On the day briefing: 10-year health plan

This briefing sets out NHS Providers’ views on and analysis of the 10 Year Health Plan (10YHP) published today, an overview of our work to influence the plan on your behalf to date, and a summary of key content in the plan. We then set out our initial next steps in response. Please contact Ella Fuller and Sophie Heywood if you have any comments or questions. 

Commenting on the 10-year health plan, the chief executive of NHS Providers, Daniel Elkeles said: 

"This plan could be a real gamechanger for the NHS, taking us a big step closer to building a better health service that patients, the public and staff are once again proud of.

"The plan brings together three key ingredients for success. 

"First, it provides a renewed focus on what good care will look like for people who depend on the NHS most by investing in GP and new neighbourhood services.

"It’s also a win for patients who will be better informed and empowered to direct care that is local, flexible and responsive to their needs as never before. 

"And it makes the NHS simpler, ensuring quicker decisions and innovations reach frontline services faster, helping the health service to get ahead of growing demand and complexity of care. 

"Hospital, mental health, community and ambulance providers will be at the heart of this process, working closely with GPs, social care and charities.  And the plan builds on good work they are already doing in many parts of England, changing the way people receive care, and providing a better experience and improved outcomes while reducing pressures on other parts of the system.

"This is a recipe that offers the prospect of progress where previous plans have faltered. While we need to see more action on rebuilding the bricks and mortar of our NHS, further support for our highly valued workforce and parity of esteem for mental health, this plan is a great starting point and all NHS providers will be keen to seize this opportunity to build a better health service."

Ends

See the statement on our website. 

Trusts ready to put government's plan for NHS into action 

Responding to the official launch of the government’s 10-year health plan, the chief executive of NHS Providers, Daniel Elkeles said:

"The hard work starts now. The focus must be now on how health services make this plan’s bold ambitions a reality and turn the tide on falling public satisfaction with the NHS.

"NHS trust leaders support the government’s three ‘shifts’ and ambitions. A joined-up, tech savvy NHS, working with partners and with cross-government support, can make the long-term changes that the heath of the nation and economy need. 

"It is great to hear the Prime Minister thank NHS staff for all that they do, too. While a workforce with the right numbers of people and mix of skills is fundamental to making the plan a success, we need to see the detail of how this is going to happen through the NHS Workforce Plan. The government’s intention to work with trade unions on “significant contractual change” for all staff is important. This must be done in a way that ensures productive industrial relations in the NHS, working in true partnership.

"The plan acknowledges too the major pressure which many parts of the NHS – including mental health services and urgent and emergency care – are under today.  While the government’s plan includes support for new ways of investing in buildings, equipment, facilities and digital technology to boost productivity and to give patients the best care possible, it will take time and resources to put these new structures in place. 

"Prevention is better than cure therefore it is encouraging to see this emphasis. An NHS fit for the future needs a reformed, sustainable social care sector alongside. Long-awaited and much needed social care reform will be vital to easing pressure on the NHS and making sure that people get the care they need at or closer to home."

Ends 

See the statement on our website. 

Our summary and analysis is focused on three key themes: 

• Major changes to how care is delivered
• Making the NHS more responsive to patients
• Simplification of how the NHS operates

We also set out the changes to the financial flows that will be made to enable those ambitions.  

In each section, we summarise key points from the plan and briefly give our view. 

Major changes to how care is delivered 

A neighbourhood health service

Key points

• New neighbourhood services will bring care together locally through patient-centred teams located in community settings.
  
  
• Neighbourhood health centres also offer wider services, including support with debt management and employment. They will operate six days a week, 12 hours a day, and be rolled out first in communities where healthy life expectancy is lowest.  
  
  
• Two new contracts will be used to support this way of working:
  • A single neighbourhood provider will deliver enhanced services for groups with similar needs for neighbourhood of 50,000 people. In many areas, primary care network footprints will be the starting point for this type of working. 
  • Multi neighbourhood providers will provide services to 250,000+ people across several neighbourhoods, for instance for end-of-life care.
    
    
• Prevention will be ‘delivered by default’ through neighbourhood services, and children and young people will be served through partnership between neighbourhood health centres and family hubs, schools, nurseries and colleges to offer timely support to children, young people and their families including those with special educational needs and disabilities. 
  
  
• The plan commits to invest more money as a proportion of health spend in the community over the next 3-4 years and increase the proportion of staff trained for community and primary care roles.
  
  
• New funding flows will be created that connect savings from improved quality of care with the investment in new services in the community, including the introduction of year of care payments (YCPs). YCPs will allocate a capitated budget for patient care over a year rather than paying a specific fee for a service. These will be trialled from 2026/27 in a small number of ‘pioneer’ systems. 

NHS Providers view 

The NHS is already driving ambitions to deliver more care close to home, as evidenced in our recent report bringing together case studies of how trusts are working effectively at neighbourhood-level for the benefit of patients and communities. It is welcome that the plan acknowledges that this work is already underway in many places, and emphasises a focus on outcomes and the need for local flexibility to build on what already exists and tailor the approach to local population needs. 

It is positive to see a commitment to shifting funding into, and increasing the number of staff working in, the community. In the past this has been missing and will be key to unlocking benefits at scale. The trialling of YCPs also represents an innovative way to help support the shift in resources from hospital to community. Further detail on both funding and workforce will be important as we move to implementation.

Trusts will play a central role in delivering government ambitions around neighbourhood working and will be pleased to see this recognised in the plan. Engagement with trust leaders will be vital in ensuring that any plan for delivery is effective. Measuring and evaluating the impact of these new models of care will be key and this will require further work to bring together national data on services delivered in the community.

Primary care 

Key points 

• The government will end the 8am rush for GP appointments, ensure people can receive same-day appointments where needed and bring back the family doctor. This will be delivered by increasing capacity in primary care, including by boosting the primary care workforce and reducing bureaucracy and administrative work for GPs, through using artificial intelligence (AI) and technology. 
  
