With the NHS Performance Assessment Framework consultation now closed, NHS England is preparing to unveil a streamlined performance framework. Designed to cut through complexity and focus on what matters most, the new framework marks a significant recalibration of how Integrated Care Systems (ICSs) and providers will be assessed.

This blog explores the imminent changes, what system leaders should expect, and how organisations can align to the sharper accountability landscape that is coming.

 

 

Why Change Was Needed

The NHS has long grappled with a sprawling web of performance indicators, often critiqued for being:

• Too numerous, diluting focus.
• Reactive, rather than predictive.
• Poorly aligned, creating misaligned incentives between organisations.

Feedback from ICSs, Trusts, and national bodies emphasised the need for a simpler, clearer framework that enables real accountability and improvement.

Leadership Insight: Simplification is not reductionism. It is an effort to make measurement meaningful and improvement actionable.

 

The Four Pillars of the New Framework

NHS England has consolidated the performance framework around four core domains:

1. Prevention

• Monitoring system contributions to reducing the burden of avoidable illness.
• Metrics include vaccination uptake, smoking prevalence, obesity rates, and reduction in health inequalities.

2. Access

• Focused on key constitutional standards:
  • 18-week RTT (Referral to Treatment).
  • Cancer diagnosis and treatment standards.
  • 4-hour A&E performance.
  • Mental health access rates.
  • Community Waiting Times metrics, reflecting rising challenges in community services.

3. Finance

• System-wide financial performance:
  • Adherence to efficiency targets (e.g. 7.1% savings for 2025/26).
  • Delivery against agency spend reductions.
  • Balanced budgets within ICS footprints.

4. Quality

• Incorporating CQC ratings, safety indicators, clinical outcomes, and patient experience measures.
• Specific focus on outcomes for vulnerable and marginalised populations to address care inequalities.

Leadership Insight: These pillars demand that Boards govern across the entire care continuum, not just operational metrics but strategic outcomes.

 

How Accountability Will Evolve

Tiered Oversight

The framework introduces tiered oversight, where:

• High-performing systems enjoy greater autonomy.
• Struggling systems receive graduated support and intervention, tailored to the scale of the challenge.

Integrated Data Platforms

• NHSE is developing enhanced digital dashboards that unify data from providers, ICSs, and regulators.
• Boards will have real-time visibility into their own and system-wide performance.

Quality Impact Assessment (QIA) Integration

• QIAs are now a formal part of performance oversight, ensuring that financial decisions and service changes do not compromise care quality.

Leadership Insight: Accountability will no longer be solely vertical (Trust to NHSE); it will be horizontal across ICS partnerships, ensuring collective responsibility.

Opportunities and Risks

Opportunities

• Greater focus enables targeted improvement strategies.
• Data visibility will support real-time decision-making.
• Increased transparency enhances public accountability.

Risks

• Without investment in data infrastructure, some systems may struggle with real-time reporting.
• Risk of local gaming if metrics are not balanced across domains.
• Cultural risk: performance frameworks have historically fostered box-ticking behaviours rather than genuine service improvement.
• Leadership capability gaps, particularly in data interpretation and cross-sector collaboration.

Leadership Insight: Boards must invest in leadership development and foster a culture of data curiosity, ensuring data is interrogated, not just reported.

 

What Leaders Should Prioritise Now

1. Audit current KPIs and dashboards to ensure alignment with the new domains.
2. Strengthen internal governance structures to integrate prevention, access, finance, and quality oversight.
3. Enhance Board and executive training in data interpretation and quality governance.
4. Foster cross-ICS collaborations to share data, insights, and resources.
5. Embed QIA protocols into financial planning and service redesign.

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

The NHS Performance Framework is more than a reset of metrics, it is a reset of leadership accountability. It signals that data fluency, strategic alignment, and transparency are no longer optional but essential. But metrics alone don’t drive improvement, leadership does.

Boards must go beyond compliance to foster a culture where performance data is not just collected, but questioned, understood, and translated into meaningful action. The real risk is not in measuring too little or too much, but in mistaking data for insight, or worse, for assurance.

At ProMedical, we partner with NHS organisations to help build governance, data capability, and workforce models that turn accountability from a reporting obligation into a strategic advantage. The Performance Framework is the tool, leadership is the craft. Those who master both will define the future of the NHS.

 

References

1. NHS Performance Assessment Framework Consultation Summary, 2025
2. NHS England Board Meeting Minutes, July 2025
3. NHS England Performance Oversight Guidance, 2025
4. NHSE Integrated Operational Performance Report, July 2025
5. The King’s Fund – Performance Management in the NHS
6. Health Foundation – Metrics and Measurement for Improvement