How the 10-Year Plan and New DHSC Structure Could Succeed — If We Break Old Patterns

The burning platform: sicker patients, longer stays, unsustainable demand

We have 7.4 million incomplete referral to treatment pathways in England, with around two-thirds waiting just to be seen (NHS England, 2025). Patients aren’t the same as in 2019: they’re older, frailer, with multiple conditions that extend lengths of stay and intensify workforce pressures. Data from NHS England and NHS Confederation reports confirms average adult elective length of stay is up ~8% since pre-pandemic levels, driven by higher acuity and social care delays. Yet our systems still chase activity targets, track outdated metrics, and reward volume over value. We can’t simply restructure NHS England into DHSC or issue another 10-year plan and expect different results. Because we have been here before, and we know what happens when we try to fix today’s NHS with yesterday’s thinking.

The pattern: familiar reforms, familiar outcomes

Over two decades we have had:

·       Connecting for Health (standardise data, failed on uptake & workflow),

·       STPs & ICSs (integrate care, but often on fragmented digital foundations),

·       GIRFT & similar (spot variation, but with varying levels of operationalisation to change local incentives).

Meanwhile we still see:

·      Unvalidated waiting lists clog PTLs and obscure true demand, making it harder to prioritise care by clinical risk rather than time waited,

·       Huge postcode variation in access and outcomes,

·       Equity gaps that widen because we aren’t resourcing differently for higher-need groups.

Even today, much of our digital and data infrastructure is designed for reporting upwards, not for empowering clinical teams managing real risk in real time.

Where smarter systems broke the cycle

Other systems didn’t just reorganise or publish more dashboards. They rebuilt operating models around live, federated intelligence tied to local ownership.

·       In Ontario, shared-data patient navigation models have reduced repeat ED visits by around 25–32% (AJMC, 2023).

·       Denmark’s municipal co-financing reforms led to roughly 30% fewer avoidable hospital admissions among older adults (PubMed study, 2013).

·       Singapore ties tiered chronic care funding to dynamic risk scoring, reducing long-stay costs and incentivising prevention over hospital episodes.They designed for prevention and equity — with incentives, data and decision rights all aligned to local teams.

What makes this moment different — and still risky

The new 10-year plan and DHSC absorbing NHSE finally bring performance, finance, digital and prevention under one roof. This could be the governance spine we needed. But unless we avoid the old pattern of central oversight disconnected from operational ownership, we will simply have bigger headquarters chasing the same activity curves, while patients wait longer and staff burn out faster.

Quick wins that would prove we have learned

Here’s how we can signal an immediate break from the past:

✅ Federated waiting list cleanses via existing FDP platforms — not just dashboards. Embed validated lists into scheduling and MDT workflows to clear duplicates and stale follow-ups.

✅ Equity-weighted funding pilots tied to prevention metrics. Move beyond volume: pay for reduced avoidable admissions, risk-adjusted throughput, narrowing deprivation gaps.

✅ Push live risk segmentation out of board packs and into daily virtual ward huddles. Give frontline teams the same intelligence that national directors see — so intervention happens in real time, not in monthly performance reviews.

Why it matters

Get this right and DHSC can show a credible route to bending cost and demand curves, fulfil the 10-year plan’s promise of moving from sickness to prevention, and prove that integrating NHSE wasn’t just a rebrand. Miss it, and we’ll be back in 2030 with even sicker patients, even longer waits, and the same reports on why fragmented data and old incentive models let us down — again. Because we truly cannot fix today’s NHS crises with yesterday’s thinking.