Policy briefing: 10-Year Health Plan for England

What has been announced?

The Government has announced its long-awaited policy paper: 10-Year Health Plan for England: fit for the future. The paper sets out, in the Government’s words, a “new era for the NHS, bringing more easily accessible care closer to home”.

The paper is framed around eight themes:

1. From hospital to community

This chapter in the paper establishes the aim to deliver more convenient care for patients, tackling the complex web of services, multiple appointments and navigating multiple care professionals.

It aims to improve GP access and capacity by recruiting thousands of additional GPs and rolling out digital tools to reduce administrative work. Neighbourhood health centres (NHCs) will be set up in every community and will co-locate NHS, local authority and voluntary sector services. NHCs will be first rolled out in areas where life expectancy is the worst. By 2026, patient initiated follow up (PIFU) will be standard where clinically appropriate. Alongside this there is a planned transformation to the dental system, with dentistry also envisaged as being positioned in the NHCs. These NHCs may also contain diagnostics, post-operative care and rehabilitation services and in addition offer other services such as employment support, smoking cessation and weight management services.  

Ultimately, the aim is that there will be a need for less acute care space, fewer emergency staff that are located in hospitals and fewer outpatient appointments as services transition into the community. Ophthalmology is featured within this section as a priority area for outpatient service redesign.

2. From analogue to digital

The aim is to make the NHS the most digitally accessible health services in the world by giving patients a greater degree of control over how they access healthcare. A new, national Single Patient Record (SPR) is envisaged to bring all of a patient’s medical information into a single place, and legislation will mandate that this information must be available to patients.

By 2028, the NHS App will function as the “front door” to the entire NHS, and provide fast advice to online GP tools for self-referral and medicines management. The NHS app will also allow patient feedback on services and use AI to streamline administrative processes.

3. From sickness to prevention

This aim is to deliver a “historic transformation” in terms of prevention, by utilising genomics, predictive analytics and AI that can provide a more complete overview of an individual’s health risk profile. Legislation around tobacco and vaping aims to create the first smoke-free generation, and the plan aims to tackle the obesity epidemic by promoting healthier lifestyle choices and investing in weight loss services and medications. The uptake of vaccinations will be promoted alongside new and emerging vaccine technology, and the NHS Genomics Medicine Service will be expanded into a new genomics population health service.

4. A devolved and diverse NHS

The paper says there will be a process for power to be devolved from the centre to the frontline, tackling the “failings of the Lansley reforms”. The form and function of the centre of the NHS will be redesigned, with the first step being the already announced merger of NHS England and DHSC, which will include a significant reduction in the number of staff. The centre will set strategy and form partnerships with investors, industry, local government, voluntary organisations and trade unions.

There will be seven NHS regions which will be responsible for performance management and the oversight of providers. Integrated Care Boards (ICBs) will become “strategic commissioners” with responsibility for all but the most specialised commissioning functions. Provider organisations such as NHS trusts will no longer sit on ICBs. Providers will be able to earn greater degrees of autonomy, those who “perform well” will be given greater freedoms; those that do not will see the NHS region step in to provide support. High performing NHS Trusts will be able to establish Integrated Health Organisations (IHOs) with responsibility for the whole health budget of local populations.

More diversity in provision of services will be created, including making use of private sector capacity where it is available. A new partnership between local government and the NHS will align ICBs with strategic authority footprints.

Finally, there will be an increased focus on patient choice. This means that patients will have greater choice and more information on which provider will suit them best. Eye care features within this section, with Gloucestershire used as a positive example of moving care from hospitals to neighbourhood settings (page 82), and showing how primary care optometrists with access to shared patient records and imaging are helping to reduce referrals to the hospital and resulting in a 14% drop in waiting lists with improved patient convenience.

5. A new transparency of quality of care

The plan describes the need for “radical transparency” to improve patient safety and avoid repeating failures of the past. The National Quality Board will be revitalised, modernising inspection systems and regulatory bodies, with an increased focus on patient feedback.

National Service Frameworks will return as ‘Modern Service Frameworks’ (MSFs). This model will be rolled out for cardiovascular disease, mental health, frailty and dementia as a first phase.

An AI-led warning system will help the CQC to take an ‘intelligence led approach to NHS quality assessment.

6. An NHS workforce fit for the future

A new workforce plan is promised for later this year. NHS staff training will be reformed and new and expanded roles will be introduced to reflect new models of care. All NHS staff will be given training on AI, with an overhaul to the education and training curriculum. Advanced practice models will be developed for nurses, midwives and allied health professionals.

7. Powering transformation: innovation to drive healthcare reform

The plan outlines five ‘big bets” on technology that will transform the NHS. These areas will personalise care, improve outcomes, increase productivity and boost economic growth. They will encompass the recurring themes of AI and genomics, alongside wearables, data and robotics. This is all to align with the government’s aim to become “the most AI-enabled health system in the world”.

NICE’s remit will expand, allowing its technology appraisal process to cover devices, diagnostics and digital products.

