The 10 Year Health Plan: what is it and what happens next?

Siva: It's a pivotal moment for health and care policy. After months of waiting the government's 10 Year Health Plan is finally here. But with the health and care system at breaking point, does the government's plan offer hope to staff, patients and the public that things will actually get better?

Hi everyone, I’m Siva Anandaciva, Director of Policy, Events and Partnerships here at The King's Fund and over the next few months in this brand-new series of The Kings Fund podcast, we are going to be rounding up the greatest developments in health and care policy, helping you make sense of the big issues and what they mean for people's health.

Today I'm joined by my Kings Fund colleagues, policy advisor, Charlotte Wickens, and senior policy lead, Sarah Arnold. And what are we going to be talking about? Well, of course there's currently no bigger health policy news story than the launch of the 10 Year Health Plan. So, Charlotte and Sarah are going to help me unpick what's actually in the health plan, why is it important and what happens next. And we'll also be answering some of your questions too. So, let's get into it.

So, Charlotte, Sarah, thanks for joining me. I always find it really hard to get across just how big these plans are, but if you were gonna try and explain it to someone who doesn't work in health policy, doesn't live in our world, how do you describe the 10 Year Health Plan and what it's trying to achieve? How would you describe it to, I dunno, my mom or my sister?

Charlotte: I think the important thing is to look back at kind of where did it come from? Where did this plan start? And I think if we look back to over a year ago when the new government came in, they came in with the policy that the NHS is broken and they kind of set out to do a really rapid diagnostic of what was going on in the health care system, that they asked Lord Darzi to do.

And I think basically what this plan is trying to do, is trying to now flip the narrative from the diagnostic where, to be honest, a lot of really difficult messages came out about the way that the NHS works with patients, the way that the NHS is run, and then flipping that into kind of what's the treatment, what's gonna happen now that makes the NHS different in 10 year’s time?

And I think that's really where this plan, the kind of genesis of it was. And so what we've had is a plan that's looking to achieve rapid change, with actually not very much money attached to that plan as well, over the next 10 years.

Sarah: And when the government came in, they came in with a high-level vision of what they wanted to do with the health system.

They focused on three shifts that you may well have already heard about, but if not, it’s what the government's been calling for - its hospital to community, analogue to digital, and sickness to prevention. And so what this plan does, in large part, is put a lot more meat on the bones of what that actually looks like.

Look, I should also say it's one in a long line of plans. We tend to see plans like this every couple of years, setting out kind of a vision or a strategy for the NHS. We last saw a long-term plan in 2019. There were ones in 2014, 2010, 2008. They come along fairly often but each time they set out the vision of what wants to happen at that current place in time.

Siva: You're absolutely right. A colleague of ours, Natalie, said something like – a 10-year plan comes around every three years, which I thought was, a great but worrying line. And my sort of go-to analogy is always transport. So if I was reading in the newspaper that the government's published its new 10-year plan for transport, not working in the field, I kind of wonder, okay, well what’s going to get better for me as a commuter? And what might get worse?

What's your take on what might get better if the 10 year plan is pulled off? And, uh, what might get worse or at least ‘stay broken’ to use West Street's language?

Sarah: Well, I think firstly to say this is framed as an answer, I think as Charlotte said, to the many problems that have been identified. Clearly, public satisfaction in the NHS is at an all-time low, and the plan really leans into that rhetoric, basically saying the NHS needs to reform or die. There is a huge amount in this plan. It's 168 pages long or 144 without references. That's really very, very long, obviously.

In terms of actually what's in there, I think the really big ideas – one is about setting up neighbourhood health centres, so having care closer to home, a kind of a one-stop shop where you can go and access not just your GP but a huge raft of community services all in one place. And another really big set of ideas is around having access to apps and other things like that that will allow you to get better information to help you control your own care.

For people working in the system, the big changes, I think, are also around tech. About changing the way that you are able to deliver services, mostly on the admin side by having a lot of support from AI to help you remove some of that admin from your daily life.

Charlotte: I think there's another part of it as well, which I think our colleague Dan Wellings really reflected on in our long read that we wrote, about the fact that actually there's been a lot of rhetoric about moving power into patient's hands, and I think there is a very strong thread through this.

And I think part of it is born through the fact that there was an engagement exercise with lots of different members of the public. There was a kind of online consultation, basically trying to reflect back what they've been told about what people find to be the difficulties when it comes to access, when it comes to their experience.

