Delivery plan for recovering urgent and emergency care services

In 2023, the government published a plan for recovering urgent and emergency care services, which built on two headline targets: reducing average category two ambulance response times to 30 minutes, and improving A&E waiting times.

On 6 June 2025, the Department of Health and Social Care published a new Urgent and Emergency Care Plan (UEC Plan). Building on its previous iteration, this plan emphasises a whole-system approach to tackling UEC pressures and includes examples of best practice from
across the country. 

This briefing provides a full summary of the Plan, outlines the NHS Providers’ view and how we’ve contributed to this agenda. If you have any questions, please contact Charlotte Lillford-Wildman.

• This plan prioritises cross-sector, system working to achieve improvements in UEC over winter. Local partners within every system will be responsible and accountable for effectively managing UEC demand, with an emphasis on multidisciplinary, neighbourhood working.
  
  
• All winter plans must be developed and tested prior to implementation, and lead to an increase in urgent care services provided in the community. This includes improving uptake of the flu vaccination among NHS staff, and expanding virtual wards.
  
  
• Capital funding injections and supportive national resources will be simplified, to ensure a bigger impact. Over £370m will be invested into supporting UEC, which could provide the equivalent of 40 new same day emergency care (SDEC) units and urgent treatment centres (UTCs). Detail on how this funding can be accessed is not yet clear.

The whole system must focus on seven key areas. These are:

1. Category 2 patients must receive an ambulance within 30 minutes.
2. Ambulance handovers must not exceed 45 minutes.
3. At least 78% A&E patients to be discharged, admitted or transferred within 4 hours.
4. Less than 10% patients to wait over 12 hours for admission or discharge from an ED.
5. Reduce the number of mental health patients waiting in EDs for over 24 hours.
6. Reduce the number of patients staying 21 days over their discharge-ready date.
7. See more children within 4 hours.
   
   

To ensure success of winter UEC plans, all plans must be signed off by all trust boards and CEOs in every system by Summer 2025. By September 2025, these plans should have been stress-tested by regional and system leaders. Each plan should outline how the system will:

• Improve rates of vaccination.
• Increase the level of care provided in primary, community and mental health settings.
• Meet the 45-minute ambulance handover time.
• Improve flow through hospitals.
• Eliminate discharge delays of over 48 hours and set local performance targets to improve discharge times more generally.

There will be a requirement for every plan to outline:

• How ICBs are improving access to primary and community care.
• How community providers are improving admission avoidance.
• How trusts are using tools to improve patient flow, including optimising triage processes.
• How ambulance trusts are maximising opportunities this winter. They are required to nominate an executive director to work with ICBs to support development of the system winter plan.

NHSE has committed to reviewing all available UEC data by the end of June 2025, and work to improve transparency of data at a local level.

UEC performance will be published in league tables, to increase accountability – we assume this will be at site-level but this requires further clarification. We are concerned about the use of league tables in the healthcare sector. We have previously been clear that any use of league tables must be understandable and useful to providers, the public and policymakers, and accompanied by relevant commentary.

Overall

NHS Providers welcomes the Government’s UEC plan as a timely intervention, published early enough to enable meaningful action ahead of anticipated winter pressures. We are encouraged by the plan’s system-wide focus, with consideration given to primary, community and mental health care, in addition to ambulance and hospital services. The additional capital investment in same-day emergency care and mental health crisis assessment centres is particularly welcome, as is the emphasis on prevention via vaccination.

We welcome the plan’s recognition of the extraordinary efforts of NHS staff, but it fails to acknowledge that the current challenges in UEC are rooted in more than a decade of underfunding and underinvestment. There is a risk that the plan relies on there being untapped potential to do more within existing systems, but in many cases, trusts are already operating at, or beyond, capacity. Progress is often constrained by systemic barriers such as workforce shortages, gaps in skills mix, and insufficient funding to support the staffing levels and service hours required to meet demand. With the risk of further industrial action looming and asks from the centre for further financial cuts, some of these structural challenges could get worse.

While the plan represents a step forward and should deliver improvements on last winter’s performance, it lacks the long term ambition needed to fully meet public expectations. More decisive action is required to improve access to primary care, ensure patients are directed to the right care in the right setting, and improve patient flow across the system. This includes reforming social care to ensure the sector is on a sustainable footing for the long term.

The operational context

Recent performance data shows that while trusts ended winter 2024/25 with considerable improvements in some areas, such as reducing category 2 response times and increasing the proportion of A&E patients seen within 4 hours, issues like long handover delays and high numbers of patients waiting over 12 hours in emergency departments persist.

The operational environment remains fragile, and the success of the UEC plan will depend not only on ambition but also on the realism of expectations and the provision of sufficient support to local systems to deliver meaningful and sustained improvement.

Capital

We welcome the plan’s commitment to capital investment, as well as the additional revenue support for the ambulance sector and primary care – both of which are long overdue. These measures represent important steps toward strengthening frontline capacity.

However, the criteria for accessing capital funding remain unclear, raising questions about transparency and equitable distribution. In the case of mental health services, we have seen the drawbacks of requiring rapid bid submissions, which can disadvantage providers without ready-made plans, despite pressing needs. That said, for systems with investment-ready proposals, this funding will be hugely beneficial and should help accelerate much-needed improvements.

