Most already know that the UK health and social care system has faced unprecedented demand in recent years. In the wake of the 2020 pandemic, this demand intensified further by widening health inequalities, increasing waiting times for hospital treatment, GP appointments and dentistry, and placing immense strain on the workforce, leading many staff to reconsider their roles.
With this growing pressure on services, and public satisfaction dropping from 70% in 2010 to 21% in early 2025, Prime Minister, Sir Kier Starmer, his wider cabinet, and the nation’s Health Secretary, Wes Streeting, set about developing a framework that would bring the NHS back on its feet - a decade-long vision that would modernise, digitise, and give people “real choice and control over their health and care.”
This article unpacks and summarises the 10-year plan and sets the stage for a string of deep dives into each of the strategic and cultural shifts, exploring what it means for all the different entities and areas within the sector, over the coming weeks.
TL;DR - What’s in the NHS Fit for the Future 10-Year Plan?
Here’s a quick overview of what the plan sets out. Jump to the section you’re most interested in:
- The Three Shifts:
A breakdown of the three shifts needed for reform. From hospital to community, analogue to digital, and sickness to prevention. - System Enablers:
What will it take to enable the plan to work? New NHS operating model, financial reform, workforce transformation, and transparency. - Expert View:
Access’s Steve Wightman gives his take on what it will take to make digital delivery work. - Conclusion:
What’s next, and why delivery will matter more than ambition.
“Reform or Die”
The decade-long initiative comes after the biggest public consultation in NHS history, with more than 250,000 responses made through the Change NHS platform. The end product is a blueprint for system change, as well as service improvement.
The viability of a health care system based on solidarity is at risk. The government cautions that in the absence of reform, more people who can afford it will be pressured to go private;, undermining public confidence in the NHS's foundational concept.
The Three Shifts at the Heart of Reform
Three radical shifts were drawn up to support this long-term strategy and dictate how care will be accessed, experienced, and delivered between now and 2035. These shifts are:
These shifts arose last year following Lord Darzi's report which made clear that the NHS is no longer fit for service and in “critical condition”. Transitioning to these new ways or working are the new doctrines that the government and industry supporters believe are the answer to long-lasting, positive change.
Here’s how the plan outlines the role of each one:
1. From Hospital to Community
Neighbourhood-led care is being showcased as a radical new approach to reduce pressure on hospitals, reduce fragmentation, and to move care closer to home.
Known as the ‘Neighbourhood Health Service’, the plan outlines that all communities will have access to NHS Neighbourhood Health Centres (NHC) where multi-disciplinary teams will operate a minimum of 12 hours a day, 6 days a week, with rollout to begin in places with the lowest life expectancy. Here, individuals will have access to a “one-stop shop” for patient care, in addition to ongoing treatment and diagnostics.
While the plan doesn’t quote targets specifically, virtual wards are also set to undergo a major expansion, enabling people to receive high-quality care in local settings and at home. New GP provider contracts will also be introduced, with triage to take place through the NHS App in a bid to improve access to same-day appointments and faster access to care outside hospitals.
While these are community-focused initiatives, they also sit within the wider ambition to embed personalised, preventative care. The NHS is aiming for 95% of those with complex needs to have a personalised care plan by 2027, and for 1 million people to have a personal health budget (PHB) by 2030. This will see eligible individuals receive a set amount of cash to spend on community care services to support their health and wellbeing within the community, including wheelchairs, mobility aids and physiotherapy.
2. From Analogue to Digital
The NHS App will act as the gateway to the health and social care system, designed to give individuals greater choice and autonomy over their care. Virtual consultations, as well as the ability to book tests and manage subscriptions, will all be manageable directly through the app, and a new “Health Store” for accessing approved apps and treatments will be available.
In addition, a single patient record will provide secure access for clinicians and those receiving care. Clinicians will also adopt a single sign-on for NHS software to reduce administrative burdens and time lost on IT calls for things like password resets. AI scribing tools will also be used to assist in note taking and other clinical tasks.
“Patients will have a ‘doctor in their pocket’... while staff will be liberated from a burden of bureaucracy and administration,” states the plan.
Broadening the use of AI and technology will also see AI in NHS hospitals everywhere by the end of the plan. These changes are expected to deliver 2% year-on-year productivity improvements and save enough clinical admin time to free up the equivalent of 2,000 additional GPs.
Training and workforce development will also be modernised to reflect the digital future. Mandatory training will be fully reformed by April 2026 to remove repetitive, irrelevant requirements and reduce the burden on staff. Informed by the forthcoming Leng Review, the NHS will introduce clearer role definitions, skills-based progression, and digital-first learning platforms in partnership with leading tech and academic institutions.
3. From Sickness to Prevention
Preventive Preventable illnesses costs the NHS billions every year, affecting both adults and children. The plan pledges to take a bold new approach to tackling public health issues with interventions that combine policy reform, targeted treatments, and early detection to reduce long-term demand on services.
A new genomics-based population health service will help identify risk earlier and offer more personalised interventions, while expanded access to weight-loss medications will be made available on a “pay for outcomes” basis. Children’s health is also a central focus, with plans to provide universal lung cancer screening, improve mental health support in schools through Young Futures Hubs, and raise vaccination uptake for HPV and cervical cancer, which the government is aiming to eradicate by 2040.
