guidance. The headline targets are that 65% of patients will wait less than 18 weeks for elective treatment by March 2026 and that every trust will need to deliver a minimum five percentage point improvement against the 18-week target by March 2026. Questions have been asked about whether that is achievable but also whether declining performance elsewhere would be accepted as the opportunity cost of this.

The guidance puts paid to some of that speculation, as alongside elective recovery the NHS is expected to deliver improvements in urgent and emergency care – with 78% of people to be seen in four hours at A&E and ambulances to respond to Category 2 calls within 30 minutes. Looking at the most recent performance data, 71% of people waited under four hours in A&E so it is no wonder that these are a roll over of last year’s targets, as they still feel stretching. With A&E’s visibly struggling to manage winter pressures, with a clear impact on patient care, despite all the talk of trade-offs this was one that Wes Streeting couldn’t countenance.

There is little to shift the sense that the NHS will be held most to account for acute performance and that restoring this is a real driving ambition.

Primary and community care

Beccy Baird

Beccy Baird Photo

In many ways there’s nothing much surprising for primary care and community services – improving access to general practice and dentistry was inevitably going to be at the top of the list for primary care.  

Although focusing on patient experience of GP access is welcome, the decision to measure patient experience of access to general practice using the ONS Health Insight Survey is concerning. We know there is huge local variation in access, particularly affecting the most deprived populations, and while this panel survey provides a national overview, it will not give the granularity of data that will allow integrated care boards (ICBs) to really understand what is happening at local level. I worry that the focus will be on improving access where it’s easiest, not where it’s most needed. 

It's good to see a commitment to improving contract oversight, commissioning and transformation for general practice, but the numbers of experienced people within ICBs available to do this are already low and will be impacted by the headcount cuts needed within ICBs. 

The focus on community services is on urgent care and response, which risks crowding out longer-term services that will help to support people at home and the aspiration to shift towards a neighbourhood health system. 

Mental health

Helen Gliburt

Helen Gilburt photo

As confirmed by the government, the commitment to the Mental Health Investment Standard remains, so that ICBs are required to increase investment in mental health in line with their overall increase in baseline allocation. What is missing is the additional percentage uplift that ICBs were required to meet that was part of the NHS Long Term Plan, which increased the share of funding for mental health services. This means that from now on any further growth in the share of funding will be at the discretion of individual ICBs.

Like other areas of care, there is a focus on operational management rather than policy ambitions for mental health services. Unwarranted variation has been a longstanding issue in mental health services and impacts the quality of care that people with mental health problems experience. Yet mental health providers have traditionally lacked the data and infrastructure to tackle this effectively, alongside a lack of consensus as to what good looks like. Without parity of capacity and capability, there is a risk that pressures to increase productivity and reduce unwarranted variation are met at the expense of ensuring that people get access to the care that meets their needs, as well as potentially compounding existing risks of poor care and safety.

Prevention and health inequalities

Ruth Robertson and Lillie Wenzel

Ruth Robertson photo

Like last year, there is a broad requirement for ICBs and providers to work to reduce health inequalities through the Core20PLUS5 approach for both adults and children. There is also some reference to preventive activity, such as ICBs delivering plans for vaccination and screening, but unlike last year’s guidance, there is no mention of moving towards WHO-recommended levels of vaccine uptake among children and young people.

The emphasis on Core20Plus5 is welcome. However, its strength is in its nuanced approach, while the guidance’s specific targets in this area are focused on clinical activity – increasing the proportion of patients with hypertension treated according to NICE guidance, and increasing the proportion of CVD (cardiovascular disease) patients whose cholesterol levels are managed in accordance with NICE guidance. Both are watered down versions of last year’s targets, with target increases no longer specified.

Lillie Wenzel photo

There is a risk that difficult decisions about prioritising resources inadvertently increase inequalities (eg, quicker appointments at independent sector providers might be more difficult for some groups to access). Our research found ICBs haven’t been held to account for delivering elective recovery inclusively, and this year’s planning guidance doesn’t give any indication of that changing. Our hope is that systems can use a new focus on local flexibility to tackle inequality, forming strong partnerships with the VCSE and local communities to understand and support groups that struggle to access care.

Overall, while the guidance’s focus on performance recovery was expected, it’s disappointing not to see an emphasis on prevention and health inequalities that matches the level of ambition set out in the health mission and the promised shift from treatment to prevention.

Workforce

Alex Bayliss

A photo of Alex Baylis

Unlike last year’s focus on improving working lives, this year the only targets for the workforce are reductions of at least 30% against current agency spend and at least 10% in the use of bank staff.

This is disappointing on two counts. First, many of the national priorities – whether improving productivity or developing neighbourhood health services – will be delivered, in practice, by supporting and trusting frontline staff to make many individually small changes, not through a few big-picture edicts from Whitehall. Not giving priority to valuing, supporting and trusting the professionalism of staff ultimately risks the NHS shooting itself in the foot.

Second, there’s evidence that happy staff are more productive staff. Again, care is needed to prioritise compassion and support in order to avoid productivity killers such as burnout, sickness absence and resignations. And we should be clear that improving productivity does not mean just asking staff to do even more, but things such as making sure they have the right equipment and facilities, and that services are designed to be easily accessible from the patient’s point of view.

Digital and technology

Pritesh Mistry

Pritesh Mistry photo

Despite the current excitement around AI there’s no AI in the planning. It is a focus on basics, on improving the foundations. The main technologies are the NHS App, Federated Data Platform (FDP), virtual wards, electronic patient records (EPRs) and electronic prescribing. These should improve both baseline digital capabilities across England and the consistency of digital functionality and so the patient experience.

Tools such as the FDP and EPRs are expected to improve productivity, but this is only possible if there is investment not just for the technology for implementation but for staff training and workflow changes as well. I expect the tougher restrictions on shifting capital to revenue funding and the unchanged revenue expenditure limit will create a challenge to the providers on their digital transformation journey. These are likely to make it harder to use capital for digital technologies, which often tend to be revenue in nature, while capping the revenue spend for digital in a climate of increasing costs.

Perhaps most importantly of all, addressing digital exclusion is part of the planning guidance. This is important to ensure that as many people as possible who want to use digital services can. It will mean providers should prioritise the time to work across organisations to address the fundamental requirements and engage in community settings to ensure digital services are designed with people to be inclusive.

Conclusion

The NHS is facing an extremely difficult challenge of trying to improve performance against key political targets, improve productivity, and change ways of working against very tight budgets. A reduction in centrally set targets may help, and local areas will have more freedom – but local leaders will be faced with some extremely difficult decisions in what looks set to be a tough year. 

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