In a speech at the June 2026 NHS Confed Expo, NHS CEO Sir James Mackey discussed progress over the last year and the need to modernise NHS services to meet what people encounter elsewhere in their day-to-day lives.
Mackey talked about the “huge amount” achieved over the last year through collaboration across the NHS. “Even in January and February, I was having arguments with colleagues in London about whether we had any chance at all of getting there on the elective objective – it still felt a long way from what was possible,” Mackey said. “You all proved people wrong; that was achievable; and for the first time in many years I think we can prove that the NHS can do multiple things at the same time….Thank you for everything that you’ve done, because nobody thought we could all pull together in the way that we did to get the results that we needed to get.”
There remains “an awful lot” to do, Mackey continued, with a need to “industrialise” in the year ahead in order to make the progress that needs to be made. The neighbourhoods conversation has been made “massively overcomplicated”, with disagreements and uncertainty about leadership, ownership, and so on, he stated, “and the risk is that we’re not bringing it to life with enough purpose, drive, and focus on impact to localise services”.
On funding, Mackey said: “We’ve got this constant tension, and we’ve had to get a hold of the money…But if I’m honest, in all the time I’ve been in the NHS, we’ve performed better and got better results when things are quite tight – when we’ve had flexibility, we tend to not spend it well. We can tolerate pilots, we can invest in something that’s supposed to stop something else, and then before you know it you’ve got two channels rather than one, so I think tension is a good thing, and we’ve just had an engagement with a service about changing payment mechanisms to enable neighbourhoods, and we’re digesting what those things mean.”
Lord Darzi’s report noted the NHS is “massively under-capitalised”, Mackey observed, “and the Spending Review gives us largely technology money and capital, but we spend it in revenue, so there’s a lot of tension in all of that”.
Mackey also talked about the need to break down the barriers between primary and secondary care, or mental and physical health. “People should not have to worry about how we’re organised,” he said. “They should just feel that it’s organised and seamless, that people are sharing information, and working together in teams.”
By the end of June 2026, NHSE plans to release Patient Experience Standards to offer more clarity on what matters to patients, Mackey shared. “Often, that’s not about waiting too long; it’s about waiting and not having a clue, not even having an acknowledgment. You wouldn’t buy something online without an immediate acknowledgement and lots of annoying updates so you know when it’s going to arrive – why can’t we do that?”
Wider trend: Neighbourhood health
Sir James Mackey, chief executive at NHS England, has outlined next steps on planning and prioritiesfor 2026/27 in an open letter to ICB and trust chief executives. Executives are asked to begin to build out strategic commissioning narratives to focus on what strategic commissioning means for the local system and how it will be developed over the next three years; plans around neighbourhood care; whether changes to financial flows or payment are sought to help with delivery; and what more can be done at the centre to help drive pace of change locally. ICBs should provide a single document via regional teams to summarise the above points by 15 May.
NHSE issued guidance for regions and ICBs setting out practical planning instructions for developing neighbourhood health centres, highlighting the role of digital in connectivity, integration, and enablement. “Digital capability is fundamental to the functioning of neighbourhood health services,” NHSE shares. “Neighbourhood health centres must therefore be planned as digitally enabled facilities, in line with the approach set out in the neighbourhood health centres design specification. Costings for proposed schemes should reflect this.” ICBs and regions are encouraged to look at the interaction between their physical estate and digital transformation as part of the planning process, with key factors including the possibility of a reduction in space requirements due to modern general practice models, and requirements for the neighbourhood workforce to have access to shared digital systems.
To gain insights and perspectives from across the industry, HTN asked a variety of professionals: What’s the greatest digital/industry/healthcare challenge with progressing towards neighbourhoodhealth and how can digital be an enabler to realising success in neighbourhood health?
