Optimism and opportunity? The Government’s 10 Year Health Plan for England
On Thursday, Secretary of State for Health and Social Care Wes Streeting published the Government’s 10 Year Health Plan for England. Predicated by the Lord Darzi report published in September, the Plan sets out to offer both an optimistic vision of the future and opportunity for the NHS on the backdrop of a concrete diagnosis of the current state of play that the NHS must ‘reform or die’. The plan sets out to fix these issues, placing science and technological innovation at the core of its Plan, hoping to propel the NHS from behind the curve to leading from the front.
The Plan is structured on three big shifts. The first, from hospital to community, rewords the NHS to Neighbourhood Health Service, shifting service from hospital to community care. Neighbourhood Health Centres are the beginning of this, functioning as a ‘one-stop shop’ with centralised patient care harnessed by AI and technological advancements. According to the NHS Confederation, support is there for this move, with health leaders committed to a more preventative, community-based NHS. This offers a complete restructure and cultural shift in the operating model, where success could be a ‘real win’ as described by The King’s Fund in reaction to the plan. However, having been long argued for by the sector, the Chief Executive of the Health Foundation Dr Jennifer Dixon DBE says she is unsure whether ‘lessons have been learned’ from past failures. The shift to community care is welcomed by the sector overall, with the British Geriatrics Society highlighting the need for co-produced neighbourhood services that provide good outcomes for older people. Picker welcomes the Plan’s emphasis on placing patients at the centre, through improved feedback routes, ‘Patient Power Payments’, and personalised care plans, and ARCO who says the move will leave patients ‘better off’.
This shift also sets out how dentistry, community pharmacy, and mental health provision will be further localised in community hubs and health centres. In reaction, the British Psychological Society say bringing mental health services to the community will lead to better outcomes, helping people at the earliest access point. Going beyond, Mind has called for more to be done including a further comprehensive plan that places mental health at the centre of the new NHS in order to truly tackle its deterioration in society.
For the second shift, taking the NHS from ‘analogue to digital’ involves the innovation of NHS technology. This includes the introduction of a Single Patient Record to streamline patient health accounts in one place, accessible from all points of provision. The NHS App is set to be revolutionised with a host of ‘My’ tools to help ease booking of appointments, cut down on archaic waste, provide quick advice, and improve the management of patient care. A HealthStore will deliver new innovative apps to further aid the experience and AI will be utilised to ‘liberate’ staff from their bureaucracy. Technological advancements must also go hand-in-hand with productivity improvements and the Plan sets forward how tariffs, new contacts, pay incentives, and financial planning will help boost this metric.
Technological advancements are welcomed by the sector and seen by the Nuffield Trust as a ‘real game changer’. NICE, a key component of new technological changes, say the Plan gives them the power to get medicines to patients faster, distribute health technology and maximise value for money through innovation. However, there is concern, as pointed out by The King’s Fund, technological improvements have often been ‘big on promise but lacking in delivery’. Further, the Chief Executive at Public Digital Chris Fleming has said that technology, especially in the NHS app, will mask the actual failure of services and, as noted by the Royal College of Physicians, can only work if co-designed with patients and staff in mind. Thus, while welcomed for its innovative ambition, more certainty is required to demonstrate its benefits.
The final shift, from sickness to prevention, sets a precedent to stop ill health at source, raise the ‘healthiest generation of children ever’, protect preventable NHS costs, and support economic growth. This includes harnessing AI and genomics to advance predictive analysis and diagnosis. The Tobacco and Vapes Bill, the introduction of healthy food standards, new weight loss drugs, investment in active lifestyles, a point scheme that rewards healthy lifestyles, strict alcohol requirements also will all work to tackle preventable risk factors.
Turning the tide on risk factors is key to saving lives and costs, and is welcomed by many in the sector, including the RCP and Diabetes UK who respectively stress that tackling tobacco and preventing obesity are key to stopping life-altering long-term conditions. On the contrary to this sentiment, the Institute for Alcohol Studies says it’s ‘embarassing’ to launch a prevention plan that ignores the most effective way to reduce alcohol harm in Minimum Unit Pricing. Healthwatch, a member of the 10 Year Health Plan working groups, welcomes some preventive initiatives but highlights the absence of plans for those with disabilities and cost-of-living support which also stand as key risk factors.
More widely, it is easy to read a long-term plan or strategy and be consumed by the breadth of positive measures that, in accordance with their objectives, will deliver beneficial change. The real sticking point involves an assessment of what choices and trade-offs were made. A key point of this is social care, a concern raised by many in the health sector even when the 10 Year Plan was only hypothesised in 2024. The Plan today, set with the backdrop of pending Baroness Casey’s Review, does little to address these concerns. The British Geriatrics Society has said that without a ‘sustainable social care system the 10 Year Health Plan will find it hard to succeed’ and therefore, as described by The King’s Fund, the Plan hinges on ’whether the government is willing to act more urgently – or indeed at all – to implement social care reforms’. Similarly, the Health Foundation says the plan is too focused on just the NHS and not the Government’s ambition to rebuild the nation’s health, reflecting concern of adverse consequences outside the three shifts. Another common theme in reaction is a question of how, which still remains pertinent to many. The Nuffield Trust articulates this well, saying the Plan is trying to ‘heal thyself’ through efficiencies and feedback but does little to address actual needs. This question also holds whether there is the funding capacity, with a lower than historic average spend projected by the Spending Review, combined with the costs of moving care to community and technological innovation.
The public perception of the Plan is that it is ambitious and clear on its foundational pillars for reforming the NHS away from a looming ‘death’. It looks to bring the service to the neighbourhood, harnessing technology to drive efficiency, bolster patent care and clamp down on health risks. However, concerns remain on its feasibility, its affordability and the potential losers, such as social care.