England’s National Health Service has set out a ten-year plan that couples service reform with a decisive push on sustainability and technology. Against a backdrop of difficult access to GP appointments, expanding waiting lists, staff demotivation and lagging cancer research, the plan frames a choice between incremental adjustments and a comprehensive overhaul. It proposes a mission anchored in universal access, free care at the point of use, needs-based treatment and public funding, with sustainability running through procurement, infrastructure and clinical innovation. The ambition is to lead genomics and AI adoption while moving care closer to communities, digitising core processes and prioritising prevention.
System Reform and Care Model
The plan follows extensive engagement with staff and the public, gathering about 250,000 inputs through the Change.NHS website. The feedback pointed to a clear appetite for change rather than defence of existing arrangements. The proposed care model recalibrates the NHS mission to combine universal access and public funding with needs-based treatment, explicitly binding delivery to sustainable practices.
Three transformations lay at the centre of this redesign. Firstly, the intention to relocate more care from hospitals to communities sets a direction to rebalance capacity and make access more convenient. Secondly, the transition from analogue to digital systems positions technology as a daily enabler of service quality and efficiency. Thirdly, the shift from treatment to prevention signals a long-term approach to population health, aiming to reduce demand by intervening earlier and more effectively.
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Delivering these shifts requires structural reform across the service. The plan ties innovation strategy and financial accountability to the sustainability agenda, indicating that investment decisions, performance oversight and operational planning will need to reflect environmental impact as well as clinical outcomes and cost. The stated ambition to lead the global genomics revolution and integrate AI at scale elevates data and digital capabilities from support functions to core clinical infrastructure.
Procurement and Digital Infrastructure
Procurement is positioned as a primary lever for system change. The plan calls for modern technology to underpin purchasing, with an emphasis on empowering staff and aligning supply decisions with sustainability and digital advancement. A key aim is to give patients seamless access to services via the NHS app, supported by simplified technology procurement and a single national formulary for medicines within two years. The document draws lessons from international examples of AI-enabled hospital systems, using them to underline the need for coherent national standards and streamlined adoption.
Operational tooling is part of the transformation. Facilities will be developed to enable automated staff rostering and procurement, reflecting a focus on productivity, resilience and accessibility. The procurement strategy shifts away from patching current problems with outdated solutions and towards best-value medicines delivered through a modernised supply chain. Technology’s impact on value and patient outcomes is placed at the centre of purchasing decisions, and sustainability is described as a core criterion rather than a secondary consideration.
Standardised value-based procurement guidance is scheduled from early 2023 to create a consistent framework across the service. Under this approach, productivity-enhancing technologies are to be purchased nationally and distributed through an internal marketplace so that patients and clinicians across settings can benefit. By April 2026, the National Institute for Health and Care Excellence appraisal process is planned to expand to devices, diagnostics and digital products. The plan links this expansion to financial sustainability and to addressing immediate service pressures, including the reduction of waiting lists for Children and Adolescent Mental Health Services through high-impact health technologies.
Net Zero and AI Ambitions
Environmental commitments are set out alongside digital goals. The NHS targets net zero emissions for direct sources by 2040 and for influenceable emissions by 2045 under the Delivering a Net Zero Health Service strategy. Collaboration with Great British Energy to install solar panels on public sector buildings is expected to support decarbonisation. All NHS organisations are tasked with cutting their carbon footprints, mitigating environmental effects and strengthening climate resilience in line with the Health and Care Act 2022.
Infrastructure financing is framed as a partnership between public oversight and private capital. The NHS plans to work with the National Infrastructure and Service Transformation Authority to mobilise private financing for revenue-generating projects such as key worker accommodation. Low-risk pension fund capital is under consideration, with Public-Private Partnerships explored to accelerate decarbonisation across facilities. The approach is presented as a pragmatic route to deliver environmental upgrades while protecting service delivery.
The digital roadmap culminates in a vision to become the most AI-enabled health system in the world, weaving AI into clinical pathways as a trusted aid for clinicians. Five technologies are prioritised as transformative for personalised care, outcomes and economic growth: data, AI, genomics, wearables and robotics. To support safe and effective deployment, educational curricula and training will be overhauled over the next three years so that the workforce can adopt and manage new tools sustainably. Hospitals are expected to prioritise safety in AI deployment and to embrace technologies that can deliver consistent access to cutting-edge care.
The ten-year plan sets a comprehensive direction that links service reform, procurement discipline and environmental responsibility with a strong digital and AI agenda. Its centre of gravity is a shift towards community-based, prevention-focused care underpinned by reliable digital access, value-based procurement and clear net zero targets. For healthcare leaders and decision-makers, the priorities are executional: align purchasing with outcomes and sustainability, modernise infrastructure to support safe AI adoption and build workforce capability to embed technology into everyday practice. If realised, the programme outlines a path to a more sustainable, efficient and accessible NHS.
Source: Sustainability Magazine
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