What to expect from the 10-Year Health Plan

The 10-Year Health Plan is a work in progress and “no one should assume it is finished” when it is published in July, NHS England chief executive, Jim Mackey, told attendees at the NHS Confederation Expo earlier this month (11–12 June).

Mackey also acknowledged that the scale of potential advancement and the ambition that exists both within and for the NHS means that whatever it does will never quite be enough.

Across two days and 180 sessions, subjects ranging from digital innovation in patient care, to the need to move away from a ‘paternalistic’ NHS, to how ready healthcare colleagues are for change, were discussed.

Speaking in the Delivering on the promise of a neighbourhood health service session, John Oldham, strategic adviser to health secretary Wes Streeting in the Department of Health and Social Care (DHSC), said that the success of the 10-Year Health Plan ultimately hinges on “hard data” that will show whether there is “a reduction in the use of health services because people feel better about themselves.”

The Expo also saw a surprise appearance from Streeting, whose keynote speech on Thursday afternoon emphasised a need for reform that he believes is the only way to ensure the NHS’ survival.

With the publication of the 10-Year Health Plan likely only days away, OT rounded up the key insights from the conference.

1 There is a lot of money – and a strong need to demonstrate value

The NHS Confederation Expo 2025 coincided with June’s Spending Review, in which Chancellor Rachel Reeves confirmed that the NHS would receive a 3% uplift in its day-to-day spending for the next three years.

This equates to an extra investment of £29 billion annually.

A through-line of discussion across the conference was the acknowledgement that, when compared to other public services, the NHS does receive a lot of money – and that those planning for the future should ensure they keep this in mind.

In his keynote speech, Jim Mackey, the chief executive of NHS England, noted that: “We’ve got what the country can afford to give us” – and emphasised that the NHS budget is comparative to the GDP of Portugal.

It is vital that the 10-Year Health Plan demonstrates good value, Mackey believes.

Speaking during The 10-Year Health plan: making the vision a reality session, Sally Warren, director general of the 10-Year Health Plan within the DHSC, noted that the NHS budget is close to £200 billion.

Those invested in the future of the NHS must “focus on the whole” picture, she believes.

“The idea that we don’t have enough money because the Spending Review isn’t giving us 6% – we’ve got £200 billion to spend in the NHS,” Warren said.

She added: “We need to focus every penny of that [towards] driving value for the health of the population.”

2 Further devolution of healthcare – and a focus on partnerships

Stephanie Cartwright, chief community and partnerships officer at Walsall Healthcare NHS Trust and The Royal Wolverhampton NHS Trust, speaking in The 10-Year Health plan: making the vision a reality session, emphasised that equal partnerships are integral to a neighbourhood health service.

“In the partnership, the NHS doesn’t dominate,” she emphasised.

“It’s a partnership of equals, and that is equals across the statutory organisations such as the NHS, the trusts, and primary care.”

The local authority, the voluntary sector, and even those working in local housing might also be integral, Cartwright said, because “they are the people who know the communities best.”

She also noted that the current NHS is working with partners more successfully than it ever has in the past.

It’s a partnership of equals, and that is equals across the statutory organisations such as the NHS, the trusts, and primary care

The 10-Year Health Plan will not include such granularity as ‘go to this person for this prescription,’ Mackey shared – but instead will have a strong strategic focus on working together locally.

There needs to be a mindset shift from the notion that fixing the NHS is someone else’s job, Mackey told attendees.

“Understand [that] there is no one turning up and fixing this soon,” he said. “It’s probably up to us, in our local place.”

This is easier, Mackey acknowledged, “if there is a bit of money and a bit of flexibility.”

Sian Stanley, GP clinical director at Stort Valley and Villages Primary Care Network, speaking in the Delivering on the promise of a neighbourhood health service session, noted that nobody should be awarded contracts with the NHS unless they can prove that they “are collaborating meaningfully with other parts of the system.”

She added: “There is not one single contract I can imagine that does not involve more than one provider in that patient’s care.”

3 Change to operating models will be an early focus

NHS operating models will be a key focus of the 10-Year Health Plan, Mackey said.

In his keynote speech, he noted that, in a political context, it is the first time in a while that there has been a desire for stretch and ambition within the NHS – and that it now needs an operating model that allows for this ambition to be delivered.

This new operating model hinges on how those working within the NHS, and those partnering with it, work together, Mackey said.

He acknowledged that this has ended up being a “complicated system.”

The desire within the 10-Year Health Plan is to reset the system and to trust local leaders more, Mackey revealed.

At a national level, NHS leaders must “create the conditions for success,” he said.

4 A stretch to achieve ambitions – and a “latent energy” for innovation

“We have to stretch ourselves now, and let rip a little bit, to try and deliver the scale of change, the pace of change, and the impact of change,” Mackey told attendees.

Mackey wants people across the country to get ahead of the NHS, bringing to the table ideas that will be matched by a willingness for innovation from the health service.

Whilst maintaining awareness that COVID-19 was a single-issue problem, there is an ambition to recreate the feeling of innovation that was present during pandemic, Mackey said.

He noted that healthcare innovation, including in areas such as trauma care, has taken place during wartime.

Setting his keynote speech against a context of the abolition of NHS England, the Spending Review, and issues in the bonds markets, Mackey acknowledged that the UK is currently also in “extreme times.”

