Reshaping healthcare for the next decade

The NHS has entered one of the most significant periods of transformation since its inception. Demand is growing faster than capacity, health inequalities continue to widen, workforce pressures are deepening, infrastructure is ageing, and patient expectations of digitally enabled access are accelerating at pace. In this environment, the question is no longer whether transformation is required but how it should happen, at what scale, and over what timescale.

Despite constant policy churn and operational volatility, one strategic framework continues to offer clarity, coherence and long-term direction: the NHS 10 Year Plan, published in July 2025. More than a high level policy statement, it has become the central interpretive lens through which Integrated Care Systems (ICS), Trusts, government bodies, and advisors understand system pressures and design the future of care. The direction set out in the Plan is shaping not only how services are delivered, but how estates are planned, how capital is prioritised, how clinical pathways evolve, and how digital maturity must accelerate.

At the heart of the Plan are three fundamental shifts that are no longer theoretical but now visibly shaping transformation programmes across the country:

1. From an acute centric model to a neighbourhood-centred system.
2. From reactive treatment to proactive, preventative, and anticipatory care.
3. From analogue, fragmented infrastructure to digitally enabled, interconnected systems.

These shifts are now emerging across transformational commissions that include neighbourhood-based healthcare models, system wide infrastructure strategies, community diagnostic centres (CDCs), clinically led estate transformation programmes, and integration initiatives across organisational boundaries.

The NHS 10 Year Plan: the strategic anchor for system transformation

The uniqueness of the NHS 10 Year Plan lies in its long term, system, and regional perspective. While short term interventions focus on immediate operational challenges, the Plan provides an integrated vision of what the future system must become: more localised, more preventative, more digitally enabled, more integrated, and fundamentally more sustainable.

The Plan mirrors the pressures and opportunities the system is already experiencing. Workforce constraints, the increase of multiple chronic conditions, the changing nature of clinical work, accelerating digital expectations, and the need to reduce variation and improve outcomes are all intensifying, making the Plan’s relevance even stronger than at publication.

The Plan shifts thinking from reactive firefighting to purposeful redesign. It reframes estates, digital, and workforce not as operational costs but as enablers of change and it provides a shared framework for transformation across geographies, organisations, and clinical teams.

In our work with ICSs, Trusts, and regional estates leaders, a consistent set of challenges is emerging. Clients describe rising capacity gaps between acute demand and community provision, estate portfolios that are misaligned to new neighbourhood based models of care, and capital programmes that struggle to keep pace with service redesign. Many leaders also reference the difficulty of planning long term infrastructure where clinical pathways, workforce models, and digital maturity are still evolving.

From these ambitions, the three shifts emerge as the clearest articulation of how the future NHS must operate.

Shift 1

Acute to community — building a neighbourhood-centred health system

The move from hospital-centred to neighbourhood care is now visible across transformation programmes. This shift recognises that the majority of health needs, including long-term condition management, mental health support, diagnostics, rehabilitation, and social care, can be delivered more effectively closer to home.

Neighbourhood based models enable:

1. Integrated multidisciplinary teams working in one place.

2. Earlier access to diagnostics.

3. Joined up care across primary, community, mental health, and voluntary sectors.

4. Reduced pressure on emergency departments and acute beds.

5. Improved continuity and personalised support.

6. More equitable access for communities with the greatest need.

For example, many systems are creating neighbourhood hubs where physiotherapists, mental health practitioners, GPs, social prescribers, and community nurses work in one location. Patients who previously relied on multiple hospital appointments can now receive assessment, diagnostics and follow up in a single local visit, improving access and reducing acute pressure.

Several ICSs we support are finding that community provision has not grown at the pace required to absorb displaced acute activity. Estates teams often highlight that existing community buildings lack the clinical adjacencies, diagnostic capacity, or digital infrastructure required to support neighbourhood models. This has driven programmes focused on repurposing under‑utilised estate, co‑locating multidisciplinary teams, and prioritising community diagnostics to create viable alternatives to hospital‑based care.

The Plan encouraged this shift, but today the momentum is driven by ICSs and DHSC programmes that recognise neighbourhood capacity as the foundation for relieving acute demand.

Shift 2

Reactive to preventative — moving from treating illness to building population health

Prevention, proactive management of long-term conditions, anticipatory care, and positive health education are now essential to long-term sustainability. This shift includes:

1. Earlier diagnosis.

2. Risk stratification and targeted intervention.

3. Community diagnostic access.

4. Behaviour change and health education.

5. Integrated support across agencies.

6. Coordinated long-term condition management.

7. Rehabilitation and wellbeing programmes.

8. Personalised anticipatory care.

The upstream model is now becoming real. Many systems are co-locating community diagnostics, wellbeing services, and long-term condition support within neighbourhood hubs, enabling earlier assessment and intervention in a single visit. This reduces acute escalation and improves access for high need populations.

Clients consistently highlight that prevention is less constrained by clinical intent than by infrastructure. Many Trusts and ICSs report that while population health strategies are well defined, existing estate and capital pipelines are still configured for episodic, acute‑led delivery. As a result, systems are increasingly re‑prioritising capital investment toward CDCs, flexible wellbeing spaces, and digitally enabled hubs that support earlier intervention and proactive condition management.

