Guidance

Tasking statements for the 10 Year Health Plan working groups

Published 12 December 2024

Introduction

The new government has committed to building an NHS fit for the future. The 10 Year Health Plan will make this commitment a reality.

In line with the government’s manifesto commitments, the 10 Year Health Plan will set out how we achieve the transformational change our health system needs. This will involve 3 strategic shifts in how care is delivered, moving care from:

• hospital to the community
• analogue to digital
• sickness to prevention

Along with these shifts, the government wants the public to have far greater control over their care. This will be a central theme of the work on the 10 Year Health Plan.

Working groups

There are 11 working groups supporting policy development for the 10 Year Health Plan for the benefit of patients, NHS staff and the wider public. There are 4 working groups developing the vision and 7 working groups developing the plans to help make that vision a reality.

The groups are working together to develop proposals which are:

• ambitious
• grounded in what patients, staff and the public want and need from the health service
• future-focussed with sequenced implementation over the whole 10-year period

The Secretary of State for Health and Social Care has been clear that the 10 Year Health Plan will be co-designed with the public, partner organisations and health staff. The working groups will use the insights they gain from the 10 Year Health Plan’s extensive engagement to inform their work.

Specifically, the government has asked the working groups to:

• listen to and act on insights from the wider programme of engagement, including the online portal and the regional discussion events
• commission the 10 Year Health Plan engagement team to test the groups’ work with partner organisations, system leaders, the public or front-line staff as needed
• demonstrate how they have taken on board this insight in their final outputs

In addition, working groups should look at examples of international best practice and consider what we can learn from these to provide high quality, effective healthcare in England.

Finally, each group will need to consider the financial implications. The plan is a decade long with the ambition of delivering an NHS that is fit for the future and financially sustainable. 

Working groups will need to take into account that public sector finances are always very tight. As much as possible, proposals should be developed to include savings through better use of overall resources and ensure sustainability in the long term. 

Tasking statements

Working groups have been given tasking statements to drive their work. This includes more information to consider, including relevant areas to focus on as well as what is definitively out of scope for that working group.

The rest of this page outlines the task and scope for each working group. They explain the current issues to consider to help them set out:

• what best practice in that area should look like by 2035
• what to do to make that happen

The outputs of the vision working groups will directly inform the work of the enabling working groups, who will focus on the necessary policy and practice changes to make this vision a reality.

Vision working groups

I can stay healthy and manage my health in a way that works for me

Summary

This working group will design a new model of prevention-focussed care. Health services and individuals will do more to prevent people getting ill and to stop health problems from getting worse.

The issue to work on

In his independent investigation of the NHS, Lord Darzi found that the health of the nation has deteriorated. Growth in life expectancy has stagnated and we can now expect to live more of our lives in ill-health. Multiple long-term conditions and mental health needs have increased, while fewer children are getting immunisations, and fewer adults are participating in screening programmes. We are facing significant societal challenges with implications for the health sector, such as:

• an ageing population
• the increase of major conditions
• the clustering of risk factors

Outline of what this working group will do

The role of this working group is to set out what a prevention-focussed health system looks like in 2035 for children, young people and adults. This service needs to both prevent the onset of ill health and stop minor illnesses becoming major illnesses.

This group will develop an ambitious but realistic plan of how health services will empower people to manage their own health in a way that works for them. This opportunity should be equitable across the population. This roadmap should take society from the health issues of the present day (as outlined by Lord Darzi) to this improved situation in 2035. It must consider the societal changes in technology, demographics and medical advances likely over the next 10 years as well as what we can learn from other countries. This should include thinking on how these changes impact health inequities, including those which result from the digital divide.

Policy proposals should incorporate the 3 health mission shifts. This is central to transforming the health service to improve the health of the nation over the next 10 years. Proposals must focus on the remit of how the following can engage with prevention offers:

• the health service
• local government
• public health functions
• community, family, and individual responsibility - including those with different abilities and higher risk

As well as stating how the NHS will support people, the group will outline what individuals are expected to do to engage with prevention offers.

In addition, the group will set out how the health system can support people to get back to or stay in work. This will include what changes are necessary across the health system at a national, regional, local and individual level to enable that vision to happen.

