4th July 2025
Core elements of the plan are to move from a hospital-centric approach to healthcare to one more focused in the community; to improve patient access to and control of their data through the NHS App; and improve healthy life expectancy through more coordinated efforts on prevention. It also includes ambitious aims for a happier, healthier, more motivated and skilled workforce, but with fewer people.
The vision has been presented, the challenge now is delivery, which will not be easy. Achieving the commitment to achieve net zero and build resilience will need to be considered in every aspect of implementation as the project moves forward. This will require dedicated leadership and oversight to ensure understanding, consistency and coordination across the system, with net zero targets and adaptation requirements featuring prominently in national policy documents and accountability frameworks to ensure a sense of shared ownership. Here, NHS England is a world leader through the work already achieved through the Greener NHS Programme.
NICE and other regulators, such as the CQC must also play a role. The 10 year plan places additional requirements on NICE to include appraisal of devices, diagnostics and digital products and to identify outdated technologies and therapies that can be removed to free up resources. NICE should also incorporate environmental costs and benefits alongside clinical effectiveness and costs in its judgement, and provide clear guidance for clinicians on managing climate-related risks. Likewise, relevant environmental metrics should be included in the oversight and assessment framework and CQC assessment processes for Integrated Care Boards and Trusts.
Encouraging more healthcare professionals to work in primary care and community-based services will only be achieved with adequate workforce planning, investment, and staff wellbeing. It is estimated that up to 20% of healthcare spending adds no value to those receiving it. Better value, more environmentally sustainable care, with greater community engagement could reduce waste both in terms of resources, medications, and unnecessary travel. Developing the advocacy role and connecting-power of health and care professionals to engage around the needs of patients and communities to influence and model more sustainable care can be a powerful driver for change, but will need to be properly resourced.
The plan places significant emphasis on digital technology tools and apps as means to empower patients and make working conditions more streamlined and easier for staff. Digital technologies and AI do have the potential to reduce inappropriate or unnecessary investigations and treatments, reduce the impact of patient transport or travel to the clinic setting, and decentralise care out of hospitals and into communities and homes. They can also improve access to care for traditionally under-served and rural populations.
It goes without saying, that with so much resting on them, it is critical that the applications developed actually work.
Historically, the NHS does not have a good record when it comes to reliable IT systems. Currently metrics and indicators are uncoordinated between different regions and there are gaps in data that measure health risks and vulnerabilities. Standardised frameworks for metrics and indicators, combined with the coordination and integration of datasets will be needed to enable practical use and predict health risks. Here, a new Health Data Research Service has been announced which will be backed by up to £600 million of joint investment in partnership with the Wellcome Trust.
About 60-80% of health and wellbeing are determined by a person’s social circumstances, environment, and lifestyle. Currently the UK is doing badly across all three. For many people, poor living conditions, fuel poverty, polluted air, lack of access to green space, a built environment poorly supportive of active travel and heavily skewed towards motorised traffic, and diets high in processed foods and saturated fats contribute to ill health and poorer health outcomes. The rising threat of climate-related health risks such as heat and vector-borne diseases is poorly understood at both the community and health service. Preventing worsening outcomes will require education and collaboration across multiple authorities.
The greatest enablers we have identified to achieve the prevention agenda are:
Improve infrastructure to enable active travel
The health benefits of active travel include improved productivity and reduced pressure on the health service associated with air pollution, physical inactivity and social isolation.
The 10 year plan includes a welcome commitment to deliver greener, safer and healthier transport, including by: decarbonising the transport system; rolling out clean technologies across road, rail, aviation and maritime sectors; and support for active travel. It recognises the benefits of active travel as an effective way to reduce emissions while also supporting physical activity and says it will partner with Active Travel England, local authorities and government departments to identify changes to boost active travel rates.
Enable and encourage healthier food choices
One in four adults and one in five children in the UK are clinically obese. Healthy, nutritious food costs twice as much as unhealthy, obesogenic food. In the UK in 2020, approximately 70,000 deaths were linked to inadequate consumption of nutritious plant-based foods and nearly 42,000 deaths were associated with overconsumption of dairy, red meat, and processed meat. Reducing meat consumption in line with increasing plant-based foods would bring significant reductions in greenhouse gas emissions while also improving health outcomes.
