Reforms to improve the NHS in England are unlikely to take full effect until the fourth year of a 10-year plan intended to chart a bold, new direction for the healthcare system, according to people familiar with the process.
The blueprint, due by the summer, is being referred to internally as the “three-seven” plan, four people with knowledge of the proposals said. The first three years are expected to prioritise clearing long waiting lists as well as building a foundation for wider changes.
This could include a bigger role for hospitals in running community services in their areas, one individual familiar with the thinking behind it suggested. The more limited ambition for the initial stages of the plan would in part be a recognition of the fiscal reality, they added.
The Department of Health and Social Care said it was “categorically untrue” that reforms were being delayed. “Fundamental reform of the NHS is urgent and the 10-year health plan will include reforms to begin within the first months and years following publication,” it said.
The government’s spending review, to conclude on June 11, is expected to allocate new money for the NHS, but the increase may not be large enough to transform the service and tackle long-standing challenges.
One person close to the process said “the financial outlook has changed significantly” since work on the 10-year plan began.
They added: “Now the primary focus is on recovering services in the next one-to-three years rather than the more transformative stuff [the government] had been planning,” which is expected in the remaining seven years.
NHS data released on Thursday showed that waiting lists for routine hospital treatment had risen to 7.42mn in March, representing the first increase since August and underlining the scale of the challenge facing health leaders and politicians.
The Royal College of Surgeons said the increase “raises questions about whether the government can realistically meet its interim target of 65 per cent of patients starting treatment within 18 weeks by March 2026”.
One first person suggested the plan could put “a gloss” on work already under way to clear the waiting list for elective treatment.
Prime Minister Sir Keir Starmer in January unveiled a series of measures, including creating up to half a million more appointments a year by opening community diagnostic centres for longer and bringing online 17 new and expanded “surgical hubs” dedicated to non-emergency operations.
However, the prospect of waiting years to see the benefits of far-reaching changes could hamper ministers’ hopes of demonstrating a revived and higher-performing service when voters go to the polls no later than 2029.
NHS England internal modelling of the elective waiting list, quoted by the Institute for Fiscal Studies in a report in March, suggested the 18-week target could be met when the total list size reached about 4mn.
One person said: “It’s debatable how excited people will be by the waiting list falling from 7mn to 4mn.”
The Financial Times reported this week that Wes Streeting, health and social care secretary, had asked for more work following an initial draft that was regarded as lacking sufficient “retail” appeal to patients.
Streeting has outlined three defining priorities: to move more care from hospitals to the community, to shift from an “analogue” to a digital service, and from treatment to prevention.
Chris Thomas has taken over as lead writer of the plan, after being seconded to the health department from his previous role heading a health research programme for the Institute for Public Policy Research. He replaces Tom Kimbasi who has stepped back to focus on policy development.
