NHS England’s latest board meeting included an update on the NHS Oversight Framework for 2025/26 following a consultation which attracted more than 150 responses, including from ICBs, trusts, and key stakeholders.
“Over 70 percent of respondents either agreed with or were neutral on the proposals outlined in the consultation documentation,” NHSE shares, adding an annexed version of each proposal along with feedback and how this has been addressed in the final framework.
“The new framework describes a consistent and transparent approach to assessing ICBs and NHS trusts and foundation trusts, ensuring public accountability for performance and providing a foundation for how we will work with systems and providers to support improvement,” NHSE states. “It sets out how we will assess providers and ICBs, alongside a range of agreed metrics, promoting improvement while helping us identify quickly where organisations need support.” Assessments will form the starting point for NHSE’s work with providers, with the framework detailing the circumstances in which providers can obtain increased freedoms, and how NHSE will identify falls in performance indicating the need to exercise regulatory powers to “step in and secure improvement”.
On the proposed approach, the framework sets out plans to place each ICB and provider into segments from 1 to 4 based on performance against short- and medium-term NHS priorities, with an additional segment, 5, available to those most in need of support. 70 percent of respondents “either agreed or were neutral” in regards to this assessment approach, although NHSE notes “some respondents felt the roles of NHS England and ICBs were still not clear enough and others questioned how the framework aligned with the future position of NHS England and ICBs given the changing operating context”.
The process of segmenting ICBs will not begin until 2026/27, NHSE shares, due to current focus on the Model ICB Blueprint, but ICBs currently in the Recovery Support Programme will continue and be assessed against their current improvement trajectory to agree a transition plan.
For capability, NHSE states that decisions around segmentation are made in relation to delivery against performance metrics, with capability ratings consulted on in 2024 no longer having a bearing on this process, but instead being considered as part of NHSE’s improvement response. 88 percent of respondents either agreed or were neutral to this proposal, resulting in an agreement that segment scoring will not include capability ratings, but will be used to inform response, such as when providers are identified for the Provider Improvement Programme.
87 percent of respondents either agreed or were neutral to proposals that providers should not have scores adjusted based on wider system performance, and 69 percent agreed or were neutral to proposals around placing organisations reporting a financial deficit in segment 3 or higher. “Respondents were concerned that penalising organisations who were meeting their agreed financial plans would create a disincentive to set ambitious goals to improve, and – that the financial segment limit will mean a large number of organisations in need of support,” NHSE shares. The financial limit will be applied only to organisational finances and will not reflect system performance, it continues, adding: “We will not limit the segment of any organisation that has an annual plan to break even that includes an in-year deficit, as long as the plan is on track.”
Simplifying the assessment process through the use of fewer metrics to make segmentation decisions also drew agreement or a neutral response from 77 percent of respondents. A move to a more focused metric list has been approved with consideration from NHSE clinical executives to ensure a balanced view of experience, safety, and effectiveness of care. A total of 62 suggestions for new metrics were received, NHSE highlights, but due to the need to “focus on fewer priorities for this year”, these have not been adopted at this time. Suggestions will be reviewed in 2026/27 when the framework is updated.
Other changes to the framework not influenced by the consultation include a proposal to “undertake a diagnostic of all organisations who are in segment four to determine entry into the Recovery Support Programme will be replaced by a more flexible approach, the Provider Improvement Programme, entry to which will be decided based on segmentation and capability”.
Future directions for the health system
NHS England has published its 2025/26 priorities and operational planning guidance, with a focus on local prioritisation and planning, reducing wait times, improving access and patient flow, and more. Promising “greater financial flexibility” for systems in managing their budgets, and increased local autonomy with support and intervention from NHSE “based on their specific needs and performance”, ICBs are asked to “take a forensic look” at their workforce and spending. Systems are encouraged to “shift their focus” from inputs to outcomes for patients and local communities, with “a relentless focus” on operational performance, productivity improvements, and reductions in variation, delays, and waste.
The UK government has published its Fit for the Future: The 10 Year Health Plan for England, aiming to “build a truly modern NHS”, with focus on moving from hospital to community, analogue to digital and sickness to prevention. The plan outlines a new operating model, a new era of transparency, a new workforce model with staff aligned to the direction, a reshaped innovation strategy, and a different approach to NHS finances.
Our HTN Now panel discussions have shared insight, learnings, and best practices from across the health and care sector, with our session on putting Lord Darzi’s findings into action reflecting on what is holding the NHS back from innovation; the challenges and missed opportunities; and the role of digital and tech in driving change, supporting a focus on prevention and promoting integrated care.
