Moving from ambition to action: tests for the NHS 10 Year Health Plan

There’s a growing sense of anticipation as we await the imminent publication of the NHS 10 Year Health Plan.  

No plan of this scale will satisfy everyone, yet with so much urgency for transformation and hope, it must deliver. The government committed to health as one of its five missions and offered an early diagnosis as the platform for reform through Lord Darzi’s review. Now, as it nears the end of its first year in office, the government is set to launch its 10-year NHS plan. 

The NHS is familiar with major reforms, and the core ‘three shifts’ at the heart of the new plan are well-established ambitions. With a system under pressure, this plan must demonstrate how ambitions can also convert into clear action for change at scale and speed. 

If action is to follow ambition, what should we look out for in the plan? 

1. Does it hardwire shifts in? 

Shifts in ambition must be backed by shifts in priorities and resources.  

Ambitions that unite people around the possibility of positive change – for example, an organising principle of a neighbourhood health service or a shift towards prevention – are the right aims, but previous similar ambitions stalled when money, staff, time and attention didn’t follow.  

To realise the community shift or to move the ambition of a ‘broader neighbourhood health service’ into action will require reallocation of funding towards community and primary care – for example, by reducing acute share of spend to below 50% across the early years of the plan or by setting investment standards towards preventive spend. Even if not fully rebalanced in the short term, can we see a clear path for systematic change throughout the plan? 

Action will rely on collaboration across a complex set of different interests. It needs a line of sight to a shared ambition lifted well above systems and institutions that instead speaks to the real difference to people’s lives and health in the broadest sense. Elevating the prevention shift as a first among equals, with the other shifts, policies and incentives reoriented towards it, would be a bold step in turning ambition into action. The prevention shift is the ultimate prize, closest to the end goal: creating good health for people’s lives, not just NHS demand reduction. 

2. Are people at the heart of the policy design?  

Successful change depends on relationships as much as logic. Any technical change – shifts, incentives, structures, technologies – needs to be about people, done with people and to be for people.  

Hardwiring as per test one is crucial, but this is all still to enable and support people to do what only people do – feel, act, reflect. Many plans are highly logical, then handed over to a mainly ‘relational’ world.  

As just one example, the ‘analogue to digital shift’ has been allocated funding in the recent spending review, so a positive step towards hardwiring as per test one. Crucially, this includes day-to-day revenue funding, which is as important as investment in the ‘kit’ itself. If the plan seizes this opportunity, it will allow proper focus on the human-facing aspects of technological change, such as investment in skills and capability for implementation, managing change, and working through how the tech will be applied in practice. These make the difference to whether this shift is truly freeing up time to care, or becomes yet another ‘new login and password’ frustration to crowd an already busy mind.  

3. Does it tackle the trade offs?  

Shifts mean going from as well as towards something, and is likely to include letting go of some existing priorities. The plan must be honest about trade-offs – what’s being prioritised and what’s not? 

The King’s Fund has previously suggested that the government should review its ambition to meet all consitutional standards – the key ‘targets’ by which we tend to judge overall NHS performance, for example ambulance or A&E waiting times – within this parliament, to avoid existing commitments pulling in different directions to the three shifts. Back to the hardwiring test, this trade-off would signal where priorities are heading and then support that with the funding and measures that drive attention in that direction. 

That’s a difficult political, and operational, decision to make. A trade-off would need to come with an explanation of a positive and valid alternative (the good news is that the three shifts are all backed as solid ambition), as well as openness, including with the public, about the choice being made and why, and a plan to get there that builds confidence.  

Confidence means that any assumptions underpinning any choice made need to be transparent and realistic, for example around the scale of the opportunity for productivity gains. 

4. Is it actually a long-term plan and does it give confidence to stick with it over the long haul? 

We now know the health funding envelope for this parliament, but not for later. We need reform that starts and invests now for a decade’s time, for nurses that haven’t been trained yet, for babies that haven’t been born yet, for AI capability that hasn’t been imagined yet.  

We don’t know exactly what the world will look like then but we need to make a start fast to keep up. Yet we have very big, visible and well-known pressures right now. There has been talk of using the plan to ‘fix the basics first’. To ensure lasting change, the plan must provide a credible decade-long roadmap, where actions taken on immediate pressures can be done with long-term transformation firmly in sight, rather than as short-term fixes.  

For people to hold their nerve through change in a politically charged system, proposals can’t feel aligned to the designs of individuals but need to follow a wider groundswell of evidence, insight and experience. 

Policy incoherence fuels implementation incoherence. No health plan can succeed without parallel attention to adult social care. The plan should clarify where its success is dependent on wider social care reform, currently under review by the Casey Commission. Coherence is needed between what the NHS is being asked to do and offered in a 10-year plan and what is happening in wider social and economic policy that affects health, including on poverty, welfare and housing. The plan is a huge opportunity to reignite the health mission . Will it seize that moment?  

Confidence hinges on rhetoric matching reality. Is devolution the goal for the NHS, as it is for wider government policy? If so, does the regular drumbeat of messages – within and beyond the plan – align with this, including the integration of NHS management into Whitehall currently taking place?   

5. Does it inspire hope? 

Above all, this plan must offer people hope, showing a clear path from ambition to action. It should be clear in what it asks for and what it offers – to citizens, patients and staff. 

The plan is an opportunity for government to listen to what people said in the ‘biggest conversation’ and to carry that listening into implementation: leading change with compassion and doing with people, not to them. 

To avoid cynicism, change must feel tangible. Ambition and principles must translate into action. People will sigh at a ‘do to’ plan heavy on structural reform and KPIs; over-reliance on ‘principles for local adaptation’ might appear empowering, but without a shift in prevailing culture, incentives and resources, it remains a form of ‘doing to.’ This could turn into another wait – for an ‘implementation plan’ and a ‘workforce plan,’– to provide the detail. 

So where’s the balance?  

A plan must offer clarity and structure without overwhelming. While we can’t predict the future, we need a plan that prepares us to navigate it confidently. One with a strong foundation – technical and relational – so that we stay constant on the goal, coherent in approach, and confident in next steps. 

Have you ever seen a perfect health reform plan? I’ve written some plans, analysed others, supported health care leaders through change on a few —but none hangs framed on a wall. 

We know action and change won’t come from perfection in a document but from starting strong, learning, adapting, and making change happen in practice. But this doesn’t give the 10-year plan a free pass – the Darzi review was a stark diagnosis of a clear need for real reform.  

Ultimately, hope and confidence for transformation will build up from a plan with a compelling vision, clarity of direction and an approach rooted in people – designed for them, with them, and acted on by them. If we can see people in the plan, then we’ll be off to a strong start.