People quite often do say that when they get in the door, the quality of the care that they get is good, but some of it is about, how do you actually get in the door to begin with? And I think the door will shift as a result of what's happening with this plan, as Sarah said, kind of digital front doors instead, or that their front door will no longer be a hospital where you go for an outpatient appointment.

And I think that will have a big impact on how people kind of experience the health care system.

Sarah: These are just to say these are the aspirations of the plan. A bit of a note of caution, I think on that in terms of like what you might actually see over the coming weeks and months is that a lot of these aspirations are a bit more in the future.

I'm not convinced we're going to see a lot of immediate change, to be honest. What the plan did set out is a plan for a lot more different new strategies to be developed. Developing NHS workforce standards, dental contract reform… We're going to see change to regulations, changes to the regulation and appraisal process for technologies, new strategies for the national quality board on quality.

All those things are going take time to both establish and then put in place. In terms of what's going to happen, say over the next year or so, besides plans, there is less. I'm not saying there's nothing, so there's definitely some ideas about trialling ideas in maternity care; the single patient record, which is an idea of kind of bringing together patient reported data all in one place - that's going to be trialled in maternity care and implementation of patient experiences, that's going to be trialled in maternity care. It's not going to be rolled out everywhere for a little bit of time.

There's also stuff in there, things on prevention that were already in train, so things that have been previously announced, things like free school dinners for children with parents in receipt of universal credit that's going to go ahead next year.

But the kind of the bigger changes are definitely going to take some time.

Siva: Great. So I've got a sense of a plan that's going to move care closer to me in neighbourhoods. A lot more technology determining how I interact with health care services and a lot more power in my hands as a patient, hopefully. But then also from what you're saying, Sarah, a bit of a reality check that this plan isn't the final word on all of those things, and they might not happen next week.

And in a way you're probably absolutely the wrong people's ask because in a good way, you're both health policy geeks, but there was so much that was trailed about the plan before it was actually published. So was there anything when you read the plan that really surprised you, that made you think, ‘oh, I wasn't expecting that’.

Charlotte: The three shifts are things that the government has been talking about for a really long time. It’s been kind of Wes Streeting's mantra in opposition into now being Health Secretary. So, it is difficult to see that these are kind of new – there aren’t any kind of new shiny surprises or rabbits as we like to say, when it comes to fiscal events.

Two points. The first bit is, I think they went further on some of the big things that need to happen in terms of, if you're going to move care into the community, the money has to follow. And I think they did actually.

I was a bit sceptical that they would write in anything too prescriptive on this, and in the end there is no timeframe attached, but actually there is a commitment to moving money and to reducing the proportion of money spent in hospitals. And that's a big commitment, especially given that we know that hospitals are facing really difficult financial challenges at the moment, and that is having an impact on patient care. And so it's a really big swing, I think, to say that they're willing to reduce that proportion in order to allow for growth in community and primary care to enable that shift to happen.

 So I think that's a really big deal and it was a surprise, I think, to me, that they were willing to be so explicit about that. I do think another surprise on the more negative side was the fact that there was very little discussion about the trade-offs.

And I think also in some of the writing, the trade-offs became even less clear. I remember seeing on X when there was a reaction saying that they'd committed to the four hour standard for A&E, but actually that wasn't in the plan. And so, it's just some of the writing around things made it quite woolly.

Sarah: One of our colleagues referred to it as a ‘choose your own adventure plan’, which I thought was quite neat. I guess what she meant by that was that you could basically, wherever you were in the health system and whatever you thought was a good idea, if you read some part of the plan, you'd probably see something in there that would reflect that, which in a way is good because it brings everyone together, but certainly presents a little bit of an implementation challenge, I would say.

Siva: And what about you, Sarah? Was there anything, when you read it, you thought, ‘oh, this is a big surprise’? Either because it's in there, or a big surprise because it was missing.

Sarah: I mean, I think overall one of the biggest surprises for me was just quite how much it read like a greatest hits of kind of previous plans, which isn't anything specific, but as in foundation trust are back, that's been proposed before. Polyclinics in the form of neighbourhood health centres.

So even some of the really big things that are framed as new ideas are in many ways sort of expansions of previous ideas. On that one though, it was nice to see that the neighbourhood health centres are looking beyond kind of the more traditional health services. We're also talking about bringing in debt advice and employment support into those community centres.

