Where is the 10-year health plan's focus on outcomes, social care and quality?
Health secretary Wes Streeting launched the government's new 10-year health plan for England on July 3, 2025
4 min read
The government's plan contains some transformational ideas, but is hampered by a misplaced focus on targets rather than outcomes, writes former health secretary Lord Lansley
Once I had got over the irritation that the 10-year health plan didn’t actually have a clear index to its contents or paragraph numbering, I settled down to read it front to back (Starmer to Streeting, as it turned out). So, what is in this: good, bad or ugly?
Let’s start with good. AI is potentially transformational in healthcare and the 10-year plan embraces that potential. A virtual assistant in the pocket of every clinical professional is great. The NHS has potentially the most complete data on the most diverse populations anywhere. AI can dramatically change clinical practice to enable the human professionals to focus on the patient, while AI puts all the information, tests, differential diagnosis, admin and follow-up in place. But the NHS has been among the worst at introducing new large IT systems, so Wes Streeting must ensure it delivers what users need.
The NHS Genomic Service can also be transformational. We have been world leaders in offering gene-editing treatments for genetic conditions, identifying gene mutations through life and optimising preventative care.
Using Our Future Health, Biobank and the new Generation Study, we can create the world-best data sources for managing population health. Good, too, to focus the Integrated Care Boards on strategic commissioning, on taking providers off the boards – it seems we have rediscovered the purchaser/provider split.
And patient choice is key. The Single Patient Record and choice of provider are good, but beg the question of what exactly can be shared and commissioned “beyond the NHS”.
Abolishing NHS England is not about ending duplication – it is about politicians taking control
Introducing ‘year of care payments’ can secure that change for those with mental health treatments or with long-term conditions, who take near two-thirds of NHS budgets, as long as quality is built in and a year of care budget can be designed. The NHS app can be a vital gateway and can be linked to wearables. But am I alone in having hospital care through a website wholly separate from the NHS app? And where is the link from the NHS app to ‘111’ and access to NHS services?
So far, so hopeful. What’s bad? Most important, this is not the NHS-owned plan, which it was in 2019. Abolishing NHS England is not about ending duplication – it is about politicians taking control. And abolishing HealthWatch (nationally and locally) and asserting that they will “bring patient voice in-house” is nonsense. Labour abolished Community Health Councils in 2003 – why do they hate independent voices on the quality of healthcare?
Bad, too, is the focus on targets rather than outcomes. Where in this plan is the development of the NHS Outcomes Framework? Only two aspects, in patient-reported outcomes and patience experience measurement, are referenced, and those as if they had only now been discovered. If the government really wants value-based healthcare, relating performance and payment to quality is the only way to secure value.
And what is ‘ugly’? Three serious omissions. One, no funded reform of social care. Across the NHS, they know how failing social care led to rising A&E admissions and thousands of avoidable admissions to hospital. I asked Andrew Dilnot to report 14 years ago. Shifting care to community settings demands better care services and care users being able to integrate their health and social care entitlements.
Two, the plan dismisses the 2023 Workforce Plan, but only promises that a replacement will arrive “later this year”. Several of the new staff contracts will take years. Training clinical staff and integrating AI, genomics, robotics in continuous professional development for new and existing staff will be critical, but where is that plan?
And third, where is the delivery plan? The 2019 10-year plan came with a delivery plan and tools for adapting strategic goals to practical delivery. This plan wants a clear framework, timetable and tools for making it happen. The last 10-year plan lasted one year. Then Covid happened. For good or ill, let’s hope this one lasts.
Lord Lansley is a Conservative peer and former health secretary