Tuesday 29 July 2025
Dr Adrian Boyle, President of the Royal College of Emergency Medicine, reflects on the government’s 10 Year Plan.
The Department for Health and Social Care has published its 10-year health plan. It was developed after an extraordinarily comprehensive consultation. Unlike previous plans, there is no explicit mention of any diseases, specialties or professional groups. The plan is for England only.
In our context this plan needs to be considered alongside the UEC plan and the upcoming refresh of the Long-Term Workforce Plan.
This plan is ambitious across all activities of the NHS in England, and it is difficult to disagree with the any of the intentions.
This is government ministers’ way of establishing and prioritising health policy for at least the duration of the next parliament. There is no Plan B, so pragmatically we have to see how we can use this to improve care.
There are some generic aims that should get widespread support.
Improving transparency is an issue that the College has consistently advocated for.
Likewise, a single patient record which is widely accessible and ambient voice technology would be helpful.
Furthermore, the plan to make the NHS a better employer is well overdue, as is the promotion of generalism and reducing mandatory training.
I think they could have gone a bit harder on reducing alcohol related harms, but there are welcome statements about increasing vaccine trust and uptake.
The idea of a single identifier for children to improve safeguarding processes across education and the NHS sounds sensible, but there may be devil in the detail.
There is some recycling of previous ideas such as league tables.
As a specialty, we are not traditionally thought of as providing preventative care, but we have important offers around, for example, alcohol misuse identification, HIV testing and violent injury prevention.
There are quite a lot of mentions about redesigning Urgent and Emergency Care.
There is an appropriate recognition that a lot of the problems in the ED are caused by poor hospital flow, and this plan is consistent with the most recent UEC reform plan.
There is some discussion about the value of virtual wards in reducing admissions and length of stay, and an increase in SDEC capacity and co-located UTCs.
I am a bit disappointed that there is no real recognition of the need to match hospital bed capacity to population need, but really good performance management of acute trust flow could mitigate a lot of this.
There is a gaping hole about the need to reform social care, but this was always outside the remit of the plan.
There is also a lot of recognition that too many people with ‘urgent’, as opposed to ‘emergency’ problems end up in Emergency Departments, and plans to try and tackle this.
I suspect ‘call before convey’ will become increasingly important.
The section on mental health Emergency Departments will need to be carefully and collaboratively implemented if it is not to create another siloed service.
There are some ideas to change the funding model for emergency care. These are a step in the right direction, but we’d need to pilot these carefully and watch for unintended consequences.
For individual departments, this means really making sure that we are capturing clinical activity with good coding, as we are probably underpaid for the work that we do.
I suspect the use of block contracts has caused attention to coding to wane.
This is an ambitious plan, and this is a difficult time to embark on large scale transformation projects.
The health delivery arms of the government, NHS England and the Integrated Care Systems, are being reduced and merged with DHSC. There are rumours of a detailed delivery plan coming out in the autumn.
The plan’s overall aims are sensible, but as always there is a difference between work imagined and work done. At the moment, I think I look at this a bit like a daunting mountain to be climbed, with some tricky technical sections and some crevasses to fall into. As with all climbs, there comes a point where you have to stop looking through binoculars and get up close and personal with the problems you are faced with, and that is when you know how things are actually going to work out.