I wasn't expecting such a focus on genomics, so this is more kind of a long-term aspiration. But the idea is for essentially DNA sequencing to help advise the healthcare system on who is more likely to get certain diseases and then to think about preventive activity to stop them getting that or to stop it being so much of a problem.

I do think the jury is a bit out on the evidence behind that and how valuable that's going to be. So, I think there does need to be a lot more thinking around that, but that's more of a long-term aspiration.

And the other big surprise for me was we knew a lot about what was going to be in there, but we didn't know so much about the balance and what was going to be emphasised. And I think what comes through really clearly when reading this is kind of tech, tech, tech is the answer and that's the number one thing above everything else that comes through. So, I think quite the extent of how much the plan is betting on technology to be the solution in nearly all aspects was a bit of a surprise to me.

Siva: I was just interested in what you were saying about the sort of ‘choose your own adventure’, which is a dated reference that I will match with, you know, all those ‘Now’ compilations of music, annual music that somebody was talking about in the office sayingat times it feels like ‘Now this is what I call health policy 42’.

Why do you think these plans tend to reuse ideas from the past? Is it because of the people writing them, or is it because they are just some truisms that if you want to fix health care, you have to look at something like a polyclinic? Why do you think it happens?

Sarah: I mean, it is notable that many of the architects of this plan were architects of prior plans, so I think that is part of it.

I think also though, they're not bad ideas. They're not necessarily bad aspirations, and I think it points to almost a commonality of vision of what people actually want the health service to look like. In a way, it's kind of good that some of these, well, nearly all of these have been mentioned before.

It means that we've learned some lessons about why they haven't managed to work in the past, and if the government and the health system actually manages to remember those lessons and learn from those lessons, I think that gives me hope that they will manage to be enacted this time. But obviously the flip side of that is there's a reason why these aren't already embedded.

They haven't worked in the past for various different reasons. So that is a note of caution.

Siva: Yeah, and I guess listening to you, it probably may be ‘surprise’ is the wrong benchmark because it wouldn't have been a good thing if we opened the plan and it turns out we've added two more shifts or we've scrapped the existing three.

There were two things that surprised me in the plan. One was just sort of ‘beliefs’. You read some of these sentences and some of the beliefs that sit behind them. I just remember reading the plan and there was a sentence that said something like, there are no consequences for failure in the NHS. I think it was in the bit about finances.

I thought, really, that's really what you believe? Because if that's what you believe, I can absolutely understand how it gears a particular type of approach to performance management or regulation. So, there was something about beliefs and the second thing was, you know, Charlotte, you mentioned they've done this long extensive consultation exercise with the public and staff, you know, eight months, probably thousands of people inputting into it.

I guess one of the things I was really looking forward to is seeing, ‘we weren't going to do this but then through the public consultation, someone suggested this great idea and we thought we'd do it’, or ‘we as the government we're planning to do this – the public thought was a barmy idea and it just wouldn't have worked so we dropped it’. There's still time but I think, you know, if you're going to start a national conversation, I'd really like to see that conversation kept going.

Now, thank you to listeners because you did send in questions. I don't think we'll get through all of them but we're going to try and get through as many as we can.

So, we got question from Vicky. Vicky asked: ‘As an NHS employed social worker, I found no reference in the plan to us as a group. We're not allied health professionals. I'd like to understand where this leaves social care and whether there's any hope of integrated commissioning to work together more effectively?’

Sarah: I mean, so social care is mentioned in the plan. I mean, if you search for it, if you can do the control ‘f’ test, there's over 50 mentions of social care in the plan but unfortunately a lot of them are just references to the Department of Health and Social Care. So, it reiterates the fact that health and social care should be together, I would say.

But what's notable is a real lack of kind of policy and ideas around social care. And that's a problem because of years without reform, many people are unable to access the care they need. That's obviously a huge problem in and of itself. It also does actually have a huge impact on the NHS when people aren't receiving the care they need through social care.

That means they'll often put more pressure on the NHS system. Now, in terms of social care reform, this is not the last we were going to hear about it. There's the Casey Commission being led by Louise Casey, which is the government's main vehicle for social care reform. But we know that's not going to report back until 2028.

And so it feels a bit strange that the interface between health and social care isn't acknowledged more and the impact that's going to have. The plan does talk a bit about the Better Care Fund, which is one way that social care is funded from the NHS. And that's going to be reformed next year.

