Update from Sir James Mackey, Chief Executive, NHS England

Welcome to this edition of The Month.

The big moment since the last edition is the publication of the new National Cancer Plan.

The Plan sets out a bold, long-term approach to improving cancer outcomes, experience and equity over the next decade – modernising our approach to cancer care and improving performance, so we meet the cancer waiting time standards by the end of this Parliament.

Most importantly, it includes how we will improve survival – so that, by 2035, 3 in 4 people diagnosed with cancer will be cancer-free, or living well with cancer, after 5 years – as well as improve quality of life for people living with the disease.

Achieving the commitments set out in the plan will require big leaps rather than incremental change. But it’s big leaps we should now be in the market for as the NHS leadership community – not just in cancer but across all key service areas.

Everything we’ve done over the last 9 months has been about creating the launchpad for you as local leaders to make those big leaps – both fixing the fundamentals through our new operating model and financial reset and – even more importantly – reigniting the ambition and belief at all levels of the NHS that will push us on to achieve the standards of access, quality and experience our patients want and need.

And we’re already seeing examples of big progress coming through, which we highlighted when we brought CEOs and primary care leaders together on 27 January.

On finance, our reset is holding; we are broadly balanced at Month 9, improving productivity, and have achieved £1 billion+ savings from agency and bank reductions – with a number of organisations achieving 75% reductions in agency spend.

On electives, in some providers, we are seeing up to 33% reductions in waiting lists alongside ~33% improvement in referral to treatment (RTT), delivered within the financial plan.

In primary care, we’re running at 8.5 million more GP appointments year on year, 7.4 million online consultation requests in November alone (63% up year on year), and the proportion of patients reporting that they found it easy to access general practice is now 75.5% and improving.

And in urgent and emergency care (UEC), operational performance has held under extreme pressure; Category 2 ambulance response times reduced by around 15 minutes during peak winter compared to last year, demonstrating what focused grip and cross-organisational working can deliver. In part, that will be thanks to the fact every region has improved flu vaccine delivery, including increasing the proportion of frontline healthcare workers who have had their jab.

There are some big pieces of work still to do – not least in the UEC pathway and tackling corridor care. We brought together stakeholders and trust leaders to discuss solutions at our event late last month, and we’ll be saying more on a specific plan soon. And you’ll see we have now published the Model ED which a number of you worked with us on.

At national level, we also want to make progress on key enabling issues, such as a leadership development offer that’s fit for purpose, clearer expectations and support from the centre to deliver, and a more coherent approach to measuring and improving both patient and staff experience.

On the latter point, that will be building on the progress Meghana outlines below on the 10 point plan for resident doctors, and recognising – as the most recent ballot from the British Medical Association (BMA), and our staff survey results tell us – that we have a lot of work to do to ensure staff aren’t just getting behind the changes we need to deliver, but are actively leading them.

If we can do that, and continue to fix those fundamentals, it will put us in the best possible position to make the big leaps we want to make and we can see coming through in system plans for the next 3 years – whether that’s finally reforming outpatients, building the new neighbourhood health service, or maximising the potential of the NHS App and wider technology to both improve our offer to patients and increase productivity.

Before all that of course we’ve got the usual sprint to the finish line at the end of March to do as well as we can on our key performance measures. I know loads of people will be working incredibly hard to do that, and have been working incredibly hard over winter, so thanks again, and let’s carry on.

Delivering a big leap on cancer care and outcomes – Mark Cubbon

Over the past year, thanks to your efforts, we have seen significant progress on recovering cancer performance.

More than 227,000 additional people received a diagnosis or all-clear within 28 days of referral, and 38,000 more started timely treatment compared to the previous year.

Early diagnosis rates have reached record highs, and patient experience scores remain strong, reflecting the dedication of our staff.

There is a lot to be proud of, but equally a lot we can and should do better – not least on early diagnosis and survival rates, where we lag comparable countries, and on the inequalities that exist in access and outcomes.

Patients have been clear with us over the development of this plan what matters to them. They want quicker diagnosis; to know they are being offered the best possible treatment backed by the latest research; and to get the holistic support they need to live well with cancer. 

The National Cancer Plan sets out how the NHS will work to meet those expectations over the coming decade – as well as welcome broader action to make England a world-leader for cancer survival.

Innovation will play a central role, whether in expanding diagnostic capacity, rolling out AI and proven technologies, data-driven performance improvement, or partnering with industry and researchers to deliver faster and fairer access to cutting edge trials.   

But the key driver of success of this Plan will be strong collective leadership to deliver better access, quality and experience right the way from first contact with primary care or screening services, through diagnosis and treatment, and beyond.

