David Oliver: The new NHS planning guidance does too little to further the government’s stated policy objectives

Last month NHS England published its priorities and operational planning guidance for 2025-26,12 outlining key improvement objectives for the NHS for the first time since Labour took office in 2024. Meanwhile, the government’s 10 year plan for the NHS3 is due to report this spring. Whatever the 10 year plan concludes won’t be enacted immediately. If we’re looking for actions to improve, stabilise, or protect services—and to navigate our way out of our current crisis—this operational plan is our only short term roadmap. But is it helpful?

In January, Wes Streeting’s Road to Recovery,4 his first mandate to the NHS as health and social care secretary, emphasised the need to “cut waiting times for elective care,” “improve urgent and emergency care,” “improve access to primary care,” “reduce the amount of time spent in ill health,” “tackle health inequalities,” and “reduce lives lost to the biggest killers—cancer, cardiovascular disease, and suicide.” It also mandated the NHS to “improve productivity,” “live within its means,” and end the “culture of overspending.”

So, how well does the operational planning guidance dovetail with these big ambitions? It contains only 18 headline national targets, which compares with 123 only two years ago and 31 last year5—in recognition of the NHS’s need to avoid competing distractions, for it to focus on and prioritise key imperatives, and for local organisations to have greater flexibility over local spending and service priorities.

The guidance calls for local “neighbourhood health teams” to help prevent hospital admissions and improve access to services. There’s a separate NHS England guide for the “what” and “how,” focusing on health and social care working together to support people at home and avoid hospital use.6 But it’s light on meaningful detail, not least about staffing and resources, and it places magical faith in collaboration between organisations that are often individually at breaking point.

The operational plan calls for a reduction in elective care waiting times, where 65% of patients will be treated within 18 weeks, 72% get a first appointment within 18 weeks, and each trust improves on these metrics by 5%. For cancer referrals, the plan calls for 75% of patients to be seen within the 62 day standard. In urgent care, the NHS is tasked with improving emergency department waiting times and ambulance response times, with at least 78% of patients to be seen within four hours and category 2 ambulance calls to be attended within an average of 30 minutes.

The plan aims to improve access to general practice and dentistry, including more than 700 000 urgent new dental appointments to be provided. Integrated care boards must have action plans for “commissioning,” “transformation,” and “oversight” by June 2025 to tackle unwarranted variation in access to a GP. But no new money has been allocated to fund the dental appointments,7 and the extra £889m allocated to the GP contract8 now provisionally agreed by the BMA is unlikely to meet Streeting’s pledges to “restore the family doctor” or “end the 8 am scramble for appointments,” given the challenges facing the GP workforce and its workload.9