One year on, is the NHS 10 Year Health Plan being delivered?

One year ago, the Prime Minister, Chancellor, and Health and Care Secretary stood up in a light-filled room at the Sir Ludwig Guttman Health Centre in East London and launched the NHS 10 Year Health Plan.  

The plan was the centrepiece of the government’s health reforms (even if it sat at the centre of a very crowded table with a host of other plans that included a new long-term NHS workforce strategy, a life sciences sector plan, a national cancer plan, a women’s health strategy, and a men’s health strategy).  

Quite a lot has changed since then.  

We now have a new health and care secretary. We will have a new prime minister. And we might have a new chancellor. The team of officials that produced the plan has been disbanded, with people moving onto different roles in the Department of Health and Social Care (DHSC) and NHS England.   

But although the people have changed, the policy direction has not. James Murray used his first major speech as the new health and care secretary to say ‘the 10 Year Health Plan remains’ along with the three strategic shifts it represents (hospital to community, analogue to digital, and sickness to prevention).  

This constancy of purpose is welcome, but it begs another question – one year on, how is the care you and I receive from the NHS any different?

Shift one: from hospital to community

Establishing a new neighbourhood health service was at the heart of the ‘hospital to community’ shift. But what was a neighbourhood health service meant to look and feel like?

After the government published the 10 Year Health Plan, and following reports of different visions at the centre of government over what neighbourhood health should focus on, the government launched a neighbourhood health framework. It set out how neighbourhood health would help improve outcomes for people with frailty, improve same-day access to GPs, and boost accident and emergency (A&E) performance in NHS hospitals. What has emerged is a vision of neighbourhood health that may help relieve pressures on NHS hospitals, but it is further removed from the more inclusive community-centred approaches some had envisioned.

The aim is still to have 250 neighbourhood health centres by 2035, with the first 120 open by 2030. As of March 2026, the government plans to open 27 centres by 2027, though this is largely by upgrading existing buildings. By providing everything from pharmacies to urgent treatments under one roof, you can see how these centres could provide more convenient and local care for patients. But the health plan’s promise of a neighbourhood health centre ‘in every community across the country’ using public private financing seems some way off still. New types of single- and multi-neighbourhood contracts, which would encourage GPs to cover larger geographies and lead neighbourhood health schemes, were to be in place from April 2026, but they are also yet to emerge (and are running out of time if they are going to be part of the 2027/28 NHS contracting rounds).

The remaining commitments included everything from requiring newly qualified dentists to spend at least some of their time delivering NHS care (a ‘tie-in’), to a totemic shift in the pattern of health spending, which would see the share of spending on hospitals fall and investment in out-of-hospital-care rise.

The common theme here? Uncertainty. When and how will dentist tie-in be implemented? How much will the share of hospital spending fall by, and over what period? Or more fundamentally – will these changes happen at all? These are huge questions for the professions, prospective clinical students, patients, and people who lead NHS services. The questions remain open one year in and speak to an overall hesitancy over whether the NHS really will be committed to the fundamental shift away from hospital care that the health plan proposed.

Shift two: from analogue to digital

An experienced health policy analyst summarised the 10 Year Health Plan with this pithy line: ‘The answer is ‘technology’. Now, what’s the question?’

Technology and innovation definitely seemed to be the secret sauce smeared all over the health plan. The promise of a single patient record to provide more co-ordinated, personalised and predictive care is clearly progressing because it is at the centre of the NHS Modernisation (Health Bill) 2026 wending its way through parliament.

But the legislation only creates the conditions for the single patient record, with much of the specifics of how it will be implemented still to be determined. For much of the past few months, the public, political and media debate has been increasingly focused on the role the US tech company Palantir plays in managing NHS data.

The NHS App also featured heavily in the health plan promises. Described as the new ‘front door to the NHS’, there were plans to have more people using the app and for it to do more things for people by 2028 (eg, communicating with professionals directly, booking appointments and leaving feedback). Usage of the NHS App has continued to increase, although it’s hard to know how much of this to ascribe to the health plan itself given the longer-term trend was already looking positive.

There have clearly been efforts to deliver on promises that the health plan made to reduce staff frustration and improve efficiency by using ambient voice technology for notetaking and single-sign-on technology. This would also help to avoid the palaver of logging into 17 different IT systems at the start of each working day. But it is unclear how much these technologies are being used in the NHS or how they are improving staff experience and patient care.

