The NHS Medium-Term Planning Framework: IHOs and Advanced Foundation Trusts
The government and NHS England have recently issued the 'Medium-Term' Planning Framework for the NHS (“the Framework”), which sets out priorities for 2026/27 through to 2028/29 and is aligned to the 10 Year Health Plan. While this sets out more detail than the 10 Year Plan, a swathe of further documents expected to be published this month are anticipated to expand on how its goals will be achieved. This is a departure from recent planning guidance, which has tended to only be issued a year at a time. Sir Jim Mackey, CEO of NHS England said the new approach would move away from short-term planning to enable the NHS to plan further ahead, which would help enable more local innovation. It is an ambitious plan which sets out priorities and expectations to achieve sustainable improvement across health services in England.
The reforms to the NHS operating model set out in Chapter 2 (p12) are said to be “designed to create the space for leaders to lead, incentivise those who do it well, and support those who need it”. Updates to the NHS Oversight Framework, to support the new operating model, are planned for 2026/27.
Integrated Health Organisations (IHOs)
IHO contracts’ role within the proposed new NHS Operating Model is described in the Framework as enabling “end to end redesigning of pathways, with efficiencies reinvested into better and more effective ways of working.” The Framework (p14) makes clear that IHOs will not, in fact, be a new type of organisation in their own right as previously thought. Rather, they will be a “contract-based delivery method” held by existing organisations, or partnerships of existing organisations working, “… within the wider provider landscape to deliver high-quality care efficiently, including through sub-contracting arrangements and, where appropriate, delegation of commissioning.” ICBs will retain oversight of these contracts and commissioner capability will be a key consideration in the IHO assessment process. A draft system archetypes document that will be published in November 2025 will explain the interplay of the new contract models including how:
- IHO contracts will work alongside multi-neighbourhood and single neighbourhood contracts.
- NHSE will assess provider capability to take on an IHO contract. Wes Streeting stated at NHS Providers this week that Advanced Foundation Trusts will be among the first to take on IHO contracts but made it clear that any Trust can hold IHO status. There will therefore be more diversity of leaders reflecting who is best placed to lead a service.
- IHO contract holders will deliver the shift of resources from hospital to community.
- IHO contracts will be responsible for a defined population.
New NHS Foundation trusts
Through the launch by Wes Streeting at the recent NHS Providers conference, he described “a new generation of foundation trusts called Advanced Foundation Trusts”, which are responsible for collaboration, productivity and quality, leading and managing NGS services to ensure they align with the strategic priorities set out in the Framework. They will contribute to the development of IHOs and support the implementation of new models of care. The new FT model will be based on excellent governance, organisational self-awareness, and transparency with earned freedoms for those who deliver and proportionate intervention where standards slip. A draft foundation trust framework will be published for consultation in November but Wes Streeting reinforced this role and announced that eight trusts are in the running for this new status ... from … Dorset to Northumbria and they are a mix of acute mental health, and community Trusts with the aim being for every trust to achieve this status. Wes added that the “earned freedoms” are real and immediate and include the ability to reinvest surpluses accumulated last year in future capital projects, more operational, autonomy and fewer ad hoc requests from the centre.
While the Medium-Term Planning Framework puts more meat on the bones of the 10 Year Plan, considerably more clarification documentation is awaited. It also leaves local leaders with competing priorities, high expectations and tight budgets. The upside for good financial managers and innovators is, if they can create good system architecture for what delivers for patients, they will be given the space to lead.
We are closely following the seismic changes ongoing within the NHS and our webinar series over the past 6 months: The Future of the NHS (in July), Organisational Change (in September) and Governance (in October), were designed to help you keep up with the latest developments and share experiences and practical ideas. If you missed these and need guidance, do contact us; sign up for one of our newsletters; or look out for our future events, in particular, our forthcoming webinar in the new year led by Nichola Lennon that will include consideration of the new NHS foundation trust constitution.