Classification: Official
Publication reference: PRN02028

To:

• Integrated care board:
  • chairs
  • chief executives
• NHS trust and NHS foundation trust
  • chairs
  • chief executives

cc:

• NHS England regional directors

Dear colleague,

Publication of the NHS Oversight Framework 2025/26

We have today published the NHS Oversight Framework 2025/26. 

It has been developed with the engagement and contributions from the NHS leadership and staff, representative bodies and think tanks, including through two public consultations. You said that NHS England’s approach to oversight and performance improvement needs to be consistent and our interactions coherent. I want to thank you and your teams for your contributions and engagement.

The new framework describes a consistent and transparent approach to assessing integrated care boards (ICBs) and NHS trusts and foundation trusts, ensuring public accountability for performance and providing a foundation for how NHS England works with systems and providers to support improvement.

This 1-year framework sets out how NHS England will assess providers and ICBs, alongside a range of agreed metrics, promoting improvement while helping us identify quickly where organisations need support.

The framework will be reviewed in 2026/27 to incorporate work to implement the ICB operating model and to take account of the ambitions and priorities in the 10 Year Health Plan.

The framework is supported by a focused set of national priorities, including those set out in the planning guidance for 2025/26, aiming to strengthen local autonomy. These are presented alongside wider contextual metrics that reflect medium-term goals in areas such as inequalities and outcomes. The contextual metrics do not constitute part of the score but will inform how NHS England responds to segmentation.

The NHS priorities and operational planning guidance 2025/26 made it clear that achieving a financial reset this year is a priority. The NHS must live within the budget it is allocated, reduce waste and increase productivity to deliver growth against demand. It set the expectation that every ICB and provider must deliver a balanced net system financial position in collaboration with its system partners. NHS England will identify organisations that are not performing and take quick action. Our approach to assessment will mean that unless providers are delivering a surplus or breakeven position, their segmentation will be limited to no better than 3.

Our improvement approach will be based on the results of our assessment and tailored to the support providers in each delivery segment need. Discussions about performance will be led by colleagues at NHS England who are experienced in addressing delivery challenges, with a focus on offering informed evidence and practical guidance that is grounded in a deep understanding of the operational challenges faced.

Our assessment will be the starting point for how we work with organisations throughout the year and will help us determine how we can support them to improve. We will do this by considering an organisation’s segment score, as set out in this framework, and leadership capability.

The framework outlines the circumstances in which providers can obtain increased freedoms. It also describes how we will determine whether a provider’s performance falls below an acceptable standard and/or has governance concerns that may lead NHS England to use our regulatory powers to step in and secure improvement. NHS England’s approach to the use of enforcement powers is set out in the NHS enforcement guidance.

We will not be segmenting ICBs in 2025/6, as this will be a year of significant change for ICBs as they transform in line with the Model ICB Blueprint to focus on strategic commissioning and implement plans to meet the running cost reductions. Support for ICBs this year will focus on the safe implementation of their plans. ICBs that are currently in the Recovery Support Programme will continue in this programme and will be assessed against their current improvement trajectory to agree a transition plan. This will be the equivalent to segment 5.

We will report ICB performance against the full suite of oversight metrics, but not issue a comparative rating. ICBs will still be assessed through a statutory annual assessment, which reviews how well each ICB is performing its statutory duties. Where there are performance or governance concerns, NHS England will step in and we may use our regulatory powers to secure improvement. We will introduce the segmentation approach for ICBs in 2026/27.

Thank you again for your continued work and engagement.

Yours sincerely,

Glen Burley, Financial Reset and Accountability Director