In a busy week for NHS policy, the government’s have published their mandate for the health service, and operational planning guidance and priorities for the coming twelve months.
NHS Mandate
Announcing the mandate, Health Secretary Wes Streeting doubled-down on his assertion that the health service was broken, not beaten.
Mr Streeting reiterated that extra money was not the solution, stating the NHS must live within its means. Tough decisions will have to be made and local systems should feel empowered to make them.
There are five key objectives, set out in detail below:
Reform to cut waiting times
As part of delivering the Elective Reform Plan, NHS England should:
- support the NHS to ensure that trusts make progress towards the 18-week standard, by continuing to maximise elective activity, increasing diagnostic and theatre capacity, and introducing the reforms it outlines.
- empower patients with choice and control over where they receive treatment, including from the independent sector
- drive expansion of the NHS App as a key part of the drive to improve communication with patients so that individual needs are better met and patients exercise greater control over their health and care
Reform to improve primary care access
NHS England should:
- enable patients to access general practice appointments in a more timely way
- enable commissioners to tackle unwarranted variation and support improvement in general practice services, including by increased investment to deliver upgrades to GP surgeries
- ensure investment in data and digital to build a more modern and productive primary and community care sector
- develop approaches with relevant partners to improve financial flows within health and social care to provide more co-ordinated services to patients as a step towards building a new neighbourhood health service
- work through the 10 Year Health Plan process to deliver an expansion in primary and community services including dental practices and pharmacies
Reform to improve urgent and emergency care
NHS England should:
- support the NHS to reduce long wait times in urgent and emergency care settings with the aim of improving patient safety, experience and outcomes
- make progress towards reducing hospital admissions, especially with respect to emergency bed use, by taking the first steps to building neighbourhood health services
- develop new approaches to financial incentives to support urgent and emergency care performance and improve the use of resources by tackling unwarranted variation in performance
Reform to the operating model
NHS England should:
- reward the best performing NHS organisations by rewarding them with financial incentives, for example flexibilities such as more capital resources
- get ICBs focused on developing the new neighbourhood health service of the future, with stronger primary and community care services closer to home, through a renewed focus on strategic commissioning
Reform to drive efficiency and productivity
NHS England should:
- work closely with DHSC to monitor the delivery of spending plans and expected outcomes against jointly agreed metrics, across both revenue and capital funding, including with the aim of delivering a 2% productivity improvement across the NHS
- contribute to a zero-based review of spending, including in NHS England’s resources with a view to making real terms cash-releasing savings
- prioritise digital integration to promote greater efficiency within the system by allowing systems to co-ordinate more effectively to deliver better outcomes for patients
NHS Operational Planning Guidance and Priorities 25/26
This document, released by NHSE earlier this week, sets out the key priorities and expectations for Integrated Care Boards (ICBs) and trusts in the coming year. The document is closely linked to the NHS mandate, particularly the five objectives above, and reflects the government’s priorities for the health service’s activity.
NHSE Chief Executive Amanda Pritchard mirrored the Health Secretary’s language concerning the need for tough decisions and the opportunity the NHS 10-year plan presents to create an ambitious, advanced NHS fit for the future.
The seven national priority areas and success measures for 2025/26 are as follows:
- Reduce the time people wait for elective care
- Improve A&E waiting times and ambulance response times
- Improve access to general practice and urgent dental care
- Improve mental health and learning disability care
- Live within the budget allocated, reducing waste and improving productivity
- Maintain our collective focus on the overall quality and safety of our services
- Address inequalities and shift towards prevention
Within these priorities are actions which seek to improve rates of diagnosis, including a target to improve performance against the 28-day cancer Faster Diagnosis Standard to 80% by March 2026. However, other choices have drawn severe criticism from experts and charities.
The number of priorities have been reduced from 32 to 18, focussing on what matters most to patients. This means that targets such as increasing the percentage of cancers diagnosed at stages 1 and 2 in line with the 75% early diagnosis ambition by 2028 has been scrapped.
BIVDA are consistent in our advocacy that early diagnosis saves lives, improves outcomes, and increases NHS efficiency. While we welcome the retention of the pledge to continue improving the 28-day Faster Diagnosis Standard, omitting ambitions to diagnose cancer earlier is in our view an error and we call on the NHS to continue to focus on this area.
