NHS productivity also continues to improve, enabling us to deliver more care for patients. Over 2023/24, NHS providers delivered around 5% more activity year-on-year, for 0.12% more income. In the first 7 months of this year the acute sector improved productivity by over 2% – double the improvement rate pre-pandemic. The NHS is on track this year to surpass the £7 billion of efficiencies delivered in 2023/24 – achieved through innovation and reform, continuous improvement, investment in technology, data and new capacity, and better workforce retention. These steps provide the springboard for us to reimagine services as part of the 10 Year Health Plan.
But the timeliness and experience of care is still not good enough. While more people are completing treatment in A&E within 4 hours, a growing number are facing waits of 12 hours or more. In elective care – and in primary, community and mental health services – despite record activity, continued high demand means improvements are not yet nearly enough to allow everyone to access services in a timely or convenient way. And this impacts staff when they can’t provide the quality and experience of care they, and their patients, want.
In 2025/26, we are giving systems greater financial flexibility to manage constrained budgets. The government has made difficult choices to provide additional funding. While this provides effective real-terms growth in the NHS budget, it must cover final pay settlements for 2025/26, increased employer national insurance contributions, faster improvement on the elective waiting list and new treatments mandated by NICE. Overall, this means NHS organisations will need to reduce their cost base by at least 1% and achieve 4% improvement in productivity, in order to deal with demand growth. NHS England will transfer a higher proportion of funding than ever before directly to local systems and minimise ringfencing, allowing local leaders maximum flexibility to plan better and more efficient services. And, to be clear, all parts of the NHS must now live within their means.
Reflecting the Mandate from government and our evolving ways of working, we have also honed national priorities to increase local autonomy. This year’s planning guidance is more focused – setting out a small set of headline ambitions and the key enablers to support organisations to deliver them, alongside local priorities. This reflects the direction of travel towards earned autonomy for systems, with support, oversight and intervention from NHS England based on their specific needs and performance. 2025/26 is a reset moment, and it starts with the planning process – with more autonomy and flexibility comes greater responsibility and accountability.
Difficult decisions will be needed, and we must meet this collective challenge together. To balance operational priorities with the funding available, while continuing to lay foundations for future reforms, the NHS will need to reduce or stop spending on some services and functions and achieve unprecedented productivity growth in others. Open and ongoing conversations will be needed with staff, the public and stakeholders at organisation, place and system level about what it’s going to take to improve productivity, reduce waste and tackle unwarranted variation. We will back local leaders to take tough decisions, where they are clearly rooted in the needs of their populations and best use of available staff, and where all reasonable steps have been taken to maximise resources available for clinical services. Equally, we will challenge organisations who are not able to demonstrate a robust approach to prioritising patient care by bearing down on duplication and waste.
