Update from Sir James Mackey, CEO, NHS England

As we get to the end of the year, it’s worth taking a moment to reflect that we are now within a whisker of delivering our key operational imperatives on referral to treatment (RTT) and urgent and emergency care (UEC), having landed the money in 2025/26 and navigated industrial action and winter. It is pretty extraordinary and I want to thank each and every one of you for your efforts through the year.

It was also genuinely encouraging to see this reflected in last week’s British Social Attitudes survey which showed that, while we still have a long way to go, our patients have seen and felt a big improvement this year after two terrible years of declining confidence. So, well done for everything you have done, and continue to do, and I hope you can take pride in this.

In that context, it’s really disappointing that the BMA resident doctors committee (RDC) has gone ahead with further industrial action. I know today has been tough for staff picking up the strain across the country – and how disruptive and challenging it’s been for many hospitals to manage it and fill their rotas following the Easter weekend. We cannot forget this action has been deliberately timed to cause havoc.

There’s a long way to go, but it looks like we’re in as good a place as we could hope on day one. I am so grateful to everyone for all you’ve done ahead of today, during today and what you will be doing over the next five plus days to contend with these pressures, maintain services and help keep the show on the road for our patients.  

I also know that many colleagues will be leaving us in the coming weeks, if they haven’t already, as part of how we’re reshaping the NHS. Lots of those colleagues will have given many years to the NHS – in some cases, entire careers. If you are among them, whatever your reason for leaving or plans for the future, I want to say thank you for that service, and best wishes for the future.

For those staying with us, there’s plenty of work to do – building on the progress we have made this year, and getting on with the reforms needed to deliver the 10 Year Health Plan.

Taking the next steps on neighbourhood health is right up there as a priority, and one of the things people are most enthused and energised about. The publication of the Neighbourhood Health Framework and Fit for the future: towards population health delivery models is an important step in realising local ambition on neighbourhood health – setting clear expectations on what services should aim to achieve and the different commissioning and delivery models available.

The role of integrated care boards (ICBs) will be crucial in this, and it was great to meet with leaders earlier this month and to hear how enthusiastic they and their staff are to take these opportunities, supported by the Strategic Commissioning Development Programme, which is now well-developed. We’ll be sharing more on this soon.

Looking forward, we now also have system plans that work in aggregate for 2026/27 and outline plans for the two following years. Regional teams will continue to work with you to refine these with you over the coming weeks and, through the new IRP, start working with colleagues with the most stubborn challenges to develop sustainable solutions to long standing problems.

What we absolutely need to avoid is the real risk that while we’re rightly focussed on making 2026/27 a success, we miss the opportunity the multi-year planning process gives us to really stretch ourselves over the medium term.

Since our last update, we’ve brought together chief executive officers (CEOs), chairs, chief operating officers, medical directors, chief nurses, and directors of communication from 30 trusts assessed as facing the biggest challenges on corridor care. We had a really good conversation about what more can be done to solve this issue, and particularly the role of involved and visible leadership – hearing powerful examples of improvement from the teams at West Hertfordshire and Shrewsbury and Telford.

As you’ve hopefully seen, we followed that event up with a letter to all trusts setting out what we will do nationally and the further work we will do with those organisations over the coming months, with the aim of seeing real improvement across the board by next winter and beyond.

Finally, I recently shared some details of the changes to our NHS England Executive team from 1 April 2026. Thank you to those colleagues who are returning to their trusts over the coming months. I am enormously grateful to you for your time, commitment, and leadership over the last year. And would like to welcome those who will be joining us for the first time.

We are also pleased to have announced that regional chairs have been appointed across all 7 regions, with most taking up post from 1 April. They are: 

• Jonathan Montgomery (South East) 
• Kathy Cowell (North West – from 1 May)
• Russell Hardy (Midlands) 
• Bill McCarthy (North East and Yorkshire)  
• Ian Peters (London) 
• Gill Morgan (South West)  
• Nick Carver (East)  

As set out in the Model Region Blueprint, regional chairs will provide visible, independent non-executive leadership across the region, working with regional directors to develop a coherent strategy to deliver against the 10 Year Health Plan, ensuring improved life expectancy and quality of life, consistently high quality services and reduced inequalities in health outcomes. Regional colleagues will have the opportunity to meet their regional chair at our forthcoming regional workshops in April.

Making neighbourhood health a reality – Claire Fuller

The publication of the Neighbourhood Health Framework is an important step towards organising care in a way that makes more sense for the people who use it.

Patients and staff have been clear for a long time: they want services that are easier to access, joined up, and focused on helping people stay well at home. This framework puts the building blocks in place to help us do that consistently across the country.

The idea is straightforward; neighbourhood health brings together the services people rely on most – general practice, community services, mental health, social care, public health, and local voluntary organisations – and organises them around a defined population. The aim is more proactive support, better continuity for people with complex needs, and fewer unnecessary trips to hospital.

The framework sets out a clear national description of what neighbourhood health should look like, alongside a set of minimum goals and measures. These cover outcomes for people with frailty, those approaching end of life, children and young people and those with long‑term conditions, as well as improvements in GP access, planned care, urgent and emergency care performance, and staff and patient experience. Health and wellbeing boards will add local priorities, ensuring plans reflect the needs of each community.

