Reshaping NHS Planning: A New Five‑Year Framework For England
In September 2025, NHS England published its new Planning Framework for the NHS in England, a guide intended to reshape medium term strategy across the service.
It is designed for local leaders across Integrated Care Boards, providers, regional teams and local government who are responsible for planning services over the next five years from 2026/27 through to 2030/31.
The framework aligns with the ambitions of the 10 Year Health Plan, bringing new expectations for coherence, collaboration, accountability and delivering real improvements in health outcomes.
In this blog I’ll walk through what the framework says, what it changes, what challenges and opportunities it presents and key tasks for local leadership as they begin putting it into practice.
What Is The Planning Framework For The NHS – And Why Now?
The NHS has long operated largely on annual cycles, with annual planning, annual funding allocations and annual negotiations. While this helps with short-term stability, it also limits capacity for longer term thinking, innovation, transformation and truly aligning services to future health needs.
The 10 Year Health Plan made clear new ways are needed. The planning framework is a response; it aims to move the NHS toward rolling five-year plans, more integrated planning, greater alignment across organisations and clearer lines of accountability.
Key purposes of the framework include ensuring planning is not just an administrative exercise but a transformational tool, to deliver sustainable improvements in outcomes, to tackle health inequalities and to adapt to demographic, workforce, financial and technological change.
It also defines the roles, responsibilities and accountabilities of different parts of the system, including ICBs, providers, NHS England regions and national teams, and sets out principles of good planning to help local leaders build credible, deliverable, integrated plans.
Core Principles For Effective Integrated Planning
At the heart of the framework are five principles that every plan should embody:
- Outcome focused.
- Accountable and transparent.
- Evidence-based.
- Multidisciplinary.
- Credible and deliverable.
These principles aren’t new in themselves but their formalisation into this framework, with expectation to abide by them, underscores how deeply NHS England wants planning to shift.
Read my blog: The NHS 10-Year Plan: Strategic Vision or Delivery Dilemma?
Who Does What In The NHS – Be Clear On The Roles And Responsibilities
One of the clear benefits of the framework is its clarity about who is responsible for what. The NHS has many actors; overlapping responsibilities can lead to duplication, unclear accountability or poor co-ordination. The framework lays this out for four levels:
- National.
- Regional.
- Integrated Care Boards (ICBs).
- Providers.
National teams set strategy and produce national tools, regions support ICBs and manage cross boundary issues, ICBs set system strategy and allocate resources, and providers deliver services and operational plans.
Boards at provider and ICB level are emphasized – they are not passive approvers but should actively contribute, review, challenge and ensure plans are realistic and aligned.
Two Phases Of The Integrated Planning Process
The framework describes a two phase process for plan development – laying the foundations (population health assessment, capacity modelling, governance) and then integrated plan development (service redesign, workforce, finance, estates, quality, equality and impact assessments).
Triangulation, which aligns workforce, finance and quality, is a central requirement, alongside robust assurance and oversight by boards.
Key Outputs & Planning Architecture
The framework sets out four key outputs:
- Five year strategic commissioning plans (ICBs).
- Five year integrated delivery plans (providers).
- Neighbourhood health plans (place/local authority level).
- National plan returns (harmonised reporting requirements).
Together, these outputs feed into a national planning architecture intended to ensure consistency, enable oversight and facilitate aggregation of data.
What’s New And What Changes?
Key shifts include moving to a rolling five year horizon, stronger integration across organisations, rigorous triangulation of finance/workforce/quality, explicit focus on inequalities and outcomes and a more active role for boards in shaping plans.
Challenges include data and analytics capability, workforce constraints, financial pressures, governance and culture shifts, uncertainty in the external environment, and the complexity of meaningfully addressing inequalities.
For ICBs, providers, and partners, next steps include strengthening analytics, setting up integrated planning structures, refreshing strategies, undertaking scenario planning, ensuring financial transparency, focusing on inequalities, embedding continuous improvement and engaging partners early.
What Opportunities Are There For Pharma, Medtech And Device Companies In The NHS Planning Framework?
The planning framework presents a clear opening for industry partners to align their offerings with NHS medium-term priorities. By emphasising five year integrated planning, NHS leaders are signaling they want solutions that can deliver sustained improvements in outcomes, efficiency and inequalities.
Pharma, medtech and device companies that can evidence long term value, rather than short term fixes, will find more receptive audiences. This means moving beyond product centric pitches and instead presenting innovations as part of pathway wide solutions that address demand and capacity, workforce pressures and patient outcomes.
A second opportunity lies in the framework’s call for triangulated planning; the alignment of finance, workforce and quality. Industry partners can play a role by demonstrating how their products or services reduce costs elsewhere in the system, free up clinician time or support new workforce models. For example, diagnostics that enable earlier detection, or devices that allow care closer to home, directly support system goals around sustainability and patient centred care.
By packaging evidence of cost avoidance, productivity gains and clinical benefits, companies can position themselves as enablers of the NHS’s integrated plans.
The emphasis on neighbourhood health plans and tackling inequalities creates further scope for collaboration. Companies can contribute by providing data, insights and pilots that show how their technologies improve access in underserved communities.
Digital tools, portable devices or treatments that reduce the need for hospital attendance all align strongly with this agenda. Working in partnership with Integrated Care Boards and local authorities, industry can help ensure innovations are designed and deployed in ways that directly support equity of access.
Finally, the framework’s requirement for credible and deliverable plans means local leaders will increasingly look for proven, ready-to-scale solutions. This is where reference sites, case studies and outcome guarantees become critical.
As outlined in my new book Embedded, companies must move from transactional sales to embedded partnerships by co‑designing solutions with providers, showing how innovations integrate into real NHS pathways and offering evidence from early adopter sites.
Those that can demonstrate success in one area will be well‑placed to expand as the NHS rolls out its new operating model.
This Is How We Meet The Future – Head On
The Planning Framework for the NHS in England marks a shift – from short term, annual cycles toward multi-year, integrated, outcome driven planning.
For NHS leaders, boards, ICBs, providers, regional teams and partner organisations, it means rethinking both what is planned and how planning is done. The framework brings clearer expectations around accountability, transparency, credible evidence and collaboration.
Implementation will be challenging. But with the right commitment, structures, investment in data and analytics, engagement across the system and cultural change, it offers a chance for the NHS to better meet future challenges; changing population needs, financial constraints, workforce issues and the imperative to reduce inequalities.
For many local leaders, the work starts now with building foundations, assessing gaps, mobilising partners and setting ambitious, yet deliverable, medium-term plans that can be refreshed and iterated.
If you’re a local leader, provider or ICB, keep this new framework close. Think five years ahead. Involve the people you serve. Ask hard questions. Test assumptions. Make sure your plans are not just document‑makers, but roadmaps to better patient care, healthier communities and a more resilient, sustainable NHS.
At www.scottmckenzieconsultancy.com, we work directly inside the NHS, supporting provider organisations, commissioners and system leaders to implement real change. We then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.
With 10 years in pharma and more than 20 years working within the NHS, Scott brings a unique dual perspective, now captured in his upcoming book, launching September 2025, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything he’s learned into a practical playbook. Whether you’re launching a new product or trying to unlock stalled adoption, Embedded shows you how to reframe your offer, align with NHS priorities and make change stick.