Delivery in the NHS this autumn: turning big plans into real reform

In recent months, the list of health plans expected to land ‘in the autumn’ has continued to grow, from operational guidance and the long-awaited workforce plan to new strategies for men’s health and cancer. Each is designed to turn the Government’s 10-Year Health Plan into action. Yet, as we approach year-end, we’ve already seen delays. With the Government under mounting pressure to deliver on its promises, now is the time to take stock of where progress is being made – and where challenges remain.

Delivering the NHS Medium-Term Planning Framework

The new NHS Medium-Term Planning Framework is quietly one of the most important and consequential documents of the year. Released earlier than usual, it gives systems longer lead-in time to prepare for the next financial year and signals an attempt to move from firefighting to reform. The tone of the framework was also notably different, shifting from talk of ‘saving the NHS’, to reshaping it.

Systems are being asked to plan over five years, aligned to the 10-Year Plan, and to show how national priorities will translate into local action. However, that’s easier said than done.

In areas where the policy machinery already exists, such as prevention, delivery planning has been easier. There’s clear evidence and established targets, like expanding access to weight-loss jabs to tackle obesity. But in newer, more conceptual areas, such as neighbourhood health, things are more difficult. It’s an idea still taking shape across the NHS, and the delivery challenge lies in definition as much as implementation. To tackle this problem, Department of Health and Social Care (DHSC) is preparing model blueprints for neighbourhood health centres to help systems understand what good looks like.

Beyond its overarching message, the framework itself contains a lot to digest. A few points of particular interest stand out:

• Sharper performance expectations across urgent and emergency care, cancer, diagnostics and elective recovery, and punchier targets than in last year’s guidance.
• A tougher productivity regime, with systems required to deliver at least 2% annual productivity gains while maintaining balanced financial positions.
• Modern Service Frameworks being introduced in areas like cardiovascular disease, serious mental illness and sepsis, moving towards outcome-based performance measures.
• Neighbourhood health formalised as the core unit for prevention and integration, with national ‘system archetypes’ and model frameworks to guide design (to be published).
• Digital by default – the NHS App positioned as the main patient interface by 2029.

Who’s in charge?

The merger of NHS England leadership with the DHSC is reshaping how decisions are made at the top. However, with 17 members, the new joint executive team looks far from the leaner, more agile structure once promised. With the new arrangements set to go live in November, this latest update points to a steady and cautious approach to integration.

With several interim appointments, dual reporting lines and overlapping directorates, the new structure feels more like a practical alignment between DHSC and NHS England than a full merger at this stage. How clearly responsibilities are defined, and how quickly decisions can be made, will be key tests as the system enters winter and moves towards the formal merger in 2027.

The NHS goes digital

Digital reform sits at the centre of the change ministers are hoping to deliver in the NHS. At Labour’s party conference, the Government’s key health announcement was the launch of NHS Online – positioning the NHS App as the front door to care, alongside the subsequent establishment of a National Commission on AI in Healthcare.

The latest Medium-Term Planning Framework also speaks to this ambition, setting out clear expectations, such as full deployment of the Federated Data Platform, all providers live on electronic patient records (EPR) by March 2026, and the NHS App becoming the default route for patient interaction.

However, questions remain around system readiness. Getting every provider live on an EPR is one thing, but embedding it within a digitally capable workforce, so patient experience truly changes, is another.

Workforce reset

The 10-Year Workforce Plan is arguably the backbone for delivering these ambitions. A full workforce strategy is in progress, but has since been pushed back to Spring 2026, a reflection of both the scale of the task and the need to get it right. Recruitment, retention and training will be reimagined, with the aim of creating a service capable of adapting to new models of care. With industrial relations still fragile, it’s not a plan the Government wants to rush. For now, Wes Streeting has the task of trying to avoid further industrial action or at least mitigate against the worst of its impact.

A new deal on medicines?

The new Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) has become a key test for a Government trying to strengthen the UK’s position as a global life sciences hub – a central ambition of its Life Sciences Sector Plan. With investment from some major industry players being scaled back, there is increasing pressure to deliver a framework that restores confidence and competitiveness. Trump’s aims to deliver Most-Favoured-Nation (MFN) drug pricing in the United States has further complicated medicines access in the UK.

There are recent signals that an agreement is close, with reports suggesting that the UK may now be preparing to fund more when it comes to access to medicines, however, what it will look like, and how far it resets relations with industry, remains to be seen.

Looking ahead

The coming months will be critical for the Government to demonstrate real progress on its health and care reform agenda. The NHS remains a key area for showing delivery against ambition. However, with several important elements still to come – including the workforce plan expected next year, major condition strategies such as cancer, and further system guidance on neighbourhoods and Integrated Health Organisations – a full picture of what this reform will deliver is yet to emerge.