The NHS’s 10-Year Plan, Fit for the Future, launched in July 2025, and updated September 2025, promises transformation: more prevention, less hospitalisation, better digital infrastructure, and stronger community care. But beneath the ambition lies a structural flaw—one that no oversight, framework or winter planning letter can fix.

🎭 The Illusion of Continuity

A 10-year plan sounds reassuring. It suggests stability, foresight, and long-term stewardship. But in reality, it spans at least three General Elections, each with the potential to change the party in power—and with it, the policy direction.

• 2025–2029: The current government sets the tone, but faces mounting fiscal pressure and public scrutiny.
• 2029–2033: A new administration may revise, rebrand, or quietly shelve key elements of the plan.
• 2033–2035: The final years risk becoming a holding pattern, with policy fatigue and leadership churn.

This isn’t cynicism—it’s precedent. Successive governments have rebranded NHS strategy with each term: The Five Year Forward View, The Long Term Plan, Change NHS. Continuity is the exception, not the norm. Long-term planning without cross-party consensus is like building on sand—ambitious, but unstable.

📬 September Signals: Jim Mackey’s Letter

On 19 September 2025, NHS England CEO Jim Mackey issued a letter to NHS leaders. It was measured, pragmatic, and quietly urgent. Key themes included:

• Primary Care Access: GP practices must offer equitable access via phone, online, and walk-in routes. From 1 October, online consultation tools must remain open during core hours—an attempt to standardise digital access and reduce bottlenecks.
• Urgent Dental Appointments: Delivery of the manifesto commitment for 700,000 additional urgent dental slots—an overdue response to years of unmet need and growing oral health inequalities.
• Digital Transformation: Mackey warned against cutting tech investment to meet short-term pressures, calling digital solutions “vital for longer-term transformation and unlocking productivity.” This is a plea to protect innovation from budgetary erosion.
• Leadership Development: Continued focus on building the next generation of NHS leaders—though the letter was silent on how leadership will be supported amid restructuring and staff reductions.

The letter reflects operational realism—but not political realism. It assumes continuity in funding, policy, and leadership that history rarely delivers.

🧱 What’s Being Built—and What’s at Risk

The plan calls for:

• Integrated five-year strategies from Trusts and ICSs, aligning finance, workforce, quality, and activity.
• A shift from hospital to community care, aiming to reduce pressure on acute services.
• Digital upgrades to streamline admin, improve access, and support remote care.
• Preventive investment to tackle upstream drivers of ill health.
• A national rollout of Neighbourhood Health Services, starting with 43 ICBs.

These are worthy goals. But they require:

• Stable funding across electoral cycles—not just headline commitments, but sustained investment in infrastructure, workforce, and evaluation.
• Cross-party commitment to strategic continuity—without which plans risk being rebranded or reversed.
• Local autonomy to adapt without waiting for Westminster—especially as regional needs diverge.

Without these, the plan risks becoming a blueprint for disruption, not delivery and then further massive costs to change direction.

🔻 ICB Staff Reductions: A Case Study in Short-Termism?

The mandate to halve ICB running costs by December 2025 has triggered chaos:

• Redundancy liabilities are ballooning. Greater Manchester alone anticipates £42 million for up to 400 redundancies. National estimates approach £1 billion.
• Funding freezes have stalled voluntary redundancy schemes, with many ICBs postponing action until 2026/27. This creates uncertainty and delays necessary restructuring.
• Staff morale is deteriorating amid rising anxiety, sickness, and a sense of disposability.
• The new Model Region Blueprint centralises oversight midstream, complicating restructuring and distancing decision-making from local needs.

This looks like reform without foresight. It prioritises optics over operational reality. The cost of these cuts—financial, human, and institutional—has not been fully counted.

🏘️ Neighbourhood Health Services: A Glimmer of Hope?

Launched on 9 September 2025, Neighbourhood Health Services aim to deliver joined-up, community-based care. The model builds multidisciplinary teams around general practice and local assets, focusing on areas of high deprivation and long-term conditions.

🔧 Core Components

• Integrated neighbourhood teams: GPs, nurses, consultants, social care, pharmacists, dentists, optometrists, paramedics, and voluntary sector partners.
• End-to-end care for long-term conditions, with a focus on continuity and coordination.
• Social prescribing and prevention to address housing, employment, and isolation.
• Local programme leads to coordinate services and align with local priorities.

💡 Why It Matters

This initiative aims to:

• Reduce fragmentation and duplication.
• Improve access and experience.
• Support healthier, more independent lives.
• Build trust through visible, responsive care.

It’s a response to growing complexity and frustration with siloed systems. As NHS Confederation notes, it’s not just about co-location—it’s about reimagining how communities participate in their own health.

⚠️ Challenges Ahead

• Workforce shortages in community nursing, social care, and allied health threaten delivery.
• Funding gaps for voluntary sector partners risk undermining integration.
• Uneven implementation across regions could widen inequalities.
• Evaluation clarity is needed—what does success look like, and how will it be measured?

🗣️ My Take: Plans Need More Than Paper

I write not as a critic from the sidelines, but as someone who has lived the cycles—seen the promises, the pivots, and the quiet retreats.

A 10-year plan is only as strong as the political scaffolding that holds it. Without cross-party consensus, transparent data, and genuine public engagement, it risks becoming another document filed away when the next Secretary of State arrives.

The NHS doesn’t need another plan—it needs honest stewardship. Reform must be principled, not performative. Transparency, accountability, and compassion are not optional extras; they are the bedrock of public trust.

Behind every policy are people: patients, staff, carers, and communities. Their stories—not just spreadsheets—must shape the future.

📚 References

1. Jim Mackey’s September Letter to NHS Leaders
2. NHS Networks: Building on Progress to Drive Reform
3. Digital Health: Technology Vital for NHS Productivity
4. Greater Manchester ICB Board Papers, September 2025
5. NHS Confederation: Neighbourhood Health Services Briefing

Click here to read an analysis of the training needs arsing from the 10 Year Plan: The Top Six Areas to Train Your Staff In from our training partners at Thornfields.