Q members reflect on the NHS 10-Year Health Plan for England: Wales, Ireland and Northern Ireland

The NHS 10-Year Health Plan for England has laid out ambitions for three shifts: from care delivered in hospitals to in communities, from a focus on treatment to prevention and from analogue to digital.

In the spirit of collaboration and learning, and to give voice to wider perspectives, we asked members from other nations to share examples those delivering the plan in England can learn from to realise its three shifts and implement large-scale change.

Here, we share the reflections of members from Wales, Northern Ireland and Ireland. We are also sharing a series of reflections from members across England on the plan and the culture and conditions needed for its implementation. Our diverse community of people working to improve health and care is uniquely placed to make a real difference to the success of its implementation. These reflections can help us all take stock of where we are and think together about how to get where we need to go.

We would love to hear reflections and lessons from other Q members across Scotland, Wales, Ireland and Northern Ireland. If you would like to contribute, please do get in touch.

NHS Wales Quality, Safety and Improvement is particularly interested in the move to a more patient-centered, community-based approach with a focus on prevention. Key areas include neighbourhood health centres, AI and the NHS App. 

The shift of care out of hospital and into communities has strong alignment with our primary care national strategic programme and its focus on care closer to home. Shifting health spending to facilitate the move towards a more patient-centred, community-based, preventative model also fits with the direction we are moving towards in Wales. 

The Health Data Research Service will benefit NHS Wales by offering the potential for comparisons to our own data. This could mean new ideas for our data sources and management and enable us to more accurately show trusts and ​‘specialties’ metrics that are working well. This brings the possibility of further and more productive collaboration.

Information on how to end the ​‘8am scramble’ does raise some thought around how more GPs will be trained over the coming years to make this a reality – and how GPs working over larger geographies will manage when the current patient workload is already vast. There will be much to learn in this space for Wales, as there will for other nations. 

There is some detail on implementation in the plan, but it is stronger in some parts than in others. Where it is included, there are suggestions of piloting approaches in one or two regions and then scaling and spreading to other areas. It’s an approach we use at NHS Wales, but we are mindful of the need to adapt pilots to local contexts and not simply adopt into other regions. 

With our developing work on a Quality and Patient Safety plan we will be looking to see how the 10-year plan shapes the Quality Plan for NHS England, acknowledging that NHS Wales already has a Duty of Quality in place. 

The three radical shifts the plan is built around are bold and necessary. The emphasis on digital transformation and AI is particularly exciting. If implemented well, it could revolutionise access, reduce administrative burden and empower patients through tools like AI triage, remote monitoring and real-time health data. 

It is encouraging to see that the plan refers to the introduction of multi-year budgets. This is essential if the NHS is to embed evidence-based interventions in practice. 

While the plan is ambitious, it could benefit from: 

• More detail on implementation  
  How will local systems be supported to deliver these changes, especially in under-resourced areas? The plan references prevention and neighbourhood models but lacks detail on emergency department and social care integration – essential to reduce downstream pressure.
• Digital transformation 
  The benefits of new technology will not be realised unless staff and patients are involved in design and implementation of how it is rolled out. There is limited evidence of this within the plan. In addition, much of the health service has basic IT and outdated equipment – these need to be updated before AI can be considered. The plan explicitly states the potential benefits of AI in supporting decision making by nurses and doctors. There is no specific mention of how AI and other aspects of digital transformation could support other professionals such as allied health professionals. 
• Stronger focus on health inequalities 
  Although prevention is emphasized, there may be merit in the plan also considering the social determinants of health such as housing, education and income. It would also be beneficial to ensure the impact of health literacy is considered at every level in the planning and implementation of neighbourhood health services. This is crucial to achieving a vision where individuals are considered active participants in their care. 
• Mental health integration 
  Mental health is mentioned but not deeply embedded across all three shifts. A more holistic approach may strengthen outcomes. 
• Public engagement 
  It is impressive to read the plan has been informed by the biggest conversation about the NHS in its history, having engaged with thousands of staff and members of the public.  Rebuilding public and staff confidence is essential to the success of the implementation of the plan. How will the public and staff continue to be engaged in the implementation of the commitments? 
• NHS workforce 
  The plan identifies the expansion of nursing apprenticeships and medical training places but does not clearly identify the need to develop the workforce in other professions (for example, dentists, allied health professionals), which is clearly required to achieve its other aims. 
• Financial sustainability 
  The plan lacks clarity about the future role of the independent sector. 

Northern Ireland has several innovations England could learn from: 

• Integrated Health and Social Care system in practice 
  Northern Ireland has had an integrated Health and Social Care system since 1973. This long-standing integration offers valuable lessons in aligning services, budgets and workforce planning across sectors. 
• Multidisciplinary Teams in primary care 
  The rollout of multidisciplinary teams – including social workers, mental health practitioners and physiotherapists – within GP practices has improved access and reduced pressure on GPs. 
• Digital health records 
  The Encompass programme, a single digital care record across all care settings, is a model of interoperability that has been implemented across provider organisations during 2024/25. 

Improvement approaches could help the plan succeed, for example: 

• Quality improvement and other related methodologies, such as implementation science, could support local teams in testing, evaluating, implementing and scaling innovations. 
• Co-production with patients and staff should be embedded in every stage of change. 
• Data-driven decision making must be democratized, giving front-line teams access to real-time insights to guide improvements. 
• The adoption of Quality Management Systems. 

Achieving the three shifts will require a big push on systems and their integration. Meanwhile, the focus on waiting lists should be matched with a commitment to addressing the whole pathway. Lastly, learning systems and implementation science can help ensure the meets its ambitions. 

While the proposed funding model and approach to implementation differ, the NHS 10-Year Health Plan shares many of the themes identified in the Sláintecare Action Plan – the strategy for reforming Ireland’s health and social care system – here in Ireland.

The vision in Sláintecare is focused on delivering universal, timely and integrated care based on need, not ability to pay, motivated by a fragmented, hospital-centric system with inequitable access and inefficiencies. In line with the NHS plan, Sláintecare is built around a shift from hospital to community care, a modern eHealth infrastructure with improved use of data and a population health approach focused on prevention.

I see multiple opportunities for Q to both support and lead the changes set out in the NHS plan, for instance: 

• Quality improvement-led redesign of care pathways, focusing on the safety of care transitions and acceptability to patients.
• The plan is strong on a data-driven, learning-oriented system – Q’s forte. Training and support could be provided to teams to deliver this. 
• The population-based approach creates an opportunity for Q (potentially in collaboration with public health experts) to develop expertise in the following areas: 
  • population health needs assessment – with a focus on health inequality 
  • service evaluation – for example, evaluating new health technologies 
  • the audit and evaluation of new pathways and initiatives.