The Labour Governments’ NHS 10 Year Plan for England was published on 4th July 2025, exactly a year to the day from their election victory on 4th July 2024. Whilst not without ambition (merging NHS England with Department of Health and Social Care, reducing headcount by 50%), it lacks the fanfare of the 1997 NHS White Paper (the new NHS modern . dependable ). Tony Blair was elected with 179 seat majority and the NHS white paper was published within 6 months of New Labour getting into government and it marked a major legislative programme in terms of the organisation of the NHS in England. Fast forward to 2010 and remember the very public brouhaha around the Conservative led health and social care act, published in January 2011, as one of the first pieces of major legislation following the Coalition government election victory of May 2010. The point is, that these governments set themselves a major task of proposing and implementing major healthcare legislative programmes very early in their terms of office. The 2025 plan, rather than proposing such an ambitious legislative programme, follows and adapts the approach taken previously by the Conservative Prime Minister Theresa May in the January 2019 publication of the NHS Long Term Plan. This 2019 plan came nearly 3 years after the Brexit referendum and was essentially the first Government attempt at making health policy post-Brexit. It was organised around three key issues, 1) ‘making sure everyone gets the best start in life’, 2) delivering world class care for the major health problems and 3) supporting people to age well. The plan outlined a series of ways to address these issues involving changes such as more collaboration between GPs and community services, new policies for tackling smoking and ‘drinking problems’ (sic), increasing the NHS workforce, making better use of digital technology and ensuring value for money. An editorial in the British Medical Journal highlighted how the plan offered a promised £20.5bn extra funding for the NHS in England, from the office of the Prime Minister. The date of publication of the NHS Long Term Plan is significant, as many of the ambitions of this project were undermined or even thwarted by the COVID pandemic, which emerged less than 18 months after its publication. Analysis from the Health Foundation (published in Sept 2021) outlines how “…no part of the NHS’s plan has been unaffected by the pandemic. Unsurprisingly, the overall picture is one of major delay, disruption, and increased demands on modern dependable NHS services”.
It would appear that the 2025 plan takes a different approach to organisation and delivery, seeking ways to segue from and build upon previous policy regimes (very much like old wine in new bottles). Maybe this is in part a reaction to the very public intense battles between professions and governments that accompanied the 2012 Act, at times threatening to derail it completely. However, whilst this might offer part of the answer, 2012 and the so-called Lansley reforms seem a long long time ago. Rather, it seems to me that the age of wide-ranging legislative programmes has changed and changed significantly in the context of two additional and other major events, namely Brexit and COVID. Given the impact of these two events on the organisation and delivery of healthcare, it might be anticipated that a legislative programme for health and healthcare would be a government priority, but it feels like the opposite is the case. It is a concern (for me at least) that a legislative programme for healthcare does not appear to be a government priority and I am trying to make sense of what this lack of priority might suggest about the post-Brexit/post-COVID policy landscape in England. In trying to make sense of these changes, there is a clear need to trace trajectories of similarity and difference across different policy regimes enacted by specific governments. Indeed, if we compare the NHS Long Term Plan and the NHS 10 Year Plan there are a number of similarities in terms of the emphasis on GPs working with communities (the hospital to community neighbourhood health plans). Similarly, the much-vaunted move from ‘bricks to clicks’ via the NHS App, resonates with 2019 plan to make better use of digital technology, and the ever present imperative to ensure value for money for taxpayers is self-evident across both plans. The 10 year plan is underpinned by appeals to change the the usual suspects, e.g. profligate professional spending, need for better value for money, new employment contracts for GPs and better services for patients. Granted there are some differences, for example the changes to NHS England and Integrated Care Boards would suggest that these elements of previous policy regimes are regarded as failed experiments. Likewise, the purported ‘reinvention’ of Foundation Trusts suggests a return to some ‘unfinished business’ by Labour Policy wonks.
There is a clear need to get beyond the presentational rhetoric and consider these reforms at a systems level in terms of what they might suggest about what is clearly the latest iteration of government attempts to exert control over the shape and influence of health care delivery in England. Rather than an age of grand gestures, where the scale of the proposed legislation (2012 Social Care Act) was claimed to be so big as to be visible from space, the presentation of the NHS 10 year plan has the feel of being predicated upon a bit of tinkering around the edges (despite the fact that there are significant proposed changes). My argument here is more about the public presentation of policy, rather than the content of the policy itself. It seems to me, in the UK at least, post-Brexit and Post-COVID, that there has been a fundamental shift away from grand policy gestures, in the context of health policy. What this might tell us about the prevailing context around the politics of health and healthcare remains to be seen, but it is an important question to ask, particularly in the comparative context of the daily largesse of policy announcements made by North American policy makers. If this largesse marks the zeitgeist of contemporary policy making then we can anticipate a different policy regime in the coming 10 years of the NHS Plan.
