The Government’s 10-Year Health Plan marks an important moment for the NHS. With its strong emphasis on prevention, digital innovation, and community-based care, the plan sets out a vision that many across health and care will recognise as both necessary and long overdue.
The ambition is clear: a Neighbourhood Health Service that brings diagnostics, mental health, post-operative and rehabilitation services closer to people’s homes, supported by multidisciplinary teams and open-access health centres. This shift—from hospital to community, from sickness to prevention, and from analogue to digital—is the right direction of travel. It represents an attempt to build a health service that fits around people’s lives rather than forcing lives to fit around the service.
The Prime Minister’s framing is confident: a “seismic shift” in care delivery that will “rewire” the NHS to meet modern expectations. The emphasis on coordinated care plans, tackling inequality, and creating more accessible, joined-up services under one roof reflects long-standing ambitions in health reform.
But as stakeholders welcome the ambition, they are right to ask: how fast, how far, and how well can this vision be delivered?
Many of the most significant reforms—expanding out-of-hospital care, rolling out AI-enabled primary care, creating new contracting models, and delivering personalised plans for people with complex needs—are contingent not just on policy direction but on robust delivery infrastructure, workforce capacity, and sustained investment.
The 2025 Comprehensive Spending Review offers a firmer foundation than in recent years, with notable resource and capital commitments. But the broader fiscal context is tight. NHS capital spending peaks in 2025–26 before falling in real terms, and funding for digital transformation, while welcome, is significantly below what is estimated to be needed. And crucially, reform of social care—the sector most interdependent with the NHS—has once again been kicked into the long grass. Without a sustainable settlement for social care, the ambition to shift care upstream will struggle. Health and social care remain two sides of the same coin, and failure to progress one imperils the other.
There is also a deeper structural challenge. This is a plan built on strategic commissioning, yet Integrated Care Boards face a highly compressed timeline to reorganise. By December, they are expected to cut their operating costs by 50%, significantly reducing headcount. The risk is that in the process of reshaping themselves, ICBs become distracted or lose the very capacity required to drive transformation, maintain local relationships, and lead complex service redesign.
More broadly, the pressing reality of current service pressures presents a double-edged sword. While reducing waiting lists and relieving pressure in emergency departments must remain priorities, there is a real danger that firefighting in the here and now will delay or dilute the deeper changes needed to deliver the three strategic shifts. Transformation cannot simply be postponed until these performance issues are fixed—it must be embedded in how recovery itself is delivered.
Perhaps the biggest concern is the apparent lack of dedicated delivery architecture to drive, track, and adjust implementation over time. The Blair NHS reform programme combined political leadership with rigorous monitoring, active support for local systems, and a clear performance framework. A long-term vision without a practical roadmap and the levers to course-correct invites drift and delay.
And delay is something the NHS can ill afford. According to the British Social Attitudes survey: public satisfaction with the NHS is at its lowest level in 40 years. That is not just discontent—it is a burning platform. If reform moves too slowly or fails to deliver visible results, there is a real risk that the public consensus that has underpinned our taxpayer funded free at the point of use system since 1948 could fracture. Giving those with a different agenda for the NHS the public ear.
So, the strategic intent is sound. The plan signals a decisive pivot toward a more proactive, preventative and personalised model of care. But delivery must be swift, visible and real—or risk support slipping away.