• The Secretary of State for Health and Social Care said that NHS England is being "taken back into direct government control". This follows more than a decade of the NHS – via NHS England (formally, the NHS Commissioning Board) – having a degree of operational independence from the government following the 2012 Health and Social Care Act reforms. 
• This process is expected to take place over a two-year period – that is the point at which the Secretary of State for Health and Social Care, Wes Streeting, wants the process to be completed. 
• Wes Streeting has asked NHS England ‘transition’ chief executive, Sir Jim Mackey, to convene a transformation team to guide the process. There will be two clinical directors within this team – one covering primary care and another covering secondary care. 
• The Secretary of State spoke of this move being intended to "liberate" NHS staff and local NHS leaders, "setting them free" from overcentralisation. He also spoke repeatedly of giving local leaders the tools they need to deliver on the government’s three shifts for the NHS. 
• Headcount across both NHS England and the DHSC is expected to be cut by around 50% and it has been reported that the savings could release around £500 million. When combined, the two organisations have a workforce of over 18,000 staff. The Secretary of State would not be drawn at this stage on how this will be cut across the two organisations: this will be worked through by the transformation team. 
• The Secretary of State spoke of this reform being "the biggest decentralisation of power in the history of the NHS", but the implications for frontline NHS organisations are not yet clear. The only clarity we have at this stage is that integrated care boards will need to reduce their running costs by 50% by Q3 2025/26, and that provider trusts will need to make further reductions in their corporate costs. 

• Reduce the time people wait for elective care, improving the percentage of patients waiting no longer than 18 weeks for elective treatment to 65% nationally by March 2026, with every trust expected to deliver a minimum 5% point improvement. Systems are expected to continue to improve performance against the cancer 62-day and 28-day Faster Diagnosis Standard (FDS) to 75% and 80% respectively by March 2026.
• Improve A&E waiting times and ambulance response times compared to 2024/25, with a minimum of 78% of patients seen within 4 hours in March 2026. Category 2 ambulance response times should average no more than 30 minutes across 2025/26.
• Improve patients’ access to general practice, improving patient experience, and improve access to urgent dental care, providing 700,000 additional urgent dental appointments.
• Improve patient flow through mental health crisis and acute pathways, reducing average length of stay in adult acute beds, and improve access to children and young people’s (CYP) mental health services, to achieve the national ambition for 345,000 additional CYP aged 0 to 25 compared to 2019.

In delivering on these priorities for patients and service users, ICBs and providers must work together, with support from NHS England, to:

• Drive the reform that will support delivery of our immediate priorities and ensure the NHS is fit for the future. For 2025/26 we ask ICBs and providers to focus on:
• Reducing demand through developing Neighbourhood Health Service models with an immediate focus on preventing long and costly admissions to hospital and improving timely access to urgent and emergency care.
• Making full use of digital tools to drive the shift from analogue to digital.
• Addressing inequalities and shift towards secondary prevention.
• Live within the budget allocated, reducing waste and improving productivity. ICBs, trusts and primary care providers must work together to plan and deliver a balanced net system financial position in collaboration with other integrated care system (ICS) partners. This will require prioritisation of resources and stopping lower-value activity.
• Maintain our collective focus on the overall quality and safety of our services, paying particular attention to challenged and fragile services including maternity and neonatal services, delivering the key actions of ‘Three year delivery plan’, and continue to address variation in access, experience and outcomes.

• Empowering patients by giving them more choice and control, and by establishing the standards they can expect to make their experience of planned NHS care as smooth, supportive and convenient as possible.
• Reforming delivery by working more productively, consistently – and in many cases differently – to deliver more elective care.
• Delivering care in the right place to make sure patients receive their care from skilled healthcare professionals in the right setting.
• Aligning funding, performance oversight and delivery standards, with clear responsibilities and incentives for reform, robust and regular oversight of performance, and clear expectations for how elective care will be delivered at a local level.