In previous years, we have talked about the moment of a consultation being a teachable moment for a patient. Consultations provide NHS staff with opportunities to both talk about health and self-management in healthcare. In 2024, the NHS delivered one million consultations every 20 hours. The group will ask how these might play a better role in increasing the agency of patients to better manage their care.

This group will draw on international comparisons and global and system perspectives to inform this plan. They’ll include examples of best practice secondary prevention-focussed health services and individual health management which are already in place across England.

This working group is focussing on secondary prevention facing services which could be developed by health services.

The government recognises the critical role played by the wider determinants of health in supporting and improving population health. The government has an ambitious agenda to improve these determinants through the Health Mission and other missions. However, they are not in scope for this working group.

I can access the high-quality and effective care I need, when and where I need it

Summary

This working group will develop a vision of a health service that enables access to high quality care which meets the wants and needs of patients and the wider public. The group will detail how policy can make this vision a reality.

The issue to work on

For over a decade now, the NHS has not consistently met its constitutional standards on access to care.

Waiting times are at record levels. The UK has slipped down international rankings on many outcome-based health measures where access is vital, ranking in the third worst of comparable countries for some causes of death.

Access to primary care is also too variable with major patient frustration at an ‘8am scramble’ and limited access to face to face appointments.

Satisfaction with the NHS has dropped to its lowest since records began. Turning this around is central to achieving the goal of “an NHS that is there when people need it”.

Outline of what this working group will do

Achieving better access and quality requires a vision that reflects what an NHS fit for the future will mean in 10 years, informed by expected demographic and technological changes, not just today’s standards with phased implementation.

This vision must be underpinned by the 3 shifts. The group will set out what delivering these looks and feels like for patients, including what high quality care means for them. To overcome obstacles that have previously prevented reform and worsened access, the group will consider:

• rebalancing capacity and demand across the health system
• redesigning pathways to support timely access to care
• moving towards a truly neighbourhood health service with more care delivered in local communities

This vision will also describe a ‘new model of care’ for patients. This vision should cover all encounters with the health service that a patient may need. This includes both urgent and elective care for acute conditions. Vitally, it must describe what this change would mean for patients, local services and national policies. It will also consider how we measure access, performance and outcomes.

Much more patient-facing technology will have a big impact on the ability of patients to access the care they need when and where they want it. Within a few years, much of the day-to-day care that presently needs some form of visit to a clinician will be delivered and held by technology. This group will start answering the questions about when and what this will cover.

For several years to come, the NHS App will be the main patient-facing NHS technology. This working group will consider how the app can promote improved access and quality of care from the perspective of patients.

My care is integrated around my needs and wishes, and I am listened to

Summary

This working group will develop a vision for what effective, integrated care should look like by 2035 for people living with one or multiple long-term conditions.

The issue to work on

The number of individuals living with long-term conditions is expected to rise significantly over the next decade.

Currently, the NHS operates a model focussed on treating acute episodes, organised around fragmented services rather than holistic patient needs.

Lord Darzi’s independent investigation of the NHS highlighted that this demographic shift has meant multidisciplinary team working is even more important. And yet NHS structures, funding flows, care models, treatment pathways, skills mix and estates have not kept pace, with GPs expected to manage and coordinate increasingly complex care. As a nation, we spend more on hospital care and less on care in communities than other comparable countries.

Outline of what this working group will do

This group will develop a vision for how the NHS can evolve to provide responsive, joined-up care to better support individuals with complex health needs who may require frequent, ongoing engagement with the NHS.

This group’s scope includes 2 key populations:

1. Individuals living with a single or multiple long-term conditions (for example, mental health conditions, disabilities).
2. Individuals with multiple complex needs, (for example, frailty or those approaching the end of life).

The NHS needs to address the changing health landscape, which shows an increase in chronic conditions and mental health needs, particularly among children and young people.

Starting with the patient perspective, this group should state what patients (both children, adults and their carers) want and need from services across the NHS to manage their conditions on an ongoing basis. The working group should set out what that care offer should look and feel like in practice. They will focus on how the NHS can empower patients, enhance their self-management capabilities and promote independence through a holistic, person-centred and responsive service.

