The NHS has been ordered to drive improvements in hospital waiting times and cancer care while at the same time cutting costs.
New planning guidance for the health service in England, which sets out national priorities for the year ahead, calls on NHS providers to reduce costs by 1%.
The NHS has also been challenged to raise productivity by 4%.
The guidance stresses the need for the NHS to meet certain challenges in the year ahead, with a particular emphasis on getting the waiting list back on track.
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Specific aims set out in the 2025/26 NHS England planning guidance include:
– To make sure that 65% of patients on the waiting list for routine hospital care to be seen within 18 weeks, which will help towards the Prime Minister’s aim for 92% of patients to be seen within this time frame by July 2029.
– To cut the number of people waiting more than a year for routine hospital treatment to “less than 1% of the total waiting list by March 2026”. The latest figures indicate that 221,889 people had been waiting more than 52 weeks to start routine hospital treatment at the end of November.
– For a rise in the proportion of people who have suspected cancer to be diagnosed or given the all-clear within 28 days – the target stands at 75% now but hospitals have been told to drive this up to 80% over the coming year – officials estimate that this will mean 100,000 more people will be seen in this time frame when the target is met.
– The Mental Health Investment Standard – which ensures that funding for mental health keeps pace with overall NHS spending – will be retained. The NHS has also been given specific targets on reducing the length of stay in mental health settings and giving more access to children and young people who are trying to access services.
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– Hospitals have been told that at least 78% of A&E patients should be admitted, transferred or discharged within four hours by March 2026. Some 71.1% of patients in England were seen within four hours in A&Es last month. The original NHS recovery plan set a target of March 2024 for 76% of patients attending A&E to be admitted, transferred or discharged within four hours, with a further target of 78% set for March 2025.
– Meanwhile ambulance services have been told that response times for so-called category 2 incidents – which includes heart attacks, strokes and sepsis – should improve to an average of 30 minutes. In December, ambulances took an average of 47 minutes and 26 seconds to respond to these calls.
– The guidance also calls for improvements to patient access to GP surgeries, an increase to the number of urgent dental appointments and improvements in safety in maternity and neonatal services.
– There are a number of demands about productivity improvements, including a call to “reduce agency expenditure as far as possible, with a minimum 30% reduction on current spending across all systems”.
The central NHS body, NHS England, plans to make £325 million in savings to reinvest in frontline services, this includes “reducing the organisational structure by 15%” – it is thought this will lead to around 2,000 job cuts.
Some 32 goals were set in the planning guidance last year but the number has been cut to 18 this year in a move designed to give local NHS bodies more freedom to deliver care to patients, officials said.
Some organisations and charities have expressed dismay over reports that specific priorities set out in 2024/25 guidance will not be repeated in 2025/26.
Fiona Carragher, from the Alzheimer’s Society charity, said: “Alzheimer’s Society is shocked to learn that dementia, including a dementia diagnosis target, has been removed from the NHS Operational Planning Guidance, meaning it is not considered one of England’s healthcare priorities.
“This glaring omission is unacceptable and sends the message that dementia doesn’t matter.”
Meanwhile, Jon Sparkes, chief executive of learning disability Mencap, said: “Scrapping vital NHS targets for people with a learning disability is a dangerous step backwards and could have serious consequences.”
Amanda Pritchard, NHS chief executive, told MPs on Wednesday: “Just because something isn’t written in planning guidance doesn’t mean it’s not important and it doesn’t mean the work won’t happen.”
Health Secretary Wes Streeting said the NHS must ‘get back to basics’ (Jonathan Brady/PA)
Health and Social Care Secretary Wes Streeting said: “If everything is a priority, then nothing is.
“I want to empower NHS leaders to deliver the innovation and reform required to fix the NHS, rather than overload them with targets which have failed to deliver better outcomes for patients.
“This new approach will see the NHS focus on what matters most to patients – cutting waiting lists, getting seen promptly at A&E, and being able to get a GP appointment.
“We’ve provided significant extra investment and given clear directions to trusts on what we expect, so there is no excuse for failure. We will reward high performance and drive up standards as we deliver on our Plan for Change and build a health service fit for the future.”
Ms Pritchard said: “The NHS must go further and faster to improve and reform care, and today’s guidance aims to deliver more timely treatment for hundreds of thousands of patients.
“In what will undoubtedly be another tough financial year, the NHS will continue its relentless focus on boosting productivity and driving efficiencies for the benefit of patients and taxpayers.
“Our main focus will always be on supporting frontline teams to deliver what matters most to patients – so it is also right that we prioritise and streamline the work of NHS England to ensure we maximise frontline resources.
“Together with Government, we have also honed down national priorities, allowing local leaders maximum flexibility to plan better and more efficient services for their population.”
Responding to the guidance, Matthew Taylor, chief executive of the NHS Confederation, said: “NHS leaders will welcome the reduction in national targets and clearer priorities that are set out in the planning guidance.
“But we should be under no illusion – this is going to be one of the most challenging financial settlements of recent years and these ambitions will be unbelievably stretching for the NHS.”
NHS Providers interim chief executive, Saffron Cordery, added: “This guidance is a stark reminder of the difficult decisions and tough trade-offs facing trust leaders as they brace for another challenging year providing vital health services.
“It tasks the NHS with tackling delays and improving patient care in every setting while also demanding stringent efficiency savings.”
Sarah Woolnough, chief executive of The King’s Fund think tank, said: “If achieved, (this guidance) will bring improvements for many patients, but emphasis in these areas will inevitably mean other services get deprioritised.
“Achieving the target of patients being seen for planned hospital care within 18 weeks will seem like a small and isolated victory in four years’ time if it meant the Government took its eye off the ball in reforming adult social care, helping the NHS to turn into a prevention-focused service that helps keep people well, and reducing health inequalities between different parts of the country.
“The plan also hopes for ambitious efficiency gains to free up much-needed resources, but few people working in the NHS will think it will be delivered without harming the quality of patient care over the coming year.”
Dr Becks Fisher, from the Nuffield Trust think tank, added: “The coming year will be particularly tough financially, with NHS trusts being asked to hit ambitious remaining targets while cutting their costs by at least 1%.
“This includes reducing the use of staff overtime, which until now has played a significant role in slowing the growth of waiting lists.”