Implementing the 10 Year Health Plan: eight things we’ve learned

A month after its release, we brought together experts to explore this ‘implementation gap’. Over a two-part webinar series, we heard from senior figures – including Dr Penny Dash, Sir John Oldham and Louise Ansari –  about how to deliver change in a way that empowers the health and care system and patients.

Here are eight key things we learned. The series was funded through sponsorship by Boehringer Ingelheim Ltd, and both sessions were chaired by the NHS Confederation’s chief executive, Matthew Taylor.

1. Neighbourhood health is about relational, not structural, reform 

Neighbourhood health was described as a transformative shift in how care is delivered – moving away from siloed services and towards integrated, community-based support. This model recognises that no single organisation can meet the complex needs of patients – particularly those with multiple long-term conditions – alone. Instead, it calls for the mobilisation of local assets, including voluntary and community organisations, as well as community members themselves, to co-manage care and improve outcomes. 

There was a strong feeling that neighbourhood health will fail if it is seen as a restructure or reorganisation of where NHS services are provided. Neighbourhood health is not just a structural reform – it’s a relational one. It must be seen as a meaningful way of harnessing the power of people and mobilising common assets beyond the NHS, within communities themselves. By redistributing power, fostering trust and investing in community partnerships, the NHS can build a more resilient, responsive and equitable health system.

From September, 42 places will be selected to pilot neighbourhood health models as a part of the neighbourhood implementation programme. The ambition is clear: build services around people, not conditions. That means frailty, long-term conditions and mental health all being managed closer to home, with community partners, including VCSE sector organisations and local authorities, playing a central role.

2. The new operating model is vital scaffolding

Key to empowering the health and care system is the move away from centralised control, moving towards a smaller and more agile centre, greater devolution to local leaders, with simpler outcomes-based rules and requirements to hold them to account for delivery.

Integrated care boards (ICBs) will lead in the creation of neighbourhood health through their role as strategic commissioners, with a mandate to tailor services to local needs. Carefully supporting systems facing the greatest challenges due to clustering, cuts and leadership changes will be critical to ensuring neighbourhood health is implemented effectively. 

At the same time, a balance will need to be struck between ensuring consistency in service delivery across the NHS and allowing flexibility in care models to reflect the unique assets and needs of local communities.

3. There is agreement on immediate and long-term priorities 

Systems are facing several knotty issues. Improving productivity remains a big challenge and pressures on ICBs have taken a toll on morale. And there’s a risk that public league tables – while intended to increased transparency – could lead to further distrust in the NHS. 

But our first webinar suggested that there is clarity and alignment on how to address these challenges. There is agreement on the immediate and long-term priorities: improve financial performance, enhance patient experience and support staff, while working to shift towards a more preventative model of care, delivered closer to people’s homes.

However, panellists acknowledged that it’s not just about what is delivered, but how it’s delivered. The government’s three shifts have been the goal of many past NHS strategies and plans. The success of the 10 Year Health Plan will lie not in articulating these challenges and the changes they will require, but in delivering them. 

4. There is strong appetite for collaboration

One of the most encouraging themes to emerge was the strong appetite for collaboration. Rather than prescribing a single way of working, the 10 Year Plan lays the foundations to empower local leaders to build on existing relationships and assets. This permissive approach is a strength – it enables continuity while driving change.

There is also a renewed emphasis on holistic, person-centred care, with a noticeable shift in language: from services to ecosystems, from silos to partnerships – all rooted in the needs of people and communities.

To make this work, providers need the headspace to strengthen existing relationships and, where this makes most sense locally, to increasingly take on greater responsibility for integrating services. This needs to be supported by a clear and consistent strategic direction from the centre, longer-term financial planning that offers greater certainty, and by financial flows designed to enable local collaboration. 

5. Want buy-in from patients? Address frustrations around access 

Our webinar on empowering the public emphasised that empowering patients is not just morally right – it’s essential for system sustainability. The 10 Year Health Plan lays out powerful levers for patients, arming them with more choice, more opportunities to give feedback on care they are receiving, with greater access to data to inform their choices about the care they receive, and financial levers in the form of patient power payments.

Overall, these are valuable improvements to empower patients, but they must be combined with greater support and access to care for patients to make use of these interventions.

The panel argued that alongside these individual measures in the plan, there is a need for deeper partnership working between patients and the NHS. Patients with multiple long-term conditions spend much of their time managing conditions outside clinical settings, yet most resources are focused on clinical touchpoints. Systematising co-management and respecting patients’ own expertise can lead to significant reductions in hospital admissions and improved health and wellbeing.

This means supporting patients with the right tools, technologies and relationships to manage their health and long-term conditions. Primary care will be key to this, connecting patients to relevant services and tools in their communities. Addressing frustrations around access to services is the first necessary step to securing buy-in from patients in this partnership. Primary care must be supported to work at scale to ensure services are more joined-up and to support the shift towards community care.

6. A culture of permission, not instruction, will unleash innovation

Delivering neighbourhood health will require a fundamental culture shift. The panel acknowledged that previous efforts to integrate services have often fallen short, largely due to incentives that reinforce siloed working and discourage collaboration. Too often, NHS services operate in isolation, disconnected from what is happening in the community. Tackling this disconnect is critical to unlocking the cultural transformation needed. Brave leadership will be key to developing new relationships with communities that facilitate neighbourhood health. 

The 10 Year Health Plan lays the foundations for moving towards a more permissive outcomes-based approach that encourages joined-up services and enables local innovation. By shifting from a model of instruction to one of permission, the system can unleash significant latent energy for innovative, effective neighbourhood health. 

7. Patients need to feel like partners in research and innovation

The importance of involving patients early in clinical research and digital innovation was highlighted. When patients are treated as equal partners, research becomes more relevant, inclusive and impactful. The NHS must move away from passive consumption and towards active participation – co-creating solutions that reflect the real needs of patients and building genuine trust.

8. Empowering the system, not just reforming it, is the ultimate aim

The delivery of the plan is still evolving, with more detail expected in the coming weeks. But the direction is clear. The NHS is being asked to move faster, go deeper and work together – putting aside organisational and professional boundaries to deliver a fundamentally new model of care that is delivered in neighbourhoods. The hope is that this time, the system won’t just be reformed – it will be empowered.

Panellists included:

• Dr Penny Dash, Chair of NHS England
• Ed Moses, Director of Policy and Engagement at the Department of Health and Social Care (DHSC)
• Dr Ify Okocha, Chief Executive of Oxleas NHS Foundation Trust
• Louise Ansari, Chief Executive of Healthwatch England
• Sir John Oldham, Strategic Advisor to Secretary of State for Health and Social Care
• Dr Duncan Gooch, GP Partner and Chair of the NHS Confederation’s Primary Care Network
• Lisa Taylor, Head of Clinical Development and Operations UK and Ireland, Boehringer Ingelheim.