The NHS England (NHSE) Board’s July 2025 meeting marked a pivotal moment for health system leadership. Against a backdrop of recovery from pandemic-induced pressures, ongoing financial constraints, and strategic reform, the Board issued clear signals on the direction of NHS policy, performance expectations, and systemic preparedness.

This edition of The NHSE Brief distils the critical outcomes and what they mean for healthcare system leaders, Integrated Care Boards (ICBs), provider executives, and NHS policymakers. For Boards and system leaders, this is not just an update, it is a call to recalibrate priorities and reinforce system resilience before the challenges of 2026.

 

Performance Signals: Progress, but Precarious Gains

Elective Recovery

The NHS has made tangible progress in reducing the longest waiting times. The 65-week wait backlog has been cut by 85%, and 52-week waits have halved since 2023. However, the 18-week Referral to Treatment (RTT) standard remains elusive, sitting at 59.8%, below the 65% target for 2025/26.

Cancer Care

The Faster Diagnosis Standard (FDS) reached 78.9%, surpassing the national threshold, while the 62-day treatment standard improved to 71.4%, edging closer to the 85% national ambition but still falling short.

Urgent and Emergency Care

Ambulance response times and 12-hour A&E wait breaches are improving, yet the 4-hour A&E standard remains unmet, with performance under the 78% target.

Strategic Takeaway: While these gains are commendable, they remain fragile. Sustained investment in capacity, flow improvement strategies, and workforce planning are essential to maintain momentum. Boards must treat current progress as fragile recovery, not a stable baseline.

 

Financial Pressures: Efficiency Versus Quality

NHSE set an unprecedented 7.1% efficiency target for 2025/26, alongside:

• A 2% workforce reduction across substantive, bank, and agency staff.

To protect care standards, NHSE has mandated Quality Impact Assessments (QIAs) for all major cost-saving initiatives, requiring senior clinical sign-off to prevent unintended harm.

Board-Level Accountability

Boards must:

• Integrate QIAs into all financial and transformation planning.
• Scrutinise efficiency measures through a patient safety and outcomes lens.
• Maintain real-time oversight of workforce attrition and operational capacity.

Strategic Takeaway: Financial prudence cannot come at the expense of patient safety. Boards must embed QIAs into their governance to ensure clinical integrity remains central. The looming risk is that in chasing efficiencies, services may unwittingly trigger capacity collapse or reputational harm if quality deteriorates.

 

Winter Planning 2025/26: Accountability Localised

NHSE has shifted winter resilience planning accountability squarely onto ICBs and Trust Boards. Requirements include:

• Formal Board sign-off of winter plans by August 2025.
• Designation of an Executive Winter Director in every organisation.
• Participation in Exercise Aegis, regional stress tests simulating winter pressures, scheduled for September 2025.

System Risks

• Workforce constraints combined with high seasonal demand.
• Discharge delays blocking hospital flow.
• Co-circulation of flu, RSV, and COVID-19 variants.

Strategic Takeaway: Success this winter will depend on local leadership, whole-system coordination, and readiness to activate surge protocols swiftly. Boards must not only sign off plans but maintain continual oversight through winter to prevent avoidable system failures.

 

Pandemic Preparedness: Exercise Pegasus and a New Playbook

A refreshed Pandemic Response Plan is in development, focused initially on respiratory threats. To test system readiness, the UK will conduct Exercise Pegasus, a Tier 1 national pandemic simulation, in autumn 2025.

Objectives of Pegasus

• Testing national and local coordination.
• Stress-testing workforce surge capacity and supply chains.
• Identifying strategies to combat misinformation.

Longer-Term Foresight

Global signals indicate pandemic threats remain a persistent risk. Boards must:

• Rehearse pandemic playbooks beyond table-top exercises.
• Ensure supply chain and PPE resilience.
• Evaluate workforce reserve strategies capable of rapid mobilisation.

Strategic Takeaway: Providers and ICBs must review pandemic plans, ensuring alignment with national strategies and readiness to integrate learning from Exercise Pegasus. The true test will come not in the exercise, but in the agility to act on lessons learned.

 

The NHS 10 Year Health Plan: Anticipating Systemic Shifts

Expected imminently, the NHS 10 Year Health Plan will advance three core strategic shifts:

1. Moving care into the community: Reducing reliance on acute settings.
2. Accelerating digital transformation: Integrating data-driven and AI-supported care models.
3. Prioritising prevention: Embedding preventative health measures across pathways.

What This Means for 2026 and Beyond

• Systems unprepared for digital maturity risk being outpaced.
• Providers without robust community service offerings may face sustainability challenges.
• ICSs must demonstrate measurable impact on health inequalities or risk reputational and funding consequences.

Strategic Takeaway: Leaders should proactively align their organisational strategies with these pillars to remain relevant and effective in future care delivery models. The Plan is not optional; it will define the commissioning landscape for the decade ahead.

 

NHS Performance Framework: Streamlined and Targeted

The forthcoming Performance Framework aims to simplify the metrics landscape, focusing tightly on:

• Prevention
• Access
• Finance
• Quality

Boards will be expected to:

• Align governance reporting to these domains.
• Enhance data transparency and real-time monitoring.
• Address underperformance proactively or risk escalated regulatory oversight.

Strategic Takeaway: Fewer metrics sharpen focus. Systems will face increased scrutiny against these core indicators, heightening the importance of delivering against national priorities. By 2026, NHSE’s tolerance for underperformance will likely reduce further, with more targeted interventions.

 

Final Word from Altin Biba, MBA, AMBA Chief Executive of ProMedical

The July 2025 NHS England Board has set the tone for a pivotal year ahead. Financial discipline, system accountability, and pandemic readiness are no longer optional but required. System leaders must navigate these dynamics with strategic foresight, operational discipline, and an unwavering commitment to patient care. Boards must remain vigilant, not just reactive, as the system faces compounded risks through winter and into 2026.

At ProMedical, we remain a trusted partner for system leaders, offering workforce solutions and clinical expertise attuned to the evolving NHS landscape. The challenges are clear, but so are the opportunities for systems that lead with agility and accountability.

 

References

1. NHS England Board Meeting Minutes, July 2025
2. NHSE Integrated Operational Performance Report, July 2025
3. NHS Financial Performance Update, July 2025
4. NHS England Winter Planning and Preparedness, 2025
5. NHS England Pandemic Preparedness & Exercise Pegasus Briefing, 2025
6. Department of Health and Social Care publications
7. The King’s Fund and Nuffield Trust policy commentary