But that's really one of the only things that's mentioned, and I think there is a huge opportunity for the way that neighbourhood health will be working to integrate a lot more closely with social care, but there wasn't very much detail or even really any detail about how that might work beyond kind of acknowledging that the social care workforce will need to be part of that.

So, I think there's a lot more to look for on social care that hopefully this is not the last we're going to see from it. And hopefully we're not going to have to wait till 2028.

Charlotte: Another colleague of mine was reflecting that A&E seems quite absent in this, despite the fact that it is one of the main services that people access because I think maybe it was Penny Dash who said this morning, the lights are always on in A&E and so it's where people turn up and actually the interface between A&E and flow through a hospital and social care is a real crunch point.

And I think we've kind of dodged that in the plan. I know there's a separate urgent and emergency care plan but it just felt like there was, there's a real opportunity to kind of reset that narrative and think about how this winter will be better. And I think if it's a government who really want to show people that things are different and that change is real, that's one really easy way of kind of looking at that system. And there was definitely an ambition to kind of look at how A&E is funded and kind of think about how you kind of incentivise things differently. But I do think the kind of the interaction with social care was a complete kind of own goal, missing in action kind of moment.

And I know that they've outsourced things to the Casey Commission as Sarah said, but that's not really going to kind of cut the mustard until 2028.

Siva: Vicky, your question also made me think, you know, there's only so much that a national plan can do becauseI don’t know, something like 15 years ago there were the original ICPs, which were integrated care pioneers, and one of the things they ran into is you've got people who are NHS employed social workers, and people who are social workers who aren't NHS employed.

You end up with people competing for the same work on different terms and conditions. So back to Sarah's point, I think there's a lot of work over how these neighbourhood teams are going to be put together, how they're meant to be working and how they bring people from different organisations. So probably back to the point of the plans to start, not the end of the conversation.

Let's try and do Derek's question because it's one that's really come up quite a lot with the closure of Healthwatch. How will the public/patient voice be heard as a necessary check and balance to authority?

Charlotte: So as I said before, there's a lot of kind of patient experience and patient voice kind of baked into the plan. But I do think the closure of Healthwatch is a really big step to make. And supposedly it's going to be replaced by an office, um, of the patient that will sit directly in the Department of Health and Social Care.

And I think one of the benefits of Healthwatch was having such a kind of dispersed model where you had an organisation that was picking up on things that patients were saying were happening to them and then bringing that together into a collective. So, where people may have thought that it was an individual issue in one area, actually, no, it is a kind of big groundswell of issues. And I think what that surfaced this for us at The King's Fund was a piece of work that we did with Healthwatch on patient admin, because it really was Healthwatch who were surfacing those real frustrations that people are experiencing. Having their appointment letter arrive after their appointment, for example.

And that's been really, really important as kind of feeding that back into the system. And again, Penny Dash over the weekend was saying that that's something that makes her want to cry. That kind of frustration that patients feel. And so not having Healthwatch be able to do that and kind of harnessing the kind of collective voice, I think is a real missed opportunity for public and patient voice. And the fact that they sat externally from the department means there's no kind of conflict of interest or any kind of issues with, with kind of speaking truth to power and being able to say, well, patients have told us this and being able to act on that or asking the government to act on it.

I think that is… it's a real risk. I think that this plan has gone so far to kind of hardwire in patient voice but have removed one of the main mechanisms that we currently use. That's not to say that this new mechanism might not be a success, but it does really feel like if something's not broken, why are we taking it out? If it's able to do what it's currently doing, can we not just keep it in there?

Siva: Sorry, can I ask you very quickly about Valerie's question, which is: ‘apart from the commitment to improvements in maternity care, there's no reference to women's health care needs in the plan’, and I think you were talking beforehand about how this might signal just what different type of plan this is to previous ones?

Sarah: Yeah, so I think in general this plan's quite condition and demographic agnostic. And what I mean by that is previous plans have had specific chapters or sections talking about a specific disease or a specific group. Like the 2019 plan had whole sections on children and young people. It had a whole section on cancer.

This plan doesn't really have any of that. There are a couple of conditions and, and groups that sort of woven slightly throughout the plan but it's much more outlining examples of how the new ways of working will potentially lead to solutions for those areas. So, what you don't really see is a whole section on this is what it's going to mean for women. This is what it's going to mean for children. So I think that's quite different.

I think it will then remain to be seen if there is enough detail in this plan or are we going to have to see new strategies, individual strategies, individual service frameworks for different groups in different conditions. And I think possibly the answer is yes on that.

