2025 has been a year of contrasts for the NHS. On one hand, we witnessed record access, survival rates at new highs, and community alternatives that gave patients dignity close to home.

On the other, urgent demand rose, maternity safety reforms stalled, and governance turbulence risked eroding trust. For those of us who believe in stewardship, dignity, and accountability, the year has been a reminder that progress is fragile unless it is grounded in culture as well as policy.

The Highs: Evidence of Stewardship Paying Off

• General practice resilience: GP teams delivered 369 million appointments in twelve months—a record that speaks to grit and commitment under strain.

• Cancer survival at new highs: Long‑term investment in diagnostics and pathways bore fruit, showing that stewardship across decades matters.

• Community alternatives scaled: Urgent community response teams offered 720,000 people care at home rather than hospital—preserving dignity and agency.

• Technology uplift: Commitments of up to £10 billion for digital transformation by 2028/29 signal a serious attempt to modernise access and productivity.

The Lows: Where Accountability Faltered

• Rising urgent demand: A&E attendances rose nearly 7% year‑on‑year, intensifying corridor care and testing dignity at its sharpest edge.

• Maternity safety too slow: National reviews warned that changes remain “unacceptable” and “too slow”—a failure of accountability to families.

• Junior doctors’ strike and aftermath: Prolonged industrial action over pay and conditions highlighted the fragility of workforce morale. Regardless of the strikes, many junior doctors found themselves unable to secure posts, a bitter irony in a system crying out for staff. This mismatch between need and opportunity undermines trust and wastes talent.

• Governance disruption: The abolition of NHS England and mandated cuts to Integrated Care Boards created uncertainty, risking stewardship and local trust. Staff in ICBs faced the threat of 50% job losses, with no clear explanation of how redundancies would be funded or managed. The silence on financial provision compounded the anxiety, leaving dedicated professionals feeling disposable. I wonder how many will be made redundant and then taken back on to fill the need and at what cost?

• Funding still tight: While the NHS was a relative “winner” in the Budget, uplifts remained modest against demand growth.

NHS Reforms: Promise and Turbulence

The government’s reform agenda in 2025 was ambitious: abolishing NHS England, reshaping Integrated Care Systems, and mandating deep cuts in running costs. The intention was to streamline and localise decision‑making. Yet the execution often felt disruptive rather than empowering. Redundancies risked losing institutional memory, and local leaders struggled to balance new mandates with existing pressures. Reform without stability risks undermining stewardship; reform without culture change risks hollow accountability.

Community Care and Technology: Shared Agency at Its Best

The most encouraging theme of 2025 was the emphasis on care closer to home. Primary eye care on the high street, urgent community response teams, and home‑first pathways all showed how shared agency between clinicians, patients, and caregivers can preserve dignity and reduce avoidable hospital use.

Equally significant was the continuation of online and technology‑driven care streams. Virtual consultations, remote monitoring, and digital triage became embedded in everyday practice. For many patients, especially those with mobility challenges or living in rural areas, these tools offered convenience and agency. 
Yet they also raised questions about equity: how do we ensure older patients, or those without digital access, are not left behind? Stewardship in 2026 will mean balancing innovation with inclusion.

Looking Ahead: What 2026 Must Deliver

• Resolve industrial disputes and workforce mismatch: Junior doctors and other staff need fair settlement and pathways into meaningful work. A system that trains but cannot employ its doctors is failing stewardship at its core.

• Maternity safety with timetables and transparency: Families deserve visible progress, not more apologies.

• Workforce retention and civility, not just recruitment: Culture matters as much as numbers. 

• Community commissioning that scales what worked in 2025: Urgent community response, primary eye care, and home diagnostics should be mainstream, not pilots.

• Governance stability that protects institutional memory: Reform must empower local stewardship, not erode it.

• Funding honesty: Modest uplifts must translate into visible changes—faster discharges, digital access that works for older patients, and primary care slots that match demand peaks.

• Technology with inclusion: Online and digital streams must be expanded with safeguards for equity, ensuring innovation does not deepen divides.

Closing Reflection

2025 reminded us that the NHS is not just a system of budgets and targets—it is a covenant of trust between citizens and institutions. Stewardship is about protecting that covenant under constraint. Dignity is about ensuring patients are never reduced to numbers in corridors. Accountability is about making promises that are kept, not deferred.

The NHS has shown resilience this year. But resilience is not enough. 2026 must be the year when industrial disputes are resolved, reforms stabilised, and culture renewed. Stewardship must become culture, dignity must be non‑negotiable, and accountability must be visible. Only then will the highs outweigh the lows in more than statistics—they will be felt in the lived experience of patients, families, and staff.

Wishing everyone a Merry Christmas and a Happy New Year. May 2026 bring health, dignity, and renewed trust in the institutions that serve us all.