To support healthier choices at scale, the government will also introduce new restrictions on tobacco and vape marketing, reform the Soft Drinks Industry Levy, and mandate health-based food reporting for large retailers as part of a wider obesity “moonshot" - which refers to an ambitious, long-term effort to tackle obesity through bold regulation and systemic change.
A new health rewards scheme will also incentivise individuals to make healthier day-to-day choices, with proposed benefits including discounts, vouchers, or recognition for increased physical activity, attending screenings, or making positive lifestyle changes.
System Reform: What Will Enable These Shifts?
The success of the Fit for the Future plan relies on more than ambition to see it succeed in the way we all hope, and all depends on whether the system can support these fundamental, long-lasting changes. That’s why, alongside the three radical shifts, the strategy sets out a series of structural NHS reforms to reshape how it will be governed, funded, staffed and held to account.
A New Operating Model
One of the most significant reforms is the proposed merger of NHS England and the Department of Health and Social Care - a move that will cut central headcount by 50% and place strategic oversight more directly in the hands of local systems. Integrated Care Boards (ICBs) are expected to take on a greater commissioning role, supported by enhanced autonomy and accountability.
The plan also introduces the concept of Integrated Health Organisations (IHOs): high-performing NHS providers with responsibility for managing the full health budget for a specific the population. A small number will be designated in 2026, with the ambition for this to become the norm by 2035.
Financial Reform
With NHS spending now accounting for 38% of day-to-day government expenditure, the plan makes clear that simply increasing funding is no longer viable. A new value-based financial model will tie resources to health outcomes, patient feedback and service transformation.
Short-term top-ups for deficits will be phased out. In their place, providers will be expected to deliver sustainable financial planning over five-year periods, with a 2% annual productivity improvement target set for the next three years. Tariffs will be based on best-practice pathways, while new “year of care” payments will be tested from 2026/27 to encourage proactive, joined-up support for people with long-term conditions.
To support innovation, all NHS organisations will be required to allocate at least 3% of their annual spend to transformation activities.
Workforce Transformation
The workforce is essential to delivering the three shifts, but the NHS of 2035 will need a very different workforce than it has today. Rather than growing the workforce endlessly, the plan aims to support, modernise and retain the staff they already have.
Every NHS staff member will receive personalised career coaching and a tailored development plan. AI will be deployed as a “trusted assistant” for nurses and clinicians, reducing admin burden and enhancing clinical decision-making.
A clear focus will be placed on training and career progression, with new measures including:
· 1,000 new specialty training posts will be created in areas with the highest need.
· A new College of Executive and Clinical Leadership will drive excellence at senior levels.
· By 2035, international recruitment will fall below 10% as more staff are recruited locally.
Pay reform, modernised contracts, and performance-based leadership incentives are also on the agenda, alongside efforts to reduce sickness rates - which currently sit at 5.1%, significantly higher than the private sector average.
Building an Transparent NHS on Transparency
The final piece of the puzzle is a renewed commitment to quality, safety, and transparency. The 10-year plan pledges to make the NHS the most transparent healthcare system in the world, putting clear, comparable data into the hands of both patients and professionals.
From summer 2025, patients will be able to use the NHS App health services to search for providers based on wait times, clinical outcomes, patient ratings and real-time feedback. Public-facing league tables will allow users to compare services, while poor performance will result in contract terminations or CQC intervention - regardless of whether the provider is NHS or independent.
A new national maternity and neonatal taskforce, co-produced with bereaved families, will also lead reforms in one of the NHS’s most sensitive areas of care.
Access View on Delivering the Digital Shift
Commenting on the plan’s ambition to modernise the NHS through technology, Steve Wightman, General Manager of Access Health and Integrated Care, welcomed the direction of travel but highlighted the need for a unified, delivery-focused approach:
“The vision and ambition are what we’ve needed for a long time, but the outstanding question of ‘how’ still remains.”
He emphasised the importance of building digital ecosystems that support multi-disciplinary teams, rather than relying on isolated platforms or legacy systems:
“It’s good to see AI and AVT being championed – we’ve seen firsthand how the use of ethical AI and voice technology can supercharge staff productivity in primary and secondary care from the get-go. But for the move from ‘bricks to clicks’ to be game-changing, we need more of an ‘all-in’ strategy, which advocates nimble digital ecosystems – rather than individual tech solutions or monolithic systems – that empower multi-disciplinary teams to communicate and work seamlessly together.”
He added that this approach would not only enhance outcomes but drive long-term efficiency:
“By doing this, the NHS can achieve economies of scale and greater value at lower costs, all while working towards the ‘seismic shift’ to of neighbourhood-based care.”
The NHS Confederation’s verdict echoes this point. They’ve welcomed the plan’s overarching vision, but are calling for more clarity on funding flows, workforce delivery and implementation timelines to ensure the reforms don’t remain stuck on paper.
Many Miles to Go
The Fit for the Future plan marks a significant moment in history where the health and social are sector have the chance to transform in ways never thought possible. To have an NHS that is more community-based, digitally enabled, and focused on prevention could have a substantial impact on the country both socially and economically - if correctly implemented.
However, while the direction of travel is clear, the roadmap for how all these changes will actually be delivered is not. Key questions around funding flows and local accountability are yet to be answered and will be crucial if this vision is to materialise and make a measurable impact.