Every part of the NHS can make a contribution to realising the goals set out in this Plan, and the work you are putting in now both to recover performance and put the 10 Plan into action through the three shifts – hospital to community, analogue to digital, sickness to prevention – will provide a vital foundation to build on.

By planning and working together – galvanising our colleagues and teams to get behind the exciting ambitions for patients – we can multiply our impact, achieve the big leaps forward we need to achieve, and in doing so save and improve millions of lives over the next decade and beyond.

Nationally we will oversee the implementation of the Plan through the National Cancer Board, and we encourage all organisations to review the plan and consider the implications and opportunities to support and own delivery locally.

The National Cancer Plan – brief guide

The National Cancer Plan sets out how we will improve performance, so we meet the cancer waiting time standards by the end of this Parliament. The Plan illustrates how we will improve survival. Our headline ambition is that, by 2035, 3 in 4 people diagnosed with cancer will be cancer-free, or living well with cancer after 5 years. Finally, the Plan will improve quality of life for people being diagnosed with, treated or living with cancer.

In support of this, key commitments in the Plan include:

• We will roll the Lung Cancer Screening programme out nationally by 2030 and increase the sensitivity of bowel cancer screening, catching thousands of cancers earlier and saving thousands of lives.
• We will deliver 9.5 million additional tests by 2029 through our £2.3 billion investment in diagnostics and ensuring as many CDCs as possible are fully operational and open 12 hours a day, 7 days a week.
• Cancer care will be designed around patients’ lives with every patient being offered a personalised cancer plan, covering their diagnosis and treatment as well as wider physical, mental health and social needs. Every patient will also have a named neighbourhood cancer lead to coordinate their care after treatment.
• We will prioritise access to specialist treatment for patients with rare cancers and improve approaches to quality monitoring. We will establish clear quality standards for cancer delivery through cancer manuals, published by tumour type.
• Children and young people with cancer and their families will get better support, including costs for travelling for cancer care paid for by the NHS.
• We will develop locally targeted campaigns to improve the awareness of cancer risk factors, reduce the gap in screening uptake and address barriers to early diagnosis in underserved communities. We will also publish regular data and assess our performance to ensure we are reducing the gap in rates of early diagnosis between the most and least deprived areas.
• We will appoint a national lead for rarer cancers and ensure we drive up survival rates to match the top nations in Europe, as well as making rarer cancers a priority for research.
• We will prevent as many cancers as we can by cracking down on illegal underage sunbed use, eliminating cervical cancer through HPV vaccination, as well as tackling obesity and creating the world’s first smoke-free generation.
• By 2028, the NHS App will be the front door for cancer care, allowing patients to manage screening invitations, appointments, and treatment plans. By 2035, it will bring together genomic and lifestyle data with the single patient record to provide personalised risk profiles and prevention advice.
• A new cancer trials accelerator will make the NHS the first-choice partner for cancer clinical trials. We will increase recruitment to clinical trials, particularly for patients with rarer cancers, from poorer areas, and from ethnic minority groups, who have been less able to join clinical trials in the past.
• More patients will be able to access genomic testing, both to find more people with a higher inherited risk of cancer and so that every patient that needs a genomic test to support treatment gets one.
• Focused on partnership, we will work with academia and life sciences to drive innovation and expand access to clinical trials, as well as charities, pension funds, social enterprise and wider civil society to deliver more for cancer patients.
• We will prioritise improvement in the most challenged trusts through intensive support and by giving them the data and digital tools to improve. We will also use the five big bets of the 10 Year Health Plan to free up capacity and give staff more time to care.

Progress on a new approach to quality – Professor Meghana Pandit, National Medical Director

Since my October update on quality, our focus has shifted from setting priorities to delivering improvements across the service.

Firstly, as many colleagues will hopefully have seen already, we completed the national launch of the Maternity Outcomes Signal System last year, along with implementation guidance, which will help rapidly identify potential safety issues so any necessary improvements to care can be made.   

More broadly, the revamped National Quality Board has now met 3 times, with an early focus on shaping a shared definition of high-quality care: care that is safe, effective, and provides a positive experience for patients, delivered inclusively and sustainably. This definition is an important basis for the new National Quality Strategy, which is now nearing completion. This strategy will aim to support teams working in every part of the NHS to deliver improvements, including through:

• stronger leadership, clearer roles and responsibilities, and more effective quality governance, including streamlined regulation
• harnessing rigorous use of data, transparency, technology, and embedded research and innovation to support continuous improvement
• value-based commissioning, a better understanding of performance and outcomes, and aligned incentives to ensure the NHS’ finite resources are deployed where they can deliver most value for patients and communities

In addition to the National Quality Strategy – and work in train on patient safety and experience – we are continuing to develop modern service frameworks in priority clinical areas. The first wave, covering cardiovascular disease, severe mental illness, and sepsis, is on track for publication in the coming weeks, with a second wave underway for children and young people, frailty, dementia, and end-of-life care.

