The NHS 10-Year Plan: Big Promises, Bigger Questions

The government’s 10-Year Plan for the NHS sets out a comprehensive vision for change. From personal health budgets and integrated health organisations to neighbourhood care centres and AI-enabled hospitals, the direction of travel is clear.

On paper, it looks like a plan that could reshape how care is delivered, how services are led, and how systems operate as “one”. But the question remains: will this be the moment things actually change?

Because we have heard this all before.

A familiar vision with firmer detail

The shift towards prevention, place-based care and digitally enabled services is not new. These principles have featured in nearly every strategy since the 1990s. What makes this plan stand out is the level of detail: clear targets, timelines and named interventions. Combine that with the opportunity to harness AI and the potential benefits are even greater.

There is recognition that new operating models will be needed, that workforce reform cannot wait, and that technology must be a central enabler of transformation. There are even plans for a new productivity index and private funding options for local health infrastructure.

Yet clarity does not always equal confidence. Change in the NHS rarely fails because of poor ideas. It fails when incentives do not align, when capability is overlooked, or when there is no headroom to act.

Reform on paper is not the same as reform in practice

The success of this plan depends on more than strategic ambition. It depends on investment reaching the right places, confidence being rebuilt, and coordination between national and local systems.

It also relies on delivery capability. Not just within the NHS, but across local government, voluntary and community sectors. This is not just a transformation plan. It is a whole-system reform agenda. If we treat it as anything less, the risk is that the strategy remains just that and nothing actually gets done.

And, of course, it depends on how funding is deployed, on whether communities get what they need, and on whether hospitals are willing to share control. These are some of the structural questions that will determine whether the vision becomes reality.

Our take

There is a lot in this plan to support. The focus on neighbourhood care, digital access and prevention aligns with the direction many organisations are already moving in. But the scale of change should not be underestimated — nor should its complexity or the pace required.

We believe success will rest on three things: clarity of responsibility and accountability, the right capabilities at the right level, and the confidence to act without being burdened by inappropriate governance.

If you are thinking about your organisation’s role in this landscape, or how best to support the teams delivering it, we would be happy to talk.