NHS England: Improvement in the NHS - Board meeting paper (4 February 2026)

Summary

A paper has been presented to NHS England's board which sets out proposals for delivering NHSE’s improvement framework. The proposals have been developed by Sarah-Jane Marsh, national director of urgent and emergency care and operations, and Glen Burley, financial reset and accountability director.

Content

Context

1. Building on the vision of the 10 Year Health Plan and the three strategic shifts, the Medium-Term Planning Framework outlined the performance targets and requirements for NHS organisations for the three years up to 2028/29, with local leaders empowered to drive accelerated change.

2. The new NHS operating model continues to develop and refine, establishing clearer roles for organisations and systems. We are returning power to the frontline and developing a new smaller centre, creating an environment for locally led improvement and transformation. Improvement is reaffirmed as a core responsibility of providers in the operating model, and the role of regions and the centre needs to shift to support this.

3. To drive transformational change, providers will be encouraged to explore ‘big leap’ improvement initiatives across whole pathways, and in doing so will convene place partners across primary care, social care, and voluntary and independent sectors.

4. During this year, local clinical and operational teams across the NHS have demonstrated how significant improvements and leaps in performance can be achieved. The Shrewsbury and Telford Hospital NHS Trust significantly reduced waiting times for patients in planned care, achieving a 17% improvement in 18-week referral to treatment performance in one year (November 2024 to November 2025). The Trust then used productivity improvements delivered in outpatients and operating theatres to fund expansion in urgent and emergency care capacity. In addition, The Princess Alexandra Hospital NHS Trust have delivered substantial improvements in urgent and emergency care services for patients, and achieved a 23% improvement in 4-hour performance in December 2025, compared to the same month the previous year.

5. Many of the proposals in this paper have been designed by a Task and Finish Group, led by Glen Burley and Sarah-Jane Marsh, and including colleagues from regional and national improvement teams, Trust Chief Executives, and Chief Operating Officers.

See also:

• How improvement will support delivery of NHS medium term priorities (2026/27 – 2028/29)
• The Model Emergency Department: high performing urgent and emergency care pathways