Clinical leadership in transition: reflections on the 10 Year Health Plan

At a recent roundtable, we convened alumni from our Clinical Directors programme to discuss what the 10 Year Health Plan means for clinical leadership. One comment captured the spirit of the conversation – honest, provocative and fully of possibility: ‘There is no one in Whitehall with a whiteboard who has got this all figured out. That can be either scary or liberating.’

The roundtable was the first in a series of alumni-led conversations designed to bridge the gap between policy and practice.

Clinical directors reflected that the 10 Year Health Plan is bold in its ambition, but its foundations are fragile. The plan landed like a manifesto, bold, sweeping and full of promise. It aims to shift hospital-centric care to community-based, preventive and digitally enabled care. But as participants dug into the details, there was a mix of excitement and concern.

Reflecting on the plan

Tech optimism versus clinical reality

The plan suggests that, by 2036, the NHS will need fewer staff thanks to AI and automation. Some participants felt this bordered on magical thinking. ‘Ambient voice technology works well in a controlled environment, but in a corridor in ED [emergency departments], it’s a different story’, said one clinical leader. This was not cynicism, but a call for compassionate realism, an approach that acknowledges the challenging conditions staff often face, while responding with empathy and understanding.

Neighbourhood health: promise and peril

Clinical leaders were cautiously optimistic about the plan’s focus on neighbourhood health, with 200 centres promised by 2035. But questions remain. What will they look like? Who will staff them? Without national service specifications, there is a real risk of postcode lotteries and inequity. We need standards that ensure fairness while allowing for local flexibility.

Delivery gaps and local ingenuity

The plan’s fragmented references to other reviews also raised concerns about coherence. With no delivery plan, local leaders are left to interpret and implement on the fly. Yet in that ambiguity lies opportunity. ‘There is never going to be enough money. So how do we make the most of what we have?’, asked one clinical leader.

Without rigid blueprints, systems can engage in relational conversations that foster genuine collaboration. But this space is fragile. If national bodies revert to a transactional approach, the opportunity for real change could collapse into compliance-driven box ticking.

‘Guerilla’ leadership: quiet acts of boldness

The plan calls for bold, relational system-savvy leadership, but offers little on how to cultivate it. One of the most powerful metaphors from the roundtable was the idea of ‘guerilla leadership’, bold, adaptive and locally driven.

One story stood out: a stroke nurse who spent half her time following up with discharged patients, asking them to send videos of their rehab exercises. ‘Am I doing the right thing?’. The answer was unspoken but clear: absolutely. This is a wonderful example of modelling the future that the plan only gestures toward.

Workforce wellbeing as strategy, not sentiment

The leadership gap is mirrored in how the plan treats workforce wellbeing, not as a strategic imperative, but as a transactional concern. It risks reducing staff to productivity assets. As the Fund recently argued, ‘the NHS cannot performance-manage its way out of exhaustion’. Without addressing morale injury and chronic overload, structural reform will not hold. There is, however, a chance for national bodies to lead differently, through trust, learning and shared purpose.

A clinician led blueprint for reform

Clinical leaders didn’t just critique at the roundtable – they offered a simple blueprint for reform:

• relational leadership over rigid hierarchies

• compassionate realism over magical thinking

• workforce wellbeing over managerial compliance

• neighbourhood care backed by equity and standards

• technology that serves people, not replaces them

• trust based accountability, not transactional oversight.

These are not just reflections; they are a call to co-create reform grounded in the lived realities of staff and patients.

With national guidance expected soon and funding decisions to follow, all signs point to a familiar script: top-down, tightly controlled and relentlessly transactional. That is the paradox. How can we speak of radical change while clinging to the same old playbook? If this is truly a moment for transformation, then the way we lead must transform too. Not with permission, but with purpose.

The future of the NHS won’t be written in Whitehall. It will be shaped in neighbourhoods, health and care facilities, with communities, and in the quiet courage of leaders who choose hope over hesitation.