  
• Where the traditional GP partnership model is working well it should continue, but there will be an alternative for GPs. The government will encourage GPs to work over larger geographies by leading new neighbourhood providers.

NHS Providers view 

Improving access to GP appointments is welcome and an important step in ensuring timely access to care for patients. It will also be vital in alleviating pressures across the whole health and care system. We understand the challenges highlighted in the document about the model of general practice, and the need for reform to meet changing needs. We are pleased that flexibility is in-built, and local primary care providers will be able to determine the model that works most effectively. Alongside NHS trusts, and other partners from across local government and the voluntary sector, primary care will be a core component of a neighbourhood health service, and it is right to see this recognised in the plan, alongside the role that trusts can play, over a larger footprint.  

Prevention 

Key points 

• The government will introduce mandatory health food sales reporting for all large companies in the food sector. This information will be used to create mandatory targets on the average healthiness of sales. The government will also update school food standards legislation, which will require joint working between the Department of Health and Social Care (DHSC) and the Department for Education (DfE). New standards for alcohol labelling will be rolled out to tackle harmful alcohol consumption.
  
  
• Access to weight loss medication and treatment will be expanded. Work will be undertaken to improve the uptake of human papillomavirus vaccinations among young people, both at school and through pharmacies. Home testing kits will also be sent to women who do not come forward for cervical screening.
  
  
• The existing NHS Genomics Medicine Service will be expanded to create a new genomics population health service, accessible to the public by the end of the decade. As part of this, the DNA of every newborn baby will be mapped to assess their risk of developing hundreds of diseases.  
  
  
• The government will focus on ‘getting prevention right’ in a child’s early years. New models will be introduced to enable health visitors to administer vaccines for babies and children in underserved groups. To support the poorest families and tackle child poverty, the value of the Healthy Start scheme is being restored from 2026 to 2027. 
  
  
• DHSC will work in partnership with the DfE to implement a single unique identifier for every child. Dependent on successful piloting, the NHS number will become the single unique identifier for children. 

NHS Providers view 

It is positive to see a focus on both primary and secondary prevention. Trusts can play an important role here, but the plan importantly recognises that the NHS alone cannot prevent ill-health. Instead, organisations from the public and private sectors will have a key role, as will the general public. The focus on improving access to preventative care is encouraging, and it is right that those commitments build on existing work to drive prevention and population health management. Given the scale of the health challenge facing the country, there will be some concern that the proposals outlined do not go far enough, and fail to tackle head on some of the wider determinants of health, including poverty and housing.

Trust leaders tell us that childhood is a key window to prevent ill-health and to improve outcomes and life chances. The emphasis on preventing ill-health is therefore welcome, but there are significant pressures in children and young people’s services and long waits for care, especially in children’s community health services, which are not acknowledged or prioritised in the plan.

Operational performance

Key points 

• Only 60% of patients currently begin elective treatment within 18 weeks. Restoring the 92% constitutional standard is a priority and important for patients. Hospital capacity will be unlocked by locally focused care, delivered in people’s homes and neighbourhood health centres. There are several ways outpatient services will be redesigned to take place outside of hospitals by 2035 in order to reduce wait times, including through: 
  • Patient-initiated follow ups; 
  • AI tools to enable triage without hospital visits; and 
  • Less invasive treatments that require a shorter hospital stays.
    
    
• The government aims to reduce pressure on urgent and emergency care by expanding urgent care in the community, improving hospital flow and increasing the use of digital tools. Key elements include:  
  • Spreading best practice in prevention and discharge to reduce variation; 
  • Expanded use of virtual wards, 111 services and population health data to reduce unnecessary hospital attendances; 
  • Expansion of same-day emergency care and co-located urgent treatment centres to streamline patient flow; 
  • Implementation of the My NHS GP tool in the NHS App by 2028 to guide patients to the right care and reduce A&E attendances; and 
  • Integrated intermediate care with neighbourhood services for faster, more intensive support. 

NHS Providers view 

The plan rightly acknowledges the scale of the challenge in reducing planned care waits and the pressures facing urgent and emergency care and provides clear articulation for why the shift to community is needed. 

For the plan to be successful, a fine balance needs to be struck in shifting funding into the community while ensuring there is sufficient resource to meet the significant pressures facing acute services. Another factor for success is that patients need to be well-informed about new services, the technological advances in their care, and what they are entitled to. 

Mental health 

Key points 

• Mental health services will be transformed into 24/7 neighbourhood care models. Assertive outreach care and treatment will be improved to ensure 100% national coverage in the next decade, with a focus on narrowing mental health inequalities.
  
  
• Up to £120 million will be invested over the course of the first half of the plan to bring the number of dedicated mental health emergency departments to 85. This will mean one co-located with (or very close to) 50% of existing type 1 A&E units. 
  
  
• The expansion of mental health support teams in schools to reach full national coverage by 2029/30; providing additional support for children and young people’s mental health through Young Futures Hubs; and recruiting 8,500 mental health staff. 
  
  
• Mental health will be an early priority in a range of areas: from the development of modern service frameworks to the use of advances in technology in care delivery, and pharmacogenomic insights in prescribing. Digital behavioural therapy for adolescents has also been flagged as an example of where work to expand the National Institute for Health and Care Excellence’s (NICE) technology appraisal process from April 2026 will focus. 
  
  
• The government and the NHS will work with local authorities to ensure children with the most complex mental health needs in residential care get the treatment and support they need. 
  
  
• Use of existing and new apps and platforms will enable patients to self-refer to talking therapies, signpost parents to support, and improve the management and the escalation of cases where there are concerns about physical or mental health. 

NHS Providers view 

We welcome national focus on stabilising and improving capacity in mental health urgent and emergency care, and implementing better evidence-based standards, pathways and mental health service models – in partnership with others like local authorities when it comes to caring for children with the most complex needs – to enable access to the right support in the right setting. Improving the availability and consistency of community-based care is fundamental to delivering sustainable improvements and we need to see more on the detail of how this will be achieved, alongside other aspects of what’s been outlined, in any delivery plan that follows today’s publication. 

