MIAA is a member of the Internal Audit Network (TIAN) which comprises the seven NHS internal audit consortiums and in-house teams operating in England. These organisations collaborate across a number of areas to leverage their collective knowledge and expertise and drive efficiency and effectiveness. The monthly insight report highlights key publications and is intended as a useful update and reference tool. This report is produced by TIAN and shared by MIAA.

NHS England (NHSE) - Unauthorised, inappropriate and unjustifiable access to confidential patient information

Sir Jim Mackey, Chief Executive Officer of NHS, has issued a letter to all NHS bodies setting out immediate steps for investigating, reporting and managing breaches in this area.

A campaign toolkit and assets are available to download to help reduce inappropriate access to patient records by ensuring all NHS staff understand legal and professional consequences, recognise the real-life impact and make safe decisions when handling patient data.

For information and action by all NHS organisations

NHSE - Medium Term Planning Framework (2026/27 to 2028/29)

New guidance has been issued to support NHS bodies to undertake research and meet the Medium Term Planning Framework requirements. This includes:
⦁    Managing research finance
⦁    Monitoring research activity
⦁    Embedding research in the NHS

For information and consideration

NHSE - Implementing quality management systems in the NHS

NHSE has published a guide to implementing quality management systems. The guidance set out the roles for different members of NHS staff and explained how they could improve outcomes and experiences for patients, carers and communities; identify risks earlier; make better use of insight and feedback; reduce duplication; support continuous learning; and improve leadership and staff engagement.

For information and consideration

NHSE - Achieving excellent patient experience

This guidance defines what excellent experience looks and feels like across NHS-funded care. This includes the behaviours, systems and culture that help people feel listened to, respected, involved and supported throughout their care. A self-assessment tool helps organisations to review current practice, identify gaps and guide improvement.

For information and consideration

Thirlwall Inquiry – Report into events at the Countess of Chester Hospital, 2015-2018

The Thirlwall Inquiry report examining the events at the Countess of Chester Hospital neonatal unit from 2015 to 2018 has said that NHS managers need to be held to greater accountability. It found that relations between managers and healthcare professionals at the hospital were often poor, and that its leadership sometimes appeared more concerned about preserving reputation than raising concerns over patient safety. The report recommended that the DHSC and NHSE must develop and put in place a barring system for all managers, that there is greater accountability regarding the movement between trusts of senior managers, and that all managers must be subject to an individual duty of candour to all patients and colleagues.

In light of this report NHSE has written to all trusts and ICBs setting out a series of recommendations and immediate actions required by all organisations, together with health and wellbeing considerations and next steps. Boards should urgently review the letter and follow up.

For urgent review and follow up by all NHS Boards

Institute for Fiscal Studies - Is the era of annual NHS top-ups over?

In recent decades, spending on the NHS in England has almost always grown faster than was originally planned. Budget top-ups have become the norm, occurring with a regularity seen in almost no other department. This analysis finds that last financial year, 2025–26, seems to have been different, with far smaller top-ups than in 2023–24 or 2024–25. 

For information

Health Services Safety Investigations Body - Mental health crisis care: care of patients in emergency departments

This report finds that people experiencing a mental health crisis are too often being cared for in emergency departments that are not designed, equipped or resourced to meet their needs. Action is required to support safe, therapeutic care in emergency departments alongside wider changes across the care pathway.

For information

Royal College of Emergency Medicine (RCEM) - Safe to care: violence and aggression against emergency department staff

Around three in four UK emergency department staff have told the RCEM that they experience or witness violence and aggression in their department on a daily or weekly basis. In this briefing, the RCEM calls on government in the four nations, and NHS leaders, to make emergency departments safe to care by: preventing violence and abuse before it occurs – starting with the eradication of long waits to be seen, crowding and corridor care, whilst strengthening security standards; supporting staff through better training, reporting, follow-up, and links with the police; and improving accountability of organisations to protect and support NHS staff, with better working across systems to ensure perpetrators face justice.

For information

MBRRACE UK – Maternity State of the Nation Report

This report from the Maternal, Newborn and Infant Clinical Outcome Review Programme, delivered by MBRRACE-UK, presents the latest findings and lessons learned regarding maternal deaths and severe maternal morbidity. The report focuses on haemorrhage, infection, neurological conditions, general medical and surgical disorders, and critical care, highlighting key areas for improving the safety and quality of maternity care across the UK and Ireland.

During September HQIP also published a number of other 2026 “State of the Nation” reports on the following areas (all available here):
⦁    Primary Breast Cancer
⦁    Metastatic Breast Cancer
⦁    Pancreatic Cancer
⦁    Non-Hodgkin lymphoma
⦁    Oesophago-gastric cancer
⦁    Kidney Cancer

For information

Nuffield Trust - All or nothing? access and variation in NHS continuing health care

NHS continuing health care (CHC) is a package of health and social care provided outside hospital, such as in an individual’s own home or in a care home, which the NHS arranges and funds. This report finds that the system is inconsistent, with wide regional variation in eligibility, spending and practice as well as resulting in potentially high costs. It makes various recommendations to improve consistency in CHC as well as improving understanding on who is and who is not accessing CHC.

For information

Royal College of Nursing - In short supply: estimating the shortfall of registered nurses in the NHS in England

This report finds that there's a shortage of an estimated 55,000 registered nurses needed to deliver care safely, more than double the official number of NHS vacancies, which was 23,046 in August 2026. In the last year, nurse numbers grew by just 1%, but experts say a 2.5 to 5.7% increase is needed. The report demonstrates that nurse numbers have been held down since 2009, while the number of doctors in NHS roles has grown at double the rate. It argues that, if nursing workforce investment had kept pace with that of doctors, there would be more than 77,000 additional nurses working in the NHS in England today.

