Fit for the Future: The NHS 10 Year Health Plan for England – Key Legal and Policy Developments

Introduction

The publication of the NHS 10 Year Health Plan for England (the “Plan”), published on Thursday 3 July 2025, marks a significant moment for the future of healthcare delivery in England. The Plan is informed by extensive public and staff engagement, with over 250,000 contributions. Presented to Parliament by the Secretary of State for Health and Social Care, the Plan sets out a plan for extensive reform, with the aim to address longstanding NHS challenges. 

This article provides a summary of the Plan’s key legal and policy developments, focusing on the main themes and commitments as set out in the executive summary and the full report.

Background and Rationale for Reform

The Plan focuses on the current state of the NHS, describing it as being at a “historic crossroads” and in “critical condition”. Following an independent investigation of the NHS, carried out by Lord Darzi, it was concluded that the NHS was struggling for four key reasons: 

1. Patients cannot schedule a GP or dental appointment;
2. Waiting lists for hospital and community care have dramatically increased; 
3. NHS staff are demoralised and demotivated; and 
4. The outcomes on major killers (e.g. cancer lag) are significantly behind other countries. 

Alongside the intention to fix these issues, the Plan confirms that the demographic change and population ageing results in a stark choice for the NHS: “reform or die.” 

Three Fundamental Shifts

Intended for drastic reform, the Plan is structured around three “radical shifts” in the NHS’s operating model: 

1. From Hospital to Community

Firstly, the Plan proposes a move away from the current hospital-centric model, towards a neighbourhood health service. This service has been designed to provide continuous, accessible and integrated care within local communities. This will involve a shift in the pattern of NHS spend, to ensure that a greater proportion of the budget is invested in out-of-hospital care. The aim is to revitalise access to general practice and to enable hospitals to focus on specialist care, by ensuring that healthcare can be provided locally (i.e. online where possible, in a patient’s home or in a neighbourhood health centre where necessary). 

1. From Analogue to Digital

With a trend of increased use of artificial intelligence (“AI”), the Plan unsurprisingly sets out a vision for a digitally enabled NHS. At the heart of this digitalised system is a new NHS App, which is designed to create a digitally accessible health system for all patients. Patients are set to have an easily accessible and single patient record, enabling coordinated and personalised care. The adaption to a digital system is also intended to reduce patient wait times and to ensure more reliable monitoring for those patients who are living with illnesses. The Plan also commits to the reduction of time wasted admin for NHS staff, mainly through the adoption of AI and other digital tools. The NHS App is intended to become live by 2028.

1. From Sickness to Prevention

The final key reform relates to healthcare disparities between the rich and the poor, for those living with ill health and childhood obesity. The Plan sets out a renewed emphasis on prevention, with the aim to increase the gap in healthy life expectancy for all NHS patients. Measures include the implementation of the Tobacco and Vapes Bill, extensive plans to end the obesity epidemic and the creation of a new genomics population health service.

Legal and Regulatory Implications

• Transparency and Patient Empowerment: The Plan introduces new transparency proposals, with commitments to publish league tables that rank providers against key quality indicators. The intention behind this publication not only relates to transparency, but it will also allow patients to search and choose providers based on quality data via the new NHS App, giving patients more choice in their healthcare. 
• Workforce Reform: Another notable change is the new workforce strategy, which sets out plans for current NHS staff to be better treated, with an intention to further motivation levels. The Plan sets out the introduction of personalised career coaching and development plans for all NHS staff, by 2023, alongside the commitment to make AI a “trusted assistant” for every nurse and doctor. 
• Innovation and Technology: The NHS is also set to become the “most AI-enabled health system in the world”, with AI and genomics integrated into clinical pathways. The Plan also commits to expanding the role of NICE to cover devices, diagnostics, and digital products, alongside the introduction of multi-year budgets to support service transformation.

Financial Sustainability

With NHS costs accounting for up to 40% of day-to-day Government spending, the Plan acknowledges that increased money does not always result in better healthcare. As such, the Plan sets out that all NHS spending will be reviewed, and figures will be replaced where necessary. This review is set to include the introduction of various new payment mechanisms, such as the year of care payments and there is an intention to shift towards rewarding providers for high-quality, outcome-focused care.

Patient Choice

The plan makes passing reference to patient choice – the mechanism that applies to provide patients with a legal right to choose the provider of their care, free at the point of use, whether that care is delivered in an NHS hospital or by an independent healthcare provider. It states that as part of its new operating model, the NHS will:

…“Introduce a new patient choice charter, starting in the areas of highest health need. This will ensure the NHS is receptive and reactive to patient preference, voice and choice.

Providers across the UK will be keeping a watchful eye over any reform of patient choice and the extent to which referring clinicians can be adequately incentivised to ensure that patients are always provided with that choice. It will also be necessary for NHS England to ensure on an ongoing basis that other policies and mechanism are not allowed to operate in such a way as to conflict with a patient’s legal right to choose.

Conclusion

The NHS 10 Year Health Plan for England has positioned itself as a break with the past, setting out a programme of reform aimed at ensuring the sustainability and effectiveness of the NHS for future generations. There are some welcome proposals in the plan. 

In particular, the Plan demonstrates a strong commitment to the adoption of medical technology and AI, with the hope of positioning the NHS as a global leader in healthcare innovation and the ability to have a “doctor in your pocket” in the form of the NHS App. 

As with any plan of this kind, the challenge is one of funding and implementation. The challenges regarding staffing in particular will need to be addressed head on and aligned with other NHS policies that may indirectly affect the ability of providers, both NHS and independent, to attract and retain skilled staff to support the wider healthcare system. 

If these reforms are effective, patients will hope to see reduced waiting times, improvements in the quality of care, and more autonomy to manage the way in which they can access NHS care. 

If you would like to discuss any of the above, please contact a member of our Healthcare Team. 

This article was written by Patrick Parkin, Rory Trust and Jade Gillett.