Fit for the Future? Reflections on England’s 10-Year Health Plan

The government’s Fit for the Future: 10 Year Health Plan for England sets out a stark choice for the NHS: “reform or die”. It promises three radical shifts: from hospital to community, analogue to digital, and sickness to prevention, supported by devolved decision-making, technology, and new financial incentives.

At Curovia, we welcome the ambition. But ambition alone will not close the health equity gap. The key questions are: who is responsible, and how will change be resourced?

Clear Lines of Responsibility?

The plan proposes a new operating model that devolves power to local Integrated Care Boards (ICBs) as strategic commissioners and encourages NHS Foundation Trusts to evolve into Integrated Health Organisations holding whole-population budgets.

Yet while this creates opportunities for local flexibility, it also raises concerns:

• Reduced budgets and increased responsibilities: we are already seeing dramatic changes in budgets and staffing for ICBs, adding another list of responsibilities will only add to the complexity of an already pressurised situation.
• Accountability risks: The plan mentions a new “failure regime” for underperforming areas, but it is not clear how accountability for health inequalities will be measured or enforced.
• Equity focus: Funding will be redistributed more equally over time, with additional resources targeted at areas facing disproportionate economic and health challenges. But will there be mandatory health equity standards tied to commissioning, or will progress depend on local leadership priorities?

Without clarity, there is a risk that responsibility for tackling health inequalities will diffuse rather than sharpen.

Allocated Budgets: Enough to Deliver?

The government acknowledges that “more money alone has not always led to better care”. Instead, it proposes value-based financial flows, multi-year budgets, and a 2% annual productivity target for the NHS.

This raises several concerns for equity:

• Neighbourhood health centres: The plan promises a centre in every community, beginning with those with lowest healthy life expectancy. Yet the funding model relies partly on Public Private Partnerships (PPP)- the UK health system already has a history of mortgaging the future (this often does not end well), raising questions about long-term sustainability and access in deprived areas.
• Prevention budgets: Initiatives to halve the gap in healthy life expectancy, such as obesity reduction, free school meals for all children in households on Universal Credit, and targeted mental health hubs, are promising. But prevention is notoriously underfunded compared to acute care. Will prevention budgets be ring-fenced, or will they evaporate under pressure from rising hospital costs?
• Digital transformation: Investment in the NHS App and AI-enabled care will benefit some, but risks widening inequalities for those facing digital exclusion—unless funding is also directed to multilingual support, community-based engagement, and offline access.

Anticipated Changes: A Vision or a Delivery Plan?

The plan is bold in vision yet still lacks detail on enforcement. It commits to halving the gap in healthy life expectancy between richest and poorest regions but does not set out who is responsible if progress stalls, or whether funding will be contingent on measurable reductions in inequality.

The Marmot Review’s eight principles remind us that equity requires action across society – not only in healthcare, but in housing, education, employment, and environment. The government’s plan acknowledges this but stops short of binding cross-departmental responsibility or ring-fenced budgets to tackle the wider determinants of health.

Curovia’s Perspective

At Curovia, our mission is rooted in the understanding that health equity cannot be achieved by doing to communities, but only by working with them. The government’s plan makes encouraging commitments to neighbourhood health services and prevention, but to succeed, it must:

• Tie funding directly to equity outcomes, not only productivity targets.
• Mandate lived-experience involvement and community co-design in all ICB-level commissioning.
• Ensure that digital-first services are always backed by culturally tailored, multilingual, offline alternatives.
• Embed accountability across government departments, not just in the NHS.

The NHS has been promised transformation many times before. This plan will only succeed if equity is at its heart, not as an aspiration, but as a measure of delivery.

As Professor Marmot concluded: “Inequalities in health arise because of inequalities in the conditions of daily life”. The question is whether this plan will finally tackle those conditions—or simply reorganise the system around them.