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 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.

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 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.

• NHS Oversight Framework 2025/26

Methodology, latest segmentation and scoring results

The NHS Oversight Framework sets out how NHS trusts and foundation trusts are automatically allocated to a segment (1 to 4) based on performance, with full details set out in the methodology manual. A dashboard and downloadable file with segmentation results, supporting data, and league table comparisons will be published shortly.

The framework sets out how the Recovery Support Programme will be replaced by the Provider Improvement Programme with the most challenged organisations placed into a new segment 5.

Performance improvement

We will use segmentation and our assessment of capability to determine how we will support providers to improve. We plan to finalise our approach to the assessment of provider capability and issue guidance during Q2.

NHS England will align our targeted improvement support offer to organisational delivery scores. Regional teams will coordinate the response to segmentation working with NHS England national teams and wider system partners.

Where performance falls below an acceptable standard and/or has governance concerns that may lead NHS England to step in and use our regulatory powers to secure improvement.

Provider capability

Given their frontline role in the delivery of care and the use of resources, the NHS needs strong and self-aware provider boards capable of delivering its priorities for patients and taxpayers.

To support this, NHS England has developed an approach to assessing provider capability which forms part of the NHS Oversight Framework (NOF). This is intended to both strengthen board assurance and help regional oversight teams take a view of boards’ grip and awareness of the challenges their organisations face and their track record of addressing them. Our view of capability will, alongside each trust’s NOF segment, inform our relationship with the organisation and any necessary support actions.

As part of the process trusts must first self-assess against a set of criteria across 6 domains derived from The insightful provider board (2024):

• strategy, leadership and planning
• quality of care
• people and culture
• access and delivery of services
• productivity and value for money
• financial performance and oversight

Trusts must return this completed self-assessment and associated evidence underpinning it (for example, a board paper) to their regions by 5pm on Wednesday 22 October. Regions will then use this self-assessment along with the trust’s historic track record of delivery and any relevant third-party assessment to arrive at a view of provider capability, which will be shared with the trust.

As the year progresses, oversight teams will monitor the trust’s track record against these self-assessments, taking account of any relevant information as it emerges in order to maintain a real-time view of provider capability to inform the relationship with the organisation.

The self-assessment form and dedicated guidance on carrying out the self-assessment are available on the NHS England website.

If you have any questions, please contact your regional oversight team in the first instance

Annual assessment of integrated care boards (ICBs)

Under the terms of the NHS Act 2006 (as amended by the Health and Care Act 2022), NHS England is required to undertake an annual assessment of each ICB in respect of each financial year and publish a summary of these assessments.

Further information can be found here: NHS England » Annual assessment of integrated care boards (ICBs)