Publish date: 29 December 2025
Dear all,
As we look towards the end of the year, I wanted to write to thank you and your staff for everything you have done.
November marked one year since I took on the role of NHS England's Regional Director for the North West, and it has given me an opportunity to reflect. It has been an incredibly long and turbulent year for the NHS. We have had to deal with so much. Even just the last few weeks have felt incredibly busy, with the work needed to prepare for another round of industrial action, the impact of the usual seasonal pressures, and a flu season that struck sooner than anyone expected.
Although I was aware of long standing and significant financial challenges across the NHS in the North West when I took on my role in November 2024, the scale and depth of the challenge reported across our region was much greater than I had anticipated. Each system was significantly off track against the financial plans and we ended the year with a deficit of almost £850m for the 24/25 financial year. We have made significant headway since then and through a combination of enhanced support and intervention and the efforts of organisations across the entire region, reduced the deficits by around £0.25bn and are now much closer to delivering financial plan targets in two of our three systems.
This has not been easy and is the result of enormous effort from many people in every part of our region. The work has been done with a real sense of purpose and determination. We still face considerable financial challenges but the work we have done this year really sets us up better for the future and we can see, and are working on, many opportunities to continue the trajectory and build on the achievements of this year across the North West
Performance was also a massive challenge when I started in post. We just weren't providing the access needed or seeing the patients we needed to see. We experienced a dreadful winter last year, particularly in Cheshire and Merseyside, and many people worked long hours to keep our patients and communities safe while getting to grips with problems across the UEC system. I could not be prouder of the way teams across the region have leaned into those challenges. We have made progress with reducing waiting times across the region, improving access to care for our patients, and making huge strides in access to primary care and GP appointments with real gains made in the increased drive to provide online appointments marking a particular success.
We have also seen significant improvements in mental health, reducing out-of-area placements from around 180 in November 2023 to single figures today. This represents a tangible improvement for some of our most vulnerable patients, whom we were previously sending outside the region for care at huge expense - literally millions of pounds. Tackling this issue head-on will positively impact the lives of those patients and their families, while freeing up resources to do more than we ever could before.
Another area that has been a particular focus for us over the last 12 months, and where, again, we have seen real tangible improvements that make actual differences to the lives of our patients is quality. While it’s clear it has always been at the heart of what we do in the North West, I have been proud to see the dedicated approach to that work. You never allow yourselves to be complacent, and the huge amount of work done by colleagues at Greater Manchester Mental Health NHS FT over the last year that led to the trust exiting the Recovery Support Programme earlier this month is clear evidence of that commitment.
There are still significant challenges ahead, but it feels like we have turned a corner. We are in a far better place as a region than we were twelve months ago. These are green shoots, and we can build on them.
Amid the relentless pressure of the last year, you and your staff have held your heads high and got on with the job of caring for our patients. That is something to be exceptionally proud of. It is almost trite to call the NHS resilient at this point, but it still feels worth saying. In the face of enormous pressure, NHS staff rise to the challenge every time. It is why many of us feel so proud to work for this institution. I have the privileged position of witnessing that effort across the whole of the North West, and I can honestly say it has been one of the most eye-opening and reaffirming things about the job.
So please receive this letter with the sincere gratitude it is meant to convey. Feel free to share it with your staff, because this is thanks from me for everyone who comes to work in the NHS in the North West every day with the desire, commitment, and determination to put our patients at the heart of everything we do.
I know many of you will be working hard over the coming period, but I hope you all find some time to rest and reflect and return next year with the same attitude. I look forward to working with you all in 2026.
Thank you,
Louise
Louise Shepherd CBE (she/her)
Regional Director
North West Region, NHS England