In a few months, the Government will publish its 10 year plan for the NHS.
But while we all wait on the report, there are a number of more immediate challenges that are being faced. We’re coming out of a winter period that has seen record numbers of people waiting 12 hours and more in A&E, ambulances taking over an hour for calls that are supposed to be answered in 18 minutes, and 13,000 people delayed in hospitals on an average day when otherwise fit for discharge. Overwhelmingly, the people most affected are older people.
This was a bad winter, but not atypical for the last few years. The lingering effects of the pandemic continue to impact these numbers, but they are also symptoms of a system that is desperate for a good plan and can’t just wait for one.
So, last month, NHS England and the Department of Health and Social Care put out 4 key annual planning and guidance documents to set out their expectations for the NHS in what will be a transitional year.
1. The Mandate to NHS England
One of the documents included was the Mandate to NHS England, which is a legal requirement setting out Government priorities for the following financial year. For 2025, it says the NHS must undertake reform to:
- cut waiting times
- improve primary care access
- improve urgent and emergency care
- improve the operating model
- drive efficiency and productivity
These will run until the launch of the NHS 10 Year Plan, allowing the Government to set out new objectives in light of it.
Read the Mandate to NHS England
2. NHS priorities and operational planning guidance
The 2025/26 NHS priorities and operational planning guidance is a key document that then sets out NHS England’s expectations for Integrated Care Boards – the 42 bodies responsible for NHS delivery across England. The guidance sets out four headline priorities:
- continue to reduce elective care waiting times
- improve ambulance response and A&E waiting times
- improve patients’ access to general practice (GP) and urgent dental care access
- accelerate patient flow in mental health crisis and outpatient care pathways.
NHS providers are also being asked to make 4% efficiency savings and NHS services that are considered to be lower value may be discontinued in some areas. There is a general demand to live within a tight financial envelope.
Read the NHS policies and operational planning guidance document
3. The Better Care Fund
Another recently published document with implications for health and care in 2025/26 is the Better Care Fund policy framework. The Better Care Fund (BCF) was introduced 10 years ago to help facilitate support and services that span health and social care. In part, this is achieved by creating integrated budgets that allow NHS funding to go on services traditionally paid for by local authority councils.
Many voluntary sector health and care services are funded out of the BCF – for example, services that support people to live safely at home following a spell in hospital. The 2025/26 Better Care Fund policy framework aims to reinforce the role of voluntary sector partners in helping people to stay at home, reducing pressure on Urgent and Emergency Care and reducing delayed discharges.
There is welcome emphasis on older people with measures on:
- cutting emergency admissions for people aged 65 and over
- average length of discharge delay for acute adult patients
- long-term admissions to residential and nursing homes for people aged 65 and over.
Local health boards will be expected to draw up plans to help people to remain independent for longer, prevent escalation of health and care needs and support people living independently. This can include things like timely, proactive and joined-up support for people with more complex health and care needs and support for unpaid carers.
Read the Better Care Fund policy framework
4. Neighbourhood Health Guidance
The final piece is the Neighbourhood Health Guidance 2025/26. This is the first formal publication relating to an overarching goal of the Government to deliver more comprehensive, joined-up services close to where people live. It is focused on enabling NHS and social care services to work better together, strengthening primary and community-based care and connecting people to wider public services and voluntary sector support (for example, local Age UKs).
For 2025/26, teams are expected to focus on those with complex health and social care needs who require multidisciplinary support, and older people living with frailty are one of the main groups on which local areas will be expected to focus.
Read the Neighbourhood Health Guidance
What does this all mean for older people?
Across all of the documents, there is a heavy emphasis on system challenges that have a significant impact on older people and their carers, from a lack of primary care to poor management of long term conditions – which are often at the root of a trip to A&E. Solving these challenges will make a significant difference to older people, as will a meaningful shift to “neighbourhood” level care, ideally fully integrated with social care.
However, the planning and operational guidance sets out the very challenging financial picture for the NHS, which will be particularly tough on lower income communities, where there are typically higher concentrations of poor health. The reality is that many areas of the country are likely to have less to spend in 2025/26 compared to 2024/25.
The reality is that the £22 billion promised last year in the Budget is already accounted for and many areas of the country are likely to have less to spend in 2025/26 compared to 2024/25. There also remains a hard target of improving the waiting lists for elective treatment. The Government has pledged that 92% of NHS referrals have a maximum wait of 18 weeks by the end of this Parliament. Currently this stands at 59%. This target is likely to dominate policy-setting for the NHS, already reflected in the guidance above.
In an ideal world, meeting this target would not only make more appointments available, which is the current emphasis, but also prevent ill health and better manage people with long-term conditions.
Last month’s guidance provides some reassurance that the system will be expected to take this into account, as does the noise around the developing 10 year plan. There is also a heavy emphasis on integrated care boards undertaking their responsibilities without too much direction from above and using their knowledge of local needs and circumstances.