These technologies were only some of the five ‘big bets’ that would bring transformative technologies to the NHS: interoperable data, AI, genomics and predictive analytics, wearables, and robotics. Regional Health Innovation Zones – announced in the Life Sciences Sector Plan – were meant to hot house these technologies, but there is little in the public domain about their progress. The health plan said it would correct a ‘lost decade’ in science and innovation, but there is a risk that it has just added on another year of loss.

Shift three: from sickness to prevention

The most important shift was the hardest to see in the 10 Year Health Plan, which only reinforced the view that this was ultimately more of an ‘NHS’ plan than a wider ‘health’ plan. The plan had the most hesitant of ambitions to ‘restart progress’ on longevity and healthy life expectancy and ‘make progress’ on prevention of the biggest killers. And as Richard Slogget has said about the prevention commitments in the plan: ‘beneath the headline ambitions sits a long tail of pledges with no firm target, no delivery vehicle, or no dedicated funding.’

It hasn’t all been bad news. ‘Health and Growth Accelerators’ have been set up in three parts of the country to try and tackle the health conditions that contribute to people falling out of work. ‘Prevention Accelerators’ have been set up in five parts of the country to expand prevention of cardiovascular disease and diabetes. Finally, a ‘Prevention Demonstrator’ was set up in Greater Manchester to trial more community-led preventative approaches to public services to ‘fix the foundations of a person’s life’ by giving them better access to housing, education and employment.

Among all this acceleration, the government under Keir Starmer has made good on its commitment to decelerate smoking by passing the Tobacco and Vapes Bill, which was first proposed by the last Conservative government. England doesn’t get to lead the world in everything, but our national politicians should be rightly proud of what they achieved here.

However, the health plan’s ambition of a ‘moonshot to end the obesity epidemic’ still seems to be partly left on the launchpad. In November 2025, the government announced proposals to extend the soft-drink levy to include sugary milk-based drinks. Later in January 2026, new restrictions on junk food advertising were brought in (after being first proposed by the Johnson government under Boris Johnson in 2021).

But several months after it was first announced, the centrepiece policy commitment that would require the food sector to meet healthy sales targets was very light on implementation detail. Not much has been said publicly since and with parliamentary recess just weeks away, time is running out for launching a consultation on this policy (which could one day stand alongside the smoking ban as a bold move to improve the nation’s health).

A new ‘operating model’ for how the NHS works and is managed

The unheralded fourth shift in the 10 Year Health Plan was a package of technocratic changes to how the NHS works. Some of these are being taken forward through the Health Bill, including plans to abolish national and local Healthwatch bodies.

For some proposals, the health plan was merely a waystation to reannounce what was already happening. For example, the manifesto commitment to create a new College of Executive and Clinical Leadership was referenced in the health plan and is happening – with its first chair announced and a chief executive announcement on the way. But that – like the integration of NHS England into DHSC – would have happened even if the health plan had never been published.

or example, the average set-up time for commercial clinical trials in the UK reduced to around 120 days by March 2026, well within the 150-day target set out in the health plan and down from the 250-day baseline prior to its launch.

There were clearly some new promises in the health plan for patients, staff and providers alike. For example, the average set-up time for commercial clinical trials in the UK reduced to around 120 days by March 2026, well within the 150-day target set out in the health plan and down from the 250-day baseline prior to its launch.

The government started a series of financial reforms, but they are still very much in gestation, including:

• plans for ‘patient power payments’ to penalise NHS organisations where patients are dissatisfied

• proposals to give high-performing clinical teams additional financial payments as a reward

• ‘deconstructing’ block contracts that pay providers a set sum regardless of how many patients are seen or how good their care is.

Work has clearly started in these areas, but reversing years of NHS payment policy is not the sort of thing that can be done quickly, unless you are willing to destabilise the finances of large parts of the NHS.

The plan also promised to ‘reinvigorate and reinvent’ the foundation trust model to give providers greater autonomy and financial freedoms. While the Health Bill might actually do the opposite, by giving the Secretary of State more power to curtail their financial freedoms, the first eight potential advanced foundation trusts were nominated in November 2025 with six confirmed in May 2026.

