NHS Confederation—2025/26 NHS priorities and operational planning guidance: what you need to know (30 January 2025)

Summary

Summary and analysis of NHS England’s 2025/26 priorities and operational planning guidance.

Content

Key points

• On 30 January 2025, NHS England published its operational planning guidance for 2025/26, outlining the priority areas and objectives for the service. This is the first planning guidance since the government was elected in July 2024.
• The 2025/26 NHS Planning Guidance sets out clear priorities to: (1) continue to reduce elective care waiting times, with 65% of patients waiting less than 18 weeks; (2) improve ambulance response and A&E waiting times, with a minimum of 78% patients seen within four hours, (3) improve patients’ access to general practice (GP) and urgent dental care access, including 700,000 additional urgent dental appointments; and (4) accelerate patient flow in mental health crisis and outpatient care pathways. 
• It sets a path for reform through development of neighbourhood health services models to prevent admissions and improve access to care. It also asks systems to improve productivity to balance system budgets and improve quality and safety of services, particularly maternity and neonatal services. 
• Fewer national priorities – just 18 headline targets (excluding other ‘requirements’), down from 31 last year and 133 as recently as 2022/23 – gives welcome focus and clarity. More funding and decision-making is devolved to systems, letting local leaders lead. Lifting most ring-fences will give them agency to innovate and use scarce resources to best effect. NHS England and the government commit to back local leaders to make difficult decisions, including reducing or stopping lower-value activity.
• The finances remain very difficult and will be incredibly stretching. Despite a 4% spending uplift at the budget, this will feel more like 2% real-terms increase for most systems once particular cost pressures are accounted for. Crucially, to balance the books, providers are asked to make eye-watering 4% efficiency savings – before new local pressures are accounted for. This is almost double last year’s 2.2% target and more than four times the NHS’s historical rate of productivity growth at 0.9%. Systems will have to make tough and unpopular decisions over service provision, closing some relatively lower value services to balance the books. 
• Balancing reform and recovery will be key. The guidance is more about recovery than reform, but putting the NHS on sustainable path will require more radical reform and transformation to deliver the three shifts. The ten-year health plan will need to work out how to do recovery and reform at the same time.