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Prime Minister Keir Starmer, via Wes Streeting, Secretary of State for Health and Social Care, has announced a sweeping 10-Year Health Plan designed to overhaul the NHS, with reforms spanning finance, performance, technology, workforce, innovation, and care quality. Described as “radical and urgent,” the plan outlines fundamental changes to how the NHS is funded, structured, and delivered. No one seems to have noticed, that unlike previous government 10 year plans for healthcare, this one doesn't even mentioned the 'NHS' in it's title! Indeed, the NHS Logo is absent from the cover of the full report! Looking at the content, and detail of this Labour Government's 'health plan', it is all about the commercialisation and industrialisation of healthcare in the UK, which has zilch to do with the principles of the NHS! The Health Services Journal has published a breakdown, as they see it, of the most important elements of the Government document entitled: This is a basic summary of that breakdown:
* Redefining roles of foundation trusts and integrated care boards (ICBs) * Abolishing various national and local health bodies * Changes to NICE regulations and the commissioning of drugs and devices * A new voluntary contract for NHS staff with performance-linked pay * New local health contracts * Linking part of provider payments to patient feedback The US Accountable Care Model (ACO) will be the blueprint for these changes. Top-performing FTs may evolve into Integrated Health Organisations (IHOs), managing entire local health budgets. The first IHOs will be designated in 2026, operational by 2027, and expected to become the norm. Finance & Performance A core focus of the plan is restoring financial discipline. Trusts could face legally capped budgets, similar to local councils, if they fail to reduce chronic deficits. The government warns that “more money has not always led to better care.” Key financial changes include: * Abolition of deficit support funding from next year; all NHS bodies must meet national planning targets. * Mandatory 3% reinvestment from each organisation’s budget into service transformation annually. * Shift in tariff pricing, from average cost to best clinical practice, to drive efficiency. * New productivity index, informed by a review led by Andy Haldane (former Bank of England chief economist). The plan stops short of promising all providers will be in surplus by 2035 — aiming instead for a majority. On care delivery, it pledges a major shift out of hospitals. By 2035, most outpatient care will occur in the community or remotely, enabled by digital tools and redesigned services. In urgent and emergency care: * The “My NHS GP” AI tool will help divert patients from A&E to more appropriate services. * By 2028, patients will be able to book urgent care through NHS 111 or the app. * Mental health crisis centres will be co-located with 50% of Type 1 A&Es, supported by £120m in funding. Ambulance services will deploy AI triage and “see and treat” approaches to reduce unnecessary hospital conveyance. Clinicians will have remote access to diagnostics and patient records for real-time decision-making.
Capital Investment While secondary care private investment was ruled out, the plan opens the door for public-private partnerships in neighbourhood health centres. A rollout will begin with public sector funding, with business cases to follow. Key capital policy changes: * Foundation trusts will gain more autonomy, with automatic approval for self-financed plans aligned to financial strategy. * Five-year capital budgets and greater flexibility to move capital across financial years. * Streamlined approval process for major national projects, limited to three levels of review. Organisational Reform The government plans for all NHS providers to become Foundation Trusts (FTs) by 2035, with the first “new FTs” approved by 2026. These will no longer require governors and will focus more on partnership working and population health. Neighbourhood health reform includes: * Strategic authorities acting as “prevention demonstrators”, with increased autonomy and pooled budgets. * A reformed Better Care Fund (from 2026–27) to jointly fund key services like discharge, rehab, and reablement.
A separate 10-Year Workforce Plan will follow later this year. While the NHS will employ fewer staff than forecast in the 2023 Long-Term Workforce Plan, those roles will be better trained and more fulfilling. Key workforce measures: New employment standards launched in April 2026, setting minimum conditions for NHS jobs Efforts to reduce dependence on overseas staff. Potential reforms to national pay frameworks, including Agenda for Change. On care quality, the plan includes tougher accountability: Services with persistent poor performance could face contract termination or new leadership. A reformed National Quality Board will develop new service frameworks in areas like cardiovascular disease, mental health, frailty, and dementia. AI-powered alert systems will help flag service failures, triggering Care Quality Commission (CQC) inspections. CQC will gain enhanced legal powers to pursue action against failing providers. Technology Digital transformation is a central pillar of the plan, which is aimed at cutting staffing levels and staff costs, thereby reducing the NHS overall budget requirements. This will lead to patients hardly ever actually speaking to a human being when contacting GP surgeries and healthcare decisions being made by AI algorithms, which will refer patients to cheaper alternatives for healthcare including medicines and drugs used and administered by pharmacies, hospitals, and available via prescriptions. A new ambient voice tech framework for hospitals and GPs will launch by 2027 to reduce admin burdens. Patients will be able to contribute data to their Single Patient Record (SPR) via verified wearables. New legislation will compel providers to share recorded data with patients. The NHS App will become the universal entry point to all NHS services by 2028, offering access to certified consumer health products. - AKA private healthcare products and services advertising!
To position the NHS as a global innovation leader, the plan introduces: A streamlined innovation procurement process New value-based procurement guidance for devices and digital tools (from 2026) An “innovation passport” to fast-track promising tech into service Creation of Regional Health Innovation Zones, offering local health systems flexibility to pilot radical new approaches The government also promises a cultural shift in how the NHS works with industry. The newly created centre for health innovation will ensure public-private collaborations move beyond transactional relationships into genuine partnerships. AKA - the full commercialisation of Healthcare in the UK as in the USA ACO model! Summary The 10-Year Health Plan signals the most ambitious NHS overhaul in decades. With a focus on decentralisation, financial discipline, digital transformation, and integrated care, the government aims to modernise the NHS while tackling persistent inefficiencies. But many of the most radical changes — including workforce shifts and financial reforms — are set for gradual rollout, with some targets extending as far as 2035. Whether these reforms succeed will depend heavily on execution, political will, and maintaining public trust in a time of rising demand and tight budgets. It is clear in the eyes of many patient care groups, that which is driving these changes is NOT patient care, but the aim of making profit from ill health as in the US ACO system. Source: HSJ / unionsafety / NHS / Gov.UK /
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