There should be a national commitment to roll out broader mental health waiting time and access standards, with integrated care boards (ICBs) and providers funded and empowered to work out together how to tackle mental health and neurodiversity care backlogs. National priorities and policies must also be designed in a way that recognises the distinctions between different mental health and neurodiverse conditions and the range of services that trusts, and their partners, need to deliver to fully meet individuals’ needs. 

Improving the collection and quality of mental health data, flow to national datasets and benchmarking, and investing in the analytical capability within mental health trusts and the wider NHS and its partners, is fundamental to improving strategic commissioning of mental health services and enabling integrated mental health care to be delivered in practice. 

Reviewing how capital funding is allocated and current barriers to spending to ensure equitable access for mental health services, and establishing and delivering a long-term capital infrastructure programme that prioritises taking an equitable approach, are also critical. Key national frameworks and mechanisms must be fit for purpose for all sectors and applied consistently. 

Making the NHS more responsive to patients

Patient choice and empowerment  

Key points 

• A new patient choice charter will be rolled out progressively, starting in the areas of highest health needs. NHS funding flows will be made more sensitive to patient choice, voice and feedback. 
  
• Patients’ personal health budgets will be expanded, and patients will be able to make self-referrals to specialist care where clinically appropriate. For elective treatment, patients will also have a choice of different providers. 
  
  
• This year a large-scale study will sequence the genomes of 150,000 adults to explore how genomics can be integrated into routine preventive healthcare.  

NHS Providers view 

The plan makes a welcome move towards shared decision-making between patients and clinicians, which evidence suggests can improve outcomes and quality of care. The introduction of self-referrals for patients could helpfully free up GP time for more complex care, although the risk of digital exclusion must also be considered. Additionally, the self-referral tool must be supported by clear clinical criteria, triage support and staff training, and the tool’s impact on service demand and quality must be monitored. 

To prescribe more tailored treatment and medications, upfront investment and capacity building for staff will be needed. There have also long been concerns about how robust existing safeguards are for trusts handling sensitive genetic and personal health data, which would need to be addressed using clear governance frameworks.   

Quality of care 

Key points 

• The plan acknowledges the scale of avoidable harm in the NHS, noting the impact of toxic blame cultures, failures to learn and weak leadership. It puts a focus on quality and emphasises listening to patients and staff.  
  
  
• There will be greater transparency and clearer accountability for high quality care. The patient voice will be strengthened and complaints processes renewed.  
  
  
• The National Quality Board will be rejuvenated with a renewed definition of good quality care and a range of clinically credible outcome measures to better assess clinical quality. A national quality strategy will be published in the autumn. 
  
  
• The Dash review of the patient safety landscape, which is noted as being crowded and noisy, will be published imminently and is set to make a series of changes.  
  
  
• The 10YHP commits to setting up a national independent investigation into maternity and neonatal services, led by a national maternity and neonatal taskforce, chaired by the Secretary of State for Health and Social Care Wes Streeting.  

NHS Providers view 

The plan’s emphasis on transparency is helpful and likely to support trusts in benchmarking the quality of care they deliver. People’s insight into the services they use, and what they consider good to look like, is invaluable to service improvement and can also help address inequalities. However, we are cautious about the risk of some interventions, such as the introduction of league tables, in misrepresenting quality of care and negatively affecting staff wellbeing and recruitment in those trusts labelled as ‘failing’. Trusts would welcome further consultation on this, and ensuring that a rounded view of what constitutes good, high-quality care is fairly reflected in the metrics. 

The ambition to improve how complaints are handled is welcome – an effective, fit-for purpose complaints system has been a longstanding challenge for the NHS. Complaints are an untapped patient safety resource, and using AI to better understand trends in complaints will be helpful. The ambition must be matched with the right resourcing and training for staff to use these tools confidently and ethically. Additionally, AI tools must enhance not replace the empathy and human judgement needed to create and maintain trust in the complaints system for patients and families.  

The 10YHP references ambitions to enhance and modernise the regulatory approach from CQC. Implementing a data-driven, ‘intelligence-led’ model for CQC should enable it to have a more rounded understanding of the quality of care trusts are delivering. We would encourage CQC to make the most of its privileged observer position by sharing good practice, engaging in improvement-focused conversations with providers, and working with organisations that have a direct role in improvement.  

Trust leaders have told us that they would welcome a national quality strategy that takes an approach of the ‘centre in the service of the local’. A national strategy could helpfully recognise that the challenge isn’t so much to embed a focus on quality but rather to enable providers to achieve a shared focus across all priorities, including across finance, operations and quality. There is also an important role for the strategy in enabling, empowering and supporting frontline staff to drive quality improvement; shifting the mindset that is currently in place from controlling processes and structures to creating supportive and enabling conditions for improvement.  

Trust leaders will welcome proposals from the maternity investigation which introduce one clear, national set of actions to improve care across every NHS maternity service. It is also important that this set of actions will be co-produced with bereaved families, and we ask that trusts are also consulted on this action plan.  

Research and innovation 

Key points 

• Commercial clinical trial set-up times will be improved from 250 days to 150 days on average by March 2026 by reducing bureaucracy and standardising trial contracts. 
• The plan mandates transparent public reporting of research activity across NHS sites, with future funding being prioritised for best performers.  
  
  
• Patient recruitment to trials will take place via the NHS App.  
  
  
• New ‘innovator passports’ will be introduced to fast-track developments that have been assessed in one part of the NHS to the rest of the system, and a new Health Data Research Service will be created.  
  
  
• NICE technology appraisal process will be expanded to cover devices, diagnostics and digital products. It will also identify outdated technologies and treatments to be removed from the NHS to prioritise more effective ones.  

