Does the Ten-Year Health Plan make the changes healthcare leaders have been calling for?
There is much to welcome in the Ten-Year Health Plan, which features more than 30 crucial measures the NHS Confederation has been calling for on behalf of healthcare leaders.
Our private and public advocacy, based on extensive engagement with our members, has helped influence a number of changes, including:
- reform of the NHS operating model
- an overhaul of the capital regime
- the introduction of new public-private partnership models
- a move towards outcomes-based and capitated payment mechanisms
- fundamental reform of the dental contract
- support for workforce development
- strengthened NHS and strategic authority collaboration to improve local growth.
These are all much-needed national improvements, which will empower local staff to deliver change. We commend the government for committing to these policy measures over the next decade.
Missing in action
But while the plan commits to a welcome direction of travel, there remain a small number of areas where it could have gone further and which we hope the government will commit to in future. In particular, we are keen to see further action on four areas:
- Overseeing delivery: Moving resources upstream from hospital to community is essential and the plan sets out practical steps to help achieve this, including reforming financial flows and developing integrated health organisations (IHOs). But to oversee delivery, the government will need to ensure it has the right data and metrics to ensure this shift is progressing. It will also need to incorporate this goal as part of the NHS oversight regime.
- Primary care contract reform: There is welcome reform to organisational financial flows and contracts, and to the dentistry contract. We look forward to working with the government and NHS England on future contracts across primary care, which will be essential to realise the government’s aspirations for neighbourhood health and primary care at scale.
- Mental Health Act implementation: While assertive outreach approaches, mental health A&Es and 24/7 neighbourhood mental health centres will help reduce crisis and Mental Health Act detentions, more is needed to support the roll out of the Mental Health Act reforms. This includes increased community provision for those with learning disabilities, supported housing and capital for the mental health estate as a whole.
- Collaborative governance: The creation of integrated care systems embodied a shift to collaboration to ensure the NHS delivers better value with the resources it has available. Integrated care board (ICB) governance structures were set up to facilitate this, bringing partners together from NHS trusts, primary care and local government. While the replacement of local authority with strategic authority leaders on ICBs makes sense to adjust to wider reform in local government, amending legislation to remove provider organisations from ICBs is concerning. If the statutory requirement is removed but ICBs leaders retain local flexibility to do this, that could be empowering. But a legal ban on provider organisations sitting on ICBs could be counterproductive to facilitate collaborative governance.
Advocacy and commitments
What we called for
1. Revise the NHS Operating Framework, based on devolution and subsidiarity, to provide clarity on roles and responsibilities for delivering the three shifts.
What the plan says
- Page 75-84: We will create a new NHS operating model, to deliver a more diverse and devolved health service... The lack of clarity in the system about roles and purpose will be fixed by establishing clear priorities, mandating fewer targets and equipping local leaders to improve population outcomes the centre of the system in Whitehall will be smaller, more agile, and focused on developing strategic frameworks and building partnerships
- Seven NHS regions... responsible... for performance management and oversight of providers
- ICBs will be strategic commissioners of local health services
- providers will continue to deliver NHS services... good or high performing organisations should have greater autonomy
- The neighbourhood health service... will bring care into local communities; convene professionals into patient-centred teams; end fragmentation... transform access to general practice and prevent unnecessary hospital admissions (page 27).
What we called for
2. Strategic commissioning led by integrated care boards (ICBs) to harness the collective power and expertise in the system to design services for outcomes, not activity.
This will require the right skills, including developing diplomatic and data analysis skills and supporting system leadership.
See Pioneers of reform: realising a new vision of ICB strategic commissioning (2025).
What the plan says
Page 79:
- ICBs will be strategic commissioners of local health services... using multi-year budgets.
- ICBs will need to evolve new capabilities to be successful in their role. Every ICB will need excellent analytical capability, to be guided by population health data, [and] capability in partnership working and an understanding of value-based healthcare.
What we called for
3. Shift spending from hospital to more preventative community and primary care services by the end of this parliament.
See Unlocking the power of health beyond the hospital: supporting communities to prosper (2023).
What the plan says
- Page 38: We will increase the share of NHS resources spent in the community and decrease the share spent in hospital over the course of this plan
- Page 42: By 2035, hospitals will spend a smaller proportion of the NHS’ total budget.
What we called for
4. Develop outcomes-based targets, aligned with local integrated care strategies and local outcomes framework, including patient-reported outcomes.
What the plan says
Page 78:
- Providers and commissioners will be measured against clear metrics, ranked on performance... Patient reported outcomes, experience and feedback will be among the most important measures on which they are ranked.
What we called for
5. Increase out-of-hospital capacity to provide preventative and more cost-effective alternative services.
See Unlocking the power of health beyond the hospital: supporting communities to prosper (2023).
