End of year message to NHS leadership
Jim Mackey, Chief Executive, NHS England
We’re heading towards the end of 2025, and it’s been quite the year.
Since taking up this role in April, I have been committed to empowering local leadership to drive forward the change we need to see, and together we have delivered a huge amount.
We have made genuine progress, navigated some significant challenges, and made a real difference to our staff and patients.
Whilst we have tried to create the right environment for this at a national level, it is the local leadership that has been on display up and down the Country that has enabled this. Local leaders taking on the personal responsibility for bringing back financial and operational discipline, reducing waiting lists, balancing the books, and putting the 10 Year Health Plan into action, all against the backdrop of re-organisation and headcount reduction.
This edition of the Month is designed to celebrate this. Alongside the usual updates from the team, you can also see some examples of this local leadership in action across the NHS, whether that be reducing out of area placements for mental health service users or working together with local partners to take a whole system approach to change.
It is this local leadership that gives me the most optimism heading into the New Year.
The headline challenges haven’t gone away – managing performance, money and industrial relations will all still be with us in 2026. However, if we can continue the momentum we have built over the past few months into next year, then I know we will come out of this in a much stronger place. The shift in public satisfaction with primary care should also give us heart that we can rebuild our connection with the public – such a key issue for us in the NHS.
I have written separately to all NHS staff to thank them for their efforts this year.
To all those working in leadership roles, you also have my personal gratitude and appreciation for everything you have done so far throughout this financial year. Give yourself some time to reflect on what you’ve achieved, as it is genuinely remarkable. We’ll all need to come back refreshed and ready to redouble our efforts in the new year. When I’ve felt most challenged, I’ve spent time with many of you and it’s re-energised my batteries because I can see what you are delivering and the power of local partnerships and energy. This year has only been possible because of you, and I look forward to continuing our improvement journey together in 2026.
Local leadership in action
Local leadership has been behind many of the improvements we have seen in the NHS this year.
Across the country, and in all parts of the system, colleagues stood up to be counted in driving the changes we need to see for our patients and staff.
In the following short video case studies, you can hear from just some of our local leaders on the changes they have been delivering.
The Royal Free London NHS Foundation Trust have been unapologetically ambitious in their drive to improve cancer performance. Listen to Dr Roopinder Gillmore, Consultant Medical Oncologist and Peter Landstrom, Chief Executive, describe the changes they have made.
Rob Aitchison, Chief Executive of Calderdale and Huddersfield NHS Foundation Trust, describes how they are leading with hope to make improvements across the Trust’s hospital and community services.
Torbay and South Devon NHS Foundation Trust made significant improvements in their performance over a 5 month period. Chief Executive Joe Teape describes how.
West Herts Teaching Hospitals NHS Trust have delivered major improvements this year: they are the second most improved Trust for 18 week referral to treatment performance, have eliminated their 65 week waits and have also made significant progress in their UEC performance. Hear from Chief Executive Matthew Coats about their journey.
Hear from Jonathan Brotherton, Chief Executive of University Hospitals Birmingham NHS Foundation Trust about the work they have done to achieve one of the best elective recovery positions in the country, including through the use of advice and guidance.
Greater Manchester Mental Health NHS Foundation Trust have placed a real emphasis on reducing out of area placements for their service users. Hear from David Warhurst, Chief Finance Officer, about how they have done this.
Financial discipline has been central to our improvement across the NHS this year. Hear from Dr Nick Broughton, Chief Executive NHS Buckinghamshire, Oxfordshire and Berkshire West ICB, about how they have turned around their position.
Jo Williams, Group Chief Executive of The Shrewsbury and Telford Hospital NHS Trust talks about how the Trust went from being in a very challenged position to delivering the most improved position on electives in the country through owning their own narrative and taking a whole-organisation approach to change.
Delivering a modern commissioning future
Glen Burley, Financial Reset Director and Accountability Director
Last month I was pleased to share the new Strategic Commissioning Framework—designed to support ICB leaders in driving forward a modern, outcomes-focused approach to commissioning.