The group will consider what a predictive, proactive, and personalised NHS could look like by 2035. This includes harnessing advancements in artificial intelligence, data analytics, and digital infrastructure to anticipate and meet patients’ needs dynamically.

Crucially, the group should outline how the 3 health mission shifts will support the delivery of this vision and align with it.

This vision must shift to an integrated model where services work closely together, ensuring that patients experience improved continuity, coordination, and comprehensive support throughout their healthcare journey.

We need to create the opportunity for patients and their families to gain valuable insights and skills to manage conditions more independently.

A shift in the balance of care - from hospital-centred to community-based settings - is essential for effective, sustainable service delivery. This vision should highlight the importance of the neighbourhood health service in supporting holistic, team-based care, enabling patients to receive continuous, community-based support to manage their conditions.

The group will consider changes necessary at national, regional, local, and neighbourhood levels to make this vision a reality. The group should focus on how we can develop stronger partnerships with health-related social care services and voluntary and community groups to enhance patient agency and engagement. The working group should identify international best practices and existing local successes as benchmarks.

Finally, this group should examine why similar visions have not succeeded previously and identify barriers (such as technical or policy constraints). The group needs to make recommendations that can help achieve this vision. Their proposals should include the potential for future science and technological innovations, especially digital advancements that can support more personalised and adaptable care.

I am treated in a fair and inclusive way, irrespective of who I am

Summary

This working group will develop principles for how care should be designed and delivered to significantly improve healthcare equity in England by 2035.

This will improve inequities in healthcare access, patient experience and outcomes.

The team will focus on vulnerable groups and those with protected characteristics.

The issue to work on

The NHS is founded on the principle of equal access for all. At the moment, the NHS does not fully achieve that goal. The 10 Year Health Plan is a chance to fully implement that principle.

Health inequities are the unfair, avoidable and systematic differences in health between different groups of people.

Lord Darzi’s independent investigation of the NHS highlighted stark inequities across our society, including:

• higher maternal mortality among black and Asian women
• greater childhood obesity in more deprived areas
• a smaller number of healthy life years for people in deprived areas
• lower life expectancy in more deprived areas

Too often, the health service doesn’t prioritise patient perspectives. People with the greatest care needs often face the greatest barriers to accessing care.

Outline of what this working group will do

The purpose of this working group is to:

• envision what equity in healthcare looks like for society in 2035
• develop an ambitious set of healthcare design principles to bring this vision to life

This should be built on an understanding of what matters to the public and the expected changes in technology, demographics and medical advances over the next 10 years.

This team will consider the current inequities in healthcare access, experience, outcomes and life expectancy that specific groups experience. The groups to consider include vulnerable groups such as children, young people and care leavers and those with protected characteristics.

It is essential to recognise the additional barriers to accessing healthcare created by fear of discrimination and stigma, such as racism or prejudice.

To develop a vision that will help address these inequities, the team should look beyond the traditional boundaries of healthcare to incorporate the 3 health mission shifts.

The team will develop innovative healthcare design principles that reflect patients’ views and create lasting change relevant to the needs of a population in 2035.

Given the importance of patient facing technology in shaping health and healthcare in 2035, it is vital that this working group plans for overcoming the digital divide. This is not a task for the NHS alone but will need the joint work from the public and private sector and should be led by civil society organisations.

Starting with the patient perspective, this group should:

• describe what patients want and need from the NHS to feel they are being treated in a fair and inclusive way
• set out what the healthcare design principles are to make healthcare fairer and more equitable, and how those design principles should work in practice, for healthcare to be holistic, patient-centred, and responsive to patients’ needs and wishes

The team should then set out the necessary changes at national, local, and regional levels to enable care to be delivered in line with the healthcare design principles that they have set out.

The group should look at what can be learned from international comparisons and pockets of best practice approaches to fair, accessible and high-quality healthcare, which are already in place across England.

Enabling working groups

People

Summary

This working group will consider how to recruit, train, and retain an NHS workforce that can meet the future needs of patients, and deliver the 3 mission shifts.