• Over the past 9 years, the cost of occupancy – the total expenses associated with occupying and operating buildings – across NHS secondary care has fallen by £0.24 billion, from £12.2 billion in 2014/15 to £11.9 billion in 2022/23 (in 2022/23 values).
• The number of patients using these facilities each year has increased by 13.8 million, from 123.9 million in 2014/15 to 137.7 million in 2022/23.
• The non-clinical occupied floor area has dropped from 44% to 33% of the total estate, below Lord Carter’s 35% target. With the integration of new technologies and modern working methods, trusts are aiming to further reduce non-clinical space to below 30%.
• The amount of floor area used for each patient attendance has decreased by 7% in the same period, contributing to the lower overall occupancy costs.
• Under-utilised occupied floor area has dropped to 1.9% from 4.4% in 2014/15.
• More than 1,850 energy efficiency schemes have been implemented since 2018/19. 81 new combined heat and power (CHP) units have been installed and 47% of the estate is now using LED lighting.
• Estates and facilities management teams have reduced the ongoing cost of their services by 17% (£2.24 billion or £16 per attendance).

1. Developing a supportive, learning environment and just culture in primary care, with sharing across the system so that the services can continually improve.
2. Ensuring that the safety and wellbeing of patients and staff is central, and that our approach to managing safety is systematic and based on safety science and systems thinking.
3. Involving patients in the identification and co-design of primary care patient safety ambitions, opportunities and improvements.

This strategy seeks to continuously improve patient safety through existing processes and structures as much as possible, rather than adding work. The timeframes for the implementation of the local commitments are intentionally flexible to allow for the piloting of different approaches, and, while this strategy is for all areas of primary care, some improvements will be implemented first in general practice and the successes and learning then used in the rollout to community pharmacy, optometry and dental services.

In summary:

• Safety culture: participate in the NHS staff survey.
• Safety systems: complete patient safety syllabus training.
• Insight: register for and use the new incident recording (LFPSE) and incident response (PSIRF) systems.
• Involvement: identify patient safety leads and lay patient safety partners.
• Improvement: review and test patient safety improvements in diagnosis, medication, referrals, optometry and dental services.

TES do not include spaces that are opened as part of winter pressure planning and refer to care given in any unplanned settings (such as corridors).

However, the current healthcare landscape means that some providers are using temporary escalation spaces more regularly – and this use is no longer ‘in extremis’.

The use of TES is never acceptable when caring for children.

These principles have been developed to support point-of-care staff to provide the safest, most effective and highest quality care possible when TES care has been deemed necessary.

The principles should be applied alongside any local standard operating procedures and arrangements governing flow pathways and safe staffing.

Core principles

• assessment of risk
• escalation
• wuality of care
• raising concerns and reporting incidents
• data collection and measuring harm
• de-escalation.

Related reading on the hub:

• Ending corridor care How and why to call it out
• A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift

A number of themes emerged from that work. They include:

• A variation across systems in pricing costs and models.
• A variation in the way that different health and care organisations capture patients’ language needs.
• A lack of consistency in the training needs required by interpreters and translators working in health and care organisations.

There is not a consistent approach to monitoring the quality and performance of translation and interpreting suppliers.

NHS South, Central and West CSU (SCW) is leading on the engagement to develop an Improvement Framework following this scoping exercise. NHS England are keen for your views and experiences of translation and interpreting services to support us towards this improvement journey and to enable stronger partnership working and the development of system-based approaches.

Operational and clinical excellence

• Building leadership and organisational capacity and capability to deliver improvement through NHS IMPACT as NHS England's single improvement approach for supporting systems and providers with continuous improvement. 
• Continuing to expand Getting It Right First Time (GIRFT) methodologies, which now cover more than 40 surgical and medical workstreams.
• Driving adoption of less clinically demanding treatments, such as the world-first rollout of subcutaneous immunotherapy for lung cancer that cuts treatment time by 75%.
• Continuing to tackle interventions of limited or no clinical value through the evidence-base interventions programme, a clinically-led programme led by the Academy of Medical Royal Colleges in partnership with NHS England.