NHS Providers view 

A number of steps to streamline research and adoption are positive. The introduction of ‘innovator passports’ will helpfully reduce duplicative compliance assessments, although local context, resources and readiness must be considered to ensure safe and effective adoption. Similarly, we are pleased to see the continuing commitment to reducing commercial clinical trial set-up times in line with the O’Shaughnessy and Tickell reviews. We look forward to the National Contract Value Review being expanded into neighbourhood health services and other out of hospital settings by 2026. Greater transparency is welcome, but we would note that performance metrics must not disadvantage under-resourced trusts or those serving more complex populations.  

Digital and artificial intelligence 

Key points 

• By 2028 the NHS App will become the “front door” to the NHS, giving patients access to non-urgent care advice, the ability to book tests, choose their preferred provider, and manage medicines and long-term conditions.  
  
  
• A new single patient record (SPR), operating as a “patient passport”, will allow clinicians to access patient information across different care settings. Initially rolling out in maternity, by 2028 the SPR will be integrated with the NHS App. New legislation will be put in place to enable patient access to their record. 
  
  
• Data, AI, genomics, wearables and robotics have been identified as the technological levers for transforming care and delivery, accelerating reform and securing financial sustainability by 2035. Multi-year budgets will be introduced to support this. Trusts will have to reserve 3% of annual spend for one-time investments in service transformation. 
  
  
• To reduce clinical administration burden, single sign on will be implemented for all NHS software. A national procurement framework process will be put in place in 2026/27 to accelerate roll out of ambient voice technology at scale safely.  
  
  
• A new HealthStore will give patients access to approved health apps, procured and funded centrally, to manage their conditions. A new platform will also be procured to support community-based services with the digital tools and capabilities needed to drive the shift to community care. 
  
  
• An NHS AI strategic roadmap will be developed, and a new AI upskilling programme will be rolled out for all staff. AI tools including diagnostics and administrative tools will be rolled out NHS-wide starting in 2027. By 2035 AI will be integrated into most clinical pathways and generative AI tools widely adopted. 

NHS Providers view 

Underinvestment and poor funding models have impacted trusts’ ability to drive sustained digital transformation, and trust leaders will welcome the commitment to multi-year budgets to help them take a longer term approach. If the NHS is to become “the most AI-enabled health system in the world”, it will need the funding and resources to progress this. It remains unclear how the £10m allocated in this year’s spending review will be allocated, and how much of this is new money. 

We welcome the plan’s commitment to a fully digitally enabled service, that allows those who are willing and able to access services digitally to do so. This will free up services for those with the most complex needs. While it is right to maximise the use of the NHS App, it will also be important to recognise that the increasing use of digital tools and technology can exacerbate inequalities in access to care and many socio-economic factors contribute to digital exclusion. The plan clearly signals that AI will be a key enabler to productivity and efficiency savings, and this does have huge potential. However, as we have seen with recent guidance on ambient voice technology, it must be safely and appropriately rolled out. Recognising and mitigating the risks associated with AI is essential. 

Workforce

Key points 

• The government commits to continue working with trade unions and employers to reform current national contracts, but has signalled the intention for significant contractual change. 
  
  
• The 2023 Long Term Workforce Plan has been rejected by this government, and will be replaced by a 10 Year Workforce Plan later this year. The new plan will aim for fewer staff by 2035 than projected by the 2023 Plan. It will also reduce international recruitment to less than 10% by 2035 (currently 34%). 
  
  
• There will be flexibility for providers to make additional payments to high performing teams, beginning in 2027 in areas with the highest health need and rolled out nationally by 2030. 
  
  
• There will be upcoming legislation for a new system to disbar poor leaders from future NHS leadership.
  
  
• The Graduate Management Trainee Scheme will expand by 50% and all NHS organisations and contractors will be required to facilitate the scheme. 
  
  
• Doctors’ clinical placement tariffs will be reformed, alongside a targeted expansion of clinical educators. Clinical training course length will be reviewed. Bottlenecks in medical training pathways will be addressed with 1,000 new postgraduate training places, prioritising UK-based graduates. 
  
  
• Nurse education providers and employers will be required to address student nurse attrition rates. There will be increased numbers of nurse consultants, particularly in neighbourhood settings, and 2,000 more nursing apprenticeships over the next three years.
  
  
• There will be new staff standards by April 2026, to underpin the NHS Oversight Framework. Quarterly data on these standards will be published by employers, with poor performance an “early warning” signal to the Care Quality Commission (CQC). 
  
  
• There is a commitment made to eliminate agency staffing in the NHS by the end of this parliament by increasing flexible working and transitioning agency workers to staff banks.

NHS Providers view

A workforce with the right numbers of people and mix of skills is fundamental to making the 10YHP a success, and we look forward to the detail of the 10 Year Workforce Plan. A key difference between the forthcoming plan and its 2023 predecessor is in the intention for far less growth in the number of NHS staff. The assumptions underpinning this will need to be made clearer. It will also be important that the equality, diversity and inclusion (EDI) improvement plan remains in place.

The government’s intention to work with trade unions on “significant contractual change” for all staff is important. This must be done in a way that ensures productive industrial relations in the NHS. Agency spending has significantly reduced already, and we believe the government’s intention to eliminate the use of agency staff by the end of this parliament is ambitious.

A renewed commitment to implementing the Messenger Review is a key part of improving the experience of working in the NHS, as well as in supporting high quality leadership. We are pleased to see it will now be prioritised and look forward to continuing to support this work. We will also be monitoring the impacts of the new very senior manager pay framework and will continue to engage on the development of regulation for NHS managers to ensure that it is fair and equitable, proportionate, and offers support and development for managers. 