Building on the Model ICB Blueprint and the 10 Year Health Plan, this framework is a critical lever for improving health outcomes and delivering greater fiscal value across systems.
The framework has landed at a challenging time for ICBs, as they focus on reshaping themselves to achieve the targeted running cost reductions, however it is designed to equip ICB leaders to deliver both these immediate changes, and embed the capabilities required for high-impact strategic commissioning over the medium term.
It is the result of extensive engagement with ICB leaders and system partners. Together, we have co-designed a practical, consistent definition of strategic commissioning, clarified the expectations of both ICBs and the Centre, and identified the key enablers for success. It also introduces an updated commissioning cycle aligned to our current priorities.
We are asking ICBs to adopt this approach as part of NHS planning for 2026/27. A baseline assessment in Q4 2026 will help identify development needs and inform local implementation. And from 2026/27, elements of the framework will be reflected in NHS England’s assessment of ICB performance.
To support this transition, a Strategic Commissioning Development Programme will launch in April 2026. Co-produced with system partners, it will build the leadership and technical capabilities needed to deliver strategic commissioning at scale.
Advanced Foundation Trusts: driving system excellence
The annual NHS Providers conference in Manchester last month was a timely platform for the Health Secretary to outline the significant progress we have made to revitalise the Foundation Trust model—essential for delivering the 10 Year Health Plan.
From April 2026, the introduction of Advanced Foundation Trusts (AFTs) will mark a step-change in provider autonomy. AFTs will benefit from greater strategic and operational freedoms, a streamlined approach to annual planning, and a regulatory relationship that recognises their strong capability and empowers their leadership teams.
This refreshed model is designed to sharpen focus on quality, deepen collaborative working, and accelerate delivery of national priorities—particularly the shift towards community-based and preventative care. Trusts will gain greater latitude to shape services and deploy resources in ways that best meet the needs of their local populations.
The first batch of high-performing trusts have been selected for assessment based on their record of delivering quality care, strong finances and effective partnerships with staff and local services. Further waves will follow, with the ambition for all NHS providers to achieve AFT status by 2035—raising standards and embedding excellence across the system.
In parallel, AFTs will be eligible for designation to hold Integrated Health Organisation (IHO) contracts, enabling them to oversee health budgets for defined populations. Where aligned with Integrated Care Board (ICB) strategies, organisations seeking IHO status will undergo additional assessment of their capability and readiness to manage population-based budgets.
As promised last month, we have launched a public consultation on the draft Guide for Applicants, which outlines the framework for assessing NHS trusts and foundation trusts for AFT status. The guide aims to balance performance levers with autonomy, incentives and rewards, ensuring the model drives improvement while maintaining accountability.
To maintain high standards, AFTs will be re-evaluated every five years—or sooner if performance concerns arise—ensuring the status remains a credible marker of excellence and a catalyst for continuous improvement
The consultation is open until 11 January 2026.
Planning for transformation: how we will support systems to deliver
Elizabeth O’Mahony, Interim Director General, Finance
As we move from vision to delivery of the 10 Year Health Plan, the Finance and Planning workstream is laying the foundations for a more sustainable, productive, and locally empowered NHS. This is about aligning our financial architecture and planning processes with the strategic shifts we are making – towards prevention, digital transformation, and care closer to home.
The Medium Term Planning Framework – and before it, the Planning Framework for the NHS in England – sets out the core principles and planning activities that systems should adopt for their own multi-year financial planning approach. It provides clarity on roles and responsibilities within the new NHS operating model and supports a shift to rolling five-year planning, enabling systems to think and act strategically over the medium term.