What the plan says
Page 38:
- We will replace the status quo of ‘hospital by default’ with a new preventative principle that care should happen as locally as it can: digital-by-default… Small amounts of community expenditure can unlock disproportionate amounts of hospital capacity. For example, a 2023 study by NHS Confederation found that £100 spent on community care could achieve, on average, £131 in acute sector savings.
What we called for
6. Agree metrics to define parity of esteem for mental health and set a target to achieve parity by 2035.
See Towards equality for mental health: Developing a cross-government approach (2019).
What the plan says
Page 91:
- We will... publish a first wave of ‘Modern Service Frameworks’ in 2026, which… will include… mental health.
What we called for
7. Develop a national framework for leadership development focused on developing key capabilities for delivering system-wide change. (Raised in a private briefing).
What the plan says
Page 107:
- We will… establish… a new Management and Leadership Framework in autumn 2025, which will include a code of practice, standards and competencies from first-line manager to board level leader, and a national development curriculum.
What we called for
8. Increase spending on the public health grant in England to at least £900 million a year in line with 2015/16 levels.
See Building the health of the nation: priorities for a new government (2024).
What the plan says
Page 83:
- The public health grant is a nearly £4 billion investment in local health outcomes… We have already confirmed a real terms increase in the grant for 2025 to 2026.
What we called for
9. Reform the dental contract, replacing units of dental activity (UDA) with a capitated-budget contract focused on improved oral health outcomes.
What the plan says
Page 31:
- With a new dental contract... we will begin the process of more fundamental contract reform... that matches resources to need, improves access, promotes prevention and rewards dentists fairly.
What we called for
10. Commit to multi-year funding allocations, supplemented by three-year outline allocations to plan investment most wisely, enabling investment to save and realise productivity opportunities over multiple years.
See NHS must be given long-term financial security to move more care closer to home (2024)
What the plan says
- Page 78: We will use multi-year budgets... to enable investment in better outcomes, not just into inputs and activity.
- Page 134: To break the old, short-term cycle we will ask all organisations to prepare robust and realistic five-year plans and demonstrate how financial sustainability will be secured over the medium term.
What we called for
11. Reforms to financial flows, using outcomes-contracts and capitated, risk-weighted payments.
What the plan says
- Page 78: We will use... financial incentives to enable investment in better outcomes, not just into inputs and activity. Resources will be tied to outcome-based targets, which all commissioners and providers will have a responsibility to help meet.
- Page 135: We will create new funding flows and payment mechanisms that connect the savings from improved quality of care with the investment in new services in the community
- Page 135: We will develop year of care payments (YCPs), through test and learn approaches. These allocate a capitated budget for a patient’s care over a year, instead of paying a fee for a service.
- Page 81: For the very best NHS FTs... we will create a new opportunity to hold the whole health budget for a local population as an Integrated Health Organisation (IHO)... Outcomes for patients would be secured through longer-term, capitation-based contracting... Our intention is to designate a small number of these new IHOs in 2026, with a view to them becoming operational in 2027.
What we called for
12. Expanded pooled budget arrangements and develop of proposals for new arrangements, which make pooling budgets easier.
What the plan says
- Page 79: ICBs will be able to pool their commissioning arrangements to allow for at-scale commissioning of new provider networks or chains.
- Page 83: Where devolution and a focus on population health outcomes are most advanced, we... will support these areas... to pool budgets and reprofile public service spending towards prevention.
What we called for
13. Revise the Carr-Hill formula for general practice so that funding is allocated consistently according to need and deprivation across the whole country.
What the plan says
- Page 136-137: We will also review how health need is reflected in nationally determined contracts, such the Carr-Hill formula for general practice.
What we called for
14. Support Mental Health Act implementation to improve acute and community services for people with severe mental illness, learning disabilities and autistic people.
See Mental Health Act Reform: evidence to the joint committee (2022).
What the plan says
- Page 35: We will transform mental health services into 24/7 neighbourhood care models. We will improve assertive outreach care and treatment to ensure 100 per cent national coverage in the next decade, with a focus on narrowing mental health inequalities.
What we called for
15. Empower ICSs to create a more inclusive economy and healthier communities by collaborating with local partners, for example through outcomes-focused funding for work and health, such as the ICS health and growth accelerators.
See Unleashing health and prosperity throughout Britain (2024).
What the plan says
- Page 79-80: We will make strategic authority mayors (or their delegated representative) board members of their ICBs... to best align the opportunities for strategic planning between the NHS and the renewed commitment within local government to support the strategic authority as a key body for growth and prosperity
- Page 68: Our Health and Growth Accelerators are testing a novel approach where local NHS systems are supported to increase – and are held accountable for – the impact they have on people’s work status. If those Accelerators are successful, we will expect all integrated care boards (ICBs) to establish specific and measurable outcome targets on their contribution to reducing economic inactivity and unemployment based on this model... [in] collaboration with local government partners – including mayors and strategic health authorities.
