18th Aug 2025

Fit for the Future: 10 Year NHS Plan

I very much welcome the Plan buoyed by knowledge that some members of the press and others stuck in outmoded tradition are very critical. So some context. The NHS understandably has for years held a near mystical place in the minds of people, even beyond the UK. Who could argue with Its concept, values and purpose? Yet for years the culture of NHS exceptionalism hid its many failures. Then in the 1990s political patience ran out resulting in the Thatcher/Clarke NHS Reform - a veritable shock to NHS complacency. I despite my different political leanings supported it, especially its primary care aspects. Since then, we have had the Blair/Milburn and the Cameron/Lansley versions. Despite the promise and some success albeit not sustained, all failed to reform the NHS. So now the Starmer/Streeting version whose principles and purpose I support, but then I have supported all the reforms! With the benefit of hindsight, the previous reforms only ‘rearranged the deckchairs.’

Why support NHS reform? For years its clinical outcomes lag our European near neighbours with some improvements only in the Blair years. And as a nationalised industry is woefully weak on customer focus. There’s more. A managerial operating model too focused on minor changes to the status quo enforced by a compliance-based governance that stifles energy and innovation. Inclusive of clinicians, a lack of continuous improvement leadership, and now coupled with a big increase in public dissatisfaction including the previously very popular general practice? The NHS the ‘jewel in the crown’ now faces existential threat and more money though welcome, is not the answer. We had a huge increase in the Blair years but no consequent sustained improvements and yet the NHS overspent despite the significant financial boost!

In the commercial world innovative benefits accrue when a disrupter challenges successfully the status quo. Think Amazon or high-tech mobile technology and AI. In nationalised industries exemplified by the NHS, disrupters get no traction and Machiavelli’s perceptive thoughts appertaining to change abound. ‘The innovator makes enemies of those who prospered under the old order, and only lukewarm support is forthcoming from those who would prosper under the new’. The previous NHS reforms introduced disrupters with much focus on general medical practice. GP fund holding in 1991 as purchasers of NHS services competing with the larger Health Authorities. Take off was slow amidst much GP opposition but by its demise in 1997 most practices were fundholders. The incoming Labour government was fundamentally opposed to a market in healthcare, although one senior figure privately referencing fundholding ‘why are we ridding the only thing that works?’. That government substituted the market for a strong target driven policy, and purchasing became commissioning still involving GPs but in a more sanitised role. Incidentally the Blair government made huge strides in improving clinical outcomes and thereby decreased health inequalities. Very impressive but I digress as was not a disrupter. The next reforms still involved GPs in a stronger commissioning role in a return to a more market-based policy. GPs were still envisaged as purchasing/commissioning disrupters whilst not recognising sufficiently their fundamental role and forte is in provision. Anyway, GPs prominence was not maintained. Machiavelli was unerringly prescient.

The new proposed reforms even before implementation are already receiving the same negativity, couched as ever in disingenuous terms. Entrenched opposition have long experience of indirectly disrupting! 

Enough of the history and context, the new policies are welcome, far reaching and ambitious. There is a growing recognition that the principles enunciated are of the future and are most likely to remove the existential threat to the NHS.

 ‘At its core, the Neighbourhood Health Service will embody new principles that care should happen:

• as locally as it can
• digitally by default
• in a patient’s home if possible
• in a neighbourhood health centre (NHC) when needed
• in a hospital if necessary

To make this possible to shift the pattern of health spending. Over the course of this plan, the share of expenditure on hospital care will fall, with proportionally greater investment in out-of-hospital care. This is not just a long-term ambition’.

And the disrupter likely to be more powerful and long lasting than any previous is through technology, widely used the world over but much less so in the NHS. Why the latter is a good question? The key technological ‘game changer’ is likely to be the greatly expanded NHS App, key features being personalised data, access to certified third-party services and AI-powered navigation. Users will have more choices for their future health care and thereby more influence on healthcare future provision. The App in conjunction with a single patient record - digital preferably - and a health data research service, puts information at the centre of care and innovation. 

Whatever the NHS envisions the provision of health services, patients and future patients - the public - by their sheer volume will likely reshape health care provision even beyond the NHS. Social care will be subject to the same forces. The 10 Year Plan anticipates this new direction. A huge opportunity for community-based services. We need to prepare now.

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