Professor Martin Powell explores the content of the new NHS ten year plan
The 10 Year Health Plan ‘Fit for the Future’ was published on 3rd July 2025. There was much that was familiar with the document. Each of the three radical shifts heavily trailed by the government of hospital to community, analogue to digital and sickness to prevention had featured heavily in many NHS plans over the years. For example, ‘prevention’ was a key feature of the NHS Act of 1946 and formed the basis of a government document ‘Prevention and Health’ in 1976, with many documents on preventing issues such as obesity and smoking in recent years.
Shifting the balance of activity from hospital to community has been a stated aim since at least ‘Our Health, Our Care, Our Say’ of 2006, and the new promise to increase the proportion of spend from hospital to community simply repeated an old promise from that document. While the document cites the recent Darzi review commissioned by the Labour government, it does not seem to be aware of its conclusion that since 2006 the NHS has implemented the reverse of its stated strategy in that the proportion of NHS spending by hospitals has increased. If it is aware, it does not seem curious as to why similar previous initiatives have not worked. The ‘neighbourhood health centres’ will be open at least 12 hours a day and 6 days a week sound suspiciously like the Health Centres discussed in the 1946 NHS Act, the NHS Walk in Centres from the 2000s, or the ‘polyclinics’ of the 2007 Darzi Report for London: Healthcare for London: A Framework for Action.
The importance of ‘digital’ albeit under the old guise of ‘IT’ featured heavily in policy disasters such as ‘Connecting for Health’ of 2005, while faith in a ‘NHS App’ might at least by tempered by the NHS Covid App experience. The claim that by 2028, the NHS App will be a full front door to the entire NHS does not seem to be concerned by the ‘Digital Divide’ that was displayed during the Covid Pandemic, and may possibly breach the Equality Act of 2010 in terms of the ‘protected characteristic’ of age.
The ‘one core purpose’ of the three shifts ‘to put power in patients’ hands’ (p. 22) has been a stated aim of countless Secretaries of State. In a sort of ‘tribute band’ to Tony Blair’s New Labour, league tables and ‘earned autonomy’ would return, private sector capacity would continue to be used to treat NHS patients (a Conservative strategy- ‘something blue’- deemed public-private partnerships by Labour in government, but ‘privatisation’ while in opposition) and Foundation Trusts (FT) would be ‘reinvented’ for a modern age. However, there were also two vital departures from New Labour. First, there would be much less new financial investment, declaring that ‘the era of the NHS’ answer always being ‘more money, never reform’ is over.’ Second, in contrast to ‘what counts is what works’, there is limited curiosity to why some of these policy retreads have not been successful previously, resulting in the danger of doing the same things and expecting different results.
Each of the three radical shifts heavily trailed by the government of hospital to community, analogue to digital and sickness to prevention had featured heavily in many NHS plans over the years.
Professor of Health and Social Policy
Martin Powell, Professor of Health and Social Policy, HSMC. Areas of work include health policy, decentralisation, partnerships, history of health care before the NHS.