Shift 3

Analogue to digital — building a digitally connected health system

The shift from analogue to digital is the most transformative and the most challenging. It requires estates, workforce, pathways, and data systems to function as a single ecosystem. Digitally enabled care includes:

1. Virtual consultations.

2. Remote monitoring.

3. Shared care records.

4. AI-supported diagnostics.

5. Digital MDT working.

6. Predictive analytics.

7. Seamless data flow across care settings.

This shift is not about adding digital tools to old workflows. It requires redesigning clinical pathways for a digital-first system. For example, some systems have rebuilt the musculoskeletal pathway so patients begin with a digital triage and self-assessment, followed by a virtual consultation and then an in-person appointment only when necessary. This redesign changes referral processes, clinical workflows, and workforce deployment, and depends on integrated digital platforms.

The Plan anticipated this and the most advanced systems are embedding digital design into estates and service planning from the outset.

In practice, clients often describe digital transformation as the most complex shift to deliver. Estates and digital strategies are frequently developed in parallel rather than together, leading to misalignment between physical infrastructure and digital pathways. Several organisations raise concerns that capital schemes risk embedding legacy models of care if digital requirements are not defined early, particularly for diagnostics, outpatient, and long‑term condition pathways.

From experience, resolving this misalignment is not always about complex structures or new programmes. In some cases, progress has been unlocked simply by creating the space for estates and digital leaders to plan together. A single meeting, shared workshop or joint governance forum can enable early cross fertilisation of ideas, surfacing interdependencies between capital plans, digital requirements, and clinical pathways before decisions are locked in. Where this alignment happens early, systems are better able to avoid embedding legacy models of care and instead design infrastructure that genuinely supports digital‑first, neighbourhood‑based delivery.

Across all three shifts, a clear message is emerging from NHS leaders: transformation is no longer constrained by ambition but by the practical challenge of aligning estates, digital capability, and clinical pathways at system scale.

How the NHS is responding — NHCs and system-level infrastructure planning

The DHSC’s Neighbourhood Health Centre (NHC) Programme is one of the clearest national illustrations of the 10 Year Plan being translated into practice. It aims to transform access to local care by creating a national network of centres that bring urgent care, primary care, community services, diagnostics, mental health support, prevention, and wider wellbeing services together under one roof.

The scale of the ambition is significant. The government has committed to delivering 250 NHCs by 2035, with the first 120 open by 2030 and an initial wave of 27 centres to be completed by 2027. These first 27 form part of an initial tranche of 50 centres backed by £200m of government investment to upgrade or repurpose existing NHS estate.

Once opened, NHCs will offer an expanded range of services including urgent treatment, GP appointments, pharmacy services, community diagnostics, and, over time, debt advice, employment and family support, and voluntary sector services. Many will operate extended hours and are being prioritised for areas with the highest levels of deprivation to maximise impact on inequalities. Crucially, the programme goes beyond physical infrastructure. It defines a consistent national model for neighbourhood-based care, standardising the core functions that centres will deliver, and embedding digital first requirements into the design from the outset.

By grounding investment in population health need, deprivation data, future clinical pathways, and integrated service models, the NHC Programme replaces piecemeal capital projects with system-wide investment. This shift enables sustainable redesign rather than incremental change and positions neighbourhood infrastructure as the backbone of the NHS 10 Year Plan.

System and regional infrastructure strategies

ICSs across England are developing system wide infrastructure strategies shaped by the 10 Year Plan. These strategies recognise that transformation cannot be delivered through isolated organisational decisions.

Systems are now mapping their full estate portfolios, forecasting population need over 10 to 30 years, prioritising neighbourhood-based assets, strengthening community diagnostics, redesigning clinical adjacencies, integrating primary, community, mental health, and acute services and embedding digital requirements into all estate planning. This approach aligns capital investment with long-term care delivery and enables integrated models of care to take root.

Together, the NHC Programme and ICS led strategies show that the Plan is actively shaping transformation, not passively influencing it.

What is still missing: digitally enabled clinical pathway transformation

Despite progress, one critical enabler remains underdeveloped: clinical pathway transformation. This is the hardest ask of the NHS because it requires deep operational and cultural change across professional and organisational boundaries.

Without redesigned pathways, the NHS risks delivering outdated models of care inside modern, community-based facilities.

Digitally enabled pathways are the missing connection between new buildings, service models, digital capacity, workforce expectations, and patient behaviours. But progress has been slow. Many trusts are developing estate transformation proposals without the clinical pathway clarity needed to define service requirements, digital needs, or workforce design. Estate and digital leaders are not consistently involved in pathway design, slowing transformation and risking misalignment between clinical ambition and infrastructure.

Delivering the 10 Year Plan requires reimagining clinical pathways for a neighbourhood-centred, digital-first system. This includes:

1. Redesigned referral flows.

2. New diagnostics routing.

3. Updated follow up models.

4. Shared care across sectors.

5. Digital prevention and self-management.

6. Integrated multi agency responses.

Only when pathways change can the Three Shifts be realised in practice.

As the NHS navigates rising demand, widening inequalities, and accelerating digital expectations, the 10 Year Plan remains the most coherent framework for sustainable transformation. It connects estates, clinical priorities, digital capability, and workforce change into a single long term direction.

The Three Shifts at the Plans core are already shaping practice, from neighbourhood-based models and regional infrastructure strategies to digital first pathways. National programmes, including the NHC Programme, show how these shifts can be turned into concrete progress.

Yet new buildings alone will not deliver the future NHS. The decisive step now is transforming the pathways that operate within them. Digitally redesigned pathways are the engine of change, enabling upstream care, integrated support, multidisciplinary working, and better outcomes.

The next decade will require bold, coordinated decisions. The 10 Year Plan provides the direction needed to make them. If embraced not as a policy document but as the operating logic for transformation, it can lead the NHS toward a model of care that is more local, more preventative, more digital, more integrated, and more resilient for the generations to come.