Dr Eleanor Roy, CIFPA Policy Manager Health and Integration
As summer approaches, the focus in the NHS is less on beaches, buckets and spades and more on the upcoming Spending Review and long-awaited 10-year health plan (10YHP). But which will come first — and will either deliver the vision the NHS needs?
The 10YHP should provide the vision for an NHS fit for the future, driving the three shifts to community-based care, digital transformation and prevention. Originally due in the spring, it was expected to precede the Spending Review. But with the Review potentially arriving first, questions remain: will it fund reform or simply reinforce existing constraints?
The spending review — what might it bring?
With echoes of “no more money without reform” lingering and the Autumn Budget's £24bn allocation, expectations of any big wins for the NHS are low.
Still, reform is in motion. While plans to abolish NHS England remain elusive, Integrated Care Boards (ICBs) are under pressure to reinvent themselves to meet the mandated 50% reduction in running costs by the end of 2025. The scale of savings expected — estimated at £1bn, remains unclear, particularly with redundancy costs excluded. There are calls for HM Treasury to create a national redundancy scheme — perhaps this will be clarified in the spending review?
A ‘place’ for prevention?
The 10YHP should provide clarity on the changing architecture of the NHS — ideally with one eye on local government reform — and define the role of place-based partnerships in delivering integrated care.
CIPFA advocates for devolving responsibility and resources to place-level, offering a framework for how this could be achieved. ‘Place’ is a crucial element of the shift towards prevention, which involves collaboration far beyond the NHS. The spending review provides an opportunity to kickstart this effort, by embedding prevention on a cross-government basis.
Financial reform and the deficit challenge
Financial reform is expected to be a central pillar of the 10YHP — including how funding flows, contracting and payment models support transformation. A clear diagnosis of the financial position of the NHS and the underlying issues affecting its resilience is essential. This work is urgent.
The NHS is currently forecast to end the year with a £300m deficit — a figure that includes £2.2bn in “deficit support” funding. Reaching this target depends on unprecedented savings and productivity gains for many organisations. A clear-eyed assessment of the system’s financial position is overdue and essential.
Addressing the NHS capital conundrum
One area where we hope to see progress is the NHS estates challenge. Recent indications that the ‘carrot and stick’ approach to capital will continue are disappointing. Capital investment is key to unlocking productivity gains, and organisations struggling financially are often those most in need of modernised infrastructure.
CIPFA has championed a fundamental overhaul of the capital regime to ensure it supports the desired outcomes. At a minimum, we hope that the spending review — and the promised infrastructure strategy — provides clarity on alternative investment models, including public-private collaborations, as well as a focus on rationalisation of the estate, both within the NHS and in partnership with the wider public sector.
Laying the foundations
The Spending Review will not be the final word on funding the 10YHP. With a formal two-year review cycle in place, this is just one chapter in a longer process. But it must set solid foundations — not just in funding, but in system reform, accountability, and the capacity to deliver lasting change.
Let’s hope it marks a credible first step towards a more sustainable, integrated and future-facing health and care system.