The government’s new 10 Year Health Plan, Fit for the Future, was published on 3 July 2025. Heralded as a bold statement of intent, it promises three radical shifts: hospital to community, analogue to digital, and sickness to prevention. Yet for all its language of transformation, much of what is proposed feels more like a reprise than a revolution.
The emphasis on prevention is a case in point. Far from being a fresh innovation, prevention has been part of the health service’s DNA since its inception. The NHS Act of 1946 highlighted its importance, while the 1976 government paper Prevention and Health explored strategies to tackle public health issues. In more recent decades, prevention has been the theme of numerous initiatives on obesity, smoking, and wider health inequalities. The question is not whether prevention should be central, but why, after so many years of focus, the outcomes remain mixed.
The shift from hospital to community also has a long pedigree. The plan’s promise to increase the proportion of spending in community settings repeats aspirations first laid out in Our Health, Our Care, Our Say in 2006. At the time, such ambitions were underpinned by a belief in more integrated, localised provision. Yet as the Darzi review later concluded, NHS spending in practice has moved in the opposite direction, with hospitals receiving an ever-greater share of the budget. The new proposals for ‘neighbourhood health centres’ open six days a week echo the health centres envisioned in 1946, the walk-in centres of the 2000s, and the polyclinics of the Darzi Report in 2007. The recycled language raises a pressing issue: why have previous attempts failed, and what confidence should the public place in this latest promise?
Digital transformation, too, is presented as if it were an untapped frontier. In reality, the NHS has pursued such projects for decades, not least the costly and ill-fated Connecting for Health programme of 2005. Today, hope is pinned on the NHS App, which is intended to become the ‘front door’ to all NHS services by 2028. Yet memories of the troubled Covid App remain fresh, and the dangers of a digital divide are plain. During the pandemic, older patients, those with limited access to technology, and disadvantaged groups often struggled with digital solutions. Without serious attention to inclusivity, there is a real risk of policies inadvertently breaching the Equality Act 2010 in relation to protected characteristics such as age.
Perhaps most striking is the plan’s declared ‘one core purpose’: to put power in patients’ hands. This, too, is hardly new. Patient empowerment has been a stated goal of successive Secretaries of State, while New Labour’s era was marked by league tables, earned autonomy, and partnerships with the private sector. The current plan revives these tools, with a promise to ‘reinvent’ Foundation Trusts and to continue using independent capacity for NHS patients. Where it diverges from New Labour is in resources and attitude. Unlike Blair’s government, this strategy does not rest on new financial investment, signalling that the era of “more money, never reform” is, in the government’s words, over. Moreover, the document shows little curiosity about why earlier versions of these policies failed, leaving the impression that the same remedies are being applied in the hope of different results.
As Professor Martin Powell of the University of Birmingham observes, the three shifts so heavily trailed by ministers have featured in NHS strategies for generations. The danger now is that Fit for the Future becomes less a blueprint for transformation and more a tribute act, replaying familiar tunes without learning from the past. For a plan so ambitious in tone, its success will depend not on how radical its language appears, but on whether it finally confronts the reasons so many similar initiatives have stumbled before.
Read the original blog here: https://www.birmingham.ac.uk/news/2025/the-10-year-health-plan-something-old-little-new-something-borrowed-something-blue