The issue to work on

Recruiting, retaining and supporting an NHS workforce that can meet the changing needs of patients will be vital to achieving the aims of the 10 Year Health Plan. Over the last 20 years, the NHS workforce has grown and undergone significant change in order to meet rising demand and deliver new treatments and services. However, productivity has struggled to recover following the pandemic and some staff feel disempowered, undervalued and overwhelmed.

Meeting the future needs of patients, and delivering the 3 shifts, will require a better staff experience.

Outline of what this working group will do

This group will need to consider:

• how skill mix, training and education will need to continue to change to deliver more preventative care
• how to incentivise and support staff to work in the community
• how to transform the way staff use technology in order to facilitate better and more timely patient care

This includes considering how to develop and embed effective leadership to build a compassionate and inclusive culture and empowering staff (clinical and non-clinical) to deliver a world-leading health service for patients.

The group should also describe a future employment model for staff that meets the expectations of new generations for flexibility, choice and empowerment.

Finance and contracting

Summary

This working group will consider how payment mechanisms, funding flows and contracting will need to change in future in order to achieve the 3 shifts.

The issue to work on

Financial flows and payment mechanisms play an important role in enabling high quality and efficient health services. At the moment they are fragmented and therefore can be a barrier to providing joined up patient care.

Outline of what this working group will do

This working group will evaluate the finance and contracting implications of the 3 shifts, identifying how these will need to change over the coming years. This includes considering how finance flows and payment mechanisms should change in order to achieve the emerging vision of the 10 Year Health Plan, improving patient outcomes, experience and choice.

This group should consider radical options for how funding is allocated and flows through the system from first principles, rather than suggesting how to make improvements at the margins.

The same is true of contracting - no contract is too sacred to consider wholesale reform. In order to deliver more joined up care in the next decade, all contracts will have to play a much bigger role in enabling coordinated patient pathways. 

This group will need to work alongside other enabling working groups, specifically:

• physical infrastructure - to ensure future funding flows align with proposed reforms of the capital regime
• data and technology - to consider how future investment and expenditure is determined
• accountability and oversight - so that finance mechanisms effectively align with accountability structures to improve priority outcomes

Physical infrastructure

Summary

This working group will consider how healthcare infrastructure, estates and the NHS capital regime need to change in order to best meet the future needs of patients and staff.

The issue to work on

The NHS is a significant estate and infrastructure owner, occupying over 30 million square metres, greater in size than the city of Bath. 

Healthcare infrastructure is critical to the delivery of safe, high-quality clinical services and a important enabler for transformational change and quality improvement.

However, a significant proportion of the NHS estate is not fit for purpose and does not support the delivery of modern healthcare. Forty-four per cent of the estate pre-dates the creation of the internet (1983) and 11% is older than the NHS itself (1948). Parts of the estate are in unacceptably poor condition, with a maintenance backlog of nearly £14 billion in the secondary care sector alone, based on the latest published data. There are also concerns about the suitability of the NHS estate for modern requirements. For instance, in primary care, 35% of the estate has predominantly been converted from formerly residential properties.

The NHS has also fallen behind international benchmarks in terms of equipment. For instance, the NHS in England has one of the lowest numbers of acute beds per capita in the OECD. Similarly, in terms of diagnostics equipment, England has only 11.8 CT scanners per million population, compared with the OECD average of 30.4 and 10.3 MRI units compared to the OECD average of 20.

Outline of what this working group will do

The policy proposals from this working group should propose changes that will deliver future infrastructure which is:

• sufficient to meet demand and performance objectives
• suitable, safe and fit for purpose for all staff and patients
• welcoming, easy to navigate and supports dignity throughout care
• an enabler of staff carrying out their roles effectively
• reflective of modern models of care
• able to change and be responsive to changing needs over time
• efficient and maximises value for money, including supporting other productivity and efficiency measures
• more energy efficient

Given the radical nature of the changes in the model of care that will come from the 10 Year Health Plan, there will be significant changes in the infrastructure needs. The buildings we use for new care models must be flexible in design, so they can adapt and change as care models evolve.