Siva: Great. Well thanks for your questions and also thank you Charlotte and Sarah. I've got a clear idea of what the plan said. How do you think the plan's gone down and what the reaction's been?

Charlotte: So I think people are cautiously optimistic. I think everyone recognises that the NHS is not in a good state at the moment and I think it was quite interesting to see, looking back at some of the kind of ones in the noughties, that there was a real sense even then that the NHS was under existential threat from, at that point, it was people opting out to go private because of how long waiting lists were. And now it feels like the existential threat is that people think that the NHS can't remain in its current form, in the sense that it's a free at the point of use service paid for by general taxation.

And so I think that was kind of woven through as well. And so I think people do get the sense that we do need to turn this around, and this does need to be different for people.

Sarah: I fully agree with what Charlotte said, and ‘cautious optimism’ is the words I wrote down too. I think the other things besides implementation that people are cautious about, one I think is more broadly is this neglect of social care and then not just social care, but also a bit of a neglect on kind of the wider determinants of health. And although the shift from sickness to prevention was in the plan, it has a whole chapter, I do think there was a general sense that there could have been areas where the government could have gone much further on. Alcohol is one of them, but also just the general idea of thinking much more broadly about its health mission.

So it's had a health mission to kind of narrow the healthy life expectancy gap, whether that's a goal or an objective or a target, but it could have gone much further than that. I think actually the wording of the plan, I can't remember exactly what it is, but they are aiming to make progress on that within 10 years, which doesn't feel like a massive ambition to me.

And the other area that I've seen kind of multiple concerns about is health inequalities. And this also links to the previous question on kind of where was there, where were women in the plan? Because the plan doesn't talk about specific groups very much. There's a risk that without explicit attention to health inequalities doing new ways of working will just entrench the existing inequalities in the system. And that is a real concern.

Siva: So let's turn to the future then, and the final question is, what happens next? What can staff in the healthcare system and what can we, as the public, expect to happen in the coming weeks and months? What differences will we notice?

Sarah: I mean, I think I already partly answered that earlier in that I genuinely don't think we're going to see a huge amount of difference immediately, apart from potentially for patients accessing maternity care where a lot of this stuff is going to be trialled.

We are going to see a lot more plans. So certainly, policy wonks are going to see a huge amount of change in that over the next couple of months in terms of things to respond to. And I also think some of the workforce changes they're trying to make happen quite soon, particularly around some of the frustrations around kind of having to do training in one area.

Then if you move jobs to another area, you have to do training on the same thing again. So they're trying to make some of that easier for staff. But generally, for patients, I'm not expecting a huge amount of change immediately.

Charlotte: I would say no for a lot of the big ticket items that we've been talking about.

So, the kind of the idea of the single patient record and all the changes to the NHS app, those are all expected to be phased in from 2028. So I think that's the point where we think change will start to kind of accelerate. Whereas at the moment I think it's a lot of the kind of build in to the change happening. And that is really important, and you need to have to be able to implement change successfully, you need to take staff with you. You need to kind of put the infrastructure in place to be able to do those changes. And so I think while it might be frustrating that I don't think the change will happen or be visible until that point, there will, it's not to say that there won't be lots of work going on in the meantime to try and make those things happen.

Sarah: And actually to add to that, I think I was being very pessimistic in terms of where I think it will… there is a bit more optimism. It's that some of this stuff is already happening, particularly around things like the neighbourhood health service.

Certain areas are effectively already doing this, and that's partly what gives the government confidence that this is possible because areas are already doing this. And so areas that are already doing it and doing it well, I think, I hope they'll have confidence to go for that even further and I hope they'll be able to take this plan and feel empowered to do more as soon as they're able.

Siva: What a great note end on so let's leave it there. Thank you Charlotte, and Sarah, for joining me. If you'd like to find out more about the 10 Year Health Plan, we've just published a long read on our website, which gives our summary and analysis of the key parts of the plan, and I think it's a really good resource so go to our website and have a look at that. You can also, while you're there, look at joining our event in September where we're going to be discussing the 10 Year Plan and the actions that are needed to truly transform the health and care system. You can find the link to the event and long read in the show notes for this episode.

And finally, we'd love to keep hearing from you. Get in touch and let us know what you thought of this episode. You can do that by email at [email protected] or via X, LinkedIn or Blue Sky. And thank you for listening. We hope you can join us next time.