The review of national care delivery standards is also progressing, with a broader lens on when and where care is accessed. The aim is to ensure patients receive safe and effective care at all stages of their pathway, whenever they need it – and we are placing an initial focus on urgent and emergency care to support the wider improvement work Sarah-Jane is leading. 

While these actions alone represent the strongest focus on quality in the NHS I can remember in my career, what is even more encouraging is the recognition that quality cannot be a standalone concept; it must be a golden thread running through every reform, operational plan, and patient interaction. By working together, we are building a safer, fairer and more responsive NHS for all.

Delivering for resident doctors – Professor Meghana Pandit, National Medical Director

As we move into February, I want to thank colleagues across the NHS for the leadership and commitment you have shown in delivering the Resident doctor 10 point plan.

When we launched the programme in August, we set ourselves a challenging goal: to make real, meaningful improvements to issues that have affected resident doctors for too long, and to do so at pace. Thanks to your action, we now have a solid foundation for the next phase of the programme.

That starts by giving resident doctors a voice at the top table, and I’m pleased to report that all trusts now have an executive lead for resident doctor issues, and 99% have elected a resident doctor peer lead to provide challenge and ensure coproduction of organisational improvement plans.

We have also seen significant progress on workplace wellbeing. In a range of areas, including access to hot food, lockers, and rest spaces, 167 of 189 trusts reported improvements between August and December last year, with resident doctor peer leads validating the vast majority of these assessments.

We now also have the first comprehensive national picture of rota and schedule transparency. Most resident doctors are receiving schedules with far more notice than before – an important step towards giving them the certainty they need to plan their lives.

Alongside this, we have put key building blocks in place for longer‑term reform.

Exception reporting reforms have gone live this week, payroll accuracy is improving through national reporting and support, three‑quarters of trusts have adopted fast reimbursement for course‑related expenses, and work on annual leave reform is accelerating through a national task group.

At the same time, all trusts have committed to recognise mandatory training completed elsewhere, 18 pilot programmes are under way to explore options for rotation reform, and work to expand the lead employer model is also progressing well.

We should be proud of what we’ve achieved and the combined impact those achievements should have for resident doctors now and in the future. But there is further to go. In the coming weeks, I am asking leaders to focus particularly on preparing for the new annual leave guidance, ensuring readiness for the launch of the exception reporting system, and continuing to support resident doctor peer leads to provide valuable insight and challenge.

While regions will now take the lead on supporting continuous improvement, we will continue to share learning across the system, highlight trusts making the biggest difference, and report progress nationally. Thank you for everything you have done so far to improve the working lives of a key part of the NHS workforce – in particular to teams working hard to implement exception reporting – and for the work still to come.

Other updates

In case you missed it

• The Maternal Care Bundle – the Maternal Care Bundle sets best practice standards across 5 areas of clinical care, for implementation by NHS providers and commissioners across England. The aim is to reduce maternal mortality and morbidity and reduce inequalities in these adverse outcomes.
• Key papers from the NHS England public board meeting on 5 February:
  • Finance
  • Productivity
  • Transparency
  • Improvement
• NHS Standard Contract 2026/27 and supporting documents
• Confirmation of urgent/unscheduled care activity requirements for NHS dental contract holders for 2026/27 – following the Government confirming that NHS dental contractors will be required to deliver 8.2% of their contract value as urgent/unscheduled activity in 2026/27, supporting more equitable distribution of unscheduled care capacity.
• Eating disorder services for children and young people – this guidance is for integrated care boards (ICBs) and providers of eating disorder services and sets out how to design collaborative, integrated services that support all children, young people, and their families and/or carers.
• Friends and family test results for November 2025 – showing the proportion of patients reporting a positive or negative experience across key service areas.
• New year letter from the NHS Chief Executive – a new‑year message from NHS England’s Chief Executive thanking NHS leaders for their exceptional efforts over the festive period, highlighting strong performance despite industrial action and winter pressures, and urging continued focus as services ramp back up for the year ahead.

Coming up

• 16 February – launch of NHS Talking Therapies campaign and UKHSA childhood immunisation campaign
• week commencing 23 February – launch of GP digital access campaign
• 23 February – Nottingham Inquiry opens
• 24 February – health and social care oral questions in House of Commons
• 28 February – Rare Diseases Day
• 6 March – entries for the NHS Excellence Awards close (5pm)