Another year, and yet another round of changes amid pharma’s biggest customer.
Those watching the news over the seasonal break cannot fail to have noticed Kier Starmer and Health Secretary Wes Streeting capturing the headlines.

Under pressure from the media, political opponents and not least his own party to “do something”, Starmer made the NHS the subject of 2025’s first big policy announcement.

It rehashed some of the noise around the budget – £25bn extra but the NHS must reform or die – and covered the importance of care closer to home, AI and tech, the NHS app, enhanced community diagnostics, faster elective care, referral management, efficiency and more use of the private sector.

“We need an NHS hungry for innovation,” he said, which sounds like good news for industry – but it must be weighed against the financial picture, which in most commentators’ eyes looks far worse than the £25bn extra makes it sound.

So, we get a flavour of what will be important. What will now follow is the detail – successive months of planning, publication and positioning that looks set to alter how the NHS will work in the rest of the decade.

This article looks at ten big areas in the sales environment worth keeping an eye on. How will these affect your customers’ priorities and their ability to affect change? What kinds of innovation will the health service respond to, and what will be kicked into the long grass?

Is the time right to interrogate care pathways? How will care closer to home be achieved? And what role will pharma have in helping the NHS achieve all this?

In late Spring, we expect the 10-year plan, setting out Labour’s vision for the NHS, to be released alongside a multi-year spending review that will determine the budget.

What will be in this plan? So far, we have some clues in the form of the Darzi review, which set out seven drivers for the future, and Wes Streeting’s response to it, which contained three strategic shifts (7 plus 3 equals 1 x 10-year plan).

Those shifts are: from treatment to prevention; from hospital to community and from analogue to digital. And those drivers are; re-engage staff and patients; tilt towards technology; rewire financial flows to support care close to home; simplify and innovate in delivery; drive productivity and contribute to UK prosperity.

Elective care backlogs and indeed reducing all waiting times are the number one priority this year for the NHS and the government. Under a new recovery plan announced in early January, NHSE is to commit to a 65% 18 weeks RTT target for 2025-26.

A joint NHS-government plan also expected to confirm a commitment to hit full 92% RTT by 2029, which is the target set in the original NHS constitution.

The 2025-26 target is part of a new “NHS elective reform plan” – but already, there are tensions between supporters of top-down targets as the most effective means of driving – and demonstrating – improvement and those who want priorities to be set locally.

A pay settlement with junior doctors last year left other staff groups frustrated at their own less generous deals and it’s likely we will see more strikes in ’25.

Industrial action is ongoing with GPs. Unions have said there is a ‘real risk’ of industrial action based on the government recommending a 2.8% uplift for public sector workers in 2025/26 (compared with 22% for the junior doctor).

The pay review body will make a recommendation soon, but expect this to be made in the context of full austerity – whatever budgetary uplift goes on staff pay, there will be less to spend on other critical areas.

On the subject of funding – though it has increased (that overall, £22-25bn envelope for the next two years, depending on who you read and what you count), there is no prospect of New Labour style sustained rises averaging 5.5% a year.

Inflation, staff pay awards and other costs means that the 2025/26 fiscal year will be incredibly tight. Some services may have to be cut and systems will make hard choices about trade-offs in the treatments and services offered.

Pathway efficiency and healthcare setting will inevitably come to play here – with the mantra being that hospital care cannot be the norm.

The plan also says new tariffs are to be used to move six procedures from day cases to outpatient settings, with the prospect of this being expanded to up to 30 areas of clinical activity in 2026-27.

The reform plan also confirms some details around elective funding for 2025-26 – providers will have “funding certainty and continue to be paid in line with the number of patients they treat, based on a planned level of activity with commissioners”.

There will also be capital incentives for the providers with the biggest performance improvements and financial support for waiting list validation.

A pledge to incentivise activity that “directly ends a patient’s wait for their care” has also been mooted, and we already know GPs are being incentivised to have a conversation with consultants for every patient referral to establish whether that patient could be kept out of hospital.

A new deal with the private sector will double the proportion of elective activity that it is funded to carry out – funding to the tune of £2.5bn annually.

Kier Starmer knows the private sector has its enemies in the NHS and the public at large, but clearly doesn’t care: “I’m not interested in putting ideology before patients”.

The independent sector will deal with joint replacements, ENT and gynaecological treatments in particular. The aforementioned elective reform plan calls for pricing reviews on services “particularly for activity where the independent sector can significantly help to reduce NHS waiting times”.

Private sector investment will also be used to expand community diagnostic hubs – 17 of them, open 12 hours a day - as part of a new “partnership agreement” between the NHS and the independent sector.

Ministers have promised to widen criteria for referral so “as broad a cohort of patients as possible” can be treated in private facilities.

Despite the push to cut waiting lists, the NHS will carry out a similar level of elective activity next year as it has this year, under plans agreed with ministers.

A target has been agreed for the service to deliver around 18 per cent more activity nationally than pre-COVID levels, on a value-weighted basis, keeping elective activity roughly at the same level as FY24/25.

What does this mean? It means a lot of the heavy lifting in this activity push will have to be done by the private sector – and Streeting and Starmer see no shame in this.

Another new target set by the government is to have the majority of patients awaiting elective treatment able to view and manage their appointment through the NHS app by spring 2026.

By March 2025, the government expects 85 per cent of acute hospitals to be connected with the app.

To those of you who may be thinking, app schmap, an ambitious range of services is set to be delivered this way, potentially creating a new local landscape of provision based on individual need and demand.

Users awaiting elective care will be able to choose from a range of providers via the app, including from the independent sector; they can book diagnostic tests through the app, including at community diagnostic centres; and they will also receive test results through the app.

It’s easy to be uneasy at the scale of the challenges that lie ahead for the NHS, and for industry as it attempts to gain traction in a sales environment with so many compromising factors, restrictions on access, aversions to spending and novelty and with great customer distraction – still.

But just as threats can be viewed as opportunities through a different lens, remember that, in order to surmount these challenges, the NHS will need products, solutions, know-how, data, insight and imagination of the life sciences industries.

While pharma can’t directly affect how fast the NHS carries out clinical activities, it can offer new pathways that make those activities easier to manage. It can act on identification, stratification and prioritisation of patients to make those waiting lists more manageable.

It can supply medicines to patients to keep them out of hospital, provide an alternative way of treatment in the community, get them better quicker so they leave acute settings to make room for others, and it can support on monitoring and outcomes.

Oli Hudson is Content Director at HSJ. Go to hsjmarketintelligence.co.uk