The King's Fund comments on the publication of 'Fit for the Future: 10 Year Health Plan for England'

Commenting on specific topics within the government’s 10 Year Plan for Health, Sarah Woolnough, Chief Executive of The King’s Fund said:

On delivery of the plan

‘There are more than 150 pages of a vision of how things could be different in the NHS by 2035, but nowhere near enough detail about how it will be implemented. Without this detail it is hard to judge how the ambitions written on the page will make a difference to the reality of the care we receive over the next few years. From what we can see in the plan, there will be regional pilots for some proposals, which means some areas of the country will see improvements to NHS services before others.'

On more patient power

‘Giving patients more power and control over their health is welcome.

‘Too often previous governments have said they’ll give patients better access to their data and deliver care closer to home, only to fall short. We need to see the detail about how this change will happen, including the tough choices needed to realise the move into the community and dismantle the barriers to more joined-up care.

‘Many patients will welcome the opportunity to give real-time feedback and communicate more easily with the health services and professionals who treat them. But as well as providing individual feedback, people want to feel assured that the NHS as a whole is improving and there’s a service wide effort to listen to and put patient’s wishes at the heart of care.'

On financial discipline and deficits

‘NHS finances have been in a critical state for most of the past decade. It is no secret that the NHS is showing signs of financial distress despite its allocation in the recent comprehensive spending review.

‘Today’s plan includes a call for NHS organisations to balance their books and to improve productivity. While we agree with the government that the answer to the NHS’s challenges is not simply to provide more money, there has to be realism about how the financial situation impacts the ability to deliver all the reforms proposed today and the impact this will have on services. It also remains to be seen how credible this ambition is given it repeats previous commitments to reduce deficits in the NHS without compromising on the range or quality of services the NHS delivers. With a few exceptions, there is far more detail on what the NHS is expected to do in future within its budget than indications of what it will stop doing to avoid busting its budget.'

On workforce and leadership

‘There has been much evidence, such as the annual NHS Staff Survey, that shows that working in parts of the NHS is not always an attractive career, with many staff reporting feeling undervalued and overstretched. Many staff have worked in the NHS long enough to have seen successive governments’ plans to improve the NHS, and will be wondering what is different this time and when they can expect to see improvements to their morale, including through the fostering of inclusive and compassionate cultures. We therefore welcome the commitment to bring forward implementing the recommendations of the Messenger Review to improve the culture of the NHS to help it recruit and retain staff.

‘The plan rightly states an ambition for a more sustainable workforce, focusing on retention and a pipeline for future staff, and aims to look at the general staffing mix rather than simply at numbers. The plan anticipates there will be fewer staff in the NHS by 2035 than the current NHS Workforce Plan projects. The government is placing a large bet on technology and automation freeing up enough clinician time so that fewer frontline staff will be needed in the future. If that bet doesn’t pay off the NHS could face an even larger staffing crisis.'

On access to services and waiting times

‘Access to GPs, long waits for A&E treatment, ambulances and planned care are all top of the public’s list of concerns.

‘This plan recommits to what we already know: that bringing down hospital waits is its key priority. But the government is still being too vague what improvements we will see in other important areas like how long we wait in A&E or for an ambulance if someone has a stroke, or for psychological treatments. Making significant progress to tackle hospital waiting lists while shifting the focus of the health service to prevent, and better manage more care in the community is a tall order. The government has to be honest with the public over what trade-offs we should expect in the care we receive.'

On neighbourhood health

‘A vision to create a neighbourhood health service is welcome, but this has long been argued for. Actually delivering this major shift of care and focus for our NHS out of hospital into communities, where previous governments have failed, would be the real win.

‘A commitment to invest more money as a proportion of health spend in the community over the next 3–4 years is to be commended. It’s this sort of concrete action that’s needed to make the shift from hospital to community a reality. We also need to see health professionals working differently, NHS estate renewed and used more imaginatively, and better links between health and social care data.

On enhancing technology

‘While the possibilities of AI are exciting and present an opportunity to improve patient outcomes and staff experience, there is also an urgent need to get the basics right first. Much of the health service is plagued by basic IT woes and outdated equipment.

‘The plan says that patient use of the NHS app and AI for staff will save billions by cutting paper and reducing human effort. The plan includes proposals for how technology will improve IT so staff don’t have to spend half an hour trying to log on to their computers before they deliver clinical care. But historically announcements on NHS tech have been big on promise but lacking in delivery as money has been diverted to other areas.

‘Strengthening the NHS app will help more people to manage their health better, but the NHS has been trying to embrace new technology for years and the clear lessons from the past are that the benefits of new technology will not be realised unless staff and patients are involved in design and implementation of how it is rolled out.'

On prevention

‘The NHS will only survive if we place prevention front and centre of reform plans. While we are encouraged by some of the measures outlined to improve health – to work with businesses to support healthier eating, and to provide easier access to weight management services and obesity treatments – taken together this does not feel sufficiently radical to provide the sea change that’s required.

‘We can’t duck the reality that we are an international outlier with stagnating life expectancy and with millions living many years of life in poor health. The government promised us a health mission to halve the gap in healthy life expectancy between the richest and most deprived. A true ‘health in all policies’ approach, across government and communities, is needed for that to be delivered.'

On structures

‘The ambition for all hospital trusts to become foundation trusts, with the highest performing organisations having more independence from central control and the ability to reinvest their financial surpluses is not new. The government will need to do more to explain just how greater freedoms for individual organisations are meant to square with an overall ambition for different parts of the NHS to collaborate and share resources to benefit their local populations.'

On social care

‘Unless the relationship between health and social care services is urgently addressed, the failures of the social care system will continue to put huge pressure on the health service. The challenge may be whether the government is willing to act more urgently – or indeed at all – to implement social care reforms.

‘The government’s prior announcement of the Independent Commission on Adult Social Care, led by Baroness Casey, offers a real opportunity to truly reform fundamental issues, such as the very tight means test. But we urge the Commission not to wait until its ultimate 2028 deadline before making its recommendations.’

Notes to editors

1. The King’s Fund’s overall response to the direction of the plan can be found here: The King's Fund Comments On The Government’s Forthcoming 10-Year Plan For Health | The King's Fund

2. We have spokespeople available for broadcast interviews, follow-up comments, or if you have background questions.

3. The King's Fund are hosting an online event on Friday 4 July, 12:00pm-1:00pm to discuss the plan’s publication and its impact on how health and care services will be planned, delivered and accessed by patients and the public. Invite can be found here – any issues please email our media inbox: [email protected]

4. We will publish an explainer on the plan with more policy analysis in the coming days.

5. The King’s Fund has an explainer on NHS key facts and figures, which has been updated: NHS: Key Facts And Figures | The King's Fund