Leaders’ Policy Briefing: Key updates

UK-wide

Chancellor of the Exchequer delivers 2025 Budget

• On 26 November 2025, the Chancellor of the Exchequer, Rachel Reeves, delivered the UK Government’s 2025 Budget. She stated that the government is seeking to:
  cut the cost of living by tackling inflation and reducing energy bills
• cut NHS waiting lists through additional appointments and the creation of neighbourhood health centres
• cut national debt and borrowing to reduce the amount spent on debt interest.

While children’s palliative care is not specifically mentioned in the Budget or accompanying documents, there are some measures contained within that could have an impact on seriously ill children, their families and the professionals and services that support them. These include:

• Freezing personal income tax and national insurance contributions thresholds for a further three years from 2028/30.
• Increasing the National Minimum Wage by 4.1% to £12.71 per hour and the National Minimum Wage for 18-20 year olds by 8.5% to £10.85 per hour from 1 April 2026.
• Removing the two child limit on the Child Element in Universal Credit.

To help our members identify key measures that may be of relevance to them, we have produced a briefing available here. We have also published a reactive statement here.

Carers UK launch new state of caring report

Carers UK have published the largest-ever study of unpaid carers in the UK, based on an online survey of 10,539 carers. The report highlights the indispensable contribution of the UK’s 5.8 million carers, whose contribution valued at £184 billion is comparable to NHS spending. Despite this contribution, the report argues that inadequate support systems result in immense personal cost, making a new social contract for carers necessary for a sustainable future. Key findings include:

1. Financial Costs and Social Care Funding Failures
   The inadequacy and cost of statutory support compel carers to fund services and cut back on essentials, leading to financial hardship.
   – 62% of carers regularly spend their own money on caring costs, while 30% spend over £100 a month.
   – Nearly half (49%) of carers have cut back on essentials while 21% struggle to make ends meet.
   – Carer’s Allowance remains the lowest benefit of its kind at £83.30 a week.
2. Lack of Local Authority Support and Respite 
   Despite legal duties under the Care Act 2014, local authority support is often inaccessible or insufficient.
   – The majority of carers (73%) have not had a Carer’s Assessment in the last 12 months.
   – 70% of carers who approached their local authority for support were only given signposting, information, or advice, or received no direct support at all.
   – Over half (52%) of carers said the number of hours they spend caring per week increased over the last 12 months.
3. Human and Opportunity Costs
   The strain on carers’ health and their inability to pursue a normal life are substantial, impacting long-term security.
   – Three quarters (74%) of carers feel stressed or anxious, and 35% said their mental health was bad or very bad.
   – 35% of employee-carers reduced their working hours, and 20% moved from full-time to part-time.
   – 76% of carers find it hard to find time to spend with family and friends, and 59% have lost touch with family and friends.

Carers UK is calling for a new social contract for carers, urging decisive action. Key recommendations include:

• Develop a fully funded National Carers Strategy and ensure sufficient local authority funding.
• Invest an additional £1.5 billion in breaks and respite services in England (with consequential funding for the devolved nations) and legislate to grant carers a statutory right to regular breaks.
• Increase Carer’s Allowance by at least £11.29 a week and introduce a new statutory right to five days of paid Carer’s Leave per year.
• Amend the Equality Act 2010 to include caring as the 10th protected characteristic.
• Develop a social care workforce strategy (to run alongside the NHS strategy) to ensure enough skilled staff are available.

You can read the full report here.

UK Government launches consultation on leave for bereavement including pregnancy loss

As part of the Employment Rights Bill, a new day-one right to unpaid bereavement leave for employees who experience the loss of a loved one, including pregnancy loss before 24 weeks has been introduced.
The UK Government is now seeking views on the details of this entitlement and has launched a consultation focusing on these key areas:

• eligibility criteria
• types of pregnancy loss in scope
• when and how bereavement leave can be taken
• notice and evidence requirements

The consultation will run until 11:59pm on 15 January 2026. More information and details about how to respond can be found here.