As well as considering current challenges, to enable effective future planning and transformation, this group will need to assess the capital regime as a whole.

This includes considering how the capital regime can support the (re)configuration of estates and wider physical infrastructure, including equipment, to meet the changing needs of patients over the next decade. This should cover any recommendations emerging from the vision working groups around how services should be redesigned, for example, to deliver the shift from hospital to the community.

This also includes considering the level of delegation and devolution of responsibilities to local organisations.

This working group will need to engage with the Finance and contracting, and Data and technology working groups to ensure alignment with future funding flows and future investment and expenditure into data and technology.

Data and technology

Summary

This working group will consider how to maximise the impact of data and digital technology in healthcare. This includes identifying the main areas to focus resources in the coming years to deliver improved patient outcomes, better staff experience and a more financially sustainable system.

The issue to work on

The NHS has taken steps towards harnessing data and digital technology to transform and improve services. However, progress has been slower than necessary to fully capitalise on these tools.

Over the coming decade it will be crucial to significantly ramp up efforts if we are to maximise the potential of these technologies and deliver a financially sustainable health system and better outcomes for patients. Data and technology can also empower patients, giving them greater control over their health and improving their ability to manage care in a more personalised and effective way. The government has identified the shift from analogue to digital as one of the 3 shifts required over the coming decade. Digital technology will also be integral to delivering the other 2 shifts (hospital to community and sickness to prevention).

Outline of what this working group will do

This working group will consider how the NHS can focus its resources and efforts over the next decade to ensure it maximises the impact of data and technology. This includes considering how the NHS can do even more than the work already planned around:

• fixing the digital infrastructure of the NHS, to ensure we can make life easier and more productive for those who work in the NHS
• modernising the NHS’s data platforms, services and models, to ensure we can use data more effectively to plan, manage and deliver services, including driving a population health management approach to improving patient outcomes and supporting neighbourhood health
• transforming digital patient facing services, including the NHS App and the single patient record, in a way that involves and empower patients
• maximising the value of NHS England’s national digital service

The work of this group will also consider how any changes will be implemented, including the resources and time needed for staff and patients to adapt to and feed back on the changes, and have them deliver their intended benefits.

By 2035 patients will have most areas of their lives enabled and enhanced by technology they can hold in their hand. We need the same to happen with their health and healthcare so that it’s also a normal part of their interactions with the NHS. This approach to the digitally enabled transformation of healthcare services will be fully inclusive of the population that the NHS serves, recognising the evidence and the risks around digital exclusion.

This working group will also consider how to enable an agile approach to data and technology over the next 10 years, to avoid a focus on individual technologies that may be superseded over time.

This working group will need to engage with the Finance and contracting and Physical infrastructure working groups to ensure alignment across future funding flows and reforms to the capital regime. It will also need to engage with the Research, life sciences and innovation working group as the transformation of the digital and data infrastructure of the NHS will be shaped by innovation in care, diagnostics and treatment options.

Research, life sciences and innovation

Summary

This working group will set out how the NHS can work in partnership with researchers, innovators and the life sciences sector to meet people’s future needs.

The issue to work on

Research, life sciences and innovation can bring major benefits to NHS patients, both individually and at a population level. This includes:

• new treatments leading to better outcomes
• improvements in existing treatments and pathways for more effective care
• medical and digital technology which enhances staff efficiency, productivity and wellbeing

The NHS has a vital role to play in the UK’s research infrastructure, supporting our role as a world leader in research (the outputs of which bring significant benefits to patients and the NHS as a whole).

Outline of what this working group will do

The group will develop an ambitious vision for how to better use research, innovation and life sciences to support the NHS over the coming decade to maximise benefits to patients in a way that meets their changing needs. Proposals must also overcome barriers to developing and spreading new innovations.

They’ll need to consider how the NHS can identify and capitalise on technologies as they emerge. The group will consider how the NHS currently embeds research, innovation and life sciences and what we can do to increase the speed and scale of adoption of new innovations.

There will be close links here between this NHS-focussed work and work to grow the life sciences sector more broadly under the industrial strategy life sciences sector plan.

