On 3 July 2025, the UK Government published “Fit for the Future: 10 Year Health Plan for England” [1]. This strategic document sets out a long-term vision for changing and improving care delivery and financial resilience in England’s public sector healthcare system. It will be followed by a specific delivery plan, and an updated workforce strategy.
This plan’s creation was announced by the incoming Labour government in July 2024, in the context of a change of ruling party and of historically high dissatisfaction with the English NHS [2]. Its remit and definition of problems were informed by the Darzi Review into the performance of the service [3]. During late 2024, a national engagement effort to inform the plan – “Change NHS” – gathered more than 250 000 contributions from staff, patients and the public. Its drafting emphasizes an urgent need to change, faith that great improvement is possible through efficiency and innovation and the goal of choice and improved experience for patients.
“Shifts” envisaged in the plan
The plan emphasizes “three fundamental shifts” in the English health service, with an extensive collection of commitments and over 200 specific initiatives.
- A shift from “Hospital to community”. This includes a commitment that the share of expenditure on hospital care will fall within three to four years. “Neighbourhood health services” will be created that connect primary and community care services through different contract models. Shared locations for this will be created as 250–300 “neighbourhood health centres” that provide integrated local services that will be staffed by multidisciplinary teams. The plan argues that this shift in resources and structure will enable savings in hospital services. There is a pledge to reform the dental contract, widely seen as unfit for purpose.
- A shift from “analogue to digital”. This would enhance the existing English NHS App, widely downloaded during the COVID-19 pandemic but limited in usage and functionality into a central interface for patient self-referral, appointment booking to neighbourhood health services, repeat prescription management, and collecting patient feedback shared with care providers. There is also to be a mandated single patient record by 2028. The plan envisages a rapidly growing role for both patient-facing and clinician support AI, with a national scheme to procure “Ambient AI” scribing interactions for care records.
- A shift from “sickness to prevention”. New public health measures include easier access to weight loss medications, restrictions on junk food advertising and restrictions on high caffeine energy drink sales to minors. The plan commits to “genomics population health service” with universal screening for newborns.
Other measures
The plan also contains several other significant policy commitments, on quality, workforce, technology and innovation, structure, and financing.
- Self-referral enabled for services such as mental health, audiology, podiatry and musculoskeletal care via the NHS App.
- An aspiration for high-performing provider bodies in the NHS to earn greater autonomy and to be rewarded with financial incentives, with 50% fewer officials employed in the central bodies of the health service.
- An emphasis on “strategic commissioning” (purchasing) as the core role of Integrated Care Boards, which are the regional fund-holding bodies of the English NHS covering populations typically around 2 million.
- Health technology appraisals conducted by NICE for compulsory adoption will be expanded to medical devices and digital products. The body will also review previously approved pharmaceutical products to eliminate those that are no longer cost effective.
- There will be a trial of “Patient power payments”, a concept where patients are contacted after care and decide whether to deduct an amount from the provider’s payment based on satisfaction with their care.
- The plan continues the long-standing interest of the English NHS in expanding the roles of different professions to take on tasks traditionally reserved for those with certain medical and nursing qualifications. It aims to expand the paradigm of training healthcare workers to individual tasks rather than wider roles, and states that there are “significant opportunities to move beyond traditional professional boundaries in a safe and productive way.”
- Measures to enhance personalized care, including the introduction of personal health budgets for up to one million people by 2030, with universal availability by 2035. A new standard that, by 2027, 95% of people with complex needs will have an agreed care plan.
- A maximum 10% reliance on overseas recruitment by 2035 – reliance on staff trained outside the UK is currently far higher, and above 50% for newly registering qualified doctors [4].
Reaction and analysis
Expert and representative bodies in the UK broadly welcomed the direction of the “three shifts” and accepted the problems the plan aims to address. Many expressed some scepticism around delivery. Common concerns were that such an expansive agenda would be difficult to deliver properly or sustainably given the relatively modest increases in the budget announced following the plan; that details of contracts and timescales were limited; and that social care and public health services in England remained unreformed and underfunded, creating a difficult context [5, 6]. The emphasis on adopting innovation has the potential to increase costs [7].
Several reactions noted that the plan brings back a higher reliance on financial incentives, competing providers and a divide between purchasers and providers [8]. This partially reverses previous moves towards greater collaboration to drive integrated care, though many of these initiatives are being retained or redeveloped as well.