10 Year Health Plan: 6 Initial Reflections

Like many we’ve been digesting the 10 Year Health Plan. Lots of ambition and energy, as well as lots to pick through.  

Here are six of our initial reflections. More to follow on each of these: 

1. Investment in virtual elective care is essential to get on top of the waitlist. We’ve seen first hand the impact which virtual elective services, advice & guidance and PIFU can have. These need to happen quickly and at scale to bring the waitlist down to pre-Covid levels. Lots of excitement in the Plan on patient-facing technology, such as through the NHS App. These are positive, but there is very little on how digital exclusion will be addressed and ensuring that digital-first services don’t become digital-only. 

2. Longer-term and outcome-based incentives are the right objectives but may prove painful to implement. The three-year revenue settlement and four-year capital settlement is welcome and essential to allow some autonomy and investment. Aligning payment incentives to outcomes feels like the right direction but challenging for a Plan which speaks to cutting red tape and bureaucracy dozens of times. Positive outcomes are delayed, expensive to measure and often intangible. The focus should be on perfecting the basics, such as accurate costing and appropriate tariff setting.  

3. Creation of a national care service with focus on better integration of health and care service and a big bet on health data flow is great news. It has been a pleasure to be able to work on making social care data available through our work with Made Tech and DHSC. We welcome the continued focus on further integration here as social care will become ever more important due to an aging population and increased medicalisation of the sector. As we have been saying for years, the plumbing under the hood is almost as important as the analysis on top, so a focus on data flows is greatly welcome as it will enable better data tools and insight to drive action where it is needed most.  

4. Children are finally acknowledged, but proposals to support their health appear limited to specific conditions. Children were mentioned 85 times in the main body of the 10 Year Plan – which is a reassuring sign that the government has not forgotten about them. However, much of the content is focused within three areas: obesity, mental health and oral health. And while the document acknowledges that “Children are sicker than a decade ago “, there is little to suggest that this statement considered what we’ve seen through our work with Children’s Hospitals: rising complexity in the acute setting, lengthy waiting lists, and strained specialist services for children whose care is unsuitable for a community setting. While the prevention, early years and inequality-tackling agenda is welcome, there is a need for more than just plans to ensure the aspirations for neighbourhood care is a success for children – starting with addressing the lack of primary care expertise and dwindling paediatric workforce. 

5. Cancer initiatives need to be transformational to improve outcomes to world-leading levels. There’s much in the plan which we know is vital for improving cancer outcomes. Lung screening, which we’ve seen pioneered in Greater Manchester, can save numerous lives. As can personalised treatment, improved screening uptake and investment in new radiotherapy machines. Longer term, investment in prevention and cancer vaccines can substantially reduce not just survival from cancer, but incidence. But in the near term: screening will only ever be a small minority of cancer diagnoses (currently ~7%), and personalised treatment will only ever move the dial on survival for some patients. The big opportunity is earlier diagnosis through primary care Urgent Suspect Cancer referrals. The plan contains relatively little on cancer-specific support to primary care, better access to diagnostics and the work which Cancer Alliances do to support quality improvement and address health inequalities. 

6. 10 years is a long time… It’s hard to imagine many people will be reading this document in 2035. Ten years can also feel like a lifetime given the rapid evolution of technology, especially when you consider ChatGPT is only 2.5 years old. In the fast-paced world of technology, predicting what the next decade may bring is challenging. Whilst a long-term vision is essential, any objectives which are a decade away will likely be lost in rounds of leadership and political change. This can’t happen and it’s essential that 12 months from now we see progress against the commitments which have been made in the shorter run. 

Join us as we track the promises of the next decade with our 10 Year Health Plan Tracker.