After many months of anticipation, the government has published its 10 Year Health Plan for the NHS in England. Nursing Times has outlined what it means for nursing.
Shortly after Labour came into power in summer 2024, prime minister Sir Keir Starmer promised the biggest re-imagining of the NHS since its inception in 1948.
It followed a rapid review undertaken by leading surgeon and former Labour minister Lord Ara Darzi, which concluded that the NHS was in a “critical condition”.
The government subsequently pledged to transform the NHS through three ‘big shifts’: moving care from hospitals into the community, shifting services from analogue to digital and moving from addressing sickness to preventing it.
Its 10-year plan for the NHS, titled Fit for the future: 10 Year Health Plan for England, has now broadly set out how the government intends for these shifts will be achieved.
However, the 168-page document is significantly focused on ambitions, rather than deep, detailed plans on delivery.
In his foreword to the plan, Sir Keir said he would build “a truly modern NHS that delivers the best and fastest treatment for patients”, and which provides better value for money.
The plan contains dozens of pledges and aims, ranging from major changes to the structure of NHS organisations to the bolstering of advanced practice nursing and a strong focus on technology.
Below are the main points in the plan which Nursing Times believes will have an impact on the nursing and midwifery workforce.
Workforce
The 10-year plan marks a slight departure from the 2023 NHS Long Term Workforce Plan, which focused on increasing the number of nurses, doctors and other healthcare staff in the health service.
Instead, it focuses on efficiency, aligning with remarks made by health and social secretary Wes Streeting about how he felt that increasing the size of the workforce was not necessarily the answer.
Pay and working conditions
Leaders and clinicians could get additional pay and funding depending on how well they are perceived to be working.
The plan said that patient outcomes, data and “direct feedback” acquired from patients via the NHS App would feed into “performance-related pay”. For leaders, pay would be “tied to performance”, the plan said.
From 2027, NHS providers will be given the ability to make “additional financial payments” to clinical teams that have “consistently high clinical outcomes and excellent patient feedback”, or are making care improvements.
The plan also said that managers would be allowed to “reward high-performing staff” and “act decisively” on under-performance.
It is not clear how these payments will be administered, or how much they may be worth.
As well as this, the government announced an intention to start a “big conversation” on changes to working contracts to reward “high quality and productive care”.
Tackling corridor care
The government said it would “end the disgraceful spectacle of corridor care” with improvements to the throughput of emergency departments.
However, specific details on how corridor care, in particular, would be addressed were not provided in the plan.
Staffing
This 10-year plan heralded the coming of another, separate document dedicated to staffing over the next decade; the government said it would be publishing a 10 Year Workforce Plan later this year.
Despite calls from the Royal College of Nursing (RCN) among other organisations to bolster the size of the nursing workforce, the plan indicated the government would be scaling back the NHS Long Term Workforce Plan, which was published in 2023.
“By 2035, we will have fewer staff than projected by the 2023 Long Term Workforce Plan, but each professional will achieve far more,” the plan stated.
International recruitment under the plan will be less than 10% of overall recruitment by 2035 with a prioritisation of a domestically-trained workforce. Details on this would come in the 10-Year Workforce Plan, the government said.
Further, the government outlined a plan to reduce the NHS sickness rate from 5.1% to 4.1%, through the better occupational health services in new ‘staff treatment hubs’.
Flexible working was also mentioned in the plan, with a pledge to widen it to the workforce, though “how best to deliver this” would be outlined in the 10-Year Workforce Plan, the government said.
Nurse roles
The nursing workforce will have a role in the government’s new neighbourhood services, the plan said, with nursing and midwifery lead posts being created to “coordinate local strategy”.
Advanced practice was also mentioned; the plan promised to develop advanced practice models for nurses and midwives “that are aligned to the delivery of the three shifts”.
Alongside this, the plan said the government would work with the Nursing and Midwifery Council (NMC) to ensure that its advanced practice regulation was “introduced as quickly as possible”.
NHS structure and performance
At a national level, ministers have already mooted a merger of NHS England and the Department of Health and Social Care (DHSC), which is confirmed in the 10 Year Health Plan.
However, the plan also included a number of other significant upcoming changes to the way the health service is made up at a more local and regional level – with a focus on devolution.
Neighbourhood care centres
A flagship policy in the 10-year plan is the creation of a so-called Neighbourhood Health Service, which will see a wide range of health teams to be set up “entirely under one roof” in local communities.
As part of the plan, the government confirmed that this would mean a smaller proportion of NHS funding set aside for hospitals over the next decade, with resources reallocated to community healthcare projects.
These community-based teams will operate in neighbourhood care centres (NCCs), which will eventually be open 12 hours a day, six days a week, according to the plan.
They would be staffed by doctors, nurses, social care workers, pharmacists, health visitors, palliative care staff, paramedics and others.
With this, the government said that the majority of outpatient care would happen outside of hospitals by 2035 – marking a significant change in the way health is delivered.
NHS England abolition
Earlier this year, Sir Keir announced an upcoming merger of NHS England and the Department of Health and Social Care (DHSC).
The 10-year plan reiterated the government’s assertion that the organisation was surplus to requirement and would be rolled into DHSC.
The 50% reduction in staffing across the two merging organisations will take place by 2027, the plan said.
However, the plan still did not state which roles would be cut, leaving uncertainty about the future of some top strategic posts occupied by nurses and midwives.
Changes to NHS organisations
A controversial system of league tables for NHS trusts is set to be introduced, with data to be gathered on the performance of clinicians, according to the plan.
