On 27 March, a substantially revised regulatory oversight framework for 2025/26 was approved for consultation by NHS England’s (NHSE’s) board.

Now called the NHS performance assessment framework, this iteration reflects feedback from engagement with trusts and integrated care boards (ICBs) about the previous draft, as well as the changing external context.

It will go out for testing and engagement in April with a short period of consultation in May 2025, and will be published at the end of Q1 with the first segmentation of trusts and ICBs happening in July.

The draft framework sets out:

• Clearer roles and responsibilities for NHSE, ICBs and providers.
• How segmentation will be assessed.
• How good performance will be incentivised and rewarded.
• The set of metrics against which trusts and ICBs will be assessed, which include those related to the NHS planning guidance for 2025/26 alongside additional measures related to finance and productivity, public health and patient outcomes, quality and inequalities, and system working.

Specifically, it is proposed that:

• Provider segmentation decisions will no longer be adjusted for organisational capability, however NHSE will evaluate capability to inform their intervention approach.
• Provider delivery scores will not be adjusted for system performance, but the extent to which they are collaborating will factor in the separate capability rating. The detail of the approach to organisational capability is not included as NHSE wish to finalise this during Q1.
• Any trust in deficit will be restricted to a maximum segment score of 3 (where 1 is the high performing and 4 is the poorest performance). A separate segment 5 has been created for trusts in segment 4 whose capability and other factors mean they should enter the Recovery Support Programme.