Government 10 Year Health Plan impact statement

23 Jan 2026 02:53 PM

However, this statement is a welcome next step following the publication of the Plan in July last year.

You can find the full impact statement here.

The statement is broken into chapters that focus on the three big shifts, outlining the plans for reform in each of these areas – hospital to community, analogue to digital and sickness to prevention. The statement then has several chapters on the ‘enablers’ needed to deliver the Plan – these chapters focus on: the operating model of the system, quality, workforce, innovation and finance. Finally, the statement ends with a chapter on growth.

Section 1

The reform chapters helpfully identify which proposals in the Plan will deliver the three big shifts. The statement uses evidence to support claims, to justify the reasoning behind the proposed reforms and provide further insight into the thinking behind the strategy; and evaluation of this evidence into the steps needed for these reforms to be a success and identifies potential barriers – both of which were notably absent in the documentation of the 10 Year Plan.

Example:

• The plan seeks to mitigate this risk by designing new financial flows to incentivise and support the neighbourhood health model with organisations supported to collaborate in prioritising prevention and improved primary or community interventions and so reduce the need for avoidable hospital care. The aim is to avoid a fragmented funding system which has hampered previous attempts at integrating care. From April 2026, several integrated care boards (ICBs) will be trialling new financial flows through a test and learn approach that will enable them to receive some of the resources they will save.
• The parallel changes to ICBs could create a risk to delivering this transformation at the speed required. ICBs are required to reduce headcount by 50%, equivalent to 12,500 jobs14F15 and reorganise, with a reduction in the current number (42) of boards. These activities could limit their capacity to provide the necessary strategic leadership to drive this change. However, over the longer term, such changes to ICBs could result in system benefits as the streamlining and refocusing of ICBs on to strategic commissioning may facilitate delivery of the neighbourhood health service.
• Reform of this type, and on this scale, has not been delivered previously. The evidence base is therefore only partial, and the scale of impacts is very difficult to assess. As services develop, ongoing work will be required to assess the funding and value for money implications of the neighbourhood health service, as well as legislative changes required. Some of this work will be iterative given the interactions between system change and NHS budgets, as well as due to the intention to learn from and adapt as we go.

The second chapter focuses on the analogue to digital shift – and the impact statement says that if successfully implemented, there are 2 key categories of opportunity from increased use of data and technology:

• Increased productivity: improved data quality and access to data could support targeting of high-risk patients and groups leading to system efficiencies.
• Increased patient empowerment: if patients engage with their health and care this could lead to increased knowledge, empowerment, and healthy behaviours.  

The statement is honest about risk during the implementation process, for example, with regards to the magnitude and complexity of implementing a system such as the Single Patient Record and also acknowledges the fact that there is a systematic tendency for project appraisers to be overly optimistic both in terms of costs and duration when discussing proposals such as the Single Patient Record.

However, the statement lacks insight into how to avoid or minimise these risks, rather just stating that they are possibility. Additionally, this shift is arguably the most fundamental shift within the 10 Year Plan – without looking at how to minimise potential risks and clear timelines (or provide documentation that does this), the plan risks successful delivery.

Section 2

Moving towards the chapters that focus on ‘enablers’ of the Plan, the statement reconfirms the future 3-tier structure of the NHS in England with a headquarters within DHSC, 7 regional teams and integrated care boards (ICBs) as strategic local commissioners.

On innovation, the impact statement provides useful analysis and insight that industry should consider, as it outlines the Government’s thinking and priorities for innovation and the cost of adoption when looking to work with industry to deliver the 10 Year Health Plan. Industry partnerships should look to demonstrate not just clinical benefit, but system level cost savings.

The relationship between technological advances and health spending is complex. In many cases, new technologies improve length and/or quality of life for patients but at an additional cost to the health service with a price that is deemed cost effective. Over the longer term this can create a cost pressure via:

• new technologies to treat conditions for which there was previously no equivalent treatment (or the effectiveness of the treatment was low) meaning more money spent on a given condition or group of patients (with associated health benefits)
• new technologies which expand existing interventions to wider populations. Overall spend can increase if a new treatment is found to be suitable for wider medical uses meaning it can address previously unmet demand for care

The estimated impact of technological progress on health expenditure growth ranges significantly. Examples of this are found in:

• studies reviewed by the OECD estimated that technological progress accounted for between 10 and 75% of observed annual growth in health expenditure. Most studies reported values between 25 and 50%.

However, benefits to patients in receipt of healthcare that uses new technology will be partially offset by costs to others where spending on new technologies displaces investment in other services.

The final chapter focusing on enablers discusses finance. A summary of evaluation and changes are below. It is worth noting here that while the plan sets good intentions, with promises a shift towards longer term funding streams and multi-year contracts, again, there are no timelines attached. An understanding of when this shift will take place is essential for the proposals that the Plan sets out, and for industry preparation.

On revenue, the current financial framework for the NHS is based on annual allocations. While these align with the government’s annual budgeting process, the lack of longer-term certainty about budgets can limit the ability for organisations to undertake major service transformation and system re-design.