Accountability and oversight

Summary

This working group will review the current approach to accountability and oversight to determine whether it:

• is fit for the future
• will help improve our priority outcomes in the long term
• will help achieve the government’s mission

The group will make recommendations and consider options for clarifying expected behaviours, organisational roles, and effective mechanisms within the system.

The work will take account of changes announced by the Secretary of State at the NHS Providers Conference in November 2024, to be implemented from April 2025.

The issue to work on

An important aim for the government is to enable everyone to live more independent, healthier lives, for longer.

This ambition involves the NHS providing high quality care and consistently recovering and improving performance against constitutional standards each year.

Public health funds and the NHS contribution to the Better Care Fund should also support more joined up working across organisations and population health.

In a comprehensive healthcare system, the public expects proper assurance on both system quality and finance. This is outlined in legislation (the NHS Constitution) and executed through the NHS England mandate.

The Health and Care Act 2022 and the consequent changes in NHS England’s operating framework signalled a shift to a collaborative and outcomes-based accountability approach. The creation of integrated care partnerships across integrated care systems strengthens the statutory footing of systems to support collaboration between the NHS, local government and other partners.

Integrated care boards, working with their partners, are vital for this collaboration and integration. NHS, independent and third sector providers should be able to collaborate in this context, supported by a provider selection regime.

This is not yet the reality of our system. Moving to an ambition of high autonomy and high accountability is challenging in the context of:

• widespread poor performance
• quality concerns in important areas such as maternity, mental health and learning disability and autism services
• substantial financial pressures (and consequently a potential desire from central government to increase scrutiny on short-term goals)

Outline of what this working group will do

We now have the opportunity to review whether the current accountability and oversight system is truly fit for purpose and whether it can drive improvement for our priority outcomes over the long term and deliver the government’s mission to build an NHS fit for the future.

Accountability is both an obligation the health system owes the public and a potential driver of improvement. It’s felt by individuals designated as accountable officers and organisations in systems.

An effective system of accountability will operate in ways that aligns this personal and organisational accountability and recognises that values and behaviours often override more formal processes and organisational arrangements. It will allow for public accountability and drive improvement.

Putting in place effective and proportionate arrangements that actually achieve this has previously proved highly challenging. This working group will therefore need to be as concerned with empowering local leaders to deliver as with providing national bodies with assurance.

Mobilising change

Summary

To enable the changes that will be outlined in the 10 Year Health Plan, this working group will determine the most impactful approaches to mobilising and engaging the following groups:

• organisations
• the workforce
• the public

The issue to work on

Enacting large strategic shifts in the system - such as the 3 shifts - is hard to achieve.

It requires the capacity and capability for change, along with the collective engagement and involvement of organisations, staff and service users. This requires shifts in processes, support offers and cultural and relational factors.

Outline of what this working group will do

Other enabling working groups will determine the detail of the technical changes we need to consider to make the NHS fit for the future, for example, changes to financial flows and accountability.

This group will concentrate more on:

• the factors which inspire people to mobilise around the changes effectively
• creating a health system focussed on continuous improvement

This includes mobilising effective cross-agency working at a local level to deliver improved health outcomes.

The 10 Year Health Plan will mean that patients will engage with their health and with healthcare differently and many healthcare roles will change. This group will look at how to build the relational and behavioural factors to support these successful changes.

A range of improvement support models have been attempted in the past which have employed a breadth of approaches, from significant national programmes to bottom-up networks.

It’s the remit of this working group to understand which models of change should be employed for the 10 Year Health Plan in order to transform services, pathways and experiences for patients and create a more effective health service in the future.

It will be important to learn lessons from previous attempts at change mobilisation, including the enablers and barriers of success and where these have varied with context. A crucial factor will be the relational nature of health systems and how this can be leveraged to build a model of change which harnesses expertise and enthusiasm across the health service, the wider sector and the public.

The group should consider a range of practical factors in addition to the model of change, such as the right balance between local and national direction and implementation, understanding the shared models for continuous improvement, measurement and evaluation and the required support and training offers which can enable the model of change.

Mobilisation will need to be effective across the whole sector reflecting the diversity of organisations and not primarily focussed on any one setting or type of institution.