At least some of the plethora of workforce commitments in the health plan – from more nurse consultants in community settings and reducing staff sickness rates, to delivering on the recommendations of the Messenger Review into NHS leadership – will have to wait for the delayed publication of the next NHS long-term workforce plan. Many of the commitments on improving the quality of care – including the implementation of modern service frameworks to set standards of care for important conditions like cardiovascular disease and dementia – will have to wait for the delayed publication of the National Quality Strategy.

Some would argue that restructuring the NHS was not a distraction from the health plan; instead, it was a critical part of the plan to reshape how the NHS operates. But it is very hard to develop major national strategies and programmes while simultaneously embarking on the largest restructuring of national and local NHS bodies in over a decade. As the government’s own impact assessment for the health plan wisely notes: ‘Making simultaneous changes to multiple layers of the NHS hierarchy creates a risk that there is insufficient capacity to accelerate change.’

Delivery needs daylight

No plan is going to please everyone. The 10 Year Health Plan omits some things that people might have wanted, such as minimum unit pricing for alcohol. The health plan includes – and has already delivered – some things that were probably a bad idea, such as performance league tables for NHS providers. Some recent policy proposals have come in after the health plan was published, such as the recent proposals for a social media ban and an Online NHS Trust.

But this isn’t the time to relitigate the history of how the health plan was developed. It’s the time to litigate whether it is now being delivered. Of course, by definition, not everything in the health plan needed to be completed within a year. It helped kickstart things like the review of the Carr-Hill formula that distributes GP funding. No one would want that rushed, but it would still be helpful to have an update on its progress.

It isn’t often I say this, but I hope this long read becomes redundant within a single day of it being published. I hope the government marks the one-year anniversary of the health plan with a comprehensive table that has a column titled ‘these are the things we said we would do’ and another column titled ‘and this is how things are going’.

Ben Coleman MP had the same idea a year ago when he asked Wes Streeting: ‘The 10-year plan has some dates by which things will happen… Could you at least pull together everything that currently has a date and produce a single timetable? It would be easier for us, and probably for everybody else out there, to deal with. Would that be possible?’

Wes Streeting’s enigmatic answer? ‘It is possible’.

Let’s say that table never gets published: where will it leave us? Partly, it should leave us confused. The absence of the missing ‘delivery chapter’ in the health plan becomes more glaring as time goes on. NHS England is now developing an ‘overarching analytical framework to support delivery of the 10 Year Health Plan, including clearer articulation of intended outcomes and their financial, workforce and operational implications’.

The fact that this is happening long after the plan is published is – to put it lightly – worrying. Not least because NHS England should cease to exist by the second anniversary of the health plan and that our analysis of long-term health plans from other countries strongly suggested that monitoring and evaluating these plans from the outset was key to successful implementation.

The lack of any clear infrastructure in DHSC to deliver the health plan is equally a worry. A year ago, you would need several hands to count the number of people with ‘10 Year Health Plan’ in their job title. Now – to ask the classic Kissinger question – who are you meant to call when you want to speak to the person in charge of delivering the health plan?

No doubt the government will say that the NHS has a renewed grip on its finances, that progress has been made on improving hospital waiting list performance, and that public satisfaction with the NHS has turned the corner after years of declines. But was that because of the health plan? It would take a brave soul to claim that.

One year in, we only have a hazy notion of what should have been delivered, when it should have been delivered, and who was meant to deliver it. Thank goodness we have things like the Health and Care Select Committee and Public Accounts Committee to extract this information in future. But a more proactive approach from DHSC could have saved everyone a lot of time.

And partly, all this should leave us just a little bit angry.

When I wrote this a few days before the one-year anniversary of the 10 Year Health Plan, I noted that the government website had last been updated on 12 January 2026. I am convinced that more progress has happened in the past year than I have captured above. But who can tell? A diffuse and varied set of commitments were made in a long health plan. Progress against these commitments is now being monitored and shared with the public in a diffuse and varied way.

Developing the health plan took eight months. Developing the plan cost £3 million. The government has created a vibe that when it comes to improving patient care, every second counts. To deliver better value for taxpayers, every pound counts. We are 10 per cent of the way into this plan and we don’t know if we are on or off track. Although we know exactly what we spent on the 10 Year Health Plan, we are still trying to work out what exactly we bought.