The 10-Year Health Plan a year on: perspectives from three NHS leaders – with Birju Bartoli, Paul Dinkin and Amanda Sullivan

Health Foundation (2025). Dazed and confused? Policy ideas behind the 10-Year Health Plan. 

Health Foundation (2026). Labour 2 years in: progress so far and prospects for health and care reform. . 

Health Foundation (2026). Testing and spreading AI in health care: the case for rapid revolution.

King’s Fund (2025). 1 year on, is the NHS 10-Year Health Plan being delivered? 

BMJ (2026). England’s 10-Year Health Plan: aligning hope with economic reality.

Jennifer Dixon:

It's now 1 year on from the publication of the NHS 10-year plan. What's been the progress over the past year? In this podcast, we have a live broadcast from the NHS Alliance's Expo last month, and we have three front-line leaders who are going to tell us exactly what they're seeing from their perspective. 

It's all about the 10-year plan. Can reform ambitions meet delivery reality? What's going on, what needs to happen next and is anyone noticing at the patient level? And we really do have a stellar panel here today from different parts of the health care system. We have Paul Dinkin, who's the Director General for strategy and health care policy at NHS England, to give us a top-down view about how the system is working. And then we have Amanda Sullivan, who is the Chief Executive of an ICB in, and this is a very long name, Derby and Derbyshire, Lincolnshire, and Nottingham and Nottinghamshire. And then we also have Dr. Birju Bartoli, who is the Chief Executive of Northumbria Healthcare NHS Foundation Trust.

I've been knocking around health policy since 1990 and I must say I've seen masses of plans, starting with Working for Patients under Ken Clarke and, I think, if you stuck them up, there's around 50 since then. There's been pretty similar ingredients in a lot of them: the left shift, analogue to digital, the prevention aim and also the aim to push more investment into primary care and integrated care. Those things have always been, I think, more or less the same for all of that time.

And then, overlaying that is some sort of narrative. So between 1990 and 2012, there was the competition and choice narrative that really, the thing to do to prod this big beast of the NHS into more activity and more action and progress, you needed to have a bit of competition to ginger them up. And then, after Lansley, it became much more about integration and collaboration with all the integrated care and the commissioning arrangements that took place there. And then, more recently, the 10-year plan, it's got a bit of everything of that in it, both of those two paradigms but with a bigger smattering on technology as the big hope to try to help improve sustainability of the NHS as a model, but also improve quality of care for everyone.

So last year, the election in July '24, Darzi report, October, good diagnostic, I thought, particularly big strong tilt to technology. We had the NHSE/DHSC chainsaw massacre in March 2025. Then we had, last July, the 10-year plan, not forgetting also the life sciences plan that came out at the same time. We've had the operating framework after that, we've had numerous pieces of guidance to help people along the way, we've got the bill, and underneath everything we've got an exacting 2025 Spending Review target of 2% efficiency. And underneath all of that we have very committed public servants and very committed clinicians trying to do their very best to make all of this work and improve care for patients.

So with that as our sort of background, I really want to now give way to our panel. So I'm going to start off with Paul to give his perspective from the centre.

Paul Dinkin:

Thanks, Jennifer. And to take your starting point as a springboard, you mentioned the Darzi Review, I think a sort of characteristically comprehensive diagnostic, for one that made quite depressing reading, I think a remarkable level of positive reception and consensus around actually what was in there, followed by the 10-year Health Plan, which I think the vision remains a good vision, the right vision. The people who wrote it will be surprised, it probably won't feel this way to them, but the hard bit is not the writing it, it is the getting on with it.

Now, given the starting point reflected in the Darzi report, the first year was always going to be, and I think has been around recovery, stability, recognising the progress that has been made across the service by NHS staff in particular. And the reason for that is because without a degree of stability, financially, operationally, it's really difficult to do genuine transformation. Set against that, I think there's been some people that have said, actually, getting back to recovering constitutional standards, etc, over the next 2 to 3 years is probably as much as we can focus on and that is what we should do. And then, we can turn to more transformational sort of ambitions.