Our aim is to give ICBs and providers greater certainty and flexibility, as a foundation for genuinely bold thinking. Following the publication of the Medium Term Planning Framework, we have last month also published revenue/capital guidance and allocations – delivered earlier than at any point in recent history – continuing the move away from short-termism and giving hospitals and systems much greater certainty over future funding. From 2026/27, the introduction of multi-year capital budgets and a streamlined capital approvals process, will enable faster investment in the infrastructure needed to support neighbourhood health, digital transformation, and productivity improvements.
We are also reforming payment mechanisms to better support new models of care. The 2026/27 NHS Payment Scheme will include new Best Practice Tariffs, a reformed Urgent and Emergency Care (UEC) payment model, and we are working with ICBs on payment models to support neighbourhood care. These changes will reward outcomes over activity and help shift resources from acute to community settings.
Fairness and transparency are central to our approach. We are reviewing the ICB allocation formula to ensure funding reflects local health needs and health inequalities. At the same time, Deficit Support Funding will be phased out, with most providers expected to return to breakeven or surplus by 2028/29.
For ICBs and providers, the Medium Term Planning Framework is a call to action. We will work with you to develop robust five-year financial and operational plans, which embed the 2% annual productivity target, as well as deliver national priorities and reflect local needs and ambitions.
I’ve had brilliant engagement from the CFO community on these issues, because they know this isn’t just about managing budgets – it’s about enabling transformation. I look forward to working together with them and wider colleagues over the coming months to turn strategy into sustainable delivery.
Adding value through effective diagnostics
Mark Cubbon, Elective Care, Cancer and Diagnostics Director
A key part of the drive to reduce our waiting lists is to ensure that the right patients are getting the appointments, diagnostics and treatment they need.
We made great progress with validation this year ensuring that only patients that need to be are on the waiting list for care. This means staying on top of details we have on our patient records and internal datasets, communicating with patients and ensuring that we are using clinic and patient time to best effect.
Another aspect is ensuring that we are using the most appropriate tools available to diagnose patients.
Right Test, Right Time does just that. Diagnostic services are fundamental to patient care. While demand for tests continues to rise, not every referral offers clear benefits. Tests that are unlikely to change management can increase waiting times and reduce access for those who urgently need diagnostics.
Right Test, Right Time, co-developed with the Academy of Medical Royal Colleges, aims to ensure that every diagnostic test adds value. It supports clinicians to hold the right amount of risk and to request tests in line with NICE guidance. This helps improve outcomes, reduces unnecessary waits and supports more effective use of diagnostic capacity.
While royal colleges will support their members, trusts also play a key role in optimising local referral pathways, governance and culture to reinforce evidence-led testing. An exciting pioneer of Right Test, Right Time in practice comes from Leeds Teaching Hospitals NHS Trust, where a clinically led demand optimisation programme is underway. You can hear direct from the team at Leeds at a webinar on Monday 26 January 2-3pm. Have a look at the Right Test, Right Time FutureNHS page to find out more.
As we focus on ensuring appropriate use of clinical and patient time, we are also strengthening our continued growth in diagnostic capacity. We have started market engagement with industry and independent sector suppliers to establish how they can support the growth in diagnostics capacity needed to deliver the public commitments on RTT and cancer performance by March 2029. The independent sector plays, and will continue to play, an important part in creating the capacity required to deliver on our performance objectives.
A couple of months back we called upon all providers to work with their cancer alliances to review further opportunities for performance improvement across a number of cancer pathways. This month I wanted to focus attention on where efforts to improve cancer performance is working.
Colleagues at the Royal Free London NHS Foundation Trust have made consistent and impressive improvements to their cancer waiting time performance. These improvements ultimately mean many more patients are starting treatment faster, and others have cancer ruled out sooner – making a tangible difference to patient experience and outcomes.
In numbers, this means that the Royal Free has recorded the second biggest year-on-year improvement (+21 percentage points) nationally for the 62-day referral-to-treatment standard, from 52% to 73% between September 2024 and September 2025. Steady progress on the Faster Diagnosis Standard has also been made, which is equally commendable.