A healthy motivated and engaged workforce

• Implementing the NHS Long Term Workforce Plan – listening to staff to improve, flexible working practices, optimising skills to better meet needs, developing a management culture and focus on improvement.
• Improving how we deploy our staff to meet the needs of patients and maximising the use of valuable staff time, reducing the need to rely on expensive agency staff when it can be avoided.
• Improving staff engagement and retention.

It outlines that work is underway on a detailed plan and update to cover all aspects of productivity improvement, including the following priorities:

• Focussing on health rather than illness by investing in preventative care, keeping people independent for longer and caring for people as close to home as possible.
• Embracing 21st century technology by investing in IT systems that work well for both staff and patients.
• Maximising value for money by taking action such as cutting duplication.

• Maintain collective focus on the overall quality and safety of our services, particularly maternity and neonatal services, and reduce inequalities in line with the Core20PLUS5 approach.
• Improve ambulance response and A&E waiting times by supporting admissions avoidance and hospital discharge, and maintaining the increased acute bed and ambulance service capacity that systems and individual providers committed to put in place for the final quarter of 2023/24.
• Reduce elective long waits and improve performance against the core cancer and diagnostic standards.
• Make it easier for people to access community and primary care services, particularly general practice and dentistry.
• Improve access to mental health services so that more people of all ages receive the treatment they need.
• Improve staff experience, retention and attendance.

Summary:

Further reading:

• NHS Confederation summary: 2024/25 NHS priorities and operational planning guidance
• NHS Providers briefing: 2024-25-priorities-and-operational-planing-guidance.pdf

Never Events are defined by the NHS as:

“Serious Incidents that are wholly preventable because guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers. Strong systemic protective barriers are defined as barriers that must be successful, reliable and comprehensive safeguards or remedies – for example, a uniquely designed connector that stops a medicine being given by the wrong route.”

 NHS England are holding a consultation on the current Never Events Framework following the findings of reports from the Care Quality Commission report, Opening the door to change, and the Healthcare Safety Investigation Branch’s analysis of Never Events, that highlighted for several types and sub-types of Never Events the barriers are not strong enough to make an incident wholly preventable, as well as further focus groups held by the National Patient Safety Team throughout 2021/22. 

The consultation asks whether on balance, respondents think that the Never Events framework is an effective mechanism to drive patient safety improvement; and bearing in mind the evidence in the consultation document, which one of the following options they prefer for its future.  

• Option 1: No change; continue with the current framework.
• Option 2: Abolish the Never Events framework and list.
• Option 3: Revise the list of Never Events to only include those with current barriers that are ‘strong, systemic, protective’.
• Option 4: Revise the definition of and process for Never Events to create a new system that does not require all relevant incidents to be ‘wholly preventable’.

The consultation will close at midnight on 5 May 2024.

1. Strategic management of quality - National Quality Board and NHS England guidance,

2. Operational management of quality – Independent Investigations (including Mental Health Homicides); Regulation 28 reports; Professional Standards; Controlled Drugs Accountable Officer Function; Whistleblowing and Freedom to Speak Up; Quality Accounts; Medicines Optimisation; Infection Prevention and Control and Antimicrobial Resistance.

3. Patient safety - Insight, involvement and improvement (including medical examiners, patient safety improvement priorities, Patient Safety Incident Response Framework (PSIRF), Learning from Patient Safety Events (LFPSE).

4. Experience – Improving patient, service user and unpaid carer experience of care; insight and feedback.

5. Effectiveness – National Clinical Audits; NICE technologies appraisals and guidance.

6. Safeguarding – Safeguarding Assurance & Accountability Framework (SAAF), including Child Protection information System (CPIS) which includes all children on a protection plan (CPP) and looked after children (LAC); child death overview process (CDOP); Child Safeguarding Practice Reviews (CSPRs); Domestic Homicide Reviews (DHRs); Female Genital Mutilation (FGM); Prevent & Counter Terrorism and Modern Slavery & Human Trafficking; Serious Violence Duty.

