The NHS continues to evolve in response to growing demand, workforce pressures, financial challenges, and shifting public expectations. For those joining the system at Board level – particularly from outside the NHS – it’s essential to understand the current context and direction of travel.
This page outlines some of the key national reviews, guidance and reform proposals shaping the future of the NHS in England – and by extension, the role of providers like Doncaster and Bassetlaw Teaching Hospitals.
Strategic direction: What’s changing and why?
A number of recent national publications and announcements point to a clear shift in how health and care services are planned, delivered and assessed. This is not just a response to immediate pressures, but part of a longer-term direction of reform.
Across all sources, three strategic shifts are consistently emphasised:
- Moving care out of hospitals and into communities, with a greater role for primary care, prevention and place-based working.
- Transitioning from analogue to digital-first services, with widespread use of electronic records, data-sharing, virtual care and digital tools for patients and professionals.
- Focusing on prevention rather than treatment, particularly addressing health inequalities, population health and the wider determinants of wellbeing.
The Darzi Review: Independent investigation of the NHS
Commissioned in 2023, Lord Darzi’s review offers one of the most comprehensive independent assessments of the NHS in recent years.
Key findings:
- Performance and satisfaction: Patient access and satisfaction are at record lows, with worsening waiting times and growing concern about NHS capacity.
- Workforce: Staffing gaps, burnout and morale issues are widespread, particularly in general practice, mental health and social care.
- Infrastructure: Years of underinvestment have led to deteriorating hospital buildings, outdated equipment and limited digital capability.
- Health outcomes: Life expectancy has stalled and inequalities have widened, while many people now spend a greater proportion of life in poor health.
- Funding imbalances: The current system still prioritises acute hospital care, while community and mental health services remain underfunded and overstretched.
Recommendations include:
- A 10-year health and care plan with clear national priorities.
- Major capital investment in estates and digital systems.
- Targeted efforts to reduce waiting times and modernise services.
- Greater focus on prevention, primary care and integrated models of care.
- Reform of leadership, governance and local accountability.
- A new approach to workforce planning, support and retention.
NHS 2025/26 Priorities and Operational Planning Guidance
Published by NHS England, this annual guidance sets out what NHS trusts and Integrated Care Boards (ICBs) are expected to focus on in the coming financial year. Core aims are:
Improve access and outcomes:
- Reduce elective and outpatient backlogs.
- Improve emergency and urgent care flow.
- Expand access to general practice and urgent dental care.
- Enhance mental health services, particularly for children and young people.
Deliver reform and transformation:
- Increase use of NHS App and patient-led pathways.
- Expand use of electronic patient records and the Federated Data Platform.
- Drive integrated models of care across systems and sectors.
- Embed digital and AI-enabled solutions.
Restore financial sustainability:
- Significant cost savings required across systems.
- A 30% reduction in agency staff spend.
- More flexible local financial planning, with fewer national ring-fences.
- Mandatory integration of Quality and Equality Impact Assessments into decision-making.
Providers and systems are required to submit refreshed Joint Forward Plans (JFPs) and prepare for the launch of a wider 10-Year NHS Plan and a new multi-year financial settlement.
You can read an abridged summary here.
Recent government proposals and reform measures
In late 2024 and early 2025, the Secretary of State for Health and Social Care outlined several major reform proposals to drive greater accountability and consistency across the NHS:
- Public performance league tables, ranking trusts against 72 national standards.
- Tiered national ratings to identify top- and low-performing organisations.
- Increased scrutiny and consequences for underperformance, including potential dismissal of senior leaders.
- Incentives for high performers, including retention of budget surpluses and reward for successful turnaround leadership.
- Tighter controls on agency spending, including potential bans in non-clinical areas.
- A revised senior leadership pay framework, linking pay more directly to quality and outcomes.
- Enhanced oversight and governance, including an updated NHS Oversight Framework.
These changes signal a renewed focus on transparency, financial discipline, and leadership accountability — with an emphasis on outcomes for patients and value for the public purse.
What this means for DBTH
At Doncaster and Bassetlaw Teaching Hospitals, we welcome these conversations about reform. Our refreshed strategy is already aligned to many of these national ambitions – from tackling health inequalities and modernising our estate, to embracing digital and investing in community-based care.
We believe strong local leadership is vital to making this vision a reality. That’s why the role of Non-Executive Director is so important – not only in holding the organisation to account, but in helping shape how we respond to national priorities and deliver meaningful, sustainable change for the communities we serve.
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