A long-awaited 10-year plan in England for the struggling NHS has been set out by the UK government.
The 168-page blueprint for change outlined the detail behind the desire to deliver three shifts: from hospital to community, from analogue to digital and from sickness to prevention.
While broadly welcomed by the sector, questions remain over how change will be delivered on the ground. A series of plans for the struggling health service have all promised similar shifts in recent years — yet none have achieved them.
The absence of a clear approach to delivery is “glaring”, noted one senior health official. Others highlighted the lack of a cross-departmental approach to improving the nation’s health.
Jennifer Dixon, chief executive of the Health Foundation, said without reform of the social care system “or co-ordinated action to address the wider social and economic causes of ill health”, the proposals remain largely “a vision”.
Hospital to community
The ambition to move care out of hospitals and into the community has underpinned several NHS plans over the years, but hospitals have continued to see far higher rises in expenditure and staffing.
The 10-year plan pledges to reverse this trend so that the share of expenditure on hospital care will fall “with proportionally greater investment in out-of-hospital care”.
The government will “deliver this shift in investment over the next three to four years”, although not until 2035 will hospitals “spend a smaller proportion of the NHS’s total budget and employ a smaller proportion of its total staff”.
A key part of this change will be the creation of a “neighbourhood health service” whose guiding principle is that people should be cared for at home wherever possible.
“This will mean we need less acute space, fewer emergency staff based in hospitals and fewer outpatient departments in future,” the plan says. Neighbourhood health centres will be established, opening 12 hours a day, six days a week, with the first wave opening in deprived areas.
Among a number of measures intended to deliver this shift, the blueprint pledges to train thousands more GPs, allowing people who want one to get a same day appointment, while the insights of genomics research will do more to prevent ill health.
However, it is not clear how the new centres are to be funded. The capital budget was frozen in last month’s spending review.
Analogue to digital
Moving the health service towards a more digital, data-rich model has been the ambition of every government for decades. Prime Minister Sir Keir Starmer and health secretary Wes Streeting hope the plan will put enough meat on the bone to make this vision a reality, although many health veterans remain sceptical.
Perhaps the biggest “retail” offer in the plan was a focus on beefing up the NHS app, to give patients more control over their own care — a plan that should be fully operational by 2028.
Patients will be given the opportunity to refer themselves for things such as talking therapies, musculoskeletal services and podiatry, as well as to connect directly with doctors.
They will also be able to order more medicines and book vaccines directly from the app. The plan is for all of these things to significantly cut costs in the health service, and free up staff time.
The government will set out legislation to create a “single patient record”, which will place a duty on every health and care provider to make the information they collect about a patient available in one place. The aim is that, from 2028, patients will be able to access the entirety of their record digitally, on the NHS app.
Sarah Woolnough, chief executive of The King’s Fund think-tank, said: “Historically announcements on NHS tech have been big on promise but lacking in delivery, as money has been diverted to other areas.”
She warned of an “urgent need to get the basics right first”, particularly as the health service is “plagued by basic IT woes and outdated equipment”.
Chris Fleming, health sector lead at consultancy Public Digital, agreed that “delivering these bold ambitions will require fundamental changes to NHS plumbing”.
Sickness to prevention
Among the measures set out in the plan is an effort to boost the public’s access to NHS weight-loss drugs. It warns of an “obesity epidemic”, with rates doubling over the past 20 years and about one in five children leaving primary school obese.
Streeting claimed that “half” of MPs in the House of Commons were using weight-loss injections.
Ministers will work with industry “to test innovative models of delivering weight loss services and treatments to patients effectively and safely” the plan says, “in a place that is genuinely convenient for citizens”. This could be “on the high street, or at any out-of-town shopping centre”.
The plan also lays out existing plans to implement rules that would ban unhealthy food advertising before 9pm, as well as ban the sale of high-caffeine energy drinks to children under the age of 16.
It also points to the government’s tobacco and vapes bill, aimed at phasing out smoking entirely.
“The specific focus on obesity is the right one,” noted Sebastian Rees, who leads health policy at the Institute for Public Policy Research think-tank.
“We would have liked to see more action on tackling harm from alcohol and gambling,” he added. “But governments have to make choices and picking obesity as the ‘moonshot’ public health mission feels like the right choice.”
Financial sustainability
The NHS is consuming an ever-growing share of state resources. The plan warns the service has developed “an addiction to deficits” and local health organisations may face legally capped budgets.
The Financial Times has previously reported that NHS finances are as precarious as they were before the Covid-19 pandemic with deficits at health service trusts in England more than doubling over the past year.
“If financial discipline does not become the norm across the NHS, we will take a new, stronger statutory approach to financial accountability,” the plan says, to manage overspending “through legally capped budgets”.
Patients will also be given powers to decide how much hospitals are paid for procedures. “No money would leave the NHS, but individual provider organisations could be penalised if patients were dissatisfied,” it says.
One health official questioned how the financial incentives would work to “genuinely move care out of hospitals”, especially if the plan does not “provide the capital funding required to build the facilities and kit we need”.
Andy Haldane, former Bank of England chief economist and FT contributing editor and columnist, will publish a review of productivity in the autumn.
“While we agree with the government that the answer to the NHS’s challenges is not simply to provide more money, there has to be realism about how the financial situation impacts the ability to deliver all the reforms proposed today and the impact this will have on service,” said Woolnough of The King’s Fund.