England & Wales

Terminally Ill Adults (End of Life) Bill begins its committee stage in the House of Lords

On 14 November 2025, the Terminally Ill Adults (End of Life) Bill began its committee stage in the House of Lords. More than 500 amendments have been tabled including one by Baroness Berger which seeks to prevent those under the age of 25 from accessing assistance to end their life.
This amendment follows evidence given by the Children’s Commissioner to the Lords Bill committee and a recently published briefing outlining the rationale for this change. The reasons cited are as follows:

• Young people aged 16-24 with life-limiting conditions face unique challenges during the transition from children to adult services. There is concern that transition periods can be destabilising and as a result, 16-17 year olds may fall through the gaps.
• To reaffirm the principle that vulnerability does not end at 18, noting that UK law already provides extended rights up to 25 for those with additional needs, such as young people with Education, Health and Care Plans.
• The difficulties associated with predicting life expectancy for young people, and the complexity of assessing capacity of young people with additional needs.
• Concern that the Bill could shape how children and young people think about life and death, influencing those already living with serious illness.

This amendment is due to be debated on Friday 5 December. We have been consulting our Advisory Council on the position we should take on this amendment.

England

UK Government announces development of modern service framework for palliative care in England

On Monday 24 November, the Minister of State for Care, Stephen Kinnock, announced that the government is developing a new modern service framework (MSF) for palliative and end of life care in England.
Due to be published in Spring 2026, the framework will be aligned with the ambitions of the 10-Year Health Plan, specifically the shift of care from hospital to the community, and will set out the roles and responsibilities of the Department of Health and Social Care (DHSC) and integrated care boards (ICBs).
Through the MSF, the government hopes to drive improvements and enable ICBs to address significant challenges facing the sector, including:

• Delays in early identification of individuals approaching the end of life.
• Inconsistencies in commissioning practices across integrated care boards (ICBs).
• Workforce challenges in both universal and specialist services.
• Gaps in 24/7 palliative care provision.
• Limited uptake and integration of personalised care and support planning, including advance care planning.

Engagement on the framework has already begun and is set to continue, providing more opportunities to further shape the MSF. We will share provide more on this as soon as possible.
In the meantime, we have published our immediate reaction to the news here.

NHS England issues strategic commissioning framework for ICBs

Following on from the Model ICB Blueprint and 10-Year Health Plan, which noted a shift towards strategic commissioning for ICBs, NHS England (NHSE) have now issued a strategic commissioning framework for ICBs.
This framework supports ICBs and others in understanding and applying strategic commissioning. It also updates the commissioning cycle and outlines the important enablers to support effective commissioning.
Strategic commissioning is defined as a continuous, evidence-based process to plan, purchase, monitor, and evaluate services over the long term. According to the framework, it comprises four stages:

This framework supports ICBs and others in understanding and applying strategic commissioning. It also updates the commissioning cycle and outlines the important enablers to support effective commissioning.
Strategic commissioning is defined as a continuous, evidence-based process to plan, purchase, monitor, and evaluate services over the long term. According to the framework, it comprises four stages:

1. Understanding the context
2. Developing long-term population health strategy
3. Delivering through payor function and resource allocation
4. Evaluating impact

While some ICBs have been carrying out the four stages, the framework notes that now is the time for a more comprehensive and consistent approach across all ICBs.
To be successful in their role as strategic commissioners, ICBs will need to ensure the following is in place:

• Strategic leadership and partnership working
• Multidisciplinary clinical and professional input
• High-quality data and analytics
• Community engagement and co-production
• Strong relationships with local government
• Market and contract management capability
• Workforce development and deployment

The expectation is that all ICBs will begin to adopt the strategic commissioning approach as part of the NHS planning process for 2026/27.
From April 2026, a strategic commissioning development programme will be launched to support ICBs. As part of this, ICBs will be required to carry out a baseline assessment against the strategic commissioning framework. NHSE will then work to incorporate elements of the framework in the assessment of each ICB as a strategic commissioner that they undertake from the financial year of 2026/27.

NHS England releases new Medium-Term Planning Framework

NHS England has issued a new Medium-Term Planning Framework to guide the transition to its updated operating model, reset the financial framework, and strengthen local autonomy through neighbourhood health approaches, a new foundation trust model, and integrated health organisations.
This framework sets out the priority deliverables that integrated care boards (ICBs) and providers must achieve over the next three years, alongside broader strategic aims that will inform five-year plans, which every NHS organisation must produce.
According to the framework, these plans should outline strategic ambitions, address population health needs across all age groups, and demonstrate transformation aligned with the 10-Year Health Plan while improving productivity. They must also show partnership working, compliance with standards, and robust financial risk management, with board assurance statements confirming deliverability.
The first submission of plans is required before Christmas and will include three-year numerical plans covering workforce, finance and performance trajectories, along with board assurance statements. Final plans will then be submitted in early February and will include refreshed numerical plans, five-year narrative plans, and updated board assurance statements.

