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NHS ten-year plan: sustainability and the three big shifts
A new ten-year plan for the NHS in England is expected in summer 2025. How do the government’s ‘three big shifts’ fit with a vision of sustainable healthcare?
Key points
• The 10 Year Health Plan will be published in 2025.
• It is expected to set out the government’s plans for reforming the NHS in England.
• The ‘three big shifts’ in the ten-year plan are: moving care from hospitals to communities; moving from analogue to digital; and moving from a focus on treating sickness to preventing it.
• These shifts offer many opportunities for more sustainable healthcare.
“The 10-year plan will set the direction for healthcare in England over the coming decade. The changes the government seeks to bring about could help to ensure the NHS is sustainable for future generations – financially, environmentally and socially – but only if sustainability is a guiding principle throughout the implementation of the plan.”
Chris Naylor, Policy Lead Centre for Sustainable Healthcare
What is the 10 Year Health Plan?
The government has said it will publish a 10 Year Health Plan imminently. It is expected to set out the government’s plans for reforming the NHS in England.
The plan is intended to achieve ‘three big shifts’ – moving care from hospitals to communities, moving from analogue to digital and making better use of technology, and moving to a focus on prevention rather than just treatment. In December 2024, the government published its Plan for Change, setting out a series of missions for this parliament. It gave a few possible examples for each of the three shifts, but otherwise there has been little detail so far.
Once the plan is published, attention will focus on how it is to be implemented.
What shaped the ten-year plan?
When Keir Starmer’s Labour government was formed in 2024, the Secretary of State for Health and Social Care, Wes Streeting MP, asked Lord Ara Darzi to conduct arapid independent investigation of the NHS in England. Lord Darzi’s report, published in September 2024, looked at access to care, the quality of care provided, and the overall performance of the health service.
The Darzi report clearly articulated numerous issues impacting the NHS, including rising demand for services as a result of deteriorating social determinants of health, such as housing, and an increase in long-term health conditions. The report also set out key themes to be taken forward, including tackling issues around access to care (e.g. waiting times and GP appointments).
Darzi said that too little of the NHS budget was spent on community-based services (such as GPs, health visitors, community nurses and mental health services), with the result that patient flow through hospitals is disrupted and productivity in hospitals reduced.
The report also highlighted austerity – insufficient funding – as one of the drivers for performance issues in the health system, alongside the impact of the COVID-19 pandemic. With budgets constrained, there has been too little money available to focus on maintaining infrastructure and embracing the potential opportunities for digital transformation.
In October 2024, the government launched a significant public engagement exercise, with regional roadshows and a dedicated online platform gathering views from patients, staff and others on the future of the NHS. This consultation was positioned as key to shaping the ten-year plan.
What does the NHS ten-year plan mean for sustainable healthcare?
The latest assessments from climate scientists indicate that the next decade will be crucial for keeping global warming within manageable limits. The period of time covered by the ten-year plan is therefore critical. Now more than ever, we need a joined-up approach to health and climate policy. Given the significant impacts of climate change and nature loss on human health, and the sizeable contribution made by the NHS towards the UK’s carbon footprint, the 10 Year Health Plan should be at the heart of this.
The Centre for Sustainable Healthcare (CSH), and others working in this area, responded to the government’s consultation with a call for sustainability to be an explicit goal in the plan. This is an important opportunity for sustainability to be embedded in healthcare, achieving better outcomes for patients and for the environment.
We have been at the forefront of driving sustainable carbon-reduction initiatives in healthcare since 2008. Through our work, we inspire people working in the healthcare system, not only explaining the need for change but also empowering people with the knowledge and tools to make positive changes in practical ways. Through our education and training, SusQI work and specialties programmes, we have worked with thousands of clinical and other health and care staff to find ways of improving care in a holistic way, taking environmental, social and economic outcomes into account.
We want to see the ten-year plan acknowledge that climate change poses a significant and growing threat to health and healthcare and identify opportunities to improve health, reduce carbon emissions and improve climate resilience.
In talking about the ten-year plan ahead of its launch, the government has highlighted the three key shifts. There are clear opportunities to implement the three shifts in ways that could benefit patients, public finances and the environment, all at the same time.
From hospitals to communities
In the government’s Plan for Change, published in December 2024, the shift from hospitals to communities is described as: “bringing care closer to where people live, including through a new neighbourhood health service to deliver more proactive and personalised care.”
Transitioning to a community-based model of care offers an opportunity to enhance sustainability by fostering patient and community resilience and leveraging local resources.
To make the most of this shift, the ‘neighbourhood health service’ needs go further than merely changing the location of care. It needs to be about building a new model of care which gives more power to patients and communities and enhances individual and collective resilience.
Viewing this shift through a sustainability lens, we can see the positive impacts of strengthening people’s capabilities to look after themselves and one another, and health and care services making full use of local resources such as green spaces and community groups. This approach has already been successful in initiatives such as green social prescribing. We see so many examples of this through our work supporting healthcare sites to transform their green spaces through planting trees and creating habitats for nature and social spaces for people.
