Labour’s 10 year plan for the English NHS
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r298 (Published 14 February 2025) Cite this as: BMJ 2025;388:r298
- Hugh Alderwick, director of policy,
- Phoebe Dunn, senior policy fellow
- Correspondence to: H Alderwick hugh.alderwick{at}health.org.uk
The NHS is in crisis after a decade of austerity, covid-19, and political failures since 2010 that weakened the health service and constrained what it could deliver.1 Patients are suffering—for instance, as they wait too long for hospital care.23 The new government has promised to recover services and transform the NHS, and is producing a 10 year plan for how this will be done.4 The plan, due in Spring 2025, will set out reforms to achieve three “shifts” in services: more community based care, prevention, and use of digital technology.
The NHS has a long history of producing long term plans, with mixed results. The NHS plan in 2000,5 for instance, formed part of a broader programme of investment and reform that contributed to big improvements in the NHS under Labour governments over a decade.6 The five year forward view in 2014,7 meanwhile, focused on developing “new care models” but was crowded out by growing pressures on services amid a decade of austerity.8
What should the latest plan do? First, government must provide hope that things will get better. The health secretary, Wes Streeting, has declared the NHS “broken.”9 Labour’s political story now needs to turn to the strengths of the NHS and clear direction for change. Public satisfaction with the NHS is the worst on record,1 and staff are stressed and exhausted.10 Any vision for the future must be combined with confidence that it can be realised. Government’s public engagement on the plan may help.11 But Streeting’s “targets and terror” approach, such as threats of sacking NHS managers, risks undermining the support needed within the health service to make the plan happen.12
Making limited funding count
Second, the plan must prioritise. NHS plans tend to suggest everything will get better, everywhere, all at once. But if everything is a priority then nothing is. And there’s not enough money to do it all anyway. Health spending is increasing at around the long term average to 2026, but growing pressures—for instance, from pay increases—will eat up a chunk of extra spending.13 The broader outlook for public finances is gloomy.14
Improving primary care should be high on the list. General practice is the foundation of the NHS, yet people are struggling to get appointments, and continuity of care is declining.15 Priorities include recruiting and retaining more general practitioners, better integrating GPs and other primary care staff, and fixing pervasive operational failures.16 This will take investment. Like many before it, this government has pledged to shift resources from hospitals to the community. Yet the flow of NHS resources since 2000 has gone in the other direction.17
Hospitals risk remaining the over-riding priority. The prime minister’s six pledges for change by the end of the parliament include one NHS target: 92% of patients waiting no longer than 18 weeks for routine hospital treatment.18 This has been missed since 2016, and making it happen will require substantial resources.
Third, policy makers should focus on how change will happen. Recent NHS plans have been weak on how care will improve.19 And government’s guiding ideas on the NHS are muddy. The health secretary’s focus on league tables20 and rewarding higher performing trusts21 sits oddly with the new NHS structure based on organisational collaboration.22
A mix of policy levers can be pulled to guide the system in a new direction. For example, NHS targets shape what gets done but are skewed towards hospitals. The NHS payment system is a complex mess of conflicting incentives and is ripe for reform. But none of this will make much difference unless policy makers strengthen the NHS’s capacity to innovate and improve in response—for instance, by developing the capabilities to identify, implement, test, and spread promising service changes.23 This includes time and resources, skilled managers, and data analytics.
A stronger national approach is also needed to shape the development of new technology to benefit the NHS—rather than just shift towards adopting it. For example, artificial intelligence could help diagnose disease but risks exacerbating inequalities.24 As a national system with a single payer structure, the NHS should fund and evaluate totemic innovations in a coordinated way. One priority should be technology that could free up clinicians’ time—for instance, by automating administrative tasks.25
Fourth, the plan needs cash. Labour has emphasised policy change—“reform”—over investment.26 But increased spending is often a major driver of NHS improvement. Labour’s NHS reforms in the 2000s were backed by real terms funding growth of almost 7% a year.27 Policy change—like targets and performance management—helped make use of extra spending.28 But the story makes little sense without the investment.29 Capital investment—in buildings, equipment, and IT—will be essential this time around. Improving care and productivity is hard in crumbling buildings and with outdated equipment.3031 Yet the NHS’s maintenance backlog—including urgent repairs to avoid serious injury—stands at £13.8bn.32
Finally, the plan needs to go with broader policy change to improve health. The social care system in England is a threadbare safety net failing too many people and adding pressure on hospitals.2933 Government has promised a plan reform after an independent review,34 but this may mean reform is ducked or delayed (again).35 A cross-government strategy for reducing England’s vast health inequalities is also needed. Labour’s last version in the 2000s—involving investment in public services and new social programmes, like SureStart—contributed to reductions in inequalities over time.3637A plan for the NHS will not be enough on its own.
Footnotes
Competing interests: We have read and understood BMJ policy on declaration of interests and have no interests to declare.
Provenance and peer review: Commissioned; externally peer reviewed.
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