A single national formulary (SNF) for medicines will be introduced to remove needless local duplication and bureaucracy, with local prescribers encouraged to use the most highly ranked SNF products.

Additional multi-year budgets will ensure NHS organisations can plan service delivery across longer timescales. In addition, NHS organisations will be required to retain 3% of their annual spend for one-off investments in service transformations.

Innovator passports will be created in 2026, preventing NHS organisations from insisting on further assessments once an innovation has been robustly assessed by another NHS organisation.

8. Productivity and a new financial foundation

The plan reinforces the productivity targets for the NHS and the need to control NHS spending to ensure a “sustainable future”. The 2% annual productivity gain for the next three years is reiterated. The previous practice of allowing NHS deficits where additional funding is found will end. Block contracts will be reformed, with payment linked to quality of care and tariffs will be based upon best clinical practice rather than average costs.

What do we say?

As our previous policy briefings and statements have said, we fully support the Government’s ambition to reform the NHS, and we agree the shifts from sickness to prevention, hospital to community, and analogue to digital are essential to achieve the change that is needed. Within that context, the 10-Year Health Plan has not come soon enough.

While long – 168 pages – it is clear the paper is a blueprint for change, not a detailed instruction manual. What this means for eye care and eye health, like most other areas in health, is the details are far from ironed out yet.

That said, the paper uses primary care optometry in Gloucestershire (page 82) as evidence of how it is possible to transform care by making the shift from hospital to community. We see this as a significant step forward; it shows the Government recognises the impact optometry and an optometry centric model is already having for the public and the NHS, and the scope for the sector to do more to meet the Government’s core aim: bringing more easily accessible care closer to home for everyone, everywhere, in England.

This conclusion aligns with the central policy we have been consistently championing: community optometry must be the first port of call for eye care and eye health. The recent report we co-commissioned by PA Consulting, Key interventions to transform eye care and eye health, demonstrated the capacity and financial benefits that that NHS could achieve by better utilising primary eye care. Our view is that Government does not need to wait years to implement this shift and see the benefits realised; community optometry is ready and willing to support the NHS now to meet the commitment to improve the public’s access to healthcare in the community.

We also support the recommendation that ophthalmology is a priority area for the NHS; the length of the waiting lists in this specialty tell the story. The premises, skills and equipment in primary eye care are available to ensure that the ambition to address this challenge are met.

Looking at the wider aims of the paper, there are areas that will also be welcome. Our members have, for many years, told us that the short-term nature of enhanced service contracts have made investment and delivery planning difficult. The acknowledgement of the need for longer term funding outlined in the paper should go at least some way to tackling that problem.

Alongside this, the acceptance in the paper that, once a service has been demonstrated to be effective, it should no longer be necessary to conduct further evaluations each time a new area rolls out a service, will be welcome news. Optometry services have time and time again been demonstrated to be safe and effective; too often, each commissioning area has felt the need to prove this for itself rather than using the existing evidence available. For example, this change in approach should mean existing services for minor and urgent eye conditions, glaucoma, cataract and medical retina – which the PA Consulting report showed already deliver health and economic benefits for the NHS – can be swiftly rolled out across all seven NHS regions.

We think the raft of services that will sit within the NHCs is ambitious; while this collation of services will undoubtedly have benefits, convenient access to primary eye care should be front of mind. The preventative aims outlined in this paper have been shown to be delivered effectively in community optometry settings. Critically, many patients who access primary eye care do so in good health. The plan clearly recognises the benefit of early detection and prevention, and we say the Government must ensure optometry can and does play a significant role within this shift. That principle will be true for a wide range of health interventions, but of course most importantly in glaucoma care. Early glaucoma detection happens almost universally within primary eye care, and when public health interventions are advocated and early intervention is championed, the importance of good eye health should not be forgotten.

There is still much that isn’t clear in the paper, and we argue that it will be essential for more details to emerge quickly. The planning guidance that will undoubtedly follow the announcement should provide some of the clarity needed. As a sector with a proven track record of delivering care closer to home, we believe community optometry must be the first port of call for the public’s eye health and eye care. Establishing how community optometry connects effectively with multi-disciplinary neighbourhood health teams will be a priority.

A key consideration that we will be reviewing closely is how commissioning responsibilities for community services are organised – this is a challenge that has historically created postcode lotteries. Without national consistency, there is a risk that patients will continue to face fragmented care depending on where they live. The paper outlines a shift from National Service Frameworks to Modern Service Frameworks (MSFs). More information will be needed. We say it is essential the approach used looks forward, with primary care services front and centre, rather than reinventing old systems that did not work the first time. We are ready to help the new combined NHS and DHSC system design these MSFs; the new frameworks must embed the voice of primary care optometry as a key stakeholder, not an afterthought.

The paper emphasises the commitment to create a digitally accessible health services, including SPRs. Investment to improve IT connectivity for the primary care sector has long been our policy ask; this improvement remains a critical success factor, but again, it must be designed with primary eye care input and collaboration.