That is obviously not the position that we've taken and I think it's not the right view for two reasons. One, because I think the distinction is a false one. I think that there's only so far you can get with the hard yards of sprint after sprint after sprint of incremental improvement. And I think we're now at a place where the change that we need to see in terms of progressing beyond that is going to have to be underpinned by some genuine service transformation and leveraging some of the things that are in the 10-Year Health Plan. And the second reason is because I think our ambition needs to be greater than getting back to constitutional standards. We need to be thinking about how we pivot towards genuinely transforming outcomes for the populations we serve.

Now, as we do that, I think the Health Foundation recently highlighted that on healthy life expectancy, we're facing the wrong direction, and have been for some years. And so, the question is, how do we pivot towards a genuinely outcomes-focused version of 10-Year Health Plan delivery in a way that reflects that? I think about that in three layers. The first layer is what are the drivers of that gap in healthy life expectancy? Now, those are really well known, mental health, CVD, cancer, MSK. I would add frailty to that list of priorities for a variety of reasons. The layer beneath that is what is the kind of delivery chain across health care? I think three blocks, one, population-level public health. The second, individual-level primary and secondary prevention. That's where IHOs and neighbourhood health and all those sorts of things come in. And the third around how we leverage technology and everything else to deliver really good access to high-quality health and social care. And then, the third layer is all of the accelerants that we're able to leverage, so digital data technology, genomics, new therapeutics, new organisational, contractual and payment models that are much more population health-oriented.

And so, I think the challenge for us now is how do we leverage those different accelerants to transform that delivery model in service of addressing the drivers of those gaps of healthy life expectancy for the population? And we need to do that in a really, really focused and deliberate way. I think there's been real progress in some of those areas through the last year. On the public health side, I think the Tobacco and Vapes Act is a genuinely landmark bit of legislation that's going to save many, many thousands of lives over the decades ahead of us. I think we have got really good work happening nationally on developing modern service frameworks for sepsis, CVD, frailty, children and young people, serious mental illness and several other areas as well, that are really trying to do that work of thinking not just what's the best practice pathway, but how do we really leverage technology, new workforce models, new therapeutics to transform care and outcomes? Nonetheless, I think we really are at a point that we need to be pivoting and accelerating across all of those areas.

The final thing I'd say is I think if that is the what, then the how is equally important, and I think sitting nationally, we've got several potential things in our toolbox. We've got the ability to mandate, to incentivize, to share best practice, to deploy improvement support. Much more importantly than all of those, we have the ability to devolve accountability and responsibility to local organisations and staff who are much closer to the communities they serve. And most radically and most importantly of all, we have the ability to disintermediate much more radically between the health service and the citizens who are relying on us to improve their health and care. And so, I think we need to tackle, in a very deliberate way, the how, as well as becoming much more focused on the what.

Jennifer Dixon:

Standing back from all that you said, which when I look at all these documents and I look at what's happening, there seem to be at least two big areas that I'm slightly surprised, given the direction of the 10-year plan, that we haven't motored more on. One is, of course, the workforce plan, which I know is coming. But the other one, which is a bit more mysterious to me anyway, is not going full throttle on AI and technology. Now, I know some of you will roll your eyes at AI again. We've got to stick to the knitting, we've got to recover. But as you say, transformation is linked to technology and is linked to stability and recovery. You would think that there would be more demand signals for at least some of the admin-busting technology that's there now. AVT, for sure, is being tried. Time is of the essence, isn't it? So can you just clear up that mystery for me as to why, or is it just coming, like the workforce plan?

Paul Dinkin:

I think it's a bit of both. I think there's some of it that's coming, some of it that's already happening out across the service. This is a continuous pattern when you sit nationally, that you spend a lot of time thinking about how do we get certain things to happen, and then you actually go around the country and visit places and you discover that actually much more of it's already happening without you. And so, it makes you a little bit more humble and a little bit more reflective on what's the role that we can play to be helpful accelerants to some of those efforts.

So I think we have to be careful on the ‘How do we sort of nationally roll out X?’ and get ourselves much more into a space on, how do we start sharing the examples and the technologies that we think are really going to make a difference? How do we start to set the right incentives for local leaders to be able to go after those opportunities? And then, what is the right stance towards how we support that? So on something like AVT, the answer might well be, actually, we don't need to be buying something and rolling it out. We need to be managing the market so that there are some pre-approved, well-understood, and value-for-money options out there for the service to be able to draw down upon, and then think about how we facilitate the right kind of change support that surrounds all of that.

