NHS 10-year plan: Fit for the future

The 5th July marked the NHS’ 77th birthday and what a hectic period it’s been!

Established in 1948, the NHS has been a cornerstone of healthcare in the UK for over seven decades. The system, long admired for its universal access and equity, now stands at a ‘historic crossroads’.

Public satisfaction with the NHS is at its lowest level, with 21% of British adults ‘very’ or ‘quite’ satisfied with the way in which the NHS runs. Satisfaction with social care is lower at 13%, according to the 2024 British Social Attitudes survey. This decline reflects growing frustration amid rising demand from an ageing population, workforce shortages, and financial pressures.

In response – and after a year in government, Labour has launched Fit for the Future: 10 Year Health Plan for England – a vision for how future care will be delivered at neighbourhood level. Prime Minister Keir Starmer described it as a plan to ‘fundamentally rewire and future proof our NHS’. The Plan arrives ten months after the government launched its national conversation on ‘Change NHS: help build a health service fit for the future’, with over 220,000 contributions from the public and health and care professionals.

Key polices

The Plan sets out to modernise the NHS by harnessing the power of digital innovation, genomics, and artificial intelligence.

It aims to ‘reinvent’ the NHS through three radical shifts in care delivery:

• From hospital to community: Moving care closer to home with Neighbourhood Health Centres open 12 hours a day and six days a week, providing community-based services.
• From analogue to digital systems: Expansion of the use of digital, technology and innovation with the Single Patient Record accessible through the NHS App by 2028. The App will be the ‘front door’ for healthcare services and the ‘doctor in your pocket’.
• From treatment to prevention: Moving to a preventative model of care delivered at neighbourhood level focussed on the social, economic and commercial determinants of ill health with the goal of halving the gap in health life expectancy between the richest and poorest regions.

A neighbourhood health service  

Central to the plan is the establishment of a neighbourhood health service, which studies show saves £131 in hospital costs for every £100 invested in community care.

The Institute for Public Policy Research has previously called for this neighbourhood NHS model, citing improved health outcomes, reduced hospital visits, and more efficient spending through strong primary care.

A commitment to shift from hospital to community will require investment in the community to make this shift a reality, as will seeing health and care professionals working differently, reimagining NHS estate and creating better links between health and social care.

Enablers of reform

To help realise the ambitions of the Plan and the new model of neighbourhood care, five enablers of care are set out across chapters five to nine of the Plan.

A new operating model

The plan commits to reform the NHS operating model to devolve and empower local leaders and communities by:

• Merging the headquarters of NHS England and DHSC, reducing headcount by 50% by 2027
• Making Integrated Care Boards the strategic commissioners of healthcare services, with the closure of Commissioning Support Units. ICBs are to aim to be coterminous with strategic authorities. They will play a central role in shaping the health and care market.
• Granting high performing services greater freedoms
• Reworking the Foundation Trust model, with the aim that by 2035 all NHS Trusts will attain Foundation Trust status and related powers, such as retaining surpluses for reinvestment and borrowing for capital projects. Foundation Trusts are expected to use these provisions and flexibilities to support population health.
• Create new Integrated Health Organisations from 2027 for the very best Foundation Trusts to hold the whole health budget for a defined local population
• Continuing to make use of the private sector capacity, with plans for private providers to expand NHS provision in disadvantaged areas
• Introducing a new patient choice charter
• Trialling a new ‘patient power payments’

A new transparency and quality of care

Under these reforms changes are made to improve the transparency and the quality of care by:

• Publishing league tables of providers and patient experience measures
• Overhauling the complaints process and improve response times to patient safety incidents and complaints
• Changing the time limit for the CQC to bring legal action against a provider and review how to improve patients’ experience of clinical negligence claims
• Establishing a national independent investigation into maternity and neonatal services together with a new maternity and neonatal taskforce
• Reforming the National Quality Board including developing a new quality strategy focussed initially on mental health, fragility and dementia and cardiovascular disease
• Improving the CQC’s approach to be a more-data led regulatory model, ready to respond to assess service quality
• Persistent poor quality of care will result in the decommissioning or contract termination of services or providers no matter the setting or whether the provider is a GP practice, NHS Trust, private provider or in the NHS

An NHS workforce, fit for the future

Workforce transformation under the plan includes a focus on a range of initiatives:

• Tech and AI-enabled productivity
• New minimum employment standards
• Addressing doctor training bottlenecks
• Growing the nursing workforce
• Developing advanced practice roles for nurses and doctors
• Establishing a new College of Executive and Clinical Leadership to define and drive excellence
• Flexible contracts to help reduce the reliance on agency staffing and new arrangements for reward of high performing senior managers
• Reducing NHS international recruitment to less than 10% by 2035

Innovation and technology

“From brick to clicks” and “A Doctor in their pocket” are the buzz words in chapter three.

The NHS is to be taken from global laggard to global leader in technology.

Five ‘big bets’ or transformative technologies (data, AI, genomics, wearables and robotics) will facilitate personalised care, improve outcomes, increase productivity and boost economic growth.

We learn about My NHS GP Tool, My Specialist Tool, My Consult, My Care, My Companion, My Medicines, My Vaccines, My Health, My Children and My Carer.

Some of the other initiatives identified:

• Creating a new Health Data Research Service, in partnership with the Wellcome Trust
• Integrating AI seamlessly into clinical pathways
• Making wearables standard in preventative, chronic and post-acute NHS treatment by 2035
• Speeding up clinical trial recruitment, with clinical trials setup time will fall to 150 days by March 2026
• Expand NICE’s technology appraisal process to cover devices, diagnostics and digital products
• Increase the role life sciences and technology companies can play in service delivery with the aim of streamlining the procurement of technology

Financial sustainability

NHS funding will move to a value-based approach with multi-year budgets focused on getting better outcomes with new financial flows incentivising innovation to support the flow of money from hospital into community and reward best practice across the NHS.

2% year on year productivity gains are to be made.

Comment

There is no alternative to reading the NHS 10-year plan cover to cover if you are in any way involved in the sector from either a public or a private sector perspective.

There is much to welcome in this 150+ page vision of how healthcare service delivery could be in 2035, but without a chapter on delivery there is still a lack of clarity about how it will be implemented. We understand this is due in September.  

There are also two more reviews to come:

• Andy Haldane, former Chief Economist at the Bank of England, to review productivity trends over time and the strategy for improvement. His report is expected in autumn 2025.
• David Lock KC to provide advice on how to improve patient experience of clinical negligence claims. His report is expected in autumn 2025 ahead of a review by the DHSC.

Over the coming weeks our health and care teams will be providing insights on the many policy proposals outlined in the Plan. There is a lot to unpack for NHS Trusts and ICBs, primary care providers, technology suppliers and innovators, social care providers and life sciences businesses.

The Prime Minister’s Foreword noted that what was needed was ‘major surgery, not sticking plasters’ and the Executive Summary refers to a ‘historic crossroads’ and us being at an ‘existential brink’. The aim is to ‘entirely reimagine how the NHS does care’ and to have ‘break from the past’.

These are bold statements.  

The aim is clear ‘to be in the driving seat of the biggest industrial revolution since the 19th century’ and the observation is made that ‘Nye Bevan never intended the NHS to be preserved in aspic’.

These are therefore exciting times. The Health Service Journal have set out a helpful timeframe with short, medium and long term deadlines and targets which they rightly describe as a ‘slew of ambitious goals’ – worth a look if you have a subscription.

It has been observed by Wes Streeting that the plan will not succeed without a proper plan for the central role of social care in neighbourhoods.

We are told that within ten years the NHS will look very different.  

Faites vos jeux!