Three shifts, two themes, one aim: what’s behind the ten-year health plan

After stretching even a civil service definition of ‘Spring’ to breaking point, it’s finally landed. At 150 pages, it’s long (and let’s be honest, it could, and should have been 20 with a more liberal use of a red pen). It’s also bold. Perhaps too bold? HSJ and other Think Tanks certainly think so.

But let’s look past that and see that the NHS has fundamentally just been reset and rewired.

Rather than focusing on all the details (we’ll do that instead on our Webinar on Tuesday – sign up here) I outline what I see as the 3/2/1 structure for the Plan.

Starting with the familiar, we all know Lord Darzi’s three shifts: from hospital to community, analogue to digital, sickness to prevention; and the Plan is based on achieving these.

Yet, read closely and what really stands out is that there are two cross-cutting themes in how to achieve them, that run through every chapter:

Firstly; ‘Take the best to the rest’, and

Secondly; ‘Power to patients’

Together, these two themes indicate a profound shift in how the health system is powered, accountable and delivered. They are the principles for what the plan calls a “reimagined NHS”, with control flowing outwards: to providers, places, and most importantly, to people and patients.

And, critically, they’re how the government hopes to achieve its one overriding aim, how it knows it will be judged at the next election, to bring down waiting lists.

Taking the ‘Best to the rest’

While saying repeatedly that no ‘one size fits all’ the plan is clear that some areas are doing better than others, leading the way and others should emulate them. This is where take the ‘Best to the Rest’ guides the new mindset of the system.

While it’s not “one size fits all,” it can be coined as “do what works, everywhere.”

This is no different to how it has always been. High-performing areas have always outpaced others. The difference now is incentives and penalties.

Services and leaders that underperform will be restructured or removed. Those who lead in outcomes, access and patient experience will be given autonomy and resources to do more. This idea of formalising best practice, earned autonomy, and pushing it system-wide underpins everything from contracting to capital spending.

Integrated Health Organisations (IHOs) – (covered by WA Advisor David Thorne here) where a provider takes responsibility for the full health budget for a local population, will be scaled from early pilots. The plan backs shared back-office infrastructure (let’s not forget that DHSC Perm Sec Sam Jones knows this area having previously been CEO of Centene UK), common care pathways, and stronger commissioning from ICBs aligned with strategic authorities.

A key mechanism for delivering “the best to the rest” will be the introduction of new Modern Service Frameworks, due from 2026. These will set clear, accessible standards for care across major clinical areas, starting with cardiovascular disease, mental health (including severe mental illness), frailty and dementia. Informed by the work of Baroness Casey’s social care commission, the frameworks will provide a national benchmark for what good looks like, while allowing local systems to tailor delivery. They’re designed to reduce unwarranted variation, drive investment into underperforming areas, and ensure that every part of the country is working towards the same outcomes.

Payment mechanisms will be geared towards keeping people out of hospital, avoiding unnecessary outpatient appointments, and for benefits to be felt across local systems. Multi-year budgets, long called for, will be introduced.

Importantly though, the Plan directs a shift in accountability. Take the Best to the Rest means power no longer sits with the centre. Providers will need to earn their freedom by delivering real and measurable improvements. Commissioners will be judged on outcomes. Poor performers won’t just be slowly tolerated, they’ll face formal interventions. While there remains a question on how quickly poor performing areas can be spotted, action taken and things turned around, it’s going to become a more transparent, data-led, rules-based system. And it’s designed to confront the quiet and arguably avoidable inequality in care and outcomes that has long allowed postcode lotteries to persist.

Power to the patient

The second crosscutting theme – power to the patient – is just as fundamental.

What it means to be a patient, and conversely what it means as an HCP caring for a patient, is going to change. For many of us working in healthcare communications and policy, this is an exciting shift – one where we genuinely consider outcomes and experiences in the round.

People will no longer just be the receivers of care deemed available and appropriate by the system.

People will shape and lead it: guided by data and intelligence (genomics is a huge winner), be enabled by technology, and empowered by new legislation.

The NHS App becomes the gateway to this transformation. Let’s be honest – a lot is being put on the App….My Vaccines, My Medicines, My Care….but let’s withhold doubt for the moment because if it works, it will let people choose providers, book appointments, manage medicines, access records and co-produce care plans.

It will also let them give feedback that informs payment and improvement – even, (how this will work is yet to be seen) withhold full payment to providers if their experience falls short.

This is a serious reframing of accountability.

But it means that the patient isn’t at the end of the system. They’re at the centre, with new tools, data and rights to steer their own care and influence system performance.

Even the way care is structured is being rethought with this in mind. From patient-initiated follow-up and personalised budgets to genomic risk scoring and home-based diagnostics, the plan is designed to give people the means and powers to manage their health.

Of course, there will be questions on whether this goes far enough, particularly with the scrapping of Healthwatch, and what the mechanisms will be for how commissioners and providers will truly involve patients from Board to Ward.

But for professionals and organisations, it means working differently: in partnership, transparently, and increasingly on the patient’s terms. The Plan talks about a ‘GP in patients’ pockets’ – there’s a literal and figurative way of interpreting that, both of which could become reality under the Plan.

One aim

All of this, the structural changes, the scrutiny, the changes to funding flows, ladders up to a clear political goal: getting waiting lists down.

Government knows it will be judged on outcomes at the election and it makes this a three-seven plan: A three-year sprint to bring waiting lists down and win public confidence. Then seven years to embed more radical transformation and shift the NHS towards a future model of care.

Whether the ambition is delivered is still uncertain – at the risk of being a naysayer, the money given is just enough to cover the ageing population, the payrises for clinicians, pensions and inflation.

There’s also a dependence on productivity to realise ambitions, which has echoes of the reliance Labour has on growth at the macro level.

But the direction of ambition is clear.

And for anyone working in or around health, whether in delivery, communications, or policy, knowing these two themes is important. Because they’re not just about the NHS plan. They’re about how the whole health system is being reshaped, powered and delivered.