What we called for
16. Prioritise professional development, skills and career pathways which promote working in community-based roles and teams, including non-statutory organisations.
(Raised in a private briefing).
What the plan says
- Page 97: Later this year, we will publish a 10 Year Workforce Plan that... will ask ‘given our reform Plan, what workforce do we need, what should they do, where should they be deployed and what skills should they have?’
- Page 99: We will build on the Leng Review to ensure the safe and effective introduction of new or expanded roles, so it is done in a way which ensures public, patient, and professional confidence is maintained... We will also set out clearly how these new team models will work, including where tasks can be safely delegated.
- Page 99: By 2035, every single member of NHS staff will have their own personalised career coaching and development plan, to help them acquire new skills and practice at the top of their professional capability.
What we called for
17. Increase in the proportion of staff working in primary and community health care.
(Raised in a private briefing).
What the plan says
- Page 29: Our work has already begun. Between October 2024 and April 2025, we recruited 1,700 extra GPs55. We will train thousands more in the coming years, and through the course of this plan we will increase the proportion of staff we train for community and primary care roles.
What we called for
18. Reform clinical educational syllabuses to include the three shifts (especially community-based care) in undergraduate and postgraduate curricula, clinical placements and experience .
(Raised in a private briefing).
What the plan says
- Page 100: Over the next three years we will work with professional regulators and educational institutions to overhaul education and training curricula.
What we called for
19. Transform work and care models, support in enhancing productivity and ways of working through technology, fostering multi-disciplinary teams with new roles, and promoting community-based care with professional development and career pathways.
What the plan says
- Page 98: Our ten-year vision is for a workforce where every individual is supported to reach their full professional potential... staff will be AI trained, digitally confident and have skills in modern leadership, transformation and innovation. Staff will be supported to develop new skills and operate at the top of their professional capability.
What we called for
20. Reform the capital spend and stream approval process to accelerate investment in and delivery of modern estate, equipment and digital tools.
Consolidate the number of approval stages from up to seven down to a maximum of five to reduce delay and cost.
See Capital efficiency: how to reform healthcare capital spending (2025).
What the plan says
- Page 138: [We will be] devolving more control over capital budgets to the frontline with fewer restrictions on what providers can spend their capital on and greater flexibility to spend funding between financial years.
- Page 138: [We will be] radically streamlining the capital approvals process to foster dynamism and swifter delivery. We expect to have at most 3 approval levels on the very largest nationally significant schemes (one provider level, one regional/national and one cross government).
What we called for
21. Deliver longer-term funding and planning cycles with more flexibility on capital spending limits.
See Capital efficiency: how to reform healthcare capital spending (2025).
What the plan says
- Page 138: Introduce multi-year capital budgets, set on a rolling five-year basis in line with wider government capital allocations. We will set out allocations up to 2029 to 2030.
What we called for
22. Devolve capacity and capability to local systems to manage budgets and existing assets and greater control over the assets in their footprint.
See Capital efficiency: how to reform healthcare capital spending (2025).
What the plan says
- Page 139: All trusts [will] have the authority to: retain 100 per cent of receipts from the disposal of land assets they own; these are a credit in excess of existing capital limits automatically in the year of disposal and require no additional authorisation.
What we called for
23. Enable systems to raise private investment to boost annual productivity growth to 2 per cent a year.
See Capital efficiency: how to reform healthcare capital spending (2025).
What the plan says
- Page 139: The Ten Year Infrastructure Strategy the Government committed to evolve its infrastructure finance models and set out that it will consider the use of Public Private Partnerships (PPP)… We will progress rapidly, working across government, on a business case around Neighbourhood Health Centres that sets out the potential and an assessment of value for money so that a final decision on the approach can be taken by the time of Budget 2025 in the autumn. Our approach will build on models currently in use (for example, from the operation since 2017 of the Welsh Mutual Investment Model).
What we called for
24. Publish and implement a digital, data and technology workforce plan that addresses recruitment, retention, training and future talent pipeline.
See Frontline digitisation: creating the conditions for a digital NHS (2024).
What the plan says
- Page 98: Our ten-year vision is for a workforce where every individual is supported to reach their full professional potential. As part of our objective to give the NHS the most AI-enabled workforce in the world, staff will be AI trained, digitally confident and have skills in modern leadership, transformation and innovation. Staff will be supported to develop new skills and operate at the top of their professional capability
What we called for
25. Improvements in providers’ and systems’ capabilities to unlock the potential of digital technology for enhancing staff efficiency and patient choice. Inconsistent digital infrastructure and maturity across ICSs hinder data sharing, efficiency and effective digital care.