NHS workforce plan pushed back to spring next year

The government has postponed publication of its new NHS workforce plan until spring 2026, after health organisations requested more time to contribute.
The plan, which will replace the 2023 Long-Term Workforce Plan, is intended to reshape the future workforce by improving training, modernising roles and introducing new minimum employment standards from April 2026. It also aims to reduce reliance on international recruitment and may reform national employment contracts.
More than 70 organisations had urged ministers to ensure meaningful engagement, and NHS Providers welcomed the delay, stressing the need for a credible plan with clear implementation to address longstanding workforce challenges.

Written statement on reforming the health system in England

On 12 November, the Secretary of State for Health and Social Care issued a written statement to parliament, providing an update on the government’s plans to reform the health system in England.
Key points made in the statement include:

• The government intends to abolish NHS England by March 2027, subject to the will of parliament.
• Integrated Care Boards (ICBs) will shift to a more strategic, prevention-focused role.
• The goal is a leaner and more efficient system, reducing staff across the Department of Health and Social Care, NHS England, and ICBs by up to 50% by March 2028. This will result in around 18,000 posts being cut and over £1 billion annually being saved.
• The Government will revitalise the Foundation Trust model, focusing on prevention and local autonomy.
• Eight high-performing trusts will be assessed to become Advanced Foundation Trusts, gaining greater freedom in decision-making and spending.
• The top-performing trusts will be eligible for Integrated Health Organisation (IHO) status, managing entire local health budgets and outcomes. Two trusts will pilot this model initially.

You can read the full statement here.

Northern Ireland

Health Minister opens 2026/2027 Core Grant funding scheme

The Department of Health has opened applications for its Core Grant funding scheme for 2026/27, designed to help community and voluntary sector organisations with core operating costs. This year, the scheme has been restructured to ensure wider access, with a maximum bid of £50,000 per organisation.
Under the 2026/2027 scheme, eligible organisations are invited to apply to one of four policy funds, each totalling £450,000:

• Public health and reducing health inequalities
• Supporting adults to live independent lives
• Supporting children and young people, including those with vulnerabilities
• Improving mental health and wellbeing

The deadline for applications is 12pm on Friday 28 November 2025. More information including how to apply is available here.

Scotland

Assisted Dying for Terminally Ill Adults (Scotland) Bill

The Cabinet Secretary for Health and Social Care has written to the Convenor of the Health, Social Care and Sport Committee, responding to the Committee’s Stage 1 Report.
The letter confirms that Scottish Government and UK Government officials continue to engage constructively on legislative competence issues. However, the Scottish Government has not yet received a response to its formal request for steps to resolve these concerns.
It states that the Scottish Government will not bring forward any amendments at Stage 2 but will publish a rolling critique of other members’ amendments, which is available here.
The letter concludes by expressing deep concern about the financial implications of the Bill, noting that the financial memorandum significantly underestimates implementation costs. It warns that delivering the proposals would require reprioritising resources within a balanced budget, which would inevitably impact other NHS services.

Scottish Government announces increase to audit income threshold for charities

The Scottish Government has announced that changes to legislation will raise the audit income threshold from £500,000 to £1 million. Subject to approval by MSPs, this secondary legislation will come into force on 1 January 2026.
The changes mean that 93% of Scotland’s 24,500 charities won’t need an audit once the new rules come into effect.
You can read the full announcement here.

Wales

Welsh Government publishes Draft Budget for 2026/27

The Welsh Government has published its Draft Budget for 2026/27. The Draft Budget includes a recurrent £3 million investment for hospices in 2026/27, continuing last year’s commitment and forming part of a revised approach to commissioning end of life care.
You can read the full Draft Budget report here.

Welsh Government announces £15.75m of funding to support unpaid carers

On 6 November, the Welsh Government confirmed that £15.75m is being provided over the next three years to continue the Short Breaks Scheme and the Carers Support Fund.
The Short Breaks Scheme enables unpaid carers of all ages to take personalised breaks from their caring responsibilities, including social outings, leisure memberships and hobby equipment.
Meanwhile, the Carers Support Fund provides emergency financial assistance to unpaid carers on low incomes, helping them purchase essential items such as food, household goods or pay utility bills.
The official press release is available here.