For information

NHS Productivity Commission – Breaking the cycle report

This final report from the Health Foundation's NHS Productivity Commission sets out the huge economic benefits and improvements to health outcomes that could be achieved through a fundamental rewiring of the NHS in England to improve productivity.  The Commission identified four drivers of productivity: workforce, capital, technology and innovation, and transformation. Within each driver, the NHS has substantial strengths. But across these areas, the same barriers to sustained productivity growth recur: short-term planning, fragmented accountability, excessive assurance requirements and insufficient capability to deliver change. To overcome these barriers, this report sets out four changes in the conditions needed for sustained productivity improvement in the NHS: from constant churn to stable direction; from ‘priority overload’ to focused accountability; from excessive compliance to freedom to deliver; and from episodic change to capability to improve.

For information

National Audit Office - Managing the flow of patients through hospital from A&E

This report looks at how well patients flow through A&E into the wider hospital in England and at the support NHS England provides to trusts to improve that flow. It finds that NHS England has targeted funding towards improving A&E waiting times and patient flow through hospitals. However, this growth in spending has not been matched with proportionate improvements for patients. The report sets out an overview of A&E services, targets and spending as well as an analysis of flow through hospitals and the factors that affect it. It also outlines what NHS England and trusts are doing to improve performance.

For information

National Audit Office - Managing digital identity

Improving digital access to public services remains a challenge for government, despite the cancellation of government’s digital ID plans. With a range of digital identity-related services, credentials, standards and governance arrangements already in place, important questions remain about how people can securely and conveniently prove who they are and demonstrate their entitlement to services. This report draws on previous work on digital transformation, data and identity, together with evidence from international audit bodies, to set out what currently exists and to help inform any future consideration of digital identity.

For information

Public Policy Projects - Why NHS transformation fails and what leaders can do about it

This report examines why large-scale NHS change programmes fail and how leaders can identify problems earlier. It argues that failures are rarely sudden or unpredictable. Instead, problems often emerge through recognisable weaknesses in programme design, management, political legitimacy, organisational culture and workforce capability.

For information

Public Policy Projects - Beyond productivity: delivering high-quality, efficient healthcare

This report examines how NHS boards can use better intelligence to identify risk, improve patient flow and connect operational performance with quality and outcomes.

For information

NHS Alliance  - Ethnic minority leadership in the NHS: progression, representation, retention and organisational culture

This report is intended to support NHS organisations, board leaders and staff to better understand the experiences of employees from ethnic minority backgrounds working within the NHS and to inform practical actions that strengthen progression, representation, retention and inclusion within NHS leadership. It seeks not only to describe ongoing challenges, but also to identify actions that support meaningful and sustained change across the NHS.

For information

Ada Lovelace Institute - Care and consideration: lessons for AI adoption in the public sector from a research collaboration with NICE

The public sector is looking to new and fast-evolving AI technologies, to improve efficiency, transform processes and deliver better societal outcomes. However, there is limited regulation or guidance for many potential uses of AI in the public sector. Public bodies are therefore grappling with their strategic approaches to AI adoption, to tap into the technology’s potential while adhering to organisational and public sector principles. This report, written in partnership with the National Institute for Health and Care Excellence, explores the conditions that would enable the public body’s ethical adoption, evaluation and governance of AI, with a focus on tools for internal processes.

For information

Chartered Institute of Public Finance and Accountancy - Sustainability reporting in the public sector: a leap forward

As climate, economic and social challenges continue to intensify, sustainability reporting has become an increasingly important tool for public sector organisations. This report reviews recent developments in public sector sustainability reporting, identifies key challenges and gaps in current practice and explores emerging reporting standards and frameworks. It recommends embedding sustainability reporting within governance, financial planning and accountability systems. In the context of public sector organisational inertia and system constraints, a phased approach to change is essential, supported by improved data infrastructure and leadership commitment, ensuring sustainability reporting delivers transparency, trust and long-term public value.

For information

HFMA - The impact of NHS bodies forming groups on NHS charities

Charities will sometimes decide to merge or work together for operational or financial reasons. All the charity regulators provide guidance on how charity mergers can be progressed. However, the guidance for charities assumes that the reason that the potential merger or move to closer working relationships is being discussed is because of discussions that the charities’ trustees are having. For NHS charities this might not always be the case, the change in arrangements may need to be considered because of a reorganisation of the corporate trustee bodies rather than because of the actions of the charity trustee. 

In England, in particular, it is not unusual for NHS statutory bodies to reorganise. Sometimes, those reorganisations are formal with new or merged statutory bodies established. Sometimes, they are informal, where the statutory bodies do not change but some or all the leadership team hold joint posts. This has implications for NHS charities whether they have a corporate trustee or are independent. This briefing considers the guidance available and the implications for NHS charities. 

While a change to the management of the corporate trustee NHS bodies may be the catalyst for change, it may be that the charities themselves consider whether an alternative way of working may allow them to achieve their objectives. This briefing considers the various ways that NHS charities might work more closely together, and highlights issues that should be considered.

For information

HFMA - Financial reporting watching brief 2026/27 and beyond

This paper is intended to update HFMA members on developments in financial reporting that may affect them as finance professionals working in the NHS. 2026/27 is a relatively quiet year for financial reporting changes. This briefing identifies the changes to accounting standards as well as public sector reporting requirements.

The September 2026 version of the brief highlights updates to public sector specific guidance and auditing standards.

For information