The NHS is facing an existential crisis. Can Labour’s 10-year plan really save it?

The government’s long-awaited 10-year plan for the NHS will be unveiled today (2 July).

Dubbed the “biggest overhaul in NHS history”, the scheme entails radical shifts in how the health service is structured and delivered.

The plan, health secretary Wes Streeting has claimed, will deliver a “fighting fit” health service.

He’s got a big mountain to climb. After more than a decade of underfunding and austerity, the health service is in crisis. Between 2010 and February 2020, the elective waiting list doubled from 2.3 million to 4.6 million; it’s now at 7.39 million. The NHS faces crumbling infrastructure, record A&E deaths and declining satisfaction among patients and staff.

Read more:

• My mum died after an 11-hour ambulance wait – the system is failing patients and health workers
• Poor mental health and feeling sad is a normal part of life, neuropsychiatrist says: ‘Life is not easy’
• We all clapped for the NHS during the Covid pandemic. Did it actually do… anything?

Meanwhile, costs continue to rise even as outcomes worsen. Illness is surging, crisis spending has ballooned and the NHS now takes up 40% of day-to-day government spending.

“If we don’t make the NHS sustainable, it will go bust,” Streeting has said. “Everyone knows how existential this is.”

Will the 10-year plan fix these problems? The stakes are high.

“Satisfaction among the public of NHS services is at rock bottom levels,” says Sebastian Rees, head of health policy at the IPPR think tank. “Unless they can do something to turn that around… faith in the system erodes.”

The NHS topped voters’ concerns before last year’s election and will likely influence the 2029 vote. Reform UK – currently ahead of Starmer’s party in several polls – has floated a controversial social-insurance model.

Labour’s majority – and the health system itself – may hang in the balance.

“Wes Streeting has, on numerous occasions, said that if you want to judge this government, judge it on its record on NHS transformation,” says Rees. “Aside from the cost of living and economic growth, health is the other big issue Labour is staking its claim for re-election on.”

“But it’s about more than that… if you don’t get this right, people will lose faith in the NHS model as it currently exists.”

So, what exactly is in the plan? Here’s what’s been revealed so far.

NHS plan’s three big shifts: Community, digital and prevention

Hospitals to communities

Care will be moved out of hospitals and into local settings like pharmacies, remote surgery hubs and diagnostic centres.

“The big day-to-day differences will be a big chunk of care that’s currently provided in the hospital setting will be provided out of hospital,” Rees explains.

This aims to address the enormous hospital backlog. Pharmacy-first schemes will expand, and private companies like Specsavers may manage follow-up appointments for procedures such as cataract surgery.

Experts support the idea, but warn of implementation challenges. This shift may require patients to give up familiar services – like in-hospital diabetes centres – for community-based alternatives

“You can have your plan… but changing the NHS means getting one and a half million people to work in quite different ways,” Rees says..

“If you hypothetically say the system is going to be better in 10 years… people are less excited about that than they are fearful about the uncertainty that exists at the moment.”

The transition also hinges on sustained investment in general practice.

“Priorities should include recruiting and retaining more GPs. This will take investment,” the Health Foundation has warned. “Like many before it, the new government has pledged to shift resources from hospitals to services in the community. Yet the natural flow of resources in the NHS since 2000 has gone in the other direction.”

Streeting has called the “family doctor” the “front door to the NHS,” and the government recently pledged £80 million to recruit ‘thousands’ more GPs by 2028/29.

Professor Kamila Hawthorne, chair of the Royal College of General Practitioners, welcomed the announcement, but warned: “The devil will be in the detail.”

“General practice is in crisis – we are overstretched, underfunded and understaffed,” she said.

Analogue to digital

Technology is central to the overhaul. The revamped NHS app, renamed “My Companion”, will use AI to triage patients, manage medication and schedule appointments.

New AI systems will also monitor hospital data in real time, flagging issues like rising surgical errors or stillbirths.

Robotic surgery is set to expand significantly. By 2035, the goal is for one in eight operations to be robot-assisted, up from today’s one in 60.