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Old wine in new bottles: the NHS 10 year plan for England
by Ewen Speed Nov 5, 2025The Labour Governments’ NHS 10 Year Plan for England was published on 4th July 2025, exactly a year to the day from their election victory on 4th July 2024. Whilst not without ambition (merging NHS England with Department of Health and Social Care, reducing headcount by 50%), it lacks the fanfare of the 1997 NHS White Paper (the new NHS modern . dependable ). Tony Blair was elected with 179 seat majority and the NHS white paper was published within 6 months of New Labour getting into government and it marked a major legislative programme in terms of the organisation of the NHS in England. Fast forward to 2010 and remember the very public brouhaha around the Conservative led health and social care act, published in January 2011, as one of the first pieces of major legislation following the Coalition government election victory of May 2010. The point is, that these governments set themselves a major task of proposing and implementing major healthcare legislative programmes very early in their terms of office. The 2025 plan, rather than proposing such an ambitious legislative programme, follows and adapts the approach taken previously by the Conservative Prime Minister Theresa May in the January 2019 publication of the NHS Long Term Plan. This 2019 plan came nearly 3 years after the Brexit referendum and was essentially the first Government attempt at making health policy post-Brexit. It was organised around three key issues, 1) ‘making sure everyone gets the best start in life’, 2) delivering world class care for the major health problems and 3) supporting people to age well. The plan outlined a series of ways to address these issues involving changes such as more collaboration between GPs and community services, new policies for tackling smoking and ‘drinking problems’ (sic), increasing the NHS workforce, making better use of digital technology and ensuring value for money. An editorial in the British Medical Journal highlighted how the plan offered a promised £20.5bn extra funding for the NHS in England, from the office of the Prime Minister. The date of publication of the NHS Long Term Plan is significant, as many of the ambitions of this project were undermined or even thwarted by the COVID pandemic, which emerged less than 18 months after its publication. Analysis from the Health Foundation (published in Sept 2021) outlines how “…no part of the NHS’s plan has been unaffected by the pandemic. Unsurprisingly, the overall picture is one of major delay, disruption, and increased demands on modern dependable NHS services”.
It would appear that the 2025 plan takes a different approach to organisation and delivery, seeking ways to segue from and build upon previous policy regimes (very much like old wine in new bottles). Maybe this is in part a reaction to the very public intense battles between professions and governments that accompanied the 2012 Act, at times threatening to derail it completely. However, whilst this might offer part of the answer, 2012 and the so-called Lansley reforms seem a long long time ago. Rather, it seems to me that the age of wide-ranging legislative programmes has changed and changed significantly in the context of two additional and other major events, namely Brexit and COVID. Given the impact of these two events on the organisation and delivery of healthcare, it might be anticipated that a legislative programme for health and healthcare would be a government priority, but it feels like the opposite is the case. It is a concern (for me at least) that a legislative programme for healthcare does not appear to be a government priority and I am trying to make sense of what this lack of priority might suggest about the post-Brexit/post-COVID policy landscape in England. In trying to make sense of these changes, there is a clear need to trace trajectories of similarity and difference across different policy regimes enacted by specific governments. Indeed, if we compare the NHS Long Term Plan and the NHS 10 Year Plan there are a number of similarities in terms of the emphasis on GPs working with communities (the hospital to community neighbourhood health plans). Similarly, the much-vaunted move from ‘bricks to clicks’ via the NHS App, resonates with 2019 plan to make better use of digital technology, and the ever present imperative to ensure value for money for taxpayers is self-evident across both plans. The 10 year plan is underpinned by appeals to change the the usual suspects, e.g. profligate professional spending, need for better value for money, new employment contracts for GPs and better services for patients. Granted there are some differences, for example the changes to NHS England and Integrated Care Boards would suggest that these elements of previous policy regimes are regarded as failed experiments. Likewise, the purported ‘reinvention’ of Foundation Trusts suggests a return to some ‘unfinished business’ by Labour Policy wonks.
There is a clear need to get beyond the presentational rhetoric and consider these reforms at a systems level in terms of what they might suggest about what is clearly the latest iteration of government attempts to exert control over the shape and influence of health care delivery in England. Rather than an age of grand gestures, where the scale of the proposed legislation (2012 Social Care Act) was claimed to be so big as to be visible from space, the presentation of the NHS 10 year plan has the feel of being predicated upon a bit of tinkering around the edges (despite the fact that there are significant proposed changes). My argument here is more about the public presentation of policy, rather than the content of the policy itself. It seems to me, in the UK at least, post-Brexit and Post-COVID, that there has been a fundamental shift away from grand policy gestures, in the context of health policy. What this might tell us about the prevailing context around the politics of health and healthcare remains to be seen, but it is an important question to ask, particularly in the comparative context of the daily largesse of policy announcements made by North American policy makers. If this largesse marks the zeitgeist of contemporary policy making then we can anticipate a different policy regime in the coming 10 years of the NHS Plan.