Ben Howlett
CEO Curia, Health, Care, and Life Sciences Research GroupThe launch of the Fit for the Future: 10 Year Health Plan for England represents a major turning point for the NHS. Launched by the Prime Minister, Secretary of State for Health and Social Care Wes Streeting, the Plan sets out to transform not only how care is delivered, but how the NHS is structured, governed, and held to account.
At its core lies a bold proposition: that the NHS must be redesigned around patients, not institutions. That means care delivered closer to home, powered by data, and oriented around prevention rather than cure. In Streeting’s words, “We will build a neighbourhood health service… so the NHS is organised around patients, rather than patients having to organise their lives around the NHS.”
This is not an incremental reform agenda. It is a deliberate, generational shift – and if delivered, it will reshape the fundamentals of health and care in England.
Three Transformational Shifts
The Plan is structured around three foundational shifts:
1. From Hospital to Community
The Plan commits to embedding Neighbourhood Health Centres in every community – integrated facilities housing GPs, nurses, physios, therapists, care workers, and diagnostic services under one roof. These centres will operate 12 hours a day, six days a week, prioritising areas with the poorest health outcomes first.
Same-day GP consultations will become the norm, with digital triage used to eliminate the “8am scramble”. The Plan also promises to restore continuity of care by “bringing back the family doctor”. For patients with multiple conditions, personal care plans will be co-created to ensure integrated, person-centred support.
Pharmacies will take on an expanded role, managing long-term conditions, screening for disease, supporting obesity and hypertension management, and delivering vaccinations. Dentistry – often cited as the canary in the NHS coal mine – will be rebuilt through reform of the NHS dental contract to increase access and participation.
Notably, more than half of the NHS’s 135 million outpatient appointments will be moved out of hospitals, with funding reallocated to primary and community care.
2. From Analogue to Digital
The Plan commits to a full digital transformation of the NHS. The NHS App will become the “front door to the health service”, offering patients a comprehensive platform to book appointments (for themselves, their children, or those they care for), access specialist referrals, receive AI-supported triage, and provide feedback on their care.
Behind the scenes, NHS staff will benefit from reduced administrative burden. Seven-password logins and manual data entry will be replaced by single sign-ons, AI scribes, and interoperable systems. A universal single patient record will mean clinicians have real-time access to accurate, up-to-date medical histories – improving safety and reducing duplication.
The Plan also promises to harness wearable devices for remote monitoring, enabling clinicians to intervene at the earliest signs of deterioration. Robotic surgery will be expanded, and the National Institute for Health and Care Excellence (NICE) and the Medicines & Healthcare products Regulatory Agency (MHRA) will be reformed to support faster adoption of high-impact technologies through “Innovator Passports”.
3. From Sickness to Prevention
Public health is given renewed prominence. The Plan pledges to halve the gap in healthy life expectancy between the richest and poorest areas, supported by direct investment and regulatory reform. School food standards will be updated, and free school meal provision expanded.
The NHS Points Scheme will reward healthy behaviours. Obesity medication – currently often restricted to private payers – will be available on the NHS as part of a “fairness-first” approach. “It should be available based on need, not the ability to pay,” Streeting declared in the Commons.
Mental health will be supported with 24/7 virtual therapy for moderate need, dedicated mental health A&E departments, and new in-school provision to support early intervention.
Perhaps most ambitiously, the Plan aims to offer genomic testing to every newborn by 2035, ushering in an era of truly predictive and personalised care.
Reform with Investment
This transformation is underpinned by the largest investment programme in NHS history. By the end of the Spending Review period, the NHS will receive an additional £29 billion per year. Capital budgets will also be increased, including for new diagnostic and digital infrastructure.
But investment will come with reform. More than 200 bodies will be abolished to reduce duplication and restore direct accountability to the NHS. League tables will rank provider performance. Failing trusts will face intervention and pay for senior leaders will be tied to outcomes, with a new “earned autonomy” model replacing blanket centralism.
A Patient Power Payment mechanism will allow funding to follow patient satisfaction – incentivising quality and responsiveness. Block contracts will be replaced with outcome-linked, year-of-care funding.
Embedding Equity and Justice
Social justice is the moral core of the Plan. Health inequalities – now described by ministers as a structural failing – will be addressed through the redistribution of resources, the localisation of power, and new regulatory frameworks that elevate the voice of the underserved.
Services will be expanded in the communities with the poorest health. Investment in infrastructure, workforce, and prevention will follow need – not historic allocation. The Plan also announces a national inquiry into maternity and neonatal services, responding to systemic failings and the demands of bereaved families for truth and change.
Streeting’s invocation of Nye Bevan’s original promise – to “put a megaphone to the mouth of every patient” – was not just rhetorical. The Plan proposes real-time feedback mechanisms and visibility over performance data to allow patients to compare services and hold providers accountable.
Challenges Ahead
Despite its scope, the Plan will stand or fall on the discipline of its implementation. Success will require:
- Sustained cross-party support and fiscal commitment
- Rapid rollout of digital infrastructure and workforce digital literacy
- Consistency of leadership and clarity of metrics
- Accountability mechanisms that reward improvement and address failure
There are also unresolved questions around social care integration, workforce capacity, and cultural change within NHS institutions – all of which will need active management if reform is to stick.
Chair of Curia’s Health, Care, and Life Sciences Research Group, Rt Hon Andrew Stephenson CBE said “The ambition set out in the 10 Year Health Plan is both necessary and welcome – but success will depend entirely on the pace, discipline, and accountability of its implementation.
“This is a moment to move beyond policy intent and focus on delivery infrastructure: aligning budgets with outcomes, empowering local systems with real autonomy, and ensuring that staff and patients are equipped to lead change. The reforms outlined here cannot remain aspirational – they must be operationalised with urgency, clarity and consistency if we are to build the modern, equitable NHS that this country both needs and deserves.”
Final Thought: From Aspiration to Delivery
Fit for the Future is a statement of intent and of belief – in a more modern, personalised, equitable NHS. It reflects a clear break with technocratic tinkering and aims instead for structural and cultural renewal.
“We know the British people are counting on us,” Streeting concluded. “It falls to us to make sure that the NHS not only survives but thrives.”
For stakeholders, system leaders, and patients alike, the next decade will determine whether that promise is kept – and whether this is remembered as the moment the NHS was rebuilt for the future, or simply another missed opportunity.
Featured image via House of Commons