This should mean that “we are effective in creating the conditions for change,” he believes.

Oldham shared his belief that the UK is “in the economic equivalent of a COVID-19 crisis.”

“Carrying on as we are will bankrupt the NHS,” he believes.

Overall, however, Oldham is positive.

When it comes to NHS reform, “the political intent is huge,” he said.

He believes that there is a strong will for change within the NHS, too.

“I believe there is a huge latent energy for innovation from staff, managers and clinicians, which has been suppressed. I think they will rise to the occasion,” Oldham said.

5 A ‘neighbourhood health service’ is something that has been wanted for ‘decades’

Mackey noted that the idea of a ‘neighbourhood health service,’ one of the three shifts that the Government is focusing on in terms of health, has been a desire for a number of years.

The concept has been talked about for decades, Mackey said – but hasn’t come about due to block contracts that ensured care was kept within the hospital setting.

The 10-Year Health Plan provides an opportunity to break down those block contracts that have kept care out of communities, he said.

“We have never managed to do it on any scale or for any period, and we’ve often ended up with duplicate costs. This can’t happen this time,” Mackey said.

However, “we’ve got to think about this over time,” he acknowledged.

“If you do something locally, in a neighbourhood, you’ll get paid for it, and if that stops the flow in the hospital, everybody wins.”

The problems will come about if this system fails to work, Mackey said.

Speaking as part of the Delivering on the promise of a neighbourhood health service panel, Oldham emphasised that people are presenting unnecessarily in A&E, which is the wrong place for them.

The neighbourhood health service will fail if it chooses to use the same systems that hospitals do, Oldham said.

If you do something locally, in a neighbourhood, you’ll get paid for it, and if that stops the flow in the hospital, everybody wins

Instead, he believes that it is “about meaningfully understanding the needs of communities, and creating not just a coalition of the willing, but a coalition of the determined.”

“I truly believe that this report, in the next 10 years, is the last chance for the NHS as we know it,” he added.

Stanley emphasised the importance of neighbourhood teams in the success of the neighbourhood health service.

She acknowledged that neighbourhood teams “are not sexy and they are not fast, but they are so important – and when it is done well, it has an enormous impact on that patient’s care.”

Those within the NHS often talk about developing relationships, but often don’t make the time to create them, Stanley believes.

She noted that, whilst no one practitioner owns a patient journey, all of those involved with a patient’s care have some part to play in it.

Primary care relationships are vital in trying to keep patients out of hospital, Stanley believes, and “you can raise the quality of that decision making if you’ve got the right support around you.”

Cartwright believes that a neighbourhood health service can be built with the help of time, trust, and relationships.

Patients will always want to have services wrapped around them at home rather than being in hospital, she told attendees, and the concept of a neighbourhood health service is “a huge opportunity that we need to grab and we need to own.”

At the same time, planners must listen to frontline staff and must always keep the patient at the centre, she believes.

The 10-Year Health Plan “is going to give us the permission to develop services at a more local level and make decisions about where to spend our money and where those services need to be,” she said.

Practitioners have “got to take that ownership at that local level,” Cartwright noted, adding: “the more that we can do that, and the more that we can create that really enabling environment, and the more success that we’ll see in this.”

6 Hard to reach groups need to be involved in implementation – and patient anxiety is a barrier to progress

Mackey acknowledged that responses to the British Social Attitudes Survey showed a strong disconnect with the public when it comes to the NHS.

“There’s a worry in that about our disconnect with the population,” Mackey said. “That is a really big problem for us all. If we cannot break that materially, we are in really big trouble.”

He added: “Let’s all remember that the NHS is owned by the population. We’re all part of that.”

In the How to involve the public in the 10-Year Health Plan session, Paul Corrigan, senior adviser in the DHSC, emphasised that successfully engaging with the public means asking specific questions around certain policies, not about their feelings or opinions generally.

“High anxiety gets in the way of saying there’s a future ahead,” Corrigan said, adding: “we’ve got to deal with today in order to deal with tomorrow.”

Louise Ansari, chief executive of Healthwatch England, noted that the DHSC is highly engaged and is listening to the views of patients regularly.

A large issue for patients currently is dentistry, Ansari said, adding that there is a general feeling that the service “is just not there at the moment.”

There is a strong desire that the 10-Year Health Plan will “get dentistry back on track,” she said.

She added: “Don't let it slide into a private-only service, only there for people who absolutely need it most, and everybody else pays. Don’t let the NHS slide into a two-tier system.”

Jessie Cunnett, trustee at National Voices, questioned whether it should be a priority to “create a way for people to see a different future.”

Robyn Chappell, lived experience manager at National Voices, believes that the public should have a say in how the plan is implemented at both local and regional level.

“That is how we’ll know the 10-Year Health Plan has the public’s fingerprints throughout it, rather than just on it,” she said.

She added: “We need to prioritise inclusion of people and communities who have been are often excluded, but we need to change the relationship with them.”

The relationship is often extractive and “doesn’t lead to actionable change,” Chappell said.

She also emphasised that “trust is something that can take decades to build.”

Closing the session, Cunnett reminded attendees that “plans don’t change things – people do.”

She added that healthcare practitioners “are the people who can really motivate others to want to listen, to learn, to engage, and to really work differently.

“If this plan is going to succeed, we have to engage in a very different relationship with our communities.”