Tackling health inequalities 

Key points 

• Specific actions in tackling health inequalities include:  
  • moving closer to fair share of funding locally, based on health need, supported by better data and a more sophisticated understanding of lifetime health risk;
  • delivering care from a neighbourhood team to improve the life outcomes of disabled people and those with a learning disability; 
  • the introduction of the single patient record; 
  • ICBs becoming strategic commissioners of local services using multi-year budgets; and  
  • requiring integrated health organisations to tackle inequalities. 
• A first wave of ‘modern service frameworks’ will be published in 2026. The new NHS operating model is also expected to deliver more equal outcomes. 
  
  
• The government will partner with charities to deliver new, formal support that helps people manage their conditions and support self-care. 

NHS Providers view 

We welcome the prioritisation of activity where there is likely to be the largest impact. It is good to see the plan recognises that challenges in the NHS exacerbate inequality and, while the causes of inequalities are complex, we need to design the NHS to tackle inequalities in both access and outcomes. Leadership, strategic focus, data analysis, and building capacity through public health expertise are key components to focus on, as we have previously set out. We also need to see a whole-government approach that includes a long-term strategic focus on addressing the wider determinants of health as well as prevention and early intervention. 

Race equality 

Key points 

• The NHS will publish employer level data on staff employment and recruitment, broken down by ethnicity, so progress can be monitored on efforts to transform the NHS into a force for social mobility and local prosperity. There is also a commitment to increase the diversity of the Graduate Management Trainee Scheme. 
  
  
• Efforts will be made to better identify the need for and initiation of HIV pre-exposure prophylaxis particularly among people from ethnic minority groups. 

NHS Providers view 

Trust leaders have seen first-hand how a diverse workforce that is representative of the communities it serves can be a game-changer when understanding local needs, tackling health inequalities and delivering better health services. The NHS needs to do more to support its diverse workforce as, despite actions being put in place, structural racism persists in the NHS and progress on race equality can be slow. We would have welcomed more in the plan on what needs to be prioritised to address race discrimination and inequity, and develop inclusive and compassionate workplaces. We hope to see evidence-based EDI targets included in the 10 Year Workforce Plan later this year, as well as a renewed commitment being made to delivering the current NHS EDI improvement plan. 

Further action is also needed to effectively address the significant inequalities black, Asian and ethnic minority communities experience in access, experience and outcomes from health services. Trust leaders would welcome ongoing national support to drive effective action on race inequalities, with a particular focus from the government and national bodies on providing challenge, sharing best practice, and holding boards to account. Mental health trust leaders and stakeholders agree that sustaining support for the implementation of the patient and carer race equality framework, alongside the wider advancing mental health inequalities strategy, is particularly critical in the short to medium term. Enduring inequalities in maternity care and outcomes also require urgent attention.  

Simplification of how the NHS operates 

Responsibilities, accountabilities and the NHS architecture  

Key points 

• The centre will be responsible for national leadership, setting strategy, priorities and standards, allocating funding, and assessing performance. 
  
  
• The regions will be maintained and be responsible, with the centre, for performance management and oversight of providers, taking a rules-based approach and using new diagnostics to understand and address the causes of poor performance, backed by a new failure regime. The regions will also work with ICBs overseeing transformation at scale, and ensuring effective implementation of structures, functions and incentives. 
  
  
• ICBs are strategic commissioners. They will be supported to develop enhanced commissioning functions, and so Commissioning Support Units are to be abolished. ICBs will develop commissioning plans, engaging with patients and the public, and use contract management to drive change and ensure delivery. They will be able to pool their commissioning arrangements to enable at-scale commissioning of provider networks or chains. They will place quality of care at the centre of their commissioning. ICBs will be supported to innovate to create more diversity in the provision of services and how they are run. The number of ICBs will reduce and they should be coterminous with strategic authorities wherever feasibly possible.  
  
  
• Provider organisations will no longer sit on ICB boards. ICBs will also be expected to monitor independent providers to ensure they are not ‘gaming’ the national payment tariff. Strategic authority mayors will join ICBs, replacing local authority representatives to better align strategic planning. 
  
  
• Integrated Care Partnerships (ICPs) will be abolished, and the neighbourhood health plan will be drawn up by local government, the NHS and its partners at single or upper tier authority level under the leadership of Health and Wellbeing Boards. 

NHS Providers view 

Regional performance management of providers is to be welcomed to enable trusting, open relationships and bring closeness to local challenges and successes. The plan does not fully explain the interaction between the responsibilities of the centre and regions in relation to regulation. However, we question whether Parliament will be satisfied with DHSC marking its own homework as both regulator and the body responsible for the performance of the NHS nationally, unless there are adequate assurances of the appropriate independence of the regulatory functions of regions.

While focusing ICBs on strategic commissioning should be hugely important in driving progress on population health and reducing inequalities, we are concerned that the plan suggests overlapping responsibilities between the regions and ICBs when it comes to strategy and planning. These will need to be clarified. In addition, ICBs will likely need to understand more about how they can prevent independent providers from ‘gaming’ the system. 

The provider model 

Key points 

• Providers will continue to deliver services based on NHS principles. Earned autonomy will mean the best performers will have greater autonomy and flexibility to develop services. The ambition is for high autonomy to be the norm in 10 years. 
• Starting this year, FTs will have their existing flexibilities restored. The FT model will be reinvented with the same core philosophy but a greater focus on partnership working and on population health outcomes. A new wave of FTs will be authorised in 2026 with the ambition that every provider is an FT by 2035. FT freedoms will include: strategic autonomy, freedom to control board composition, the ability to raise capital and retain and reinvest surpluses.
  
  
• The requirement for FTs to have governors will be removed. More dynamic arrangements to take account of patient, staff and stakeholder insight will be introduced. 
  
  
• The best FTs can be commissioned to hold the whole health budget for the local population as an Integrated Health Organisation (IHO), accessing longer-term, capitation-based funding. A small number of IHOs will be designated in 2026 with a view to being operational in 2027. IHOs will have their own rigorous authorisation process. 
  
  
• The NHS will establish its own self-financing improvement capability taking the best of the NHS to the rest of the NHS. 

