It’s not hyperbole to say the UK’s health system is sitting at a watershed moment. After years of strain, a sense of urgency surrounds NHS reform. Yet, this urgency is accompanied by an almost paralysing policy complexity.
Our recent conversations with NHS leaders and policymakers have laid bare the central challenge everything needs to change, and yet nothing can change fast. This collides with mounting public expectations. Portland polling shows 47% of people believe the NHS needs significant reform in 2025.
To meet those expectations, the NHS 10-Year Plan and Spending Review must confront a series of fundamental paradoxes — tensions that won’t be solved, only managed.
1. Stabilising a broken system while delivering visible reform.
Currently, policymakers are expected to design for the future, while firefighting the present. After years of single-year budgets, stability will be found in a longer-term funding cycle. Yet that sits alongside relentless political pressure for visible progress. Deep, system-wide redesign is hard when you’re also expected to show results by next month’s performance report.
2. Driving national standards while enabling local solutions.
Reducing unwarranted service variation across the NHS is vital – there is a baseline of clinical care we should all expect. But overcorrecting risks stifling local innovation. Integrated Care Systems (ICSs) were built to foster population-led, place-based health. Without clarity on the non-negotiables of national standards, we risk continuing the postcode lottery. Push too far in either direction, and the system either fragments or becomes rigid.
3. Getting the basics right while embracing innovation.
There’s broad agreement that the NHS needs to overhaul its approach to tech and data. But digital transformation means little if frontline staff don’t have working kit, or if systems can’t talk to each other. The temptation to pilot shiny new tools — from AI-powered diagnostics to virtual wards — must be balanced with investing in core digital infrastructure. Innovation must make it easier for people to navigate the NHS, not be a bolt on to the existing web of complexity.
First announced in October 2024 and now expected in early July the NHS 10-Year Plan is urgently needed to provide vision and stability.
The elephant in the room is political and public attention span. Designing and delivering long-term policy requires patience — something at odds with our 2025 news cycles and electoral timetables. But if Ministers want to truly transform the NHS, they’ll need to put the needs of future patients ahead of short-term political wins.
This scale of reform cannot be solely a strategic or operational exercise – it must also be cultural. At present, person-centred care is too often an afterthought. Until the patient experience, not just system performance, becomes the anchor for policy and decision-making, reform will fall short of the transformation people need.
The UK’s health system doesn’t lack ideas or ambition — or good people to deliver on them. But it needs a mindset reset. One that puts people first, is honest about trade-offs, and accepts that meaningful change takes time. Progress is possible. But only if we stop expecting it overnight.
If your organisation is thinking about these issues, get in touch with Portland’s health team to discuss how you might navigate this policy environment, or to hear more about our polling capabilities.
