Bringing the NHS 10-Year Health Plan to life: Lessons from the frontline
As momentum builds around England’s 10-Year Health Plan, three weeks of national conversations reveal a common theme: clarity of purpose, but deep concern about delivery. Drawing on insights from health leaders across Newcastle, Manchester and London, David Meates, Member of the New Zealand Order of Merit, explores three critical shifts needed to turn vision into lasting change.
Over the past three weeks in the UK, one detail has explicitly stood out for me. The clarity of purpose in every room I’ve been in.
I’ve been fortunate to participate in a series of forums and conversations across Newcastle, Manchester, and London with a key focus on the 10-Year Health Plan for England. Energy and engagement has been central to each of these discussions. Each conversation boiled down to a clear focus and purpose going forward – to create a future-focused health and care system that shifts from hospital to community, from analogue to digital, and from treating sickness to preventing it occurring.
The ambition is bold and correctly placed. The challenge lies not in the vision, but in the execution. The critical question we’re all asking is – how do we turn this vision into something real?
The plan has generated cautious optimism, but also a shared awareness of the significant obstacles we currently face. Fiscal pressures, workforce shortages, long waiting lists, outdated systems, and real-time access issues all cast a long shadow over future ambitions.
The fact is, accelerating our current approach or upgrading our tools alone won’t be sufficient to reach our destination. Something deeper is required.
I believe that three fundamental shifts are required to deliver on the promises outlined in the 10-Year Plan.
1. Restoring hope and trust
At the heart of every effective health system is hope. The quiet, daily belief that things can get better. This belief is what drives the immense effort from all health professionals, despite relentless pressures.
Hope has always been a currency in health. But it’s also fragile. And right now, many in the system have noted this hope slipping away.
NHS professionals I spoke with across the country described feeling overwhelmed, disillusioned, and exhausted. They’re still committed to their patients, but trust in the system, and in its leaders, is wearing thin. Ongoing frustration due to decision making that seems disconnected or random is a common trend. Secondly, the restructuring processes that feel more about prioritising image over real impact
One comment stayed with me:
“We’re under more pressure than ever as I try to do my best for my patients and the system.”
It’s time we acknowledged that truth and acted on it.
Restoring hope starts with rebuilding trust. That means showing up consistently as leaders. It means involving people in the decisions that shape their work and listening to their insight, not just collecting feedback after the fact. Most importantly, it means creating safe environments where people feel supported to do the right thing – not blamed when something goes wrong.
The health system’s greatest asset isn’t a piece of tech or a shiny new facility. It’s the continuous effort of the people who power it. When that effort disappears, or individuals lose hope, everything slows – decision-making, responsiveness, innovation. Reigniting that belief is not a soft ambition. It’s a hard necessity.
2. Simplifying the system
Health and care are inherently complex. But over time, complexity has been layered upon complexity, creating systems so convoluted that even those within them can’t easily explain how they work.
When a system becomes too complicated to navigate or understand, trust and confidence begin to erode. Efficiency suffers. The focus shifts from patient-centred care to managing processes, and decision-making becomes paralysed by layers of governance and red tape.
We must simplify. Not by dumbing things down, but by designing for clarity and connection.
In Canterbury, New Zealand, where I helped lead a decade-long transformation of the health system, we faced a similarly fragmented landscape. One of the most effective enablers we developed was HealthPathways – a platform that helped us agree, document, and communicate how care should be delivered across the system.
HealthPathways was more than a website. It was a living, breathing model of shared clinical decision-making. It brought together hospital clinicians, GPs, nurses, social care providers, and community organisations to answer a fundamental question: How do we do it around here?
It became our shared operating model – linking hospital and community, translating policy into practice, and integrating digital tools with real-world care. Most importantly, it helped rebuild trust and alignment across the system.
Importantly it made the system legible again, something that captured local reality while still being evidence-informed. And it was something that simplified – not added to – the work of delivering great care.
3. Unleashing the workforce
One of the most striking things about the health sector is that it’s filled with incredibly bright, capable people. Clinicians, managers, administrators, volunteers, many who are natural problem solvers. They see the issues every day, and they often know how to fix them.
But far too often, we tie their hands.
When decision-making becomes too removed from the point of care, responsiveness grinds to a halt. The urgency and nuance of frontline issues are lost in the shuffle of distant approval chains. The result? A system that reacts to crises instead of preventing them. A system held together by band-aids rather than built on resilience.
Empowerment isn’t just about giving people freedom, it’s about enabling them to flourish.
The people delivering care need to know their judgement is valued and that their leaders will back them when they take the right risks for the right reasons. Blame cultures, micromanagement, and punitive accountability systems have no place in a future-focused health service.
“Let me solve the problem with my team. We know what to do, we just need the space to do it.”
This was the common cry from across the system. The good news is, we don’t need to invent new capabilities. We simply need to remove the obstacles that are blocking the ones we already have.
A final thought
The 10-Year Plan is an important and necessary roadmap. But roadmaps are only useful if we’re willing to start walking. What’s needed now is not another layer of strategy, but a renewed commitment to the people who will make the change real.
That means restoring hope. Not with slogans, but with visible, supportive leadership. It means simplifying a system that has become too complicated for its own good. And it means unlocking the talent that’s already here, waiting for the signal that it’s both safe and encouraged to lead.
If we can do that, the future of health and care in England isn’t just possible. It’s already within reach.
About David Meates
David is an accomplished health system innovator most noted for his time as CEO of the Canterbury District Health Board leading the Canterbury Initiative. David is a frequent commentator and presenter on health system transformation and the role that HealthPathways can play within it.