The 10 year plan places emphasis on tackling the obesity crisis with a number of actions including: restricting junk food advertising targeted at children; ensuring schools provide healthy, nutritious food; support for families; soft drink levies; and updating current outdated nutrient profiles used to categorise foods. Mandatory healthy food reporting will be placed on companies and supermarkets, which will then be used to set targets for improvement. This mandatory report must go beyond healthy sales to incorporate key health and sustainability criteria – the Eating Better Alliance has published this report on what needs to be included.
The NHS can lead the way by introducing plant-based by default menus for patients and staff to reduce the consumption of red meat and dairy while increasing the uptake of fruits, vegetables, cereals, legumes and nuts to prevent ill health and support recovery.
Increase access to green space and encourage nature-based prescribing
In the NHS nature-based interventions are valuable strategies for preventing ill health, supporting patients to recover from illnesses, and promoting good health and wellbeing. Participation in nature-based activities can have a positive effect on psychological, social, physical, and intellectual outcomes. Existing evidence suggests that nature prescribing programmes have the potential to save the NHS £100 million per 1.2 million people.
We couldn’t find any mention of green space or nature in the 10 year plan, which is disappointing as green space and access to nature will surely play a role in the shifts to community and prevention.
Affordable, energy efficient homes
Cold homes cost billions a year through increased costs to the NHS, higher caring costs, lost productivity, and carbon emissions. There were almost 5,000 excess winter deaths in the UK in 2023 caused by people living in cold homes. The cost of retrofitting all low-income homes in England to bring homes up to the standard advised by the Climate Change Committee would pay for itself through avoided health and climate costs, with savings that would accumulate over decades.
The 10 year plan recognises the role that poor housing plays in driving poor health outcomes. It says the government is taking action to improve the standard of rented homes requiring social landlords to act promptly to fix housing hazards. This will initially focus on damp and mould, which can cause respiratory illness and other health problems. The Department for Energy Security and Net Zero (DESNZ) is also leading the development of a new Warm Homes plan and Fuel Poverty Strategy, backed by £13.2 billion of investment to help make homes warmer, more comfortable and energy-efficient. It says DESNZ will work with the Department of Health and Social Care to help ensure more health-vulnerable households get the help they need to improve their homes.
Enforce clean air
Air pollution is associated with about 30,000 deaths in the UK annually. Domestic wood burning has become the largest source of PM2.5 pollution in the UK (22%) and is associated with £0.9 billion in health-related costs. Prioritising interventions that reduce air pollution while also contributing to achieving net zero targets can significantly benefit public health.
There is a commitment in the Plan to work with the Department for the Environment, Food and Rural Affairs (DEFRA) as they set out action on air pollution through the Environmental Improvement Plan review. This will set out policies and measures to reduce emissions, concentrations and population exposure to the most harmful pollutants, further steps to improve understanding of air pollution and activities to increase public engagement on air quality issues.
Collaborations with the health community to improve awareness of and communications on the health impacts of air pollution is highlighted as an action that will be explored. They could start with the Blueprint for Government Action on Clean Air which was published by the Healthy Air Coalition earlier this week.
A forthcoming consultation on reducing emissions from domestic burning is also highlighted as an opportunity to engage on ways to improve air quality. In the medium term, it says DEFRA will refresh the government’s ambition on air quality through a review of the air quality strategy and long term air quality targets.
End to fossil fuel dependency
Climate change, which is predominantly driven by the burning of fossil fuels – coal, oil, and gas – is the greatest threat to human health and threatens the resilience of health systems. Reducing reliance on fossil fuels for energy is the most important intervention for protecting the health of the population.
While not explicitly mentioned in the 10 year plan, the commitment to decarbonisation, for example through the installation of solar panels on public buildings; cleaner air through electrification of transport and better access to active travel; and interventions to insulate homes, will all contribute to shifting to a cleaner environment less reliant on fossil fuels.
The plan has been published. The challenge now is delivering.