So I think there's a little bit of horses for courses on this, and it's going to be very different for different types of solutions and different types of problems that we're trying to solve. And I think we're all kind of edging forward and trying to work out how to do that. And we're trying to do that in a reasonably prioritised way, because we've not got a brilliant track record, I think, of rolling out in a managed way.

Jennifer Dixon:

Yes, centralised stuff.

Paul Dinkin:

And it's not just the rollout of the technology, it's capturing the benefit at the other end. So on AVT, that needs to be better quality interactions between clinicians and their patients or capturing the productivity opportunities from seeing more patients. We need to work out what those are and how we support people to understand and capture those, not just to implement the technology.

Jennifer Dixon:

Indeed. Evaluation, very important. Thank you.

Amanda, let me turn to you now. How are things, from your perspective, progressing with the aims of the 10-year plan?

Amanda Sullivan:

Yes, thank you. I do think, as public servants, we really do have to make sure we deliver this plan now. On a positive note, I do think there is much more alignment between policy, practice, the kind of pressures that are being felt in the services that will drive a different pace around this and obviously, we have got to make sure that that happens. There are some areas where we are seeing really significant changes in the way that people are working. There's growing levels of integrated neighbourhood teams and how front-line teams are operating together. We've certainly had a real focus on the use of data, because then you can segment the population and really target efforts and resources to where there is most health gain, and that does show certain population cohorts, such as frailty, end-of-life, that we have to be quite radically different in terms of how we organise care for those groups.

But part of our role is to enable the front-line teams and make that happen through the commissioning levers that we have, and one of the things we've focused on is the shared record in the Nottinghamshire area. And that's been kind of fully operational in its latest iteration over the last year, and we believe that's saved around 38,000 clinical hours just by the fact that people are not having to spend ages ringing. They can actually get the information they need for more integrated care. Having said that, I do agree with the earlier comments around just trying to get more operational efficiency of carrying on doing what we're currently doing isn't going to work. It will help a bit, but it won't give us the scale and pace of change that we need. So I think it's not about just doing things better, there is some of that, but it's also doing better things and really shifting the access of care into the neighbourhoods. That will create some turbulence, where people are used to receiving services in a particular way or where people are used to providing or commissioning services in a particular way.

What we've done over the years from a commissioning perspective is we've layered services on, so urgent community response, 1-1-1 response pathways, expanding out-of-hours GPs, urgent treatment centres. We've add all of these things into the system. We now need to really think about how they work together in a properly integrated way and navigate people to the right service rather than people being moved around or revert to A&E as a default. So there's a real delayering and really reconstructing a much more joined-up, whole approach to urgent and emergency care, and we will need to be quite thoughtful around this of how the tentacles go into neighbourhoods and out again, and people's experience of that.

The other thing is I think we are going to have to be much more collegiate across the different sectors within the NHS. No one bit of the NHS can deliver this and if we're waiting for other bits of the system to deliver, it won't work. For years, we've been commissioning more and more community services or different urgent care access points. It doesn't really have that much impact on hospital demand unless that works with the hospital pathways as well. So I do think we need a much more collegiate and joined-up approach around shared objectives on that.

And then, my third observation is what do we need to do for our populations in service terms, and all the different contractual arrangements, different payment incentives can be used as enablers, but actually, we need to keep the main thing the main thing. So I'm optimistic and committed. I think we are going to have to think quite differently and work across sectors in a way that probably isn't traditional in the NHS.

Jennifer Dixon:

Just thinking back a decade or two, we've had so many different iterations and permutations of attempting to have more collaboration, integration, and we've had some success, but it hasn't really been full throttle in the way that really is set out in the 10-year plan. Is there any more rocket fuel in the reform plan that can really make this stuff motor a bit more than we've seen in the past 15 years?

Amanda Sullivan:

The imperative there is so clear now and people are working under incredible pressure in some of the service areas, and I think that in itself is an incentive to think how can we move things forward. Some of the levers that will be coming out we can use, but there's already a lot of things that we can do to join up budgets and things as well. So I think the biggest thing will be everybody coalescing around a few big-hitting areas, and probably led by the data on what those population cohorts are, and then it will gather more momentum. Previously, and we were, for example, a vanguard site a number of years ago, things got to a point and then kind of things didn't quite align, and we just ended up keeping some of what we'd done and reverting back to what we'd done previously. So I just think we all have a leadership responsibility to make sure that we keep pushing and we keep pushing on this this time, because as you say, it's been in the ether for a long time.

