At the Institute for Government’s annual conference, Wes Streeting delivered a keynote speech on NHS reform, noting “modernisation can’t be dodged any longer”, setting out an approach to modernisation focused on empowering people, offering freedom to the frontline, shifting to prevention, using tech to support productivity, and spending taxpayers’ money with care.
Turning first to empowering patients, Streeting said: “If public services are designed around the convenience of the institution, the result is silos, hand-outs, delays and poor performance. When those services don’t coordinate, the public pays twice: in money and in misery. If public services are designed around the citizen, the result should be joined up support, better impact and better value for money.”
The NHS App is helping to close the gap between the service received by the wealthiest and the rest of the population, according to the health secretary, with three million more patients using the app on a monthly basis compared with a year ago. Patients can now request appointments online, review their test results, track prescriptions, or ask for a second opinion where there are concerns a loved one’s condition is worsening, and next year this will be expanded through NHS Online, which will support them in seeing a specialist online for conditions such as cataracts, prostate cancer, and endometriosis.
“Running twenty-first-century public services on analogue systems is not a neutral choice; it is an active decision to waste time, money, and human potential,” Streeting said. “Paper forms, endless queues, and outdated IT don’t protect the public – they protect inefficiency. Worse, they shift the burden of failure onto users.” Digital services will help put users in control, he continued, with digital driving productivity and preventing highly trained staff from spending hours on tasks that can be automated.
On freedoms for the frontline, Streeting said: “Centralisation has infantilised NHS leaders and stifled the frontline….We’re stripping out layers of bureaucracy, trusting professionals, and giving teams the tools to drive self-improvement and better outcomes. Roles, resources, and responsibilities are being devolved to the frontline.” He also looked at the importance of partnering with industry and the voluntary sector to help drive innovation toward the prevention agenda.
In concluding remarks, the health secretary described the scale of change required as “enormous”, adding: “If we opt for timidity or incrementalism, we will fail. Nor can we accept the binary choice of recovery or modernisation. It is only through bold transformation that we will cut waiting times at the pace that’s needed.”
To read the speech in full, please click here.
Wider trend: NHS reform
A joint executive team has been announced across the Department of Health and Social Care and NHS England, to offer unified leadership as part of the transition to a single organisation. It follows the announcement from Keir Starmer back in March that NHS England would be brought back “at the heart of government, where it belongs, freeing it to focus on patients, less bureaucracy, more money for nurses – an NHS refocused on cutting waiting times at your hospital”. The joint executive team will help bring policy and delivery from both organisations together, managing directors from related work areas from 3 November 2025. Joint regional teams have also been established to focus on local delivery, improvement, and performance.
The UK government published its Fit for the Future: The 10 Year Health Plan for England, aiming to “build a truly modern NHS”, with focus on moving from hospital to community, analogue to digital and sickness to prevention. The plan outlines a new operating model, a new era of transparency, a new workforce model with staff aligned to the direction, a reshaped innovation strategy, and a different approach to NHS finances. AI, technology and digital tools play a key role in realising the ambitions in the plan, with the UK government signalling the intention for patients to gain “real control through a single, secure and authoritative account of their data and single patient record” aiming to deliver more co-ordinated, personalised and predictive care.
NHS England has published its medium term planning framework to outline the priority deliverables ICBs and providers should focus on for the next three-to-five years. The framework sets out a new operating model, a revised foundation trust model, the creation of integrated health organisations, changes to the financial framework, and opportunities for greater local autonomy through a neighbourhood health approach.
NHS England has announced plans for an “online hospital” to go live in 2027, with an aim to deliver up to “8.5 million appointments and assessments in its first three years”. The service, NHS Online, will aim to connect patients virtually to clinicians based anywhere in England, with triage to be completed through the NHS App, and appointments for scans then offered at local community diagnostic centres. The initial focus will be on planned treatment areas with the longest waiting times, with NHS England planning to extend the offering to further areas if clinically safe to do so remotely. Tried-and-tested innovations already in use in the NHS, such as AI and remote monitoring, will be built and scaled in the first instance.