Much of this builds on, and brings together, the foundational work systems have been implementing across health and care for some time. Integrated neighbourhood teams will play a central role, bringing together professionals from across health and care to work as a single team for their population. They will help people stay healthier for longer, intervene earlier when needs escalate and make it easier to navigate support.

A great deal of this begins now. In fact, through the National Neighbourhood Health Implementation Programme (NNHIP), it’s already happening. We launched the programme in September 2025, in 43 Places across England, from Cornwall and the Isles of Scilly to Sunderland. It’s a large-scale change programme for all partners involved in delivering neighbourhood health: the NHS, local government, social care providers, other statutory and non-statutory organisations, civil society, and communities. The NNHIP is bringing these partners together to work differently to improve health outcomes by addressing complex needs at a local level, especially in deprived areas where healthy life expectancy is lowest. 

We will also start to see changes in how services are commissioned and funded, giving local partners more flexibility to join up care and remove barriers that have held back progress for too long.

Another visible part of this shift will be the development of Neighbourhood Health Centres, the first of which have now been announced. These will bring GP services together with community, local authority, and voluntary sector support in modern, accessible spaces. With 250 planned by 2035, they will become a clear point of access for most day‑to‑day health and wellbeing needs.

This framework builds on what many places are already doing well. It aligns with wider reforms across early years, mental health, social care, housing, and employment – recognising that health doesn’t sit in isolation.

Neighbourhood health is ultimately about restoring confidence by making services more coherent, more personal and genuinely closer to home. The framework gives us the aims and the parameters – and Fit for the future: towards population health delivery models, provides a big part of the ‘how.’ Our task now is to turn it into real change for the communities we serve.

Seizing the opportunity of new delivery models – Glen Burley

Earlier we published Fit for the future: towards population health delivery models, which sets out the next stage in delivering the 10 Year Health Plan.

It gives a clear and practical route for how we move away from fragmented care towards a model that puts neighbourhoods, prevention, and population health at the core of what we do.

The case for change is well known. Patients move between services that are too often commissioned, funded, and delivered on different footprints. Staff spend time working around organisational boundaries that don’t make sense for the people they care for. And resources haven’t always followed the shift we all want to see into proactive, community‑based care.

The new population-based contracts – integrated health organisations (IHOs), multi-neighbourhood providers (MNPs) and single neighbourhood providers (SNPs) – are about giving systems the tools to fix this. They align responsibility and incentives around defined populations, support primary and community care to take on a stronger role, and create the conditions for providers to redesign whole pathways rather than work in isolation.

Crucially, this isn’t structural upheaval and imposition from the centre – it’s a permission slip to let local leaders build on what already works and change what doesn’t.

For providers, it’s a real opportunity. Organisations with strong capability and a track record of improvement will be able to take on wider responsibility for planning and allocating resources, using better data and actuarial insight to shift care closer to home and invest in prevention.

For ICBs, the shift towards strategic commissioning continues, setting outcomes, supporting ambition, and holding the ring so that partnerships can flourish.

The year ahead will be a developmental one. Neighbourhood footprints will be agreed, new financial flows will be tested, and the first designations for IHO contract holders will be made. It will require partnership, candour, and the maturity to focus on what works for patients, rather than organisational interests.

Inevitably, it will be bumpy – but if we stay focused, we can lay the foundations of a modern NHS that provides better treatment, better value and care delivered as close to home as possible.

Thank you to everyone already shaping and testing this work. Your leadership and local insight are what will make this shift real.

In case you missed it

• Urgent community care: clinical decision making framework: this framework supports teams to balance patient, clinical and system risk, so more people can benefit from safe care out of hospital. It lists 8 key actions for managing patients in the community and identifies which patient cohorts and presentations should be considered for community-based care.
• Children and young people’s patient experience survey 2024: national qualitative report: this report shares national insights from qualitative thematic analysis of written responses to the NHS Patient Survey Programme.
• Preparing for NHS dental quality and payment contract reforms: this letter outlines key dates and essential information commissioners and dental providers will need as the NHS quality and payment dental reforms are implemented.
• Broadening the 700,000 urgent dental care commitment: this letter confirms the significant progress made by integrated care boards and dental teams in increasing access to dental care, including urgent care, over the past year. It sets out the next steps following improvements to commissioned capacity, safety net provision, and patient referral pathways through 111 and other access points.
• Martha’s Rule: core standards: this guidance helps NHS providers to meet the new Standard Contract requirements by describing what they should have in place for the safe, effective, and reliable implementation of Martha’s Rule.
• Changes to the GP Contract in 2026/27: this letter from Dr Amanda Doyle, National Director for Primary Care and Community Services, provides information on arrangements for the 2026/27 GP contract.
• Actions to deliver Agenda for Change uplift and a fairer deal for nurses: this letter updates colleagues on, and asks for support in implementing, the Government’s announcements on supporting nurses and the acceptance of Pay Review Body recommendations for AfC staff in 2026/27.
• ONS: Public service productivity statistics
• NHS England Board meeting papers – March 2026
• British Social Attitudes Survey – Public satisfaction with the NHS and social care

Coming up

• 13 April – Parliament returns from Recess
• 16 April – NHS monthly operational performance statistics