Jennifer Dixon:

So Birju, aren't you the top manager in the country according to the HSJ? Is that right?

Birju Bartoli:

Yes. Sorry, I'm embarrassed.

Jennifer Dixon:

You're looking embarrassed. Yes. Well, congratulations-

Birju Bartoli:

Thank you.

Jennifer Dixon:

... first off, well done for that. I mean, clearly, recovery is key. Clearly, transformation is key. And so, can you tell us, from your perspective, how is it going with respect to delivering both of those?

Birju Bartoli:

Yeah. So I think that the recovery agenda, it's not one recovery or transform, it has to be done both in parallel. Our recovery journey has very much been about time. So the value of time both for patients and for staff. Yes, it hits a performance metric, but actually, it's valuing patients' time. It's the one thing our patients tell us all of the time is that they don't want to wait and if they are being asked to wait, then keep us informed as to where we are next. We, within Northumbria, really do take that to heart. So it's one of the things that we've always driven in terms of not settling for national standards, but wanting to drive for constitutional standards, because the organisation believes in valuing patients' time, and now our staff see it as well as valuing their own time.

So I absolutely believe in the parallel nature of recovery, but also transforming at the same time. It can't be a linear process. So we've, a bit like Amanda, were part of the vanguard, what, 10 years ago, I think it was, and have, for a number of years, had very good relationships across primary care and local authority colleagues, voluntary sector in particular. Some of that was really built out and extended in part of our patch during the vanguard period, and we've tried to maintain some of that. Albeit, like Amanda, I think there were some bits that fell back as a consequence of the national direction changing.

We have absolutely reinvigorated that on the back of the 10-year plan and I think this first year of the plan has very much been about re-cementing some of those relationships and working through what our common purpose is. So we've done some internal modelling, for example, that would suggest if we maintained our clinical model as is, did the ‘do-nothing scenario’, we would have to open another 230-odd beds within 15 years. We don't have the money to do that. We don't have the workforce to do that. Those patients that we would need to accommodate in those additional beds will be exactly the same patients that primary care need to see, and a large proportion of those patients will also be what our social care colleagues will need to see. So that common purpose about needing to do something different has been really powerful.

I think the other bit that has been powerful that we probably underestimate, is the national push to this. I think that possibly was there 10 years ago. It fizzled out. I think it's important that we maintain that this time round because we can't afford for that to go. Not wanting to be too political, there has been a little bit of unrest, if this all changes, what does that mean for the neighbourhoods? And I think our view is very much, look, we know this is the right thing to do. So actually, almost ignore the politics, ignore what's kind of happening nationally. We know we need to do this, because remember that common purpose that we've got. And that's, again, been really helpful in terms of tying us together.

And then, a big part, which I think Paul did allude to, has been around digital and that drive to try and ensure that we have one digital record, possibly one of the reasons we haven't made all the leaps that you allude to, there's a foundational level of digital maturity in all NHS trusts that varies quite considerably. So in some places, it's really quite mature. In other places, it's not yet... We are saying everybody has to do everything to a certain level, and we can't because we're all at very different starting points.

Probably about eight years ago, some of you will remember the big WannaCry incident. Our board really took a step, had a deep look at itself. We'd invested in clinical services. We'd done nothing around digital at all, and had to pivot to say, ‘We need to do something.’ Our clinicians, we thought what they wanted at the time was a nice, new, shiny EPR, and they said, ‘We just want our computers to work.’ That's really humbling when you're told that. So we've spent a lot of time building that infrastructure, which I think on a lot of this stuff, be it around digital, be it around delivery of neighbourhoods, is about building those foundations that are really strong. That takes time, but it means you can go a lot faster later on.

Jennifer Dixon:

Yeah. Given that left shift is such a big part of the reform plan, have you seen any shift? And what will it take, from your perspective, to safely allow that?

Birju Bartoli:

Because we're an acute and integrated community trust, one, in terms of our reach is really quite broad already into our communities, because we've had to be that way in order to ensure that we can match that urban and rural delivery that we've always been very committed to doing. So for us, we start from a good place in terms of some of the neighbourhood discussions. It took us a little while to really get our heads around, when all the 10-year plan stuff came out, to say, actually, what does this mean for us? Because I think we're doing bits of this already.

