It is time for a 10-year national health plan

This piece first appeared in National Health Executive magazine, issue 104, on 27 May 2025: It is time for a 10-year national health plan – National Health Executive magazine

We need a national health plan

The long-awaited government NHS 10-Year Plan is imminent. Its focus must go beyond clinical care in our hospitals and NHS reform. What the NHS needs is a national health plan. Because health cannot be the responsibility of NHS management alone; it must reach across government departments – from the Treasury, education, housing, and environment to business and food.

All parts of government must work together to tackle the wider factors impacting health, so that we can build a society where people are able to live healthier lives for longer.

As a nation we’re getting sicker

Abolishing NHS England was eye-catching, but the NHS alone can’t deliver the wider improvements in health we need. The 10-Year Plan is expected to include a number of shifts: care closer to communities, better use of technology, and prioritising prevention over treating sickness. This is welcome, but we know ever-growing NHS budgets are not sustainable. Even with health spending protected in the short term, the government cannot spend its way out of this crisis. Waiting lists remain at record levels. Despite some progress over the past 10 months, at the current pace it could take 14 years to meet the 92% target for patients being seen within 18 weeks. Even if reached, this would hardly be a national achievement — lagging behind countries like France, where the average wait is just 10 weeks.

As a nation, we’re getting mentally and physically sicker. Life expectancy is flatlining. Over the last decade, more than one million people in England have died prematurely due to health inequalities. As disparities widen, the need to focus on the social determinants of health is stronger than ever.

So, what could a national health plan achieve? First and foremost — a healthier society, with people living longer, more active, happier, and healthier lives. Second, an NHS that is fit for purpose: providing world-class care, free at the point of use, and operating within its means. Here’s how we could do it:

Expanding our definition of prevention

The government promised to end ‘sticking plaster politics’. Wes Streeting has been clear that he wants the NHS to shift from treatment to prevention. Prevention cannot apply only to infections or smoking; it needs to address the socio-economic problems that bring people into GP surgeries and A&E departments.

Access to nutritious and affordable food for our children

Our children should have the opportunity to thrive, no matter where they grow up. A key factor in ensuring this is access to nutritious and affordable food. The government has introduced Free School Meals for children in Reception to Year 2, regardless of income, but more action is needed. Healthy food and balanced nutrition in childhood result in both health and financial dividends — tackling child poverty, ensuring a healthier population, and putting financial power in the hands of people to better support their own health.

Sixty percent of parents receiving Free School Meals were able to spend more money on food for their family as a result. This is a win-win — a scalable intervention that could support better population health, family finances as well as the government’s balance sheet.

More money for the NHS with a tax on unhealthy foods

The recent ban on junk food advertising to our kids is a step in the right direction, but companies that make millions from selling unhealthy foods to us and our families need to pay more. The NHS is already spending billions on treating obesity — a figure set to rise to over £9.7 billion a year by 2050.

The Soft Drinks Industry Levy (SDIL) incentivised food companies to make healthier products without harming sales or profitability. The government has started the process of expanding this levy to more products; a potential ‘milkshake tax’ is positive, but the government should build on this and introduce a salt and sugar levy for all foods. A proposed sugar and salt reformulation tax could benefit public health and generate between £2.9 billion and £3.4 billion per year — funding that could go directly to the NHS.

Dirty air is the largest environmental risk to health

Four in five people in the UK live in cities. Poor air quality causes long-term illness and contributes to around 43,000 deaths each year. It disproportionately affects people who live in lower-income neighbourhoods and are from minoritised communities. Ella Adoo-Kissi-Debrah, a nine year-old girl who died in 2013 after a fatal asthma attack, became the first person in the UK to have air pollution listed as a cause of death. She lived next to the South Circular Road in Lewisham, South London. Her death was tragic, but it wasn’t inevitable.

Taking action at both local and national government level can have a positive impact. Recent data from the Mayor of London shows that London’s expanded Ultra Low Emission Zone is helping people across the capital to breathe cleaner air.

Tackling air pollution should be a win for public health and the environment. However, fresh plans to allow wood-burning stoves – a major source of air pollution – in new homes are simply a failure of common sense and a regressive step. Evidence from the Chief Medical Officer shows that wood-burning stoves emit 500 times more harmful particles than gas boilers. This is on a par with the harm done by fumes from car exhausts and needs to be taken seriously.

Instead of taking a step backwards, a national health plan should include clean air as a top priority.

Affordable homes for healthier lives

Housing must be part of a national health plan too. Good homes support people to stay healthier. Public Health England recognises that precarious housing increases people’s risk of developing mental and physical health conditions. Housing costs more than ever. Poor housing is taking money out of the pockets of people who can’t afford it and then making them sick. The worst living conditions are in the private rented sector, where insecure, poor-quality housing is compounded by a lack of support and protection for tenants.

The government’s ambitious housing targets, and additional commitments of £2 billion more for affordable homes, is not NHS spending, but if done right, it can support our health. Government should not compromise on standards, should build good quality homes, and support a well-regulated private rental sector – this can be a solid foundation for population health.

Time for a plan for the nation’s health – not just the NHS

To meet today’s health challenges, we need a joined-up, decades-long, cross-government plan that looks beyond an NHS focus. We know NHS innovation has the power to transform lives and clinical care, but it cannot take on the task alone. That means seeing prevention beyond factors like smoking and alcohol, and looking to the wider social and environmental factors that shape our collective health — from the air we breathe, to the quality of the homes we live in, and the food on our tables. A plan for bold action that is prevention-focused and committed to health equity.

The prize is a society where we can all stay healthier for longer, but government must act now.