Why the Government’s new 10-year plan for the NHS needs an overhaul

On 3 July 2025, the government launched its 10-year plan for the NHS. While there are many ideas within the plan which are positive, overall it suffers from a lack of joined-up government (not within the remit of the Department of Health and Social Care alone to fix), a failure to learn from the successes (and failures) of the 1997-2010 renewal of the NHS — and it is difficult to believe that it can succeed.

Many of the themes within the plan make good sense: shifting from treatment to prevention is clearly the right approach; moving wherever possible from hospital to community also makes good sense, though it may not produce the anticipated short-term savings. Moving from analogue to digital is double-edged: there can be no downside to automating bureaucracy but there could be a huge downside from automating human contact with patients. Tackling regional health inequality — the so-called inverse care law — is welcome. And better treatment of NHS staff will be essential.

Where the plan is weaker is in seeing the big picture. It begins by citing Lord Darzi’s conclusion that the NHS is in critical condition, and implies that he “revealed the sheer extent of [the NHS’s] current failings.” Lord Darzi did conclude that the NHS was in critical condition — but in no way did he imply that this was down to failings of the NHS itself rather than wider policy failings such as sustained underfunding (particularly capital underinvestment), weakening of preventive care and exacerbating the social determinants of ill health. You cannot break a country and then blame the NHS for failing to pick up the pieces.

The last labour government oversaw a very successful renewal of the NHS. In 1997, public satisfaction with the NHS had hit what was then an all-time low; by 2010, public satisfaction had risen to an all-time high. This government urgently needs to learn from what worked — and avoid what did not work — during that renewal. Our report, The Rational Policy Maker’s Guide to Rebuilding the NHS, analysed the 1997-2010 turnaround in detail, and showed that the increase in healthcare output was almost entirely driven by proper funding of the NHS. The other initiatives launched in that period (like PFI, which now appears to be back on the table, despite past failures) were collectively negligible (at best). Overall, the turnaround succeeded because that government did look at the big picture: they did fund in line with need; they did tackle prevention; and they did deal effectively with the social determinants of ill health — in particular, through the poverty reduction initiatives.

This plan may improve prevention, but it is not planning to fund in line with need: it is proposing an increase in funding lower than the increases during the 1997-2010 period and to a spend per head far lower than that of almost all our peer countries. It contains — due to the lack of joined-up government — no realistic attempt to tackle the social determinants of ill-health. Indeed the only mention of that vital issue comes in the financially illiterate passage, “The NHS today accounts for 38% of day-to-day government spending – a figure projected to rise 40% by the end of the decade – crowding out investment which could tackle the wider social determinants of ill health. That is unsustainable.”

The reason why the NHS rises as a percentage of total spend is because, under austerity, all other Departments have been starved of funds to an even greater extent. That is unsustainable, but not because of excessive spending on the NHS. That the plan perpetuates such muddled thinking is not the fault of the DHSC — it is down to a misplaced commitment to the government’s fiscal rules.

There is no question that the UK is in a difficult situation now: more difficult than in 1997. But it is not as difficult as in 1946. After the Second World War, our debt:GDP stood at around 250%, roughly half of GDP had been diverted to the war effort — we had been making things that suddenly nobody wanted any more. We had lost around 1 million people. And our infrastructure was in worse shape than today.

National renewal was a priority then as now. But if Attlee had been constrained by today’s fiscal rules, he could not have implemented the Beveridge Plan — and that means that we would have no NHS today. Thankfully, Attlee listened to Keynes who said, “Anything we can actually do, we can afford.” He found the money. And he ushered in the most successful period in the UK’s economic history.

When governments are determined and resourceful, they can find a way.

The 10-year plan warns of the danger of turning the NHS into a poor service for poor people — ironically, as it stands, this plan perpetuates that danger.

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