7. Mental health, learning disabilities and autism.

By significantly expanding domestic education, training and recruitment, we will have more healthcare professionals working in the NHS. This will include more doctors and nurses alongside an expansion in a range of other professions, including more staff working in new roles. This Plan sets out the path to:

• Double the number of medical school training places, taking the total number of places up to 15,000 a year by 2031/32, with more medical school places in areas with the greatest shortages, to level up training and help address geographical inequity. To support this ambition, we will increase the number of medical school places by a third, to 10,000 a year by 2028/29. The first new medical school places will be available from September 2025.
• Increase the number of GP training places by 50% to 6,000 by 2031/32. We will work towards this ambition by increasing the number of GP specialty training places to 5,000 a year by 2027/28. The first 500 new places will be available from September 2025.
• Increase adult nursing training places by 92%, taking the total number of places to nearly 38,000 by 2031/32. To support this ambition, we will increase training places to nearly 28,000 in 2028/29. This forms part of our ambition to increase the number of nursing and midwifery training places to around 58,000 by 2031/32. We will work towards achieving this by increasing places to over 44,000 by 2028/29, with 20% of registered nurses qualifying through apprenticeship routes compared to just 9% now.
• Provide 22% of all training for clinical staff through apprenticeship routes by 2031/32, up from just 7% today. To support this ambition, we will reach 16% by 2028/29. This will ensure we train enough staff in the right roles. Apprenticeships will help widen access to opportunities for people from all backgrounds and in underserved areas to join the NHS.
• Introduce medical degree apprenticeships, with pilots running in 2024/25, so that by 2031/32, 2,000 medical students will train via this route. We will work towards this ambition by growing medical degree apprenticeships to more than 850 by 2028/29.
• Expand dentistry training places by 40% so that there are over 1,100 places by 2031/32. To support this ambition, we will expand places by 24% by 2028/29, taking the overall number that year to 1,000 places.
• Train more NHS staff domestically. This will mean that we can reduce reliance on international recruitment and agency staff. In 15 years’ time, we expect around 9– 10.5% of our workforce to be recruited from overseas, compared to nearly a quarter now.

Retain – Embed the right culture and improve retention

By improving culture, leadership and wellbeing, we will ensure up to 130,000 fewer staff leave the NHS over the next 15 years. We will:

• Continue to build on what we know works and implement the actions from the NHS People Plan to ensure the NHS People Promise becomes a reality for all staff by rolling out the interventions that have proven to be successful already. For example, ensuring staff can work flexibly, have access to health and wellbeing support, and work in a team that is well led.
• Implement plans to improve flexible opportunities for prospective retirees and deliver the actions needed to modernise the NHS Pension Scheme, building on changes announced by the government in the Spring Budget 2023 to pension tax arrangements, which came into effect in April 2023.
• From autumn, recently retired consultant doctors will have a new option to offer their availability to trusts across England, to support delivery of outpatient care, through the NHS Emeritus Doctor Scheme.
• Commit to ongoing national funding for continuing professional development for nurses, midwives and allied health professionals, so NHS staff are supported to meet their full potential.
• Support the health and wellbeing of the NHS workforce and, working with local leaders, ensure integrated occupational health and wellbeing services are in place for all staff.
• Explore measures with the government such as a tie-in period to encourage dentists to spend a minimum proportion of their time delivering NHS care in the years following graduation.
• Support NHS staff to make use of the change announced in the Spring Budget 2023 that extended childcare support to working parents over the next three years, to help staff to stay in work.

