The NHS’s priorities and operational planning guidance for 2025/26 was finally released in late January.

Having had time to fully digest the document and all the commentary surrounding it, we offer our considered take on what it really means for NHS Trusts.

Karina Malhotra, our Managing Director and the Founder of Acumentice, sat down with Michael Watson, one of our Principal Consultants, to discuss all the ins and outs.

Here’s an abridged version of their conversation. For the full discussion, watch the video here.

Addressing elective care challenges

Karina: The Labour government have committed to achieving the 92% RTT target by summer 2029. But do we have faith in the delivery mechanisms that have been described in the elective reform plan to support this uplift over the next few months and up to 2029?

Michael: It’s interesting when you really dig into the elective reform plan, a lot of the solutions proposed – Community Diagnostic Centres (CDCs), straight to test, patient initiated follow-up (PIFU), and so on – have been around for a little while now and haven’t really delivered. Certainly, the NHS failed to deliver on the ambition of the original elective recovery plan. Unless we can really learn from why those things haven’t delivered, it’s slightly difficult to believe they are going to deliver such a year-by-year percentage point increase up to 2029.

Karina: You’re so right. Learning from what hasn’t worked is obviously the best way forward. But, looking at the work you do in this space, what kind of themes are coming out when you’re going into organisations to address elective care problems?

Michael: Something which often gets overlooked is the impact of the pandemic and post-pandemic period on staff, both individually and regarding the levels of organisational memory around the management of waiting times and elective care. Some of the fundamental things we try and support organisations on – good waiting list management, demand and capacity planning, trajectory modelling and PTL process – have been not necessarily forgotten, but certainly devalued. Getting back to those basics, in addition to the necessary innovations like CDCs, can provide the balance to create the step change that is needed to reach the required end point in 2029.

Neglecting community mental health

Karina: A glaring gap for me in the current priorities document is the fact that there is no mention of the community mental health waiting time standards, that have been talked about for a good couple of years now. With over 46,000 service users waiting more than 2 years for treatment, and 70% of these being children and young people, it feels very strange to completely ignore holding systems to account in mental health in the way we do for physical health.

Michael: That’s right. It does feel like a gap. But I suppose it’s also important to see the positives in this. Where there’s been a huge reduction in the number of things being measured and prioritised in the planning guidance, mental health is still there and doing reasonably well. The Mental Health Investment Standard has been preserved and it’s good to see a recognition of the importance of reducing length of stay, plus the long-standing commitment to reduction of inpatient beds for people with learning disabilities and autism.

But, as you said, the waiting times thing feels like a gap. NHS England made a really positive move in last year’s planning guidance, defining the metrics around mental health waiting times. However, in only looking at crisis and inpatient services and not looking at community services, you’re only looking at half the picture. We all know that people deteriorate when they’re waiting longer, and that those people are then more likely to present in crisis and to be in those very inpatient beds that we’re trying to reduce.  

The role of digital innovation

Michael: One of the other big pushes in the planning guidance is around digital transformation and innovation. What are some of the barriers and reasons why digital transformation hasn’t happened at the pace we would like so far?

Karina: We have a great ecosystem of innovation, there are 15 Health Innovation Networks that are putting some great innovator sand companies through programmes year on year, but the challenge – from being one of those people and talking to similar founders – is the uptake. There are procurement barriers, cultural resistance, and a general scaling challenge.

My biggest question – not just to the NHS, but the government too – is how are the smaller companies coming up with niche innovations being brought to the table? Roundtables operated by the government always have the bigger players at the table, but is that stifling innovation?  

Fewer priorities, but will this improve progress?

Karina: We have far fewer priorities in this document, which should mean sharper focus. But without learning from the past and bold action on innovation adoption, do you think progress will be slow?

Michael: Simplifying the planning guidance and reducing the number of priorities is welcomed by systems, but on the other hand just setting targets and expectations is not the same as delivering outcomes and providing support. The national support offer is more challenged than it’s ever been, so we have to ask the question: who is there to support providers and healthcare leaders, and who is there to support and develop the staff who are needed on the ground to implement these changes?    

You can watch the full video here.

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