The plan also includes more ambient voice technology (AVT) – AI tools that transcribe visits, extract key details and create summaries.

With NHS staff overstretched, productivity gains could be game-changing; Streeting claims AVT could raise doctor productivity by up to 20%.

But there are concerns about AI errors and risks to patient privacy.

Recently, the NHS’s chief clinical information officer warned that many AVT systems now in use don’t meet NHS rules.

“They hold a substantial degree of risk – both in terms of information governance and patient safety,” the British Medical Association has advised doctors.

Treatment to prevention

Prevention is another cornerstone. The government wants to tackle poor health at its roots – from obesity to smoking – to avoid costly hospital admissions.

Much of this is behavioural. A new government partnership with supermarkets will look at reformulating products and rearranging store shelves to make healthy choices easier. Officials claim that cutting 200 calories a day among people who are overweight could halve obesity levels, lifting two million adults and 340,000 children out of the condition.

“Through our new healthy food standard, we will make the healthy choice the easy choice, because prevention is better than cure,” Streeting said.

It’s a bold goal – especially since the UK currently has Europe’s third-highest adult obesity rate, costing the NHS £11.4 billion a year.

Still, behavioural shifts aren’t enough. Rees stresses that real prevention must tackle widening health inequalities.

“We know that there’s a long-term mission to boost healthy life expectancy in England and to close the gaps… Just from an accountability perspective, we need clear targets.”

Targets could include cutting smoking rates in deprived areas by 30% or addressing alcohol misuse.

Where will the money come from?

The government’s plans are ambitious. But delivering them will mean investment.

The government is pouring money into the day-to-day side of the NHS. At the recent spending review, it promised a £29bn annual increase in day-to-day NHS spending by the end of this parliament – a 2.8% boost for the Department of Health and Social Care, while most other departments received real terms cuts.

“That is what the British people voted for and that is what we will deliver. More appointments. More doctors. More scanners,” said chancellor Rachel Reeves.

But capital spending – the money for buildings and equipment (including those scanners that Reeves mentioned) – has flatlined.

“We know that there is not going to be additional capital injected into the NHS,” Rees said. “So I think one thing that we might see in this plan is some sort of consultation announced on how to bring in additional private finance into the NHS.”

Starmer has previously hinted at dramatic changes to the funding model: “We have to fix the plumbing before we turn on the taps.”

Julia Grace Patterson, CEO of Every Doctor, voiced strong concerns about the possibility of private sector involvement.

“I expect that Starmer and Streeting will decide to partner heavily with the private sector to realise their plans, and I expect they’ll try very hard to sell these ideas to the public.”

She warns against repeating past mistakes.

“If this is the case… we need to be clear-eyed. Public-private partnerships have been a disaster for the NHS. We won’t pay off the PFI hospitals in England until 2050, and they’re costing us billions!”

The private finance initiative (PFI) involved private funding for hospital design, construction and maintenance, leaving the NHS with long-term repayments – up to 16% of the income of some trusts. One repayment window stretches from 1998 to 2050.

A full return to PFI is unlikely, but newer models like community diagnostic centres – where private providers front costs and get reimbursed – may increase.

“I suspect that there’ll be a lot of reluctance… to sign anything off that means the government is liable for paying off big debts long run to private actors,” he says.

“People think [the NHS] is a single provider model… whereas for a lot of services, it’s always been a mixed model of provision. GPs are private contractors to the NHS, pharmacies are the same.”

“There might be specific things that people currently get in a hospital that they can get straight through pharmacy or optometry… that would be a change, but probably less radical than both supporters and critics (of privatisation) would envision.”

Do you have a story to tell or opinions to share about this? Get in touch and tell us more. 

We don’t follow headlines. We lead with the truth.

Every week, Big Issue digs deeper – telling stories others don’t. We’re free to be bold, to speak up for those society overlooks and to put people at the heart of everything.

If you value journalism that entertains and cuts through the noise you can help us to keep it going.

Support independent journalism from £5 a month.