There's elements that I think have come out in one of the neighbourhood documents recently around frailty, around our urgent emergency care. We've split off emergency to our urgent, which is primary care-led, so it's GP-run. We've already done that. We're now looking at some of our elective pathways as well to say, how can we work differently with primary care so that more is done? Some of our outpatient models as well has really shifted to support more work within primary care. I think that blurring of boundaries, which goes back to relationships between primary and secondary care clinical discussions, is really key.

Jennifer Dixon:

It strikes me, moving into the future, we've got a lot of technology raining down on the health system to try this, try that. How are we going to move forward? How can we have some more rapid testing of this? Presumably, you're getting some pressure from clinicians to be able to try stuff, to reduce bureaucratic drag. How do we move forwards on that?

Birju Bartoli:

I think Paul's point about having a certain number of suppliers on board would be really helpful and one that, where it's relevant, have passed through any kind of MHRA regulation. I think there is something as well that we're all going to have to be really careful on, which is it doesn't become a nice, new, shiny toy. So AVT, for example, it might produce better quality, but if you're not getting more productivity out of it, there is a big cost to AVT currently. So you could be spending millions, which will perhaps bring better quality, but you've got no productivity gain out of it. It needs to be more thoughtful rather than, ‘Right, everybody needs to have AVT everywhere now.’

Jennifer Dixon:

Amanda, I don't know how your outfit is feeling about technology and its approach to trialling certain things that may be promising?

Amanda Sullivan:

Yeah. I mean, we are very keen to do that. We're just forming a collaborative across the whole cluster, actually. And one of the things we're keen to do is try and get as much coherence across the whole system with any new developments as we can, because we've spent a lot of years looking at interoperability and trying to get different systems to talk to each other so we can have a shared record. So I think what we're trying to do now is, we still have got more to do to get things to talk to each other, but to try and get more of a coherent view and to link it to the service objectives as well.

So I agree, I think we need to be mindful of it, because it has to be seen as embedded and enabling, not as an end in itself, because if the clinical models and the way of working doesn't change with the technology, then the benefits of the technology won't be realised. But I do think things like remote monitoring, some of the community and secondary care and primary care linkages around how we do more shared decision-making to keep people at home, I think there is real, real potential there.

Jennifer Dixon:

Yes. And the other factor here, to get sight of what is beneficial and get it into the system, you really need to have proper monitoring of whether it works or not. There seem to be two big arms at the moment. One is the formal research architecture, which does take a while because of governance. And then, there's something called ‘in-service testing’, and that's, at the moment, quite patchy with respect to the quality of work, so you can have all sorts of claims going on. One of the things we need, isn't it, is much more proper sight of what's actually happening and independently assess?

Paul Dinkin:

I think that's right, and one of the things that we can do is to try and help generate that evidence base. I'm just very, very keen that we avoid leaning in too much in a lot of this. So yes, we can do some of that. But actually, what we really need is to be able to say, actually, we've done some horizon scanning, these are the technologies that are coming on board. These are the ones that it looks like have the greatest proven potential to make a really big difference.

And then, some of that responsibility around, actually, you need to pick the right technology that fits into your local systems, work with your clinical and other communities locally to be able to do the change management and actually the value capture at the other end. I think we just can't disempower everybody too much by saying, ‘This is precisely the benefit you're going to get.’ We need to be able to say, actually, to some extent, ‘Let's create the incentives, let's create the market management,’ whatever else that we need to do, allow people to do that. And as I said, where there's a role for us to play in terms of being able to give a proven evidence base, and therefore a confidence level in what some of those more foundational technologies are, then great, we should do that. And certainly the point around the MHRA is an important one as well, I think, too.

Jennifer Dixon:

Yes, indeed, indeed. So we've got 4 minutes left. Where is your hope and what needs to happen next?

Paul Dinkin:

Okay. So loads and loads of hope. I think one thing that I haven't commented on is the left shift bit. Amanda, you made the point that, actually, there's a case now for needing to do this, both in terms of what's right for the communities we serve, and addressing some of the terrible numbers around frailty admissions, etc, is really overwhelming, but so is the international evidence base in terms of bed days for different cohorts compared to where we are in England. So I think there's a huge amount to go at there, and there's a lot of hope when you go around the country of just how much work is happening, how many really good examples of innovation and new interfaces between primary and secondary care that are emerging.

