Nurse walking in empty ED corridor towards new patient that arrived by ambulance

The Urgent & Emergency Care Plan 2025/26: Evolution, Promise & Challenges

By / / Emergency Department Management, Leadership, Policy

The NHS England Urgent and Emergency Care (UEC) plan for 2025/26, published on 6 June 2025, marks what officials describe as “a turning point for the NHS” and “the most transformative agenda we have seen in over 2 generations.” But how does this latest iteration differ from previous efforts, what are its strengths and weaknesses, and what core strategies could actually deliver meaningful change?

How the 2025/26 plan differs from previous iterations

A shift from fragmentation to system-wide accountability

The most significant departure from the 2023-25 recovery plans lies in the plan’s explicit rejection of what it calls “blame shunting” between different parts of the system. Where previous plans focused primarily on individual performance targets, the 2025/26 approach demands that “each part of the system has responsibility for improving UEC performance” with winter plans requiring evidence from every component – ICBs, primary care, community providers, trusts, and ambulance services.

The original 2023 recovery plan set relatively modest ambitions: 76% of patients being admitted, transferred or discharged within four hours by March 2024, with improved ambulance response times for Category 2 incidents to 30 minutes on average over 2023/24. The updated 2024/25 guidance raised the bar slightly to 78% of patients seen within four hours in March 2025.

New focus areas and enhanced ambitions

The 2025/26 plan introduces several novel elements:

Data transparency revolution: For the first time, the plan includes a commitment to publish A&E performance data from each individual hospital in England, moving beyond trust-level reporting. This addresses long-standing calls from the Royal College of Emergency Medicine.

45-minute handover standard: The plan commits to “eradicating last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard”, representing a more aggressive timeline than previous iterations.

Mental health integration: Unlike earlier plans, there’s substantial focus on mental health pathways, with £26 million of capital to support crisis assessment centres and specific targets to reduce 24-hour waits in A&E for mental health patients.

Digital infrastructure: The plan allocates £20 million in the Connected Care Records programme and commits to rolling out the NHS Federated Data Platform to 85% of acute trusts by March 2026.

Reduced target proliferation

Significantly, the 2025/26 approach reflects lessons learned about target fatigue. The overall number of targets has been reduced from 31 to 18 (compared to 133 back in 2022/23), suggesting a more focused approach than the scatter-gun approach of earlier years.

What’s good and what’s problematic about the plan

The positive elements

Honest assessment of current state: The plan’s unflinching acknowledgment that “we’ve normalised asking our staff to deliver sub-optimal care, and our patients have all but given up hope of expecting a reliable service in urgent care” represents a refreshing departure from previous documents that often understated the crisis.

Investment backing: The £370 million capital investment, including around 40 new Same Day Emergency Care and Urgent Treatment Centres and almost 500 new ambulances, provides tangible resource commitment rather than just aspirational targets.

Prevention focus: The emphasis on vaccination uptake, with commitments to improve uptake by at least 5 percentage points towards pre-pandemic levels, acknowledges that demand management is as important as capacity expansion.

Community-centric approach: The plan’s focus on neighbourhood health services and the recognition that “at least one in five people who attend A&E don’t need urgent or emergency care” suggests a more reasonable understanding of demand drivers.

Concerning limitations and criticisms

Lack of ambition on 12-hour waits: The Royal College of Emergency Medicine has highlighted a critical flaw: the plan accepts that 10% of people will face A&E waits of more than 12 hours, when no patient should. Dr Adrian Boyle noted that this “lacks ambition” when the goal should be complete elimination of such waits.

Limited new funding: While £450 million sounds substantial, RCEM notes this “is not new money and will come from existing funding”, raising questions about whether resources match ambitions.

Implementation uncertainty: Critics point out that the guidance “fails to address how the ‘national shame’ of corridor care and excessive A&E waits will be tackled”, suggesting a gap between aspiration and actionable strategy.

Four-hour standard compromise: Maintaining the four-hour standard at 78% when “the stated aim is that 95% of patients should move through the ED within this time – something which hasn’t happened for a decade” suggests acceptance of suboptimal performance rather than genuine recovery.

Workforce Concerns: While the plan demands improved performance, it provides limited detail on how workforce capacity will be expanded to deliver these improvements, particularly given ongoing staff shortages and burnout.

Core strategies for successful delivery

Leadership-driven cultural transformation

Research consistently shows that “there appears to be a direct correlation in successful UEC performance from those organisations who have well defined, clinically led internal professional standards that are used to frame their collaborative culture”. The plan recognises this, stating that “leadership is the single most crucial factor that will determine our success this winter”.