NHS Providers view 

We applaud the commitment to releasing providers from the command and control culture that has evolved in the NHS, and to supporting local leaders to lead. This is far more likely to lead to better quality of care and productivity, and help improve the culture of the NHS, as will improved clarity about responsibilities and accountabilities.

There is welcome confirmation that FTs will have their existing flexibilities restored, and that the ambition is to reinvent the FT model to enhance provider autonomy but with a new focus on partnership working and improving population health. It is not clear from the 10YHP whether existing FTs will be required to be reauthorised under a revised assessment process incorporating these factors. Trusts will have views about the new-FT assessment criteria: a regime in which FT-style freedoms can be earned via good performance on a range of metrics, for example, would be very different to the original assessment process for FTs, which had more emphasis on corporate governance and board capability.   

The earned autonomy outlined here relates to authorisation as an FT, but clarity is needed on how earned freedoms will be assessed, and granted or removed, and whether NHS Oversight Framework segmentation is relevant in this process.  

Removing the requirement for FTs to have governors will require primary legislation. Trust views on the value of councils of governors are diverse, with many valuing their contribution greatly. We would be keen to work with the DHSC and NHS England (NHSE) to develop alternative models that might fulfil the expectation that next generation FTs put in place ‘more dynamic’ arrangements to take account of patient, staff and stakeholder insight. Moreover, the focus on the governor role as bringing insights to FTs ignores their crucial parallel role in oversight (designed to balance the freedoms enjoyed by FTs) through board challenge, and specifically their role in appointing independent non-executive directors (NEDs), including trust chairs. Preserving NED independence is crucial to good corporate governance and we will be keen to ensure what is in place for the new FTs preserves NED independence from government. 

IHOs are potentially positive and can play an important role in joining up care for local populations. It will be important that IHOs are set a clear purpose and outcomes, and within this, are also given the scope to determine locally how that is delivered. Patients must be at the heart of IHOs, and excessive focus on organisational form can distract from this. However, without more detail about their purpose and the authorisation process it is hard to comment further at this stage.   

Finally, our members may note that neither provider collaboration/collaboratives nor groups are mentioned in the document, which uses the terminology ‘provider networks or chains’. Partnership working and integration is encouraged throughout the plan nonetheless, not least through the new FT model.  

Drive to financial sustainability 

Restoring rigorous financial discipline

Key points 

• To restore financial discipline, additional funding for deficits will end. This year, £2.2bn in deficit support will not go to systems failing to meet financial plans. Support will be phased out by 2026-2027. 
  
  
• A more transparent financial regime will be introduced that will hold leaders accountable for financial plans, with enhanced oversight and regulatory interventions for non-compliance. All NHS organisations will be expected to deliver compliant plans from 2026-2027. If financial discipline does not become the norm across the NHS, then a stronger statutory approach will be implemented. 
  
  
• By 2029-2030, most providers are expected to generate a surplus, transforming the NHS into a growth driver. Authorised NHS foundation trusts can reinvest surpluses in future capital projects. 

NHS Providers view 

The 10YHP outlines some fundamental reforms to the underlying financial framework that will re-focus the health service on delivering value-based healthcare.  

A core part of the NHS’ post-pandemic recovery has been improving productivity. The 10YHP’s target to improve productivity by 2% year-on-year is not new. Indeed, as we have consistently raised with government and national bodies, trusts have been working hard on improving productivity through local initiatives that focus on delivering better value for patients and taxpayers. Over the last three years, the health service has improved productivity by over 2% a year on average. While the recent rate of growth sits some way above average productivity growth in the NHS, efforts from trusts and their leaders have clearly made a difference. The key focus will now shift to how government and national bodies can support trusts by targeting investment towards the long-term enablers of productivity growth – capital investment, embedding technology, right-sizing the NHS workforce and reforming social care. The 10YHP provides some of the answers to these questions. 

The scale of ambition within the 10YHP sits alongside the scale of the challenge facing trusts. The plan is published at a time where trusts are making exceedingly difficult choices about what they can realistically afford to deliver, including reducing staff headcount and scaling back some services. Trust leaders are already facing a difficult challenge in balancing the delivery of key performance objectives (e.g. 18-week waiting times) within the financial envelope they’ve been allocated. While supportive of the 10YHP, there needs to be recognition of the huge challenge of achieving the ambition within the available budget. This will need to be kept under review as the 10YHP is implemented, as part of an ongoing honest conversation with the public about what the NHS can realistically deliver. 

Shifting to long-term financial planning 

Key points 

• The plan signals a shift towards greater long-term planning with 3-year revenue allocations and 4-year capital settlements being introduced from 2026-2027. 
  
  
• All organisations will be tasked with designing robust 5-year plans that demonstrate medium-term financial sustainability, which will need to be routinely refreshed. 
  
  
• In the future, all organisations will be required to reserve at least 3% of their annual budget for one-time service transformation investments. 

NHS Providers view 

Trusts will enthusiastically support the ambition to move towards greater long-term financial planning. Trust leaders have been increasingly frustrated by the annual planning process that hinders efforts to tackle tough challenges and reinforces a focus on delivering short-term savings, rather than long-term benefits for patients. 

Introducing sharper incentives 

Key points

• Block contracts will be phased out, with providers to be paid for activity that has been delivered. There will be an option for payment to be withheld for poor quality care and for payment to be topped up for high quality care. 
• National tariffs will shift away from being based on average cost and will instead be based on best clinical practice in order to maximise productivity. This will commence with services which already have clinically evidenced service delivery models that can be used to calculate costs. The number of new best practice tariffs will also be increased year on year. 
  
  
• The long-term aim is to introduce more widespread tariff mechanisms that enable funding in the NHS to follow the patient. A new financial flow will be trialled which will give patients the power to decide the proportion of the payment that will be paid to providers. If patients are dissatisfied with their care, they can opt for funding to be diverted to regionally held NHS improvement funds.  