Reform – Working and training differently

Working differently means enabling innovative ways of working with new roles as part of multidisciplinary teams so that staff can spend more time with patients. It changes how services are delivered, including by harnessing digital and technological innovations. Training will be reformed to support education expansion. It will:

• Focus on expanding enhanced, advanced and associate roles to offer modernised careers, with a stronger emphasis on the generalist and core skills needed to care for patients with multimorbidity, frailty or mental health needs. This includes setting out the path to grow the proportion of staff in these newer roles from around 1% to 5% by the end of the Plan by:  Ensuring that more than 6,300 clinicians start advanced practice pathways each year by 2031/32. We will support this ambition by having at least 3,000 clinicians start on advanced practice pathways in both 2023/24 and 2024/25, with this increasing to 5,000 by 2028/29. We will increase training places for nursing associates (NAs) to 10,500 by 2031/32.
• We will work towards this by training 5,000 NAs in both 2023/24 and 2024/25, increasing to 7,000 a year by 2028/29. By 2036/37, there will be over 64,000 nursing associates working in the NHS, compared to 4,600 today. o Increasing physician associate (PA) training places to over 1,500 by 2031/32. In support of this, around 1,300 physician associates (PAs) will be trained per year from 2023/24, increasing to over 1,400 a year in 2027/28 and 2028/29, establishing a workforce of 10,000 PAs by 2036/37.
• Grow the number and proportion of NHS staff working in mental health, primary and community care to enable the service ambition to deliver more preventative and proactive care across the NHS. This Plan sets out an ambition to grow these roles 73% by 2036/37.
• Work with professions to embrace technological innovations, such as artificial intelligence and robotic assisted surgery. NHS England will convene an expert group to identify advanced technology that can be used most effectively in the NHS, building on the findings of the Topol Review.
• Expand existing programmes to demonstrate the benefits of generalist approaches to education and training and ensure that, at core stages of their training, doctors have access to development that broadens their generalist and core skills.
• Work with partners to ensure new roles are appropriately regulated to ensure they can use their full scope of practice, and are freeing up the time of other clinicians as much as possible – for example, by bringing anaesthesia and physician associates in scope of General Medical Council (GMC) registration by the end of 2024 with the potential to give them prescribing rights in the future.
• Support experienced doctors to work in general practice under the supervision of a fully qualified GP. We will also ensure that all foundation doctors can have at least one four-month placement in general practice, with full coverage by 2030/31.
• Work with regulators and others to take advantage of EU exit freedoms and capitalise on technological innovation to explore how nursing and medical students can gain the skills, knowledge and experience they need to practise safely and competently in the NHS in less time. Doctors and nurses would still have to meet the high standards and outcomes defined by their regulator. •
• Support medical schools to move from five or six-year degree programmes to four-year degree programmes that meet the same established standards set by the GMC, and pilot a medical internship programme which will shorten undergraduate training time, to bring people into the workforce more efficiently so that in future students undertaking shorter medical degrees make up a substantial proportion of the overall number of medical students.
• The Plan is based on an ambitious labour productivity assumption of up to 2% (at a range of 1.5–2%). This ambition requires continued effort to achieve operational excellence, reducing the administrative burden through technological advancement and better infrastructure, care delivered in more efficient and appropriate settings (closer to home and avoiding costly admissions), and using a broader range of skilled professionals, upskilling and retaining our staff. These opportunities to boost labour productivity will require continued and sustained investment in the NHS infrastructure, a significant increase in funding for technology and innovation, and delivery of the broader proposals in this Plan.

• Priority 1: cut NHS waiting lists and recover performance.
• Priority 2: support the workforce through training, retention and modernising the way staff work.
• Priority 3: deliver recovery through the use of data and technology.
• Continue work to deliver the NHS Long Term Plan to transform services and improve outcomes.

Information about the delivery and continuous improvement review.

Resources and materials

Access improvement resources including good practice pathways and guidance documents.

Real-time data

Access real-time data to support improvement activities.

Urgent and emergency care improvement

These resources provide guidance and support to drive continuous improvement in urgent and emergency care services.

Elective care improvement

These resources provide guidance and support to drive continuous improvement in elective care improvement.

Primary care improvement

These resources provide guidance and support to drive continuous improvement in primary care improvement.