Another example illustrating how the shift to the community could deliver sustainability benefits was seen in Hampshire Hospitals NHS Foundation Trust. We worked with the trust to run a Green Team Competition in which clinical teams developed and tested ideas for service improvement. One team evaluated the impact of providing intravenous antimicrobial therapy on an outpatient basis, instead of needing to stay in hospital. The service improved patients’ experience of care, allowing them to be discharged earlier, and saved the equivalent of over 25,000kg of carbon dioxide every year, as well as an annual financial saving of over £115,000.
From analogue to digital
Plan for Change describes the shift from analogue to digital as, “rolling out new technologies and digital approaches to modernise the NHS, including bringing together a single patient record.”
At CSH, we believe that new technology should be assessed against the ‘triple bottom line’ – does it deliver improved health outcomes while minimising financial, environmental and social costs?
Priority should be given to technologies with a lower environmental impact or those that enhance sustainability by aligning with the principles of sustainable healthcare. CSH’s medical director, Dr Frances Mortimer, developed the principles, published in 2010, and they have been used across the healthcare sector as a foundation for practical and sustainable change. The principles include:
• Preventing illness and promoting health
• Empowering patients
• Streamlining care processes to boost efficiency and reduce waste
• Implementing low-carbon interventions, approaches, or pathways.
As an example of the potential impact of technology, the Telehealth Team developed by Mersey Care NHS Foundation Trust has significantly reduced hospital admissions and use of health and care services by people living with long-term conditions, with associated benefits in terms of carbon reduction.
Care should be taken to support the adoption of the right technologies, not just the newest. This can mean giving attention to systems and infrastructure. For example, switching from single-use to reusable medical equipment can often safely reduce the carbon footprint of products and lead to significant financial savings, but this requires processes to support sterilisation of larger volumes of equipment. We are currently working with the Department of Health and Social Care on a pilot project assessing the environmental and financial benefits of moving from single-use to reusable medical technologies.
Healthcare facilities also need to rapidly deploy new technologies to improve energy efficiency and generate local renewable power as part of the target to deliver a net zero NHS by 2040. While this will require upfront capital investment, these technologies can also deliver significant financial returns for the NHS.
From treatment to prevention
In Plan for Change, the shift from treatment to prevention is described as “shortening the amount of time people spend in ill-health by preventing illnesses before they happen, as well as earlier identification and management of chronic conditions.”
Prevention is the first principle of sustainable healthcare, and many interventions can deliver triple bottom line benefits – positive outcomes for the environment, finances, and society, alongside health improvements. These broader benefits should be measured and reported to inform decision-making.
For example, there are climate co-benefits to many measures that would improve and maintain physical and mental health, such as supporting ‘active transport’ –choosing walking and cycling over driving – and healthier, plant-based diets. There can also be co-benefits for nature. This year, we are expanding our Nature Recovery Rangers project, which works with NHS partners to improve green spaces and integrate nature into patient care, staff wellbeing and community engagement. The rangers maximise the role green spaces play in the prevention of health issues, supporting positive patient outcomes, recovery, and the creation of a healthier environment.
Empowering patients with long-term conditions to look after their health can mean fewer hospital stays and surgical interventions, as can early and innovative intervention. Within the healthcare system, getting to grips with over-prescribing and over-investigation is also important in avoiding harm and unnecessary financial and environmental costs. We work with numerous clinical specialties to look at where positive changes can be made. For example, we are currently working in partnership with the UK Kidney Association and Health Innovation North East and North Cumbria to reduce the carbon footprint of kidney care while preventing avoidable hospital activity and delivering excellent care to patients.
Shifting to a more preventive approach is also an important theme in several of the projects developed through our Green Team Competitions. For example, in The Christie Hospital in Manchester, a team used light therapy to prevent a debilitating side effect in patients with head and neck cancer. This intervention demonstrated a significant reduction in symptoms, medication requirements and hospital admissions, leading to projected annual savings of almost 43,000kg of carbon dioxide and around £500,000.
What can I do to support sustainable healthcare?
The three big shifts in the ten-year plan can be implemented in ways that bring together health and climate policy. We want you to be a part of that.
At the Centre for Sustainable Healthcare, we develop resources to support the NHS and other health systems to reach net zero carbon and wider sustainability. We work with clinical teams, senior leaders and others to support the adoption of sustainable approaches.
An easy first step is to join one of our free community networks and connect with thousands of like-minded health professionals, academics and students looking to gain new knowledge, collaborate and network, and advance the field of sustainable healthcare.
We offer a range of services designed to support you, from carbon footprint analysis and reviews of NHS Green Plans, to bespoke Green Team Competitions. Our Green Space for Health team inspires and supports healthcare sites in transforming their green spaces for health, wellbeing and biodiversity.
We also offer a range of sustainable healthcare courses designed for all health and social care staff with an interest in sustainable practice, plus net zero leadership training for boards.
The three big shifts we expect to see in the ten-year plan offer clear opportunities for sustainable healthcare. Whatever the final details are, there will be opportunities to implement the plan in a way that helps to create a more sustainable healthcare system, and we mustn’t miss the opportunity to do so. We would love for you to join us as we embark on the next ten years of sustainable healthcare.
This blog is a joint piece by the Centre for Sustainable Healthcare and Greta Hughson — a freelance editor and writer who generously volunteers her time with us.