NHS Providers view 

The 10YHP’s ambition to move to a financial model which is characterised by offering financial incentives to deliver change will help support the delivery of the plan’s aims. In principle, trust leaders will support the shift away from block payments towards greater use of activity-based payment models which are more closely linked to patient experience and the quality of care delivered. Realigning tariffs to focus on best practice, rather than average cost, will also deliver better value for patients and taxpayers.  

Re-aligning funding distributions 

Key points 

• The 10YHP recognises that the current flow of NHS resources does not accurately align with the areas of highest health need across the country, leaving areas with higher health needs under-resourced.
  
  
• From 2026/27, funding allocations will more closely align to an area’s “fair share” of funding. The Advisory Committee on Resource Allocation will review health needs to inform resource allocation by 2027 to 2028, with extra funding in the interim for areas facing significant economic and health challenges. 
  
  
• Government will also review how health need is reflected in nationally determined contracts, such as the Carr-Hill formula for general practice. 

NHS Providers view 

Trusts will welcome the acknowledgement that the current financial framework is not fit for purpose and support the government’s ambition to better connect funding flows with the ambitions of the 10YHP and return the NHS to financial sustainability. A more transparent approach to the financial regime is welcome. Government’s ambition to transition back towards “fair share” allocations will help re-align funding to where health need is highest and address regional health inequalities. Removing deficit support funding is an important step in this process, and ensuring the right pace and phasing of its removal will be critical to allow trusts to move towards financial balance as sustainably as possible. 

Reforming the capital regime 

Key points 

• Government will introduce multi-year capital budgets, devolve more control over capital budgets to the frontline and streamline the capital approvals process. Furthermore, new FTs will have the freedom to determine their levels of capital spend each year (in accordance with agreed plans). 
  
  
• Funding for operational capital expenditure on maintenance work will flow to trusts in line with the level of infrastructure need, leaving systems free to focus on working with regions to strategically invest capital in new services and capacity. 
  
  
• Government will look to reform public dividend capital charges. 
  
  
• Government will do more to align financial incentives to increase estate utilisation and dispose of under-used land. Trusts can already retain 100% of land disposal receipts, credited automatically without additional authorisation. Proceeds from disposals can be used across financial years by notifying DHSC by year-end. Trusts can access bridging loans from DHSC for immediate investment, repaid from future disposal proceeds. 
  
  
• A new programme aims to establish neighbourhood health centres in every community, starting with the most deprived areas, in collaboration with the National Infrastructure and Service Transformation Authority.  

NHS Providers view

The plan acknowledges that the NHS capital regime is “dysfunctional”, which has left the NHS estate in disrepair. Trust leaders will welcome the introduction of multi-year capital budgets and reforms to streamline the capital approvals process, which are practical steps which will provide trusts with greater certainty and flexibility to spend their capital allocations more effectively. Government’s decision to explore the use of more innovative finance models (e.g. PPP, pension fund capital) is an important first step to providing trusts with further routes to obtain the capital investment they need to deliver neighbourhood health and transform their existing estates to operate as productively as possible. However, the scale of infrastructure need across the NHS estate is vast. While these reforms are encouraging, it is difficult to see at this stage how such reforms, alongside flat real-terms capital budgets over the course of the current spending review period, will be sufficient to deliver all of the ambitions of the 10YHP. 

Implementation of the plan

The 10YHP sets out a positive vision for the future of the NHS and key changes that should contribute to improvement. There is now a need for a rapid focus on implementation and alignment with the wider policy framework – how trusts are resourced, incentivised, held accountable, and supported by the centre to transform. A clear focus on the ‘how’ will set it apart from the NHS plans that have come before, and ensure it succeeds where others have not had the impact envisioned. Legislative change will also be required to enable some commitments to be realised.

A delivery plan will need to outline clear priorities. Trust leaders will play a central role in implementation, and are ready to work with the government to make the ambitions set out a reality. 

The 10YHP acknowledges some of the challenging trade-offs and choices that will now need to be made. This is particularly important given the scale of the financial pressures facing the NHS, and the difficult decisions that will need to be made locally in response. Our recent survey on the financial reset shows that nearly half of trust leaders (47%) are scaling back services to deliver financial plans, while a further 43% are considering this option. Many will agree with the vision, and the case for change, but fewer will understand how this can be delivered in the extremely challenging financial context.  

The government will need to carefully consider the balance between immediate and longer-term priorities, and between delivery and transformation. This is not impossible: the two can go hand in hand, and short-term stability will support longer-term transformation. Nevertheless, there must be adequate focus on both.

Provider sector ownership of the plan is a first step to moving away from the top-down control and overcentralisation which the 10YHP explicitly sets out to dismantle. 

In addition to the requisite funding and investment, factors that will contribute to its delivery include: 

Alignment: Alignment between the plan and other transformation and reform agendas is vital to effective implementation. For instance, policy on the quality landscape or the NHS workforce must support, not distract from, the ambitions of the plan. Social care reform remains an urgent priority. 

Local flexibility: Any delivery plan needs to support and enable trusts to deliver high quality care. Flexibility at a local level will be needed to enable trust leaders, and their partners, to implement the 10YHP in a way that best suits local needs and populations. Different approaches may be needed to get to the intended outcome, depending on factors such as geography, demography and deprivation. 

Realism: It is important that a future delivery plan acknowledges the challenges facing the NHS and is clear about the prioritisation and trade-offs that are needed to be made to achieve the ambitions set out. Delivery timelines also need to be realistic. 

Staff and patients: An engaged and motivated workforce will be central to the implementation of the plan. To effectively deliver on the reforms outlined, there must therefore be a sustained focus on policies that promote staff wellbeing and a positive working culture; clear, values led communication; and equality, diversity, and inclusion in the NHS. Likewise, patients and all who use the NHS must continue to be engaged in the journey, and inform it.

Measuring and evaluating implementation: Progress on implementation should be independently reviewed and made public. There was a lack of baseline data which made it difficult to robustly evaluate progress over the first five years of the 2019 Long Term Plan. This should be addressed in a future delivery plan. 