Implementation approach:

  • Establish clear internal professional standards created collaboratively with clinicians
  • Ensure visible clinical leadership that models collaborative values
  • Create meaningful escalation processes when standards aren’t met
  • Foster a culture of “we” and “us” rather than departmental silos
System-wide flow optimisation

The evidence base strongly supports focusing on “5 universal flow principles” that can transform patient experience:

  1. Involving patients, families and carers in their care
  2. Working together to create trust and support
  3. Ensuring patients get to the right team at the right time
  4. Making sure every step adds value
  5. Using data and evidence to drive decisions

Key flow interventions:

  • Implement the “Ready to Admit” concept where “patients are moved from the emergency department as soon as they were ready to go”
  • Ensure “patients do not wait in the emergency department for test results that were not critical to their emergency care”
  • Develop specialty ambulatory pathways that avoid unnecessary admissions

These interventions will benefit from acute sites using ‘time of referral’ (from acute site locations like ED, SDEC or assessment units) as an early starting point from which to measure specialty workflow, accountability and performance.

Technology-enabled care coordination

The plan’s digital investment could be transformative if properly implemented. “Modifying operational processes with a focus on patients in different UEC settings will improve productivity, flow and the patient experience”.

Digital implementation priorities:

  • Accelerate Connected Care Records rollout to give paramedics access to patient summaries
  • Use real-time data from the Federated Data Platform for dynamic capacity management
  • Implement remote monitoring technology in care homes, which has been shown to “halve falls and prevent ‘long lies’, strongly associated with hospital admissions”
Integrated discharge and community capacity

The plan’s focus on eliminating discharge delays offers significant opportunity. In some trusts, 1 in 4 bed days are lost due to delayed discharges. Successful systems demonstrate how this can be addressed.

Community integration model:

  • Implement the Leicester model that reduced acute delays from 12 days to 1.45 days by focusing community bedded capacity on higher dependency patients
  • Expand virtual ward capacity with the 10 core components outlined in the virtual wards operational framework
  • Develop neighbourhood multidisciplinary teams that have shown “a 9% reduction in hospital attendances for over 65s and a 20% reduction in falls-related acute attendance”
Ambulance service transformation

The plan’s emphasis on “call before convey” and enhanced clinical triage could significantly reduce inappropriate conveyances. Currently, half of ambulance incidents convey patients to an emergency department, with significant regional variation (45 to 54%).

Ambulance reform elements:

  • Expand clinical triage capabilities in Emergency Operating Centres
  • Develop Single Points of Access that accept calls directly from care homes and GPs
  • Increase “hear and treat” rates from the current 8.1% to 20.7% variation
  • Enhance paramedic-led care in the community through “see and treat” approaches
Prevention and demand management

The most cost-effective improvements focus on preventing unnecessary demand. Every thousand childhood vaccinations saves around 4 hospital admissions, demonstrating the potential impact of prevention strategies.

Demand management priorities:

  • Achieve 70% vaccination rates for RSV catch-up cohorts and 60% for routine cohorts
  • Expand pharmacy-based care for common conditions to reduce primary care pressure
  • Implement comprehensive vaccination campaigns for healthcare workers

Conclusion: promise amid pragmatic concerns

The 2025/26 UEC plan represents both evolution and ambition. Its system-wide approach, honest assessment of current failures, and focus on data transparency suggest genuine commitment to change. The substantial investment in community alternatives and digital infrastructure could transform how care is delivered.

However, the plan’s acceptance of continued 12-hour waits, reliance on existing funding streams, and limited workforce solutions raise legitimate concerns about whether it can deliver the step-change improvement that both staff and patients desperately need.

Success will ultimately depend not on the plan itself, but on the quality of local implementation, the sustaining of political and executive commitment, and the ability of frontline teams to translate good intentions into daily practice. As one expert noted, “embedding the learning from the reinvented changes to improve flow in hospitals… remains the greatest challenge for the NHS, that is, ‘doing what has always been done and expecting a different result.'”

The question is whether this plan finally breaks that cycle, or simply represents another well-intentioned iteration of familiar themes. The answer will be written in the corridors, ambulances, and community services where patients meet the NHS at its most crucial moments.

We value your take on the 2025/26 plan. Share the post with your colleagues, review the references and let us know in the comments what your view is.

References

Primary policy documents
Professional body responses & analysis
Research & evidence base
News & commentary
Historical context
St Emlyn’s blog posts and podcasts

Cite this article as: Stevan Bruijns, "The Urgent & Emergency Care Plan 2025/26: Evolution, Promise & Challenges," in St.Emlyn's, June 13, 2025, https://www.stemlynsblog.org/the-urgent-emergency-care-plan-2025-26-evolution-promise-challenges/.

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