Insights from the 10-Year Health Plan: the role of NHS providers in the NHS
The NHS Fit for the Future 10-Year Health Plan (the Plan) was published on 3 July 2025. The Plan outlines three main objectives for the future of healthcare: moving care from hospitals to community settings, transitioning services from analogue to digital, and shifting the emphasis from sickness to prevention. To achieve these objectives, as part of a devolved and diverse NHS, the Plan sets out a number of structural changes for NHS providers.
As part of a series of articles analysing the implications of the Plan, for healthcare providers, these two articles focus on the future roles of NHS providers. The first looks at the ‘Journey to Foundation Trust status’ and the second considers ‘The future of Foundation Trusts’.
A new operating model: from hospital to community
Underpinning these changes is the central aim, detailed in the Plan, to transition of services from hospitals to community and neighbourhood settings. This shift aims to free up hospitals to focus on delivering specialist care for those who need it most. Integrated Care Boards (ICBs) will have greater flexibility to contract Neighbourhood Health Services, including with NHS Trusts, as part of this shift.
The transition to a Neighbourhood Health Service will result in a greater proportion of NHS expenditure being directed toward community-based care. This shift aims to reduce reliance on acute hospital spaces, decrease the number of emergency staff needed in hospital settings, and scale down the number of outpatient departments required.
NHS providers will be expected to work collaboratively with the community, primary care, social care and voluntary sectors to ensure the support of this new model. There will be opportunities for the NHS providers to lead this reform. However, there are risks if the NHS providers fail to give sufficient confidence to the Commissioners that they are operating services to a sufficient standard and do not engage with the shift to community care. Alternative providers could be identified to manage the integration and transformation of services resulting in some NHS providers being required to adopt to the changes rather than helping to guide and lead them.
The Plan does outline a major ambition for the NHS providers of becoming Integrated Health Organisations (“IHOs”). These new structures will provide greater control over the entire health budget and are presented as the ultimate aspiration for any NHS provider. The Plan does present the need for change and the requirement to tackle the difficult challenges many NHS providers are currently facing, as being a period of pain with the opportunity to become an IHO as being the aspirational award for completing this process.
Journey to Foundation Trust status
The transition to Foundation Trusts
The Plan sets out a commitment to authorise a new wave of Foundation Trusts (FTs) in 2026, with the goal of transitioning all NHS providers to FT status by 2035. This change is designed to grant them greater autonomy, enabling them to focus on improving population health and fostering stronger partnerships with other providers.
To achieve FT status, NHS providers will need to demonstrate excellent performance in key areas, including delivery on waiting times, access to services, quality of care, and financial management, as well as achieving higher productivity levels than their peers. Additionally, NHS Providers must show a proven track record of collaboration and a commitment to working in partnership to deliver better health outcomes.
A new regulatory function within the Department of Health and Social Care (DHSC) will oversee the authorisation process, ensuring that only high-performing NHS Providers are granted FT status.
The transition to FT status will also require NHS providers to modernise their governance arrangements, including implementing updated constitutional documents to reflect this new structure and ensure compliance with the regulatory framework.
Currently there are 77 NHS trusts across the country many of which have applied for FT status in the past and have faced difficulties which prevented their previous applications from being successful. It is not currently clear how the system will differ from previous applications and what processes will be put into place to assist those who have had problems historically.
It is advisable that all NHS providers should start reviewing their performance data, financial position, and governance structures to ensure that they identify any known issues. Once they have this they will provide the bedrock of your transition planning and they will assist in being ready to respond to the DHSC once the formal requirements are published.
Once authorised, FT’s will benefit from enhanced financial autonomy, including the ability to retain surpluses, reinvest in capital projects, borrow funds independently, and have greater control over the composition of their boards. Further benefits are discussed in our second article which considers the future of FTs.
New failure regime
In addition to promoting the benefits of moving to FT status the Plan makes reference to introducing a new ‘failure regime’ designed to ‘bring performers up to standard.’
There is little specific detail as to what this will entail although it does reference the use of a new ‘rules-based process’ and ‘[a] new diagnostic process to better understand why persistent under-performance is taking place’. The scope and content of this will be an essential development when it is published. It is however it is likely that existing analysis and metrics will underpin any new tool and consequently no provider should be surprised if they are monitoring these.
The Plan confirms that powers will be given to the Commissioners which include these options:
- provision of support and guidance on managing identified problems;
- support in reconfiguring the organisations;
- ‘replacing the leadership team, and incentivising new, more effective leaders to take over and tackle the problems at hand’
- ‘placing a failing provider into administration, so it can be taken over by another’
The Plan confirms that in 2025 and 2026 a list of failing providers will be produced with action plans to turn them around. It is advisable for any NHS provider who is identified as failing engage with the process and obtain support from professional advisors to help ensure that they can work through the ‘turn around’ program with limited risk of falling foul of the failure regime.
The NHS Oversight Framework 2025/26
Since the publication of the Plan the NHS Oversight Framework 2025/26 (NHS England » NHS Oversight Framework 2025/26) (“the Framework”) has been updated. This will be used to allocate each NHS providers into five segments. Consistently high performing NHS Providers will be placed into segment one with the most challenged providers placed in segment five. It is noted that NHS Providers with a financial deficit will be capped at segment three. This will be used to inform the support or intervention needs of each NHS provider.
The Framework refers to the NHS Enforcement Guidance published in 2023 (NHS England » NHS enforcement guidance). It is anticipated that this will be updated to form the basis of the new failure regime.
It is important to focus on the positive objective which underpins these changes and that the Government is committed to addressing and resolving problems which NHS providers have faced often for decades. This is required to meet their ambition of ensuring that ‘by 2035, every NHS provider should be an FT’.