What does the NHS Medium-Term Planning Framework mean for neurological conditions?

18/11/2025

Georgina Carr, Chief Executive of The Neurological Alliance (England), writes:

NHS England has published its new Medium-Term Planning Framework (2026–29) setting out how the NHS intends to deliver the ambitions of the 10-Year Health Plan for England.

As ever, the detail matters, and while there’s a lot to welcome, there are also reasons for concern, particularly for people affected by neurological conditions.

What we welcome about the medium term planning framework

For many years, NHS planning has been dominated by short-term funding and planning cycles and shifting priorities. This framework’s three-year horizon is a much-needed step forward, creating space for systems to plan realistically and to invest in long-term improvement.  This latest guidance document has been published earlier in the year compared to previous versions. This should also give systems more time to plan properly – and, crucially, to engage people and communities meaningfully in those plans.

The framework reinforces the ambition to strengthen “neighbourhood health teams” – collaborative multidisciplinary teams intended to help bring support closer to home. This has the potential to reduce the many hours and miles thousands of people affected by neurological conditions have to travel for the right input and support. This mirrors our own calls for networked models of neurological care, where local teams are digitally connected, multidisciplinary, and able to access the right specialist input when needed.

We also welcome the emphasis on improving the NHS workforce’s experience of work. Supporting staff morale, retention, and wellbeing are critical for the sustainability of services, particularly in many neurological specialities where workforce shortages are incredibly acute.

What are our concerns?

As initially set out in the 10-Year Plan, Modern Service Frameworks (MSFs) are now the main mechanism for setting service priorities. The first wave of MSFs covers cardiovascular disease, serious mental illness, and sepsis. Neurological conditions risk being left behind unless we can secure an MSF in the next phase.

The aspiration to deliver more care closer to home only works if the workforce is available and supported. Our analysis ahead of the NHS 10-year workforce plan for England  and findings from My Neuro Survey 2024/25 show neuro services are already operating under immense strain, with some of the longest waiting times in the NHS and fragmented community provision.

While the framework mentions improving patient experience, the focus remains on surveys rather than genuine co-design and shared leadership. To deliver real change, community voices must help shape decisions from the start.

There is rapid expansion of digital and AI tools in the NHS, but little detail on how staff, people  affected by long term conditions and communities will be supported to use these safely and confidently.

And, with more than 20 additional guidance documents expected, plus new NHS legislation due in 2026, planning remains challenging, and accountability hard to define, until the full picture emerges.

What’s next for neuro service delivery?

The direction of travel is right: longer-term, more local, digitally enabled care. But as things stand, the list of priorities is vast and the path to delivery narrow.

At the Alliance, our focus is on:

  • Securing a Modern Service Framework for neurological conditions to drive consistent quality and prioritisation.
  • Embedding the neuroscience workforce plan within NHS England’s 10-Year Workforce Plan. Our recent consensus statement, Building a Clinical Neuroscience Workforce Fit for the Future, sets out what’s needed to deliver a sustainable, multidisciplinary workforce for the future.
  • Developing a Neuro Neighbourhood Health model, showing how integrated, community-based neurological care can work in practice, connecting general practice, community services and specialist expertise.
  • Ensuring evidence on patient experience, such as My Neuro Survey, is available for systems to plan their priorities.
  • Elevating the voices of people affected by neurological conditions as reform continues – through our work with NHS England’s transformation programmes, the UK Neuro Forum, and Integrated Care Systems across England.

Final thoughts

Plans don’t deliver change, people do. Alongside the 10-Year Health Plan, this framework sets an ambitious direction, but it will only succeed if national ambitions are matched with investment in workforce, capital, and genuine  partnership with people and communities.

We’ll continue to work with NHS England, professional bodies and our member organisations alongside experts by experience to ensure neurological conditions are not left out of the next phase of reform.