Beyond Ambition: An Irish Perspective on the 10-year plan for the NHS

From this side of the Irish Sea, the newly launched NHS 10 Year Health Plan (Fit for the Future) has a familiar ring. The vision of a digitally enabled, community-centred, and prevention-focused health service is admirable, but it also evokes a sense of déjà vu. In both Ireland and England, we’ve seen successive governments sweep in with bold reform agendas, only to overlook a critical foundational step: evaluating what has already been tried, learned, and often, abandoned.

Ireland’s own experience with Sláintecare [1] mirrors many of the NHS plan’s aspirations. Like the NHS, we aim to shift care from hospitals into communities, integrate services around the needs of people rather than institutions, and harness digital tools to empower both citizens and professionals. But the path to these goals has been obstructed by fragmented governance, weak implementation structures, and the perennial intrusion of short-term political priorities. The NHS plan, for all its ambition, may fall prey to the same forces.

To be fair, the plan’s diagnosis is largely correct, waiting times are untenable, outcomes are stagnating, and the current model is unsustainable. Its ambitions to strengthen prevention, decentralise care delivery, and embed digital tools are directionally sound. Yet these “radical” shifts; neighbourhood health services, digital-first access, and a new focus on prevention, have appeared in one form or another in the Five Year Forward View (2014) [2], the Long-Term Plan (2019) [3], and earlier reform cycles. Without a transparent evaluation of why previous iterations fell short, there is a real risk of what Partha Kar in the BMJ has aptly called “old wine in new bottles” [4].

Ireland can particularly relate to the tendency toward what Hugh Alderwick in the BMJ describes as “redisorganisation” [5]. The NHS plan’s proposal to abolish NHS England, restructure integrated care systems, and reinvent provider roles echoes the ongoing flux of organisational reform in Irish health policy. We too have repeatedly seen new structures established before prior ones were embedded or evaluated. Change fatigue is real, for staff, citizens, and leaders alike.

Notably absent in both jurisdictions is a commitment to building robust learning health systems, frameworks that prioritise feedback, reflection, and iterative change over one-off transformation plans. We are still trapped in a cycle of implementation without evaluation and reform without reflection. The NHS plan claims to have consulted widely, but even this engagement seems to have fallen short of genuine partnership. Patients may be asked to rate their care or choose their provider through an app, but rarely are they involved in shaping system reform at its source. Ireland, despite a rhetorical commitment to co-design and partnership in Sláintecare, faces similar deficits in embedding citizen voice into governance and decision-making.

Another shared vulnerability is the growing allure of financialised care and market-driven mechanisms. England’s proposal to link payment to patient ratings, use “patient power payments,” and expand private sector delivery may create incentives that distort care priorities and exacerbate inequities. In Ireland, while the system remains predominantly public, similar pressures exist around contracting and outsourcing. Equity cannot be an afterthought in system design.

The workforce dimension also warrants closer scrutiny. The NHS plan suggests that a leaner, digitally supported workforce will suffice in future, a premise at odds with reality. In both countries, healthcare professionals are burned out, under-resourced, and navigating increasing complexity. Technology should be seen as an enabler, not a replacement for the relational, context-sensitive work of health and social care. Without sustained investment in staff wellbeing, training, and team-based models of care, no plan will succeed, however visionary.

The plan’s techno-optimism also risks overselling the transformative potential of data, AI, and genomics. While digital transformation is essential, trust, literacy, and access remain serious challenges, especially for marginalised groups. Simply offering patients more information or app-based control does not address the structural determinants of inequality. As Alderwick notes, the NHS may be designed as a universal service, but the risk is that it becomes a poor service for poor people, a fate Ireland must also guard against.

And finally, the NHS plan, for all its breadth, remains an NHS plan, not a comprehensive health and wellbeing plan. The document acknowledges the role of social determinants but defers action on social care and offers limited proposals for intersectoral collaboration. Ireland too struggles to align its health reform agenda with wider action on housing, education, and income. Health systems alone cannot create health.

In summary, Ireland can both learn from and caution the NHS as it embarks on this new chapter. We share similar ambitions and face parallel challenges. The temptation to restructure without reflection, to digitise without equity, and to reform without partnership must be resisted. A better future for our health systems lies not in reinventing the wheel every electoral cycle, but in building the structures for learning, listening, and long-term collaboration.

Rather than repeating mistakes in parallel, perhaps our two systems can now look across borders, share lessons honestly, and place a shared commitment to equity, trust, and continuous learning at the heart of health system renewal.

References

1. Committee HotO. Sláintecare Report. Houses of the Oireachtas Committee; 2017.
2. NHS England. Five year forward view. 2014.
3. Alderwick H, Dixon J. The NHS long term plan. British Medical Journal Publishing Group; 2019.
4. Kar P. Partha Kar: The NHS 10 Year plan is torn between genuine change and political expediency. British Medical Journal Publishing Group; 2025.
5. Alderwick H. Government’s 10 Year plan for the NHS in England. British Medical Journal Publishing Group; 2025.