On capital, there will be transition costs within central organisations to design new allocations and payment approaches, and familiarisation and awareness costs within systems for financial regime changes, which typically take years to develop and bed in. There is a risk that administrative costs and challenges of operating some of the policies may out-weigh any service improvements at least in the short term.

Furthermore, setting 5-year capital budgets on a rolling basis aims to support longer-term strategic decision-making. Logically, it is difficult for organisations to optimise investments, changes and innovations in the presence of high future uncertainty. While setting longer allocations limits to some extent the NHS's ability to make short-term allocative adjustments in response to new events and trends, these downsides are likely to be outweighed by the reduced short-termism and the improved budgetary incentives on the system.

On productivity, the ambition in the plan is more than double the NHS’ historic average and is likely to translate to a higher challenge in some settings. Based on historic evidence, this will be a stretching target and if not achieved, will hamper operational and financial performance.

On tariffs, the NHS payment scheme for secondary healthcare already includes a number of Best Practice Tariffs (BPTs) and the plan intends to increase the use of this approach. The use of BPTs more widely could spread this effective practice, providing incentives for providers to implement more efficient approaches to providing care and improve patient experience. BPTs have driven behaviour change and improved the efficient use of resources.

Secondary care payments will also be further refined through changes for urgent and emergency care to incentivise same-day and out-of-hospital care. These will be developed at the same time as year of care payments (YCPs). This approach is intended to incentivise more proactive care for the eligible population, shifting care away from acute settings towards neighbourhood settings.

In addition to trialling YCPs in pioneer systems, payment approaches outside of hospital will also change with the expansion of tariffs to community and mental health services. This statement outlines that the Plan is considering a tariff-based approach could drive activity in these services that would support wider aims, such as clearing the elective backlog, encouraging problems to be solved in lower cost settings, or preventative interventions such as care planning or core care processes.

However, the statement acknowledges that implementing best practice tariffs for individual services in scope of a year of care payment would be challenging. Further consideration will need to be given to which services are most appropriate for each approach.

On the shift towards Foundation Trusts, the statement says that as the provider landscape becomes a more mixed economy of new FTs and those still progressing towards FT status, there will be a need to ensure capital investments by FTs do not crowd-out the spending requirements by other providers. Historically, FTs have principally been providers of acute activity and the Government cannot be certain that unconstrained capital spending will not result in greater investment only into secondary care, risking neighbourhood health ambitions.

In terms of the final chapter, which focuses on growth, there are mixed messages from the impact statement.

The statement is candid in stating that for health spending to continue growing, the government will need to increase overall spending and/or reprioritise resources from elsewhere. The statement suggests that this could be facilitated by wider economic growth, borrowing or additional tax revenue.

However, this raises questions around how the proposals and reforms evaluated and outlined in detail throughout this statement will be delivered given the current economic environment. As mentioned in the introduction, the NHS has a budget settlement until 2028 to 2029 for revenue funding and 2029 to 2030 for capital. Initiatives that require funding beyond these periods will be subject to future years spending reviews and as such, the deliverability of those proposals is less certain given the timelines of the Plan and current pace of delivery.

Additionally, the statement mentions the publication of a new 10-year health infrastructure strategy. While improvements and reform to the NHS’ infrastructure is welcome, there are no timelines for the development of this strategy – let alone delivery of it. Given the lack of timelines provided for the 10 Year Plan, a clear roadmap on this next strategy is essential.

However, on growth, the statement is overwhelmingly positive about the opportunities that technology can provide as an enabler for delivery of the Plan:

Example

• More investment in digital technologies and improving data accessibility will support higher quality care more efficiently provided, hence boosting productivity. For example, approximately a third of a community-based clinician's time (or 88 days per working year) is estimated to be spent on administration and patient coordination.

Additionally, the statement does promise a monitoring and evaluation process of the 10 Year Plan, which will be informed by DHSC's evaluation strategy and states that they are exploring 2 types of monitoring and evaluation, one for individual proposals and another for the plan as a whole. This will be added to the Evaluation Registry once approved, which is a publicly available, online catalogue of all government evaluations.

Conclusion

In conclusion, this impact statement is a welcome stepping stone towards delivery of the 10 Year Plan and does provide some useful insight into the thinking behind the development of the Plan, including reiteration of key proposals and supporting evidence.

However, timelines and clarity on the financial frameworks for delivery remain outstanding leaving no clear plan for implementation. While the statement highlights the importance of long-term contracts and multi-year planning to support industry planning and sector stability, the statement leaves a lot for readers to deduce in terms of which elements of the Plan will be implemented first.

Additionally, while the statement provides welcome evaluation and evidence, the presentation of this is balanced to the point where it is just a presentation, rather than building towards a solution or conclusion on how the Government should proceed with delivery.

The final challenge here is pace of change. Given that the 10 Year Plan was published in July and this statement has only just been released 6 months later, there is a need for increased speed of delivery. It is no secret that the NHS and economy cannot afford to wait to see the changes promised in the Plan, delivered.

In terms of immediate priorities, the government must accelerate and publish the timelines for delivery, outline the priority areas for implementation, and increase transparency on next steps by engaging with industry and system partners at regular intervals for input and evaluation.