So much of it feels like a bit of a cottage industry that is kind of like we've got some really good relationships that have developed here and here between these clinicians and these local GPs, how do we actually create the right conditions to be able to industrialise, standardise, scale some of that and the impact associated with it? And you asked about the difference between where we've been before on some of this and talking about priorities. Priorities are people being able to book into urgent care. What are we doing for our higher risk cohorts who are most at risk of an avoidable hospital episode? What are we doing to reform outpatients? All of those sorts of things. That's got to be the centrepiece of what we're trying to transform. And then, all of the bit that comes around it, we've got to be as an enabler for that. And that to me is exciting, and I think there's a lot of appetite to be able to move as quickly as we can on it.

Jennifer Dixon:

I think we've got an enormous opportunity to leverage the assets of a national system towards the technology environment. Many other health systems have quite fragmented, different payers, different providers. We've actually got quite a unified system. So we could, as you say, industrialise, but we could leverage the assets across system learning, sharing of information. We've got world-class universities to help with the evaluations and so on. So we really could, if we join the dots, sort of craft this for the future, couldn't we? Amanda, your areas of hope?

Amanda Sullivan:

Yeah. I do think there is an energy and a momentum around this now that hasn't been there probably ever or certainly for a long time. And Paul, you mentioned around how different groups of clinicians work together. I do think a much more collegiate way of working, shifting the access of care to neighbourhoods and sharing that expertise and coming together around properly shared problem solving from all the different angles is going to be necessary. But my hope is that there is enough momentum there now to start for that to become more the norm rather than the exception.

Jennifer Dixon:

Thank you so much. Birju, last word with you.

Birju Bartoli:

So a lot of energy, I think, behind this. And I would say that we've had a year of thinking and reflecting and working out what the 10-year plan means for us in particular, I think now is about delivery. We need to turn this into actual actions now, almost a little bit of can we stop talking about it and cement what we're actually going to do? And I think that would be the one real push, I think, that we now need, because we do have a habit of talking and talking a bit more. So for me, the hope very much is about moving into the next phase of this, which is around delivery, and so we get kind of 2 years down the line, and we're sitting here again and saying, ‘We've now done all of these things," and we're thinking about what the next 5 years will bring.’

Jennifer Dixon:

I'm sure that's music to the ears of the new secretary of state. I wish she were listening to this. So I think that's a great message to end on. I'm glad there's hope here, which there should be. Thank you so much and good luck to everyone in your progress.

So we must leave it there. Thank you to our panellists for this discussion, and I hope you enjoyed that debate that we had. I heard a few points there. The first thing was, although the headlines of the reform are clear, which Paul set out, some progress being made, there's still a lot that's being clarified and developed. 

Second was a lot of distraction with the shadow of reorganisations going on, plus financial pressures. And the distraction means pulling away from energy on transformation. 

Third, I was struck by Amanda and Birju's repeated emphasis on leadership, teamwork, relationship issues over the structural or technical things, Birju's message to localities to have agency if some aspects of reform are murky, just press ahead, develop things, don't wait for instructions was a good one.

And on the shift to cross-boundary working in the community, Amanda put a lot of weight on collaboration and relationships. And I think perhaps I'm an old sceptic, this is clearly important, but we have seen 30 years of talk about this type of thing, and I think just putting weight on relationships by themselves as a means to get collaboration working in the community and neighbourhoods is just not going to be enough. So what else needs to be done? 

And then, finally, the discussion on technology. I was quite struck that this is a dog that didn't bark, or at least I made it bark. It didn't seem front of mind for the panellists, and given what we are thinking here at the Foundation, it seems to me that it's the one big area of hope for sustainability of the NHS model itself.

I hope you enjoyed that discussion, what was said, what wasn't said, and we look forward to more analysis of progress as the months go by on this pod. So in the meantime, thanks as ever to Sean and Leo at The Health Foundation, to Paddy and his team at Malt for producing this podcast, and many thanks to you all for listening. And goodbye until next month from me, Jennifer Dixon.