NHS trusts would be given further autonomy over how they operate and spend money, should they be deemed to be performing well by the government.
The plan stated that all trusts would become foundation trusts in the coming years, reigniting an ambition from previous Labour governments that all trusts should ultimately aim to achieve foundation status.
However, the plan also said some current foundation trusts would soon become integrated health organisations (IHOs) over time, as a further development of the integrated health system approach.
The first of these IHOs would be set up in 2026, according to the plan, when they will hold “the whole health budget for a defined local population”.
The way NHS organisations are funded is also set to change. The government said it would redistribute local funding to trusts in areas facing the greatest “economic and health challenges”.
However, all NHS organisations will be mandated to dedicate around 3% of their annual spend on one-off investments in service transformation and improvement.
Hospital trusts may also lose money if patients are dissatisfied with their treatment or care. A new scheme, called ‘patient power payments’, will see patients contacted after care and asked if they think the full payment for the cost of their care should be given to the provider.
Emergency care
Expanding emergency and urgent care services featured heavily in the plan. It stated that all providers would set out how they will expand access to these services in the community to avoid hospital admissions.
As well as this, the government announced that it would use the NHS App to get more patients into urgent care appointments, to further reduce unnecessary attendances at emergency departments.
On mental health, the plan stated that £120m would be set aside to create 85 new dedicated mental health emergency departments.
This last move was outlined in an announcement last week, with some further details now given in the plan.
It said these units would take walk-in patients, those brought by ambulance and police referrals, with “rapid assessment” to take place within four hours.
They would administer “short-term support”, safe discharge or onward referral.
Nursing education, development and training
With an ongoing nursing shortage and the government aiming to reduce the international recruitment on which NHS has relied in recent years, questions have been asked how more nurses will be trained and retained. The plan does contain some detail, in this regard.
Education
The government said it would create 2,000 more nursing apprentices over the next three years with a focus on the “areas with the greatest need”.
Ongoing difficulties at universities to attract and retain student nurses were not addressed explicitly in the plan, though it did include a demand for education providers to address attrition rates.
As well as this, the plan stated that student placements in primary and community healthcare providers would be expanded, to encourage more graduates into these settings.
Training
Sitting alongside the plan’s ambitions around AI and other technology, the government said it would “overhaul” digital training and education.
Separate to this, the plan said it would create 1,000 new “specialty training posts” over three years, though whether this would be for both doctors and nurses was not specified.
Technology
Health secretary Mr Streeting has been vocal about his support for the use of technology as a means to solve many of the challenges facing the health service.
The plan does not deviate from this, with artificial intelligence (AI), robotics and the NHS App all featuring heavily.
NHS App
Throughout the plan, the NHS App’s ever-growing feature list is mentioned.
Chief among the proposed expansions to the app include the ability for patients to book appointments, receive advice and self-refer to services, including mental health talking therapies.
By 2028, patients would be able to communicate with health professionals “directly”, according to the plan.
Alongside this, the plan promises to give everyone in the country “a doctor in their pocket” through a “virtual assistant” which would provide advice and guidance 24/7.
The app will also facilitate patient feedback and digital pre-assessments.
Artificial intelligence
The plan asserted that the NHS would soon be the “most AI-enabled health system in the world”, with AI “seamlessly integrated into clinical pathways”.
It stated that AI would become “every nurse’s and doctor’s trusted assistant”.
In practice, what this means, according to the plan, will be the use of AI everywhere from diagnostics to record keeping.
AI scribes, the plan said, would “liberate” staff from the “burden of bureaucracy and administration”, while an early-warning system would facilitate the spotting of death or poor patient outcome trends in hospitals.
The plan is light, however, on the detail of exactly which AI technologies would be deployed and from where it would be procured.
Other technology improvements
The government pledged to introduce single sign-on for staff, which, it hoped, would reduce wasted time on resetting and changing passwords for staff.
Meanwhile, further improvements to digital record keeping are also being promised.
Surgery robots are to be used more widely in hospitals under the plan too.
Public health
Tobacco and junk food
A longstanding promise by the government to prohibit the sale of tobacco to anyone turning 16 this year, or younger, was included in the plan.
The government also reiterated that it planned to heavily restrict junk food advertising.
School and young people’s health
The government pledged to expand mental health support teams in schools, which would include “health practitioners”, with national coverage by 2030. However, which practitioners would be included was not specified.
The plan included an aim to improve human papillomavirus (HPV) vaccination uptake in schools.
An restoration of the Healthy Start scheme, which provides food for pregnant people and those with children under four who live in poverty, was also promised – something nursing organisations like the Institute for Health Visiting (iHV) have been calling for.
Maternity
Improvements to maternity care were included in Labour’s 2024 general election manifesto. Today’s new plan indicates that the government wishes to follow through on this pledge.
A national investigation
The plan indicated the upcoming creation of a national independent investigation into maternity and neonatal services in England. It referred to the need for systemic change in maternity, following a decade of multiple scandals in the sector.
This, perhaps, runs contrary to a call from Royal College of Midwives chief executive and general secretary Gill Walton, who told Nursing Times earlier this year she hoped the government would move away from reviews and inquiries and towards action.
National Maternity and Neonatal Taskforce
Chaired by the secretary of state for health and social care, this taskforce, the plan said, will create a national maternity and neonatal action plan.
The government promised that this would lead to “rapid improvement of maternity and neonatal quality and safety”.
Genomics
The government said it would move towards universal genomics testing for newborns, as part of a wider aim to increase the amount of people in the country having their genomes mapped.
