Implementing the Ten-Year Health Plan: ensuring an effective approach to change

As national organisations supporting healthcare improvement, we welcome the bold ambitions and optimism set out in the Ten-Year Health Plan. These vital reforms are needed to address deep-seated health inequalities and put the NHS on a long-term sustainable footing. 

Many people will be reading the plan, agreeing with its vision but wondering how to best approach the change required to get there. Bridging the gap between having ideas and delivering improved outcomes requires a clear, fresh and effective approach to implementation. A credible approach to change will consider staff, communities, the way things are done and the support available to them. While a clear plan is needed, ultimately it is people – not a plan on its own – that will deliver a health service fit for the future.

Learning from what works, an effective approach to leading change must: 

• Equip staff and communities with the support they need to lead the design and delivery of changes to services they know best.   
• Couple proposals for data transparency, new funding flows and incentives with the space, support and permission for healthcare teams to be innovative and agile in continually evolving services in response to user needs. 
• Use systematic improvement methods: approaches that enable a culture and practice of rapid experimentation and achieve lasting safety, quality and productivity benefits for all. 
• Combine the commitment to shape services locally with flexible and effective ways to help people learn from and adopt what’s happening elsewhere. 

With our nationwide connections to health and services, we are here to help a devolved operating model work. Bringing in the evidence, examples and experience of our members, we look forward to working with the Department of Health and Social Care, NHS England and chief executives to design an effective implementation strategy. Together, we can create a joined-up system for learning, improvement and transformation. 

How improvement approaches can make the plan reality

Equipping local teams with the licence, tools and connections to implement change well is mission critical. Otherwise, flagship recommendations will take too long and fail to deliver at scale. 

In practice, this means:

From hospital to community 

• Fostering a shared neighbourhood health vision across local partners and communities. 
• Providing support for multi-agency place-based teams at multiple levels to build the high levels of trust and cooperation required. 
• Developing VCSE partnerships and leaders skilled in understanding and tapping into community assets and process re-design to make a reality of the new neighbourhood health centres. 

From analogue to digital

• Capitalising on the transformative potential of technology to reshape services.
• Avoiding simply adding a ‘digital front door’ to broken processes, which would quickly lose patient confidence Invest in redesigning processes, schedules and roles ahead of digitisation so that newly tech-enabled service models are safe, reliable and better value. 
• Co-designing with staff and patients; investing in digital literacy and proactively addressing access barriers so they can fully trust in new approaches and are confident to stop ‘back up’ processes. 

From sickness to prevention

• Building community wealth and health through vibrant partnerships across the whole of the public sector, businesses, voluntary, community and social enterprise (VCSE) organisations and communities themselves. 
• Strengthening partnerships between public health teams, health and wellbeing boards, integrated care board population health functions and NHS and primary care practitioners working within communities.
• Promoting wider use of public health improvement tools, including asset-based community development and the population health intervention triangle of civic, community and service-led actions.

Quality and productivity 

• Building staff understanding and support for a broader vision of quality, which encompasses productivity, safety, equity, effectiveness, timeliness and experience.
• Ensuring the evolved role of the National Quality Board and the Modern Service Frameworks are accompanied by the space and skills for staff to properly feed in and then implement local changes.  
• Increasing the speed of spread and adoption of what works through an NHS-wide learning system; and creating productive safe spaces for people to improve with their peers. 

New operating model, organisations and partnerships

• Helping create a joined-up improvement system to orchestrate national, regional and local initiatives to address our biggest challenges. Aligning and improving regulation and performance management guided by what will practically enable service transformation. 
• Building analytical capacity and shared understanding of patient needs and operational flows to guide the design of new organisations and the re-shaping of services. Coupling this with change skills and relational leadership to create enabling workplaces for change.
• Creating local quality management systems and culture that can provide reliable local accountability and continuous improvement, as regulatory oversight reduces. 

What needs to happen next?

Matthew Taylor, Chief Executive, NHS Confederation: 

“We welcome the plan’s bold ambitions and endorse the move towards a more devolved operating model where the centre is more enabling and less prescriptive, and the service establishes its own ‘self-financing improvement capability – drawing on the talent, innovation and energy of the best of the NHS’.

Any implementation planning must be accompanied by a clear theory of change and leverage a peer-to-peer approach that should underpin a more devolved model. Including how we both allow those who are able to accelerate progress and trial new models and help those who continue to need support. It should also set out the ‘how’ around resetting the relationship between the NHS and the public, so communities are at the heart of reform and we support people to be active in their own health.”

Daniel Elkeles, Chief Executive, NHS Providers: 

“The NHS Ten Year Plan represents the biggest re-imagining of how the NHS delivers care and operates in a generation.  The key challenge now is translating that into action. Some trusts have made a running start, innovating and collaborating to deliver progress on the three big shifts, but we need to go further and faster, creating a gravitational force for improvement that impacts on every part of the service. 

NHS Providers is proud to be part of that project, exploring and sharing new approaches, pointing out the pitfalls and showcasing success, so that working together we can build a better NHS that measures up to the ambitions set out in the plan.”   

Suzie Bailey, Director of Leadership and Organisational Development, The King’s Fund:

“The government’s Ten-Year Health Plan is a major opportunity to not only change what the NHS does, but also how it does it. To turn the vision of a reformed health service into reality, national leaders should recognise that staff and patients have the deepest understanding of needs in their area. Local leaders should be given the flexibility on how best to meet local needs and the freedom to collaborate with their communities to design and deliver high-quality services. For these reforms to be a success, they can’t simply be ‘done to’ the health and care system, they need to be ‘done with’ staff and communities.”

David Fillingham, Chair, Lancashire and South Cumbria NHS Foundation Trust and Chair, NHS National Improvement Board:

"I greatly welcome the vision, hope and optimism that the Ten-Year Health Plan brings. We now need to all work together to support its successful implementation. The plan itself recognises that this can't be done just by edicts from Westminster or Whitehall. We need to nurture local innovation right across the NHS and create a culture of creativity and experimentation. 

We need to make sure that individuals and organisations aren't afraid of failure and are given the confidence to rapidly test out new ways of working, learning as they go. We need to create the curiosity and relationships at multiple levels, to scale the most promising local innovations. This is how we can genuinely ‘spread the best of the NHS to the rest of the NHS’.... by building an NHS-wide learning system."

Jacob Lant, Chief Executive, National Voices: 

“The Ten-Year Health Plan offers hope for what services could be like in the future, but getting there is going to be a team effort. At National Voices, we aim to connect our member charities, the wider VCSE, and communities with NHS leaders at national and local level to help design solutions that tackle real-world problems based on people’s real-life experiences of care. 

“By putting users at the heart of the implementation process, we can ensure services better meet people’s needs first time and unlock the power of individual and collective agency to promote better health and condition management. Crucially we understand that agency is not an equitable concept, and we can help ensure that services are designed to work with patients to tackle inequalities in all its forms and help put the NHS on a more sustainable footing once more.”

Penny Pereira, Managing Director, Q:

“The Ten-Year Health Plan for England sets out an exciting vision. Now we need a systematic and inclusive approach to implementation that will inspire staff and actually work. Collaborative improvement approaches give people the means to lead changes to services in practice, measuring and iterating as they learn together. 

The size and diversity of the Q community shows there are examples, expertise and energy for transformation in every part of the NHS to build on. Too often great ideas and critical insights get stuck in silos. We need purposeful and effective approaches to scaling what works and connecting across sectors if we’re to achieve the shifts described in the plan. We’re excited to play our part over the weeks, months and years ahead.”