NHS Planning Guidance 2025/26: Expected Changes and Priorities
Where is NHS England’s Planning Guidance for 2025/26 and what will we be looking for when it is finally published?
The NHS Planning Guidance is an annual group of documents that set out NHS England's priorities, targets, templates and financial framework for the coming year. The priorities that NHS England chooses will show how they plan to balance immediate operational priorities with longer-term strategic ambitions. The Guidance is used by Integrated Care Boards (ICBs) and Trusts in England to plan effectively for the coming fiscal year. The resultant plans are then used by NHS England and its Regional Teams to manage local NHS performance in-year.
Agreeing the Planning Guidance requires NHS England, the Department of Health and Social Care (DHSC) and HM Treasury to resolve a set of tensions: how much money to provide to the NHS; how much “financial stretch” to build into the planning guidance; and which priorities to require tangible progress on? The desire to see substantial progress on several priorities, with limited increases to the NHS budget, tends to lead to high levels of financial stretch built into the planning guidance. These tensions will be challenging to resolve this year, as set out in the recent Darzi review, so it is perhaps no surprise that this year’s Planning Guidance has been delayed.
While the NHS Planning Guidance 2025/26 has not been published at the time of writing, we are expecting it in the coming weeks – although the 2024/25 Planning Guidance was not published until March 27 2024.
Once it is published, the Planning Guidance will demonstrate the Government’s choices on priorities, targets, funding – and on the level of financial stretch for each local NHS system to manage.

Government Priorities: The Planned Care Milestone and the Three Strategic Shifts
January's "Reforming elective care for patients" publication has already set out some key priorities for planned care, addressing the Government’s Milestone pledge to end hospital backlogs. Rather than targeting the longest waiters, there is a clear shift towards improving overall 18-week performance, with a national target of 65% by March 2026 and each trust required to demonstrate at least a 5-percentage point improvement over 2025-26.
Additionally, the Government has also set out three strategic shifts for the NHS. Looking at these in relation to the NHS Planning Guidance 2025/26, we will want to understand:
- Shift from Hospital to Community: In most cases, funding decisions between hospital and community care are devolved to ICBs, with specific targets (e.g., development of virtual wards, confirmation of the Mental Health Investment Standard as part of 2025/26 financial framework) shaping the degree of freedom that ICBs have. As Lord Darzi set out, the trend in recent years has been for “right drift” (towards hospital) rather than “left shift”, so this shift is particularly challenging and requires a change against the tide. We will examine the extent to which funding commitments and choice of targets are likely to enable this shift or instead focus on shorter-term operational priorities in a way that is likely to continue the “right drift.”
- Shift from Analogue to Digital: There is widespread frustration that the “shift to digital” isn’t happening faster. Nonetheless, this is an area where substantial progress is being made each year, with ever-fewer Trusts left without EPRs, more patients able to manage bookings digitally, and the functionality on the NHS App increasing. We will examine the extent to which the Planning Guidance’s funding commitments and/or targets explicitly create space to accelerate digital developments.
- Shift from Treatment to Prevention: While there are new prevention initiatives that are growing (e.g., RSV vaccination programme initiated in 2024, targeted lung screening), in general the last decade has seen a “right drift” from prevention to treatment. The funding has also flowed in this direction, with Primary Care Services representing a smaller share of expenditure, compared to hospital services. We will examine the investment levels in Primary Care Services and other preventative services, and how these integrate with existing initiatives.
Some details on how the NHS Planning Guidance 2025/26 will deliver these shifts may already have been revealed by the recent leak of the draft Urgent and Emergency Care (UEC) Improvement Plan. This leak suggests that the Planning Guidance will maintain the 78% four-hour A&E performance target for 2025/26, supported by several prevention and community focussed action points, including improving vaccination rates, rapid triage to avoid admissions, and expanding community-based urgent care. Additionally, new payment models for urgent and emergency care may be trialled to incentivise care delivery in community settings.
Funding and Financial Assumptions
Following the Autumn Budget 2024’s announced increase in funding for NHS England, it is likely that NHS England will see approximately 3.0% real-terms funding growth between 2024/25 and 2025/26, much of which will flow through to ICBs. The local NHS needs to use the funding to care for a growing and ageing population (such that the real-terms funding growth per age-weighted capita will be only ~ 1.7%, not 3.0%), and also to: recover deficits from 2024/25; pay for increases in planned care activity sufficient to reduce waiting lists; and potentially to repay deficits from prior year. The Government has signalled a minimum 2% productivity improvement expectation across departments, the requirement in the local NHS is likely to be significantly higher.
From a financial perspective, key questions we will be asking, when the Planning Guidance is published, include:
- What is the overall level of financial stretch and how does it compare to 2024/25?
- Will the Mental Health Investment Standard continue to apply, requiring Integrated Care Boards (ICBs) to increase spend on mental health services in line with ICB programme allocation base growth?
- To what extent is there greater devolution to ICBs, and more ability to decide local priorities?
- Have there been any modifications to the weighted capitation formula that might affect how funding is distributed geographically across the NHS in England?
Stay Updated
The PSC will provide detailed analysis once the NHS Planning Guidance 2025/26 is published. To be notified when this is published, follow us on LinkedIn. If you have any questions in the meantime or want to discuss how we can support your organisation in preparing for Financial Year 2025/26, contact us at hello@thepsc.co.uk
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