Change NHS consultation response

NHS Providers submitted evidence to the government’s Change NHS consultation. We also provided oral evidence to the Health and Social Care Committee's inquiry into the 10YHP in December 2024.

Member and stakeholder engagement

Over subsequent months, we have undertaken significant engagement with trust leaders to further develop our understanding of what the 10YHP needs to include from a trust perspective. This has informed our programme of work to shape the development of the plan and our engagement with colleagues at NHS England (NHSE) and the Department of Health and Social Care (DHSC). 

Our work included holding roundtables with trust leaders who were members of policy working groups set up by the government to support the development of different aspects of the plan, which supported discussion and mutual understanding across the groups. During this engagement, trust leaders described what an effective 10YHP should look like, and what would be needed to enable local leaders to deliver the government’s reform agenda for the benefit of patients and communities. 

We were part of the 10YHP Partners Council and maintained engagement with senior national stakeholders within NHSE and DHSC on the plan’s development separately throughout. We also facilitated a number of network sessions for members to contribute to the development of the plan. This included sessions with Paul Corrigan, Sally Warren, and Tom Riordan CBE. 

This engagement has informed a series of blogs we have published in recent months covering: the conditions for the plan’s success; making the shift to community a reality; supporting the shift from treatment to prevention; and the importance of culture at a time of transition.  

Sector specific work 

We carried out mental health sector specific engagement with members and stakeholders to inform a briefing we published in June setting out what needs to be prioritised in the short to medium term to deliver high quality, sustainable mental health services in line with the “three shifts”. This built on a briefing we published in April, which explored the key challenges currently facing the mental health sector and how trusts are responding and innovating. We also hosted a session with the 10YHP team at our February meeting of the Mental Health Leaders Network to discuss how to ensure the plan will adequately support the sustainable delivery of high-quality, accessible mental health services. 

We published a long read from the Community Network, hosted by the NHS Confederation and NHS Providers, focusing on the key role community services can have in unlocking the challenges facing the NHS, and delivering the government’s ambitions in the 10YHP. We also organised a panel session focused on the plan at the Community Network’s meeting in October 2024, in addition to having regular sessions with NHSE to give updates on the development of the plan. We also attended an Association of Ambulance Chief Executives workshop in December to support their contribution to the plan’s development. 

Other topic specific work 

We hosted a roundtable in February between HM Treasury officials and trust leaders to discuss how trusts can support the government’s mission to implement the three shifts and what support trusts need to return the NHS to financial sustainability. We held another roundtable in June to bring trust leaders together to discuss integrated care models, including how NHS trusts and foundation trusts are progressing this locally, and where there are opportunities for the 10YHP. 

We published a case study-based report highlighting how trusts are already working at neighbourhood level to support people in the community, reducing pressure in other parts of the health and care system, and improving patient experiences and outcomes.  

We also carried out targeted member engagement and published a report informed by this in May 2025 focused on tackling inequalities in maternity care.  

In May, we also engaged extensively with NHSE on the strategic commissioning role of ICBs prior to publication of the Model ICB Blueprint, and published a briefing on it. 

We held a member roundtable, co-convened with NHS Confederation, where NHSE explored ICB and provider trust reactions to the proposed oversight framework for 2025-26 and we submitted a response to the NHSE consultation. 

It is vital that an implementation phase follows the publication of the 10YHP to give further detail about what will be delivered and when. NHS Providers will offer to work with DHSC and NHSE to inform and shape any implementation phase and delivery plan. We will do this based on the feedback and insights of trust leaders. We will also be developing our support offer in response to the plan in the coming weeks. 

Following the publication of the 10YHP, we also expect the government to publish, later this year, its revised Long Term Workforce Plan. We expect this to align with commitments made in the 10YHP. The government’s decision to abolish NHSE will need to be achieved through primary legislation; we are expecting a Bill to be brought forward in the next King’s Speech, most likely later this year and we will be seeking to ensure the legislation supports the NHS with solid underpinning for delivery of the plan.  

Our Annual Conference and Exhibition, taking place 11-12 November, will be a unique opportunity to come together to discuss a range of issues relating to the 10YHP and to highlight the impact of changes on the delivery of care in the NHS. This year’s theme, Recharge, reflects the level of reform underway across the NHS and the energy, commitment and leadership that providers will bring to it. It also recognises the importance of creating space to reflect, learn, and re-examine relationships across the NHS, with local communities, staff and wider partners. The conference will explore the opportunities and implications of providers enjoying greater freedoms and what this means for accountability, service users and communities, as well as collaborative approaches across and beyond the healthcare system which are delivering system wide change in population health. Book now. 

10 Year Health Plan 

Fit for the future: 10 Year Health Plan for England

NHS Providers submissions 

Change NHS consultation: The 10 year health plan for England, Nov 2024

Health and Social Care Committee 10 year health plan inquiry oral evidence, Dec 2024

The Spending Review 2025, Feb 2025

Consultation on the NHS Performance Assessment Framework, Jun 2025

NHS Providers reports and briefings 

Provider collaboratives building capacity: investing in community provision, Mar 2025

Mental health: shifting the focus, Apr 2025

Jobs and services on the line as NHS budget squeeze bites, May 2025

Bold action: tackling inequalities in maternity care, May 2025

Model ICB Blueprint, May 2025

Mental health: delivering the three shifts, Jun 2025

Delivering on ambitions for a neighbourhood health service, Jun 2025 

A health bill fit for the future, Jul 2025

NHS Providers blogs 

Ambition on prevention must be to go further, faster, Apr 2025

The NHS 10 year health plan: conditions for success, May 2025

Culture more important than ever at a time of transformation, May 2025

The digital road to preventative care, May 2025

Bringing care closer to home: making the shift to community a reality, Jun 2025

Ministers are promising to reinvigorate FTs. Here’s what they need to think about, Jun 2025