10-Year Plan: Key policies revealed

The plan was published this morning, setting out a wide range of changes to NHS financial management, accountability and care delivery, which prime minister Keir Starmer said were “radical and urgent”.

These are in addition to several key changes revealed by HSJ in the past 10 days: A significant overhaul of foundation trust and integrated care board roles; abolition of numerous national and local bodies; changes to NICE regulation and drugs and devices commissioning; a new voluntary staff contract with performance-related pay; new contracts for neighbourhood health; and patients determining part of providers’ payment for activity.

Finance and performance

The plan said NHS trusts could have their budgets legally capped like local councils if the service cannot fix its “addiction” to deficits and said “more money has not always led to better care”.  

As part of measures to restore financial discipline, the document states deficit support funding will be removed entirely from next year, with all NHS bodies expected to deliver operational plans that meet planning guidance targets, with “no exceptions”.  

All organisations will in future be required to carve out 3 per cent from annual budgets for investments in service transformation, while tariff prices will shift from being based on average costs to best clinical practice, to drive productivity. 

Andy Haldane, former chief economist at the Bank of England, will be asked to review productivity trends over time, to inform a new productivity index to track local and national performance.  

As reported previously, the document outlines a new financial regime with sweeping changes to the existing tariff system. However, it only commits to a “decisive shift” in investment from hospitals to community over a decade, rather than within this parliament as previously promised, although investment in neighbourhood health centres will ramp up in the coming years.  

The final version of the plan has watered down a commitment for all providers to be in surplus by the end of the decade, instead stating this should be the majority.  

The plan says greater use of remote care, more being done in the community, and avoiding unnecessary appointments mean the NHS will “end outpatient care as we know it”, setting a target that “by 2035, most outpatient care will happen outside of hospitals”. 

In terms of urgent and emergency care, the plan said “My NHS GP”, a new AI-enabled tool in the NHS App, will help patients to find alternatives to A&Es. By 2028, the plan pledged that more patients will be able to “book” urgent care services via 111 or the app.  

It reiterates ambitions set out in the urgent and emergency care strategy for “mental health emergency departments” and added the £120m funding will cover 85 crisis centres, meaning there will be one co-located with (or very close to) 50% of existing type 1 A&E units.  

There is very little else on mental healthcare ambitions, with a pledge to ”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,” the document said.

Greater use of AI by ambulance trusts will also be used to avoid sending ambulances when they are not needed. “See and treat” – where ambulance staff attend but do not take a patient to A&E – will be strengthened through improved access to specialist teams to offer support and advice, as well as ambulance staff being able to access the single patient record. 

The specialist advice could be from hospital staff or from neighbourhood teams but they will all be able to view the patient remotely and have access to diagnostics.    

Capital 

There is a greater openness towards private capital investment. However, plans to use this for secondary care - ruled out in last month’s government infrastructure strategy - were removed from the final plan.  

Instead, a business case will be worked up for public-private partnership for “neighbourhood health centres” in every community. The rollout will start with public sector capital. 

Much of the capital strategy relies on greater freedoms awarded to foundation trusts, as previously reported. Their capital plans are expected to be automatically approved where spending is funded by operating activity. 

There will also be greater flexibility for capital spend between financial years, and five-year capital budgets, in line with wider government. 

Nationally-held capital budgets will only be held in “exceptionally strong” cases such as the New Hospital Programme, and the capital approval process sped up with three approval levels – at most – for the largest schemes. 

Organisational change 

As already reported, the Department of Health and Social Care will seek to approve the first “new FTs” in 2026, but the plan confirmed an ambition for every NHS provider to become an FT by 2035. 

They will no longer be required to have governors, and will have a “greater focus on partnership working and on population health outcomes” than the current FT model.  

As part of capital regime reforms, new FTs will also be able to “process larger self-financed schemes as long as they are consistent with overall financial planning”. The “very best” FTs will have the opportunity to hold the entire health budget for a defined local population as an “integrated health organisation”.  

IHOs will “become the norm” over time. Initially, a small number of IHOs will be designated in 2026, with the aim for these to become operational in 2027.  

In terms of neighbourhood, the plan said government will work with strategic authorities - with which ICBs should be coterminous where possible - as “prevention demonstrators”. These demonstrators will have “increased autonomy” to trial new approaches to prevention supported by mayoral “total place powers”. They will also be able to explore opportunities to “pool budgets and reprofile public service spending towards prevention”.  

The Better Care Fund will also be reformed from 2026-27, with a focus on “providing consistent, joint funding” to services which are “essential to deliver in a fully integrated way” such as discharge, intermediate care, rehabilitation and reablement. 

Workforce and quality

The plan has promised a new 10-Year Workforce Plan later this year and said there will be fewer staff in 2035 than projected by the NHS Long Term Workforce Plan, but that they will have “better training and more exciting roles”. 

It has promised to introduce a new set of staff standards which will, for the first time, “outline minimum standards for modern employment”, which will be introduced in April 2026. 

It set out vague promises on reducing the NHS’s dependence on overseas staff and alluded to reform of national employment contracts amid longstanding frustration over pay structures such as the Agenda for Change framework. 

The 10-Year Health Plan signalled that poor quality care won’t be allowed to persist, with options including bringing in new leadership teams or providers, and ultimately decommissioning or terminating the contracts of existing services. 

The National Quality Board will be reformed and develop a new quality strategy for the NHS, as well as modern service frameworks, similar to the national service frameworks used in the past. The first wave of these frameworks will come next year, with priorities including cardiovascular disease, mental health, frailty and dementia. 

A new AI-led warning system will build on the capabilities of the federated data platform to flag concerns, which could trigger a Care Quality Commission inspection. 

The plan said that when concerns are identified, the CQC will “rapidly assemble inspection teams of highly qualified staff” to assess service quality. The CQC will also be given additional powers to bring legal action against providers.

Technology

There will be an ambient voice technology framework for hospitals and GPs in 2026 and 2027. The document points to an (as yet unpublished) study in London showing savings in clinician time.

The document says patients will be able to add their own data to the planned new single patient record from “validated wearables”. 

The SPR – which will first be trialled in maternity services – will be made possible “through new legislation that places a duty on every health and care provider to make the information they record about a patient, available to that patient”.

The NHS App will be a “full front door to the entire NHS” by 2028. It will “help direct patients to well evidenced consumer healthcare products”.

Innovation

The 10-Year Health Plan confirmed the government’s intention to streamline procurement and adoption of innovative technology, invest in research and development infrastructure, and foster closer working with industry. 

Alongside plans for an innovation passport, next year the government will introduce value-based procurement guidance for devices and digital products. 

To drive innovation, the government said it will invest in the infrastructure needed for improving research, such as setting up Regional Health Innovation Zones “to give health systems the permission and flexibility they need to be more radical and forward-looking on innovation”. 

The plan also pushes for the NHS to be a better partner with industry. “The new centre will ensure relationships with industry are genuine partnerships, where too often they have been transactional,” it explains. It commits to expanding “the role life sciences and technology companies can play in service delivery”.