The Society for Acute Medicine welcomes the ambition set out in the NHS 10-Year Plan today (03 July) and supports its overarching aim: to deliver a more integrated, person-centred and preventative health and care system. These goals are necessary and right.
However, from an acute medical perspective, there are fundamental gaps between the aspirations of the plan and the lived realities on the ground. Without urgent attention to these realities, the plan risks remaining conceptual rather than deliverable.
Back to Basics: What was the NHS designed to do – and what is it being asked to do?
The NHS was founded in a post-war era to deliver episodic care. For decades it delivered this with distinction. But today’s demographic and clinical landscape is dominated by chronic conditions, increasing complexity and widening health inequalities.
We are asking a mid-20th century structure to deliver 21st-century care. That requires structural – not superficial – change.
Acute hospitals remain a critical part of the system. They are not relics of the past, nor optional parts of the future. Any vision of a functioning health service must recognise their central role, not marginalise them in favour of models that are unproven at scale.
Integration requires infrastructure – not just ideals
The ambition for integrated, community-focused care is conceptually sound. But ambition is not a substitute for infrastructure. Integrated care cannot function without:
- A parallel, properly funded social care plan
- Interoperable, modern IT systems
- Streamlined and consistent referral processes
- Digital platforms that are reliable, accessible and supported by staff training
Currently, we face the opposite: fragmentation. Clinicians waste valuable time navigating multiple, outdated systems. Simple tasks such as logging onto a computer (or “resuscitating computers on wheels”) can take several minutes. Referral pathways vary wildly between boroughs, providers and even teams. Disjointed electronic patient records hinder safe, joined-up care. These are system failures. We cannot deliver integrated care with disintegrated systems.
Inequalities risk being exacerbated, not solved
The plan rightly promotes prevention, personalisation and digital access. But these can inadvertently widen disparities if not designed with equity at their core.
- Many patients – particularly older adults and those in deprived communities – are not tech-savvy or health-literate.
- Digital-first and self-management approaches may disproportionately benefit the most engaged and well-resourced patients.
- Hyper-local “neighbourhood care” could intensify postcode inequalities without national oversight and coordination.
If we are not careful with this approach, we will create systems that work best for those who need them least.
Corridor care, capacity gaps and the illusion of progress
“Making Every Contact Count” is aspirational. But, in practice, many of these “contacts” occur in corridors, waiting rooms, cupboards and ambulances. That is not person-centred care – it is crisis management.
Acute care teams remain in constant firefighting mode. The proposed three shifts in the plan are welcome, but there is little indication of how we move from firefighting to fireproofing. Capacity has not kept up with demand. Social care blockages keep patients in hospital longer than necessary.
The result is overcrowded emergency departments, avoidable deaths and exhausted staff. These are not transitional challenges. They are urgent and persistent. Reform must start here, not after the fire has burned out.
The workforce crisis is not an inconvenience – it is the core issue
Any plan that does not address the people who deliver care is fundamentally incomplete.
The NHS workforce was already burned out before COVID-19. Many now describe a generational fatigue. People want to give high-quality, compassionate care but they do not have the tools, time, or space to do so. The result is moral injury and loss of experienced clinicians.
Leadership must be compassionate not just in tone, but in practice. National strategy must be matched with the local capacity to act. We need system-wide support and not just isolated “areas of excellence.”
Population health requires a biopsychosocial and whole-system lens
Shifting to population health is the right direction, but must be done with caution. We need care that is:
- Biopsychosocial (combines biological, psychological and social factors), not siloed into organ-based specialties
- Co-managed with patients but designed for all, not just the digitally literate
- Informed by whole-system data, not fractured across incompatible platforms.
Current feedback mechanisms focus heavily on top-down metrics. We need triangulated feedback: from patients, clinicians and operational outcomes. Financial models must avoid incentivising local cost containment that drives system-wide inefficiencies.
Innovation should be encouraged, but it must be shared and scaled, not siloed in the most stable or well-funded areas.
Conclusion: Rebuild the foundation
The Society for Acute Medicine supports reform. Acute care has always adapted to meet demand, but we cannot rebuild a burning platform by tipping it upside down.
The NHS 10-Year Plan in reality must:
- Fix the foundations: starting with capacity, workforce and basic system infrastructure
- Re-centre people: patients and staff alike
- Prioritise equity and safety over structural aesthetics
- Ensure digital transformation is meaningful, inclusive and usable on the front line.
Acute care is not separate from the system, it is the safety net. But, right now, we are relying on the safety net to carry the entire structure. That is not sustainable.
We urge NHS England and the Department of Health and Social Care to work closely with acute care leaders to co-develop the next stage of delivery. We are ready to contribute but it must begin with reality, not rhetoric.