Mental health

There is much to welcome in the plan’s focus on mental health, with clear recognition that high-quality mental health provision is essential to improving urgent and emergency care. It rightly highlights the need for mental health trust chief executives and boards to play a full and active role in shaping local winter plans and makes an important statement that no patient should be waiting over 24 hours in emergency departments – a standard that must apply equally to those in mental health crisis. The plan reflects several key messages from our recent briefing, including the need to stabilise and expand capacity across the mental health UEC pathway, and to design more coherent, accessible service models to reduce the current fragmentation caused by multiple, uncoordinated providers.

We also welcome the requirement for system winter plans to show how mental health inpatient stays will be kept as short as possible. Mental health trust leaders are committed to improving patient flow and reducing variation in lengths of stay – but this must be underpinned by close partnerships across physical and community health services, and by tackling inconsistencies in the availability of community-based care, which are critical to delivering sustainable improvements.

The additional £26 million in capital funding to support the development of crisis assessment centres ahead of this winter recognises the need for urgent investment in mental health UEC. However, while the commitment is positive, the overall funding envelope feels relatively limited given the scale of need, and there are understandable concerns among trust leaders about how many areas will realistically benefit. Even in systems that are successful in bidding for this funding, there are questions about how far it can stretch to deliver meaningful impact, particularly in areas facing significant infrastructure or workforce challenges.

Cross-sector working

A key strength of this UEC plan is its whole-system approach – from primary and community care to mental health and acute hospitals – signalling a shift toward a truly integrated system and a recognition that UEC demand is often determined by wider system pressures. We are particularly pleased to see greater alignment between Government and national bodies, including the Department for Levelling Up, Housing and Communities, and NHS England, through the establishment of Discharge and Admissions Groups. These groups have the potential to support more effective collaboration between health and social care, and between the NHS and local authorities on meeting discharge targets. While the impact will ultimately depend on how this works in practice, the approach is promising.

However, it’s crucial that national support and direction for local government is fully aligned with the expectations set out for NHS organisations and wider system partners. Ongoing pressures in social care mean that this is essential to ensure joined-up delivery and to avoid placing unrealistic demands on already stretched services.

Ambulance services

The plan’s requirement for ambulance trusts to nominate an executive director to work with each Integrated Care Board (ICB) on developing system winter plans is a welcome acknowledgment of the critical role ambulance services play in effectively managing UEC demand. Ensuring ambulance trusts are directly involved in planning will help align priorities across the system and support more effective coordination.

However, this is a substantial ask for those ambulance trusts operating across multiple ICBs - given the complexity and resource demands involved. It will be important that this expectation is matched with appropriate support and recognition of the operational pressures these services are already facing.

League tables

We welcome the commitment to a redesigned improvement function and better coordination across the various support offers available to trusts.

The Plan states that it will “commit to publishing league tables on performance to drive improved transparency and public accountability and also to encourage less effective systems to work more closely with high performing systems to accelerate improvement.” We have previously expressed our concerns about the proposals for league tables, including that these fail to address the deep-rooted causes of pressures on health services, and that they could endanger psychological safety, create perverse incentives and make speaking up less likely.

NHS England and DHSC must be aligned in their vision for ‘league tables’, and these should be in line with what becomes the new NHS operating model. Any new league tables should seamlessly fit within the landscape of the new oversight and assessment, and performance, improvement and regulation frameworks, without introducing new layers of bureaucracy, oversight and regulation. League tables should be published in a consistent and transparent way, making sure they are understandable and useful to providers, the public and policymakers, and accompanied by any relevant commentary. NHSE and DHSC should recognise that the reason for organisational “failure” might be beyond the immediate control of health leaders, and systemic issues might be getting in the way of improvement.

Workforce

For any NHS reform to succeed, there must be a strong, resilient workforce to deliver the asks, with the right skill-mix. At present the NHS workforce faces many pressures, including workforce shortages and recruitment and retention challenges.

It is notable that this Plan does not acknowledge the need to fix workforce gaps - without this, it may be a challenge to deliver some of the more ambitious targets outlined. We look forward to the upcoming refresh of the NHS Long Term Workforce Plan, which must bring forward clear measures to tackle workforce shortages in the NHS.
Looking to the future – the 10-year Health Plan and prevention
It is encouraging to see that the UEC plan is structured around the three key shifts, aligning with the Government’s forthcoming 10-Year Health Plan.

The focus on prevention – including through boosting vaccine uptake, improving care coordination for frail patients, and enhancing communication with parents around children and young people’s services - is a positive and necessary step. These efforts align with broader system ambitions to move from reactive to proactive care, reducing pressure on acute services over the long term.

However, the rising trend in vaccine hesitancy presents a serious challenge. Without a dedicated strategy to build public understanding and trust in vaccinations, efforts to improve uptake may fall short. As the NHS moves towards a more preventive model of care, it will be essential to pair operational plans with sustained public engagement and education to ensure lasting impact.

NHS Providers has played a key role in shaping and supporting the UEC agenda, ensuring the voices of trust leaders across all sectors are heard at the national level. We have highlighted the operational realities on the ground and championed the need for a whole-system approach to UEC improvement.

Top contributions to this agenda:

• Being active members of NHS England’s UEC Expert Reference Group, including ensuring a cross-system approach to tackling UEC pressures and the importance of factoring in mental health need.
• Ongoing monitoring and reporting that provides real-time insight into how UEC services are coping with seasonal pressures, based on direct feedback from trust leaders across England via our Activity Tracker, Winter Watch analysis and case studies.