NHS 10-Year Plan: It’s Change Or Bust – And The NHS Chooses Change
The NHS 10-Year Plan opens with a terrifying warning: without fundamental reform, the NHS as we know it will cease to function.
Chapter one of the plan ‘It’s Change or Bust’, sets the tone. It describes an NHS at a historic crossroads, overwhelmed by growing demand, outdated structures, workforce fatigue and worsening public confidence.
The case for change is laid out with urgency and precision. Waiting lists have ballooned, satisfaction is at record lows and the people who rely most on the NHS are being let down by a fragmented, hospital centric model that no longer fits the needs of a modern population.
Importantly, this chapter doesn’t just describe what’s going wrong, it explains why the existing system is no longer capable of delivering on its founding mission. Outdated working models, episodic care and centralised bureaucracy are cited as core barriers.
Same NHS principles – delivered in a radically different way
The plan doesn’t walk away from the core principles of the NHS; universal, free at the point of use and funded by general taxation, but does argue that these principles must now be delivered in a radically different way.
Patients need to be empowered; care needs to be continuous, not fragmented, and prevention needs to replace reactive crisis management. The future NHS must be predictive, personalised and digitally enabled.
This shift isn’t just philosophical. It is grounded in a robust engagement process that reached more than 250,000 people via the Change NHS website, and involved staff, patients, Royal Colleges, charities and academics.
The verdict was unanimous, with no one defending the status quo. The public and professionals alike are demanding transformation. There’s a growing consensus that the NHS must now be reshaped around patients, not organisations and that it must move with the same pace and innovation as the rest of society.
Reimagining the model: From hospitals to people and from treatment to prevention
A central message from chapter one is that the NHS is still shaped by the demands and assumptions of a previous era. Designed in a time when infectious disease was the biggest threat and hospital based care was the norm, today’s NHS is struggling to meet the needs of a population living longer, often with multiple long term conditions and expecting far more choice and control in their interactions with public services.
Rather than continuing to pour more money into an increasingly inefficient system, the plan calls for a total rethink. It promises to make prevention the new default, digital the new foundation and neighbourhood teams the new front line.
It identifies four structural shifts driving the need for change:
- An ageing population with complex needs will require joined-up, home based care.
- Chronic illness now dominates NHS demand, accounting for 65% of spending.
- Public expectations are rising; people want the same responsiveness they experience in retail and banking.
- Cost pressures are unsustainable. The NHS already accounts for 38% of day to day government spending, with that figure set to rise. Without reform, the system will be unaffordable.
While the challenges are stark, the opportunities are compelling. Advances in genomics, data and AI mean the NHS has an unprecedented chance to become proactive rather than reactive.
This makes the bold claim that the NHS is better placed than any other global system to harness these breakthroughs. It has the data, the population coverage and the mission. What it needs now is the will to act.
What this means for pharma, medtech and device companies
This chapter of the 10-year Plan is not just a cry for help. It is a declaration of intent and a clear signal to industry. The NHS is not simply asking for better products or services. It is asking for help to redesign the system.
For pharma, medtech and device companies, the message is simple, your value will no longer be measured solely by your clinical data or regulatory approval. It will be measured by how well you support system transformation.
If your offer helps move care out of hospital, supports early intervention, reduces pressure on overstretched services or empowers patients to manage their own health, you’re in the right place. But your proposition needs to go beyond the product. It must show how it supports integrated care models, contributes to health equity and enables real world delivery through existing (or supported) workforce.
In my new book, Embedded, I call this the Four Filters, every offer must improve outcomes, reduce workload, support income and be deliverable.
This is a fundamental shift from transactional selling to strategic partnership. As I explain in the book, one of the biggest mistakes companies make is starting with ICBs when they should begin with providers.
The same logic applies here. If your offer doesn’t have clinical champions, operational buy-in and a clear fit within the evolving pathway, it will struggle to land, no matter how strong the headline evidence.
A warning for those who wait
One of the most striking parts of the first chapter of the plan is the clear suggestion that the public may soon lose faith in the NHS altogether if change does not come fast enough. Wealthier patients are already going private in record numbers, and polls show that a majority of the public now expects charging to increase.
This undermines the solidarity on which the NHS depends. If those who can afford to opt out do so, the risk is that the NHS becomes a safety net for the poor and, as the plan rightly says, a poor service for poor people.
This message should resonate deeply with suppliers and innovators. If the public loses trust in the system, the political and economic conditions for major investment in services, workforce or innovation, will disappear.
That makes it all the more important that industry leans in now, supporting transformation from the ground up and showing NHS partners how innovation can improve not just care, but sustainability.
Embedded lessons: From product to pathway
In Embedded, I describe this moment as the transition from products to pathways. In the past, companies could lead with their product and expect clinicians to find a home for it. Not anymore.
Today, you need to start with the problems the NHS is trying to solve, waiting times, workforce strain, rising admissions, and show how your offer supports the solution.
You must be ready to work across settings, support multidisciplinary working, offer real world data and service models and help frontline teams deliver outcomes with limited bandwidth.
Success here depends on the quality of your partnerships, not the size of your sales force. And it starts with understanding the direction of travel.
Be a partner, not just a willing supplier
Chapter one of the 10-Year Plan is a rallying cry. It doesn’t shy away from the pain the NHS is in, but it also offers a bold, optimistic vision of what could come next. For pharma, medtech and device companies, this is not just background reading. It is a strategic map.
This is your chance to become part of a national reset, not as a supplier waiting to be commissioned but as a partner in redesigning care. The challenge is significant. But the reward is long term relevance, deeper partnerships and the opportunity to be truly embedded in the future of the NHS.
If the NHS has chosen change, the only question left is, have you?
About Scott McKenzie Consultancy
At www.scottmckenzieconsultancy.com, we work directly inside the NHS, supporting provider organisations, commissioners, and system leaders to implement real change. We then help pharma, medtech and device companies interpret what’s happening, so they can engage the right stakeholders, align with NHS priorities and get their innovations embedded into care pathways.
With 10 years in pharma and more than 20 years working within the NHS, Scott brings a unique dual perspective, now captured in his upcoming book, launching September 2025, Embedded: How Pharma, MedTech, and Device Companies Can Get Their Products into NHS Pathways and Stay There, which distils everything he’s learned into a practical playbook. Whether you’re launching a new product or trying to unlock stalled adoption, Embedded shows you how to reframe your offer, align with NHS priorities, and make change stick.