See Frontline digitisation: creating the conditions for a digital NHS (2024).
What the plan says
- Page 28: We will fully digitally enable the Neighbourhood Health Service, with the NHS App allowing patients to book appointments, communicate with professionals, see who is on their team, share their data, receive advice and self-refer or tests: a ‘doctor in the pocket’ of every patient.
What we called for
26. Digital tools and data analysis using population health management approaches are crucial for risk stratification and population segmentation, facilitating monitoring progress and ensuring sustained investment.
See Pioneers of reform: realising a new vision of ICB strategic commissioning (2025).
What the plan says
- Page 78: ICBs will need to evolve new capabilities to be successful in their role. Every ICB will need excellent analytical capability, to be guided by population health data.
What we called for
27. Require all health and care providers to publish into a comprehensive Citizens Account to support self-management. Ensure a shared patient record system supports integrated care, removes silos and leverages AI for population health management and coordination.
What the plan says
- Page 48: We will introduce a new Single Patient Record (SPR). The SPR will bring together all a patient’s medical records into one place. Clinicians will be able to securely access it in order to deliver higher quality care - and patients will be able to add their own data from clinically validated wearables. The SPR will operate as a patient passport, making sure patients get seamless care no matter where they are in the NHS.
What we called for
28. The NHS needs adequate capital funding to invest in digital technology, an extra £3.1 billion capital funding over the next three years, with parity of investment across provider types.
See Frontline digitisation: creating the conditions for a digital NHS (2024).
What the plan says
- Page 137: We have boosted the capital budget by £3.1 billion from financial year 2023 to 2024 to financial year 2025 to 2026 - and invested more than £2 billion in technology and digital to support higher quality and productive care.
What we called for
29. Improved procurement. Many mental health providers are already using AI to aid in diagnosis, delivery of therapy and administrative or clinical decision-making tasks. But navigating the technology market and implementing the most evidence-based solutions remains challenging. This process could be brokered more effectively to ensure the best outcomes.
What the plan says
- Page 55: To accelerate [adoption of AI], and bring benefits to the frontline more quickly, in 2026 to 2027 we will undertake a framework procurement process that can be accessed by all NHS organisations and provide support to GPs and trusts, so they can adopt this technology safely.
What we called for
30. Primary care provider collaboratives can unite primary care providers at local and system levels to have a collective voice.
See Realising the potential of primary care provider collaboratives (2024).
What the plan says
- Page 30: We will encourage GPs to work over larger geographies by leading new neighbourhood providers.
What we called for
31. Form effective partnerships across the public sector, voluntary, community and social enterprise (VCSE) sector and businesses, equipped with the right levers and incentives to focus on helping people keep healthy.
See How health and care systems can work better with VCSE partners (2020).
What the plan says
- Page 78: The function of the centre will change alongside its form. Alongside setting strategy, its purpose will be to form partnerships with investors, industry, local government, employers, small or medium-sized enterprises (SMEs), voluntary organisations and trade unions. There will be an explicit goal to make the NHS the best possible partner and the world’s most collaborative public healthcare provider.
What we called for
32. Introduce earned autonomy over capital spending, earned through positive regulator reviews, with a cascading amount of freedom allowed based on past performance.
See Capital efficiency: how to reform healthcare capital spending (2025).
What the plan says
- Page 138: The best providers should be empowered to manage their own assets. Over time, new FTs will therefore no longer receive or be dependent on NHS capital allocations but will have the freedom to determine their levels of capital spend.
What we called for
33. Drive change laterally through a combination of peer review and challenge and peer support. See Leadership and improvement.
What the plan says
- Page 80: NHS will also establish its own self-financing improvement capability - drawing on the talent, innovation and energy of the best of the NHS.
- Page 83: From 2026, we will set the expectation that every single or upper tier local authority participates in an external public health peer review exercise, on a five-year cycle, with the results directly informing local plans. We will work with the Local Government Association and other improvement experts to help local government public health services improve and adopt best practice.
What we called for
34. Introduce a Single National Formulary for medicines in England to free up more of local teams' time to improve care and reduce variation in patients' access to medicines.
What the plan says
- Page 126: We will... move to a Single National Formulary (SNF) for medicines within the next 2 years. We will create a new formulary oversight board, responsible for sequencing products included in the formulary based on clinical and cost effectiveness, supported by NICE. Local prescribers (such as clinicians and pharmacists) will be encouraged to use products ranked highly in the SNF but will retain clinical autonomy as long as they prescribe in line with NICE guidance.