A refreshed approach to intellectual property in the NHS
Fiona Bride, Interim Chief Commercial Officer
Last month, the Department of Health and Social Care and NHS England, in partnership with the National Institute for Health and Care Research have published their updated intellectual property (IP) guidance for the NHS in England, replacing the 2002 document.
We know that effective IP management underpins the ability to maximise value in our organisations’ innovations by enabling them to be translated into the benefits for staff, patients, and commercial opportunities that will drive the healthcare reforms within the 10 Year Health Plan and Life Sciences Sector Plan.
We are pleased to have worked closely with government on this refreshed guidance, which brings much-needed clarity and consistency to how innovation is supported across the health service, and will help to get new treatments and technologies to patients faster.
The updated guidance outlines good practice principles, a step-by-step approach to effective IP management, and actions for organisations providing or commissioning NHS services to take. Supported by real-life case studies and exemplar templates, it aims to empower organisations to protect valuable assets and ensure innovations benefit both the NHS and the public.
The guidance is primarily intended for individuals positioned to be responsible for IP management, including those in finance, commercial, innovation, research, or executive roles.
The NHS has an exceptional record in bringing forward the latest innovations to patients, and this guidance will strengthen this further, giving clinicians, researchers and partners the confidence to progress ideas that improve care, and help to deliver the ambitions of the 10 Year Health Plan.
Please share with any colleagues who could benefit from the insight captured.
In case you missed it in November and December
Principles for providing patient care in corridors – Our guidance supports point-of-care staff in delivering the safest and highest quality care possible when corridor care has been deemed unavoidable. It replaces the Principles for providing safe and good quality care in temporary escalation spaces, published in September 2024.
NHS oversight framework – The 2025/26 Q2 segmentation results and public performance dashboard are now live, including NHS league tables for acute, mental health, community and ambulance trusts. A more detailed version is available to NHS staff via the Model Health System.
Strategic commissioning framework – As set out in the Medium Term Planning Framework, the Strategic Commissioning Framework sets out the expectations of ICBs as strategic commissioners, and what ICBs and providers can expect from us, as part of a step-by-step guide with an updated commissioning cycle. A strategic commissioning development programme to identify and build the skills and capabilities needed within ICBs for successful strategic commissioning will follow.
Ethnicity recording improvement plan – Our plan sets out targeted actions to strengthen the quality, consistency and completeness of ethnicity data recording.
The NHS Assembly: bringing different voices to the work of NHS England 2019-25 – This report provides an overview of the NHS Assembly, including its origins, membership, key achievements, and the lessons learned from its work.
Sir James Mackey and the Secretary of State addressed the annual NHS Providers Conference. You can read the Secretary of State’s speech, which included an update on advanced foundation trusts.
Financial framework and allocations – The Medium Term Planning Framework set out the ambitions and priorities for the next three years. The financial framework and allocations including the technical guidance are set out below to support the development and delivery of plans over the medium term.
Advanced foundation trusts consultation – This consultation seeks feedback on proposals for how NHS trusts and foundations trusts will be assessed for advanced foundation trust status as we reinvigorate the foundation trust model to re-empower boards and incentivise good performance, and on the additional criteria we will ask candidates for integrated health organisation designation to meet. This consultation closes at 11.59pm on Sunday 11 January.
Voluntary redundancy scheme – A national model voluntary redundancy scheme has now been agreed with the Government. Final details of this scheme, together with the accompanying technical guidance to support implementation, was shared with ICB leadership and can be found on the NHS Futures website.
Coming up
- New Years Honours (30 Dec)
- First MMRV vaccines delivered (from 1 Jan)
- DHSC: ‘Less healthy’ food advertising restrictions come into force (5 Jan)
- House of Commons and House of Lords return from Christmas recess (5 Jan)
- 1 year since Elective Reform Plan (6 Jan)
- Monthly Operational Stats (15 Jan)
Your feedback matters. Our aim is to make these bulletins as useful as possible for you. If you have any feedback, please email england.theweek@nhs.net