NHS at 77: National treasure or system on the brink?

On 5th July 2025, the NHS turned 77, just as the Labour government marked its first year in power. It was a moment ripe with symbolism, celebrating the UK’s most cherished institution while reflecting on what’s been achieved, what’s changed, and what remains dangerously unresolved.

At LSE Health’s 30th Anniversary, experts asked the question on many minds:

 “Is the NHS still a national treasure, or has it become a system in managed decline?”

In this blog, Dr Richard Dune explores Labour’s first year in power, the implications of the 10-Year Health Plan, and what needs to happen next to transform rhetoric into results, particularly for those of us delivering training, compliance, and workforce solutions within health and social care.

Labour’s mandate - A reset in health and care?

Labour’s 2024 election platform was ambitious and urgent. It promised:

• Shorter waiting times through shared referral lists and overtime pay

• A nationwide rollout of Neighbourhood Health Centres

• A long-term workforce plan

• Better access to mental health and community-based services

• A National Care Service with fair pay and national standards

• Full-scale digital transformation and AI integration

• And no new taxes, instead relying on non-dom tax reform for funding.

This was more than a manifesto; it was a bold reset of the UK’s health and care systems, offered at a time when public trust in the NHS had reached an all-time low.

The 10-Year Health Plan - Vision or vague ambition?

Just two days before the NHS anniversary, Labour unveiled its 10-Year Health Plan for England, described by many as the most transformative blueprint since the Lansley reforms.

Its message was clear:

The NHS is broken, and the choice is “reform or die.”

The plan revolves around three strategic shifts:

1. Hospital to community - A new Neighbourhood Health Service embedded in localities
2. Analogue to digital - AI tools, wearables, single patient records, and a “doctor-in-your-pocket” NHS App
3. Treatment to prevention - CVD screening, mental health support in schools, and new population health models.

The ambition is commendable, but as those of us in compliance know, vision without execution is a risk. Without robust governance, implementation frameworks, and performance monitoring, plans this size can fail.

A year on - What’s actually changed?

Twelve months into the new administration, early wins are visible - but so are the cracks. Progress on access and pay has been made, yet critical gaps in workforce strategy and operational recovery remain.

Operational performance

• Four million extra appointments have been delivered, doubling the target

• NHS waiting lists fell from 7.62 million to 7.42 million, a small gain, yet still far from being fully recovered

• Some improvement in A&E and cancer treatment metrics

• Martha’s Rule was launched in over 140 hospitals, allowing families to escalate deteriorating patient cases.

Workforce and pay

• A 22% cumulative pay increase was awarded to NHS staff

• Junior doctors remain in dispute, with the BMA demanding a 29% pay rise

• A new long-term workforce plan, promised to replace the 2023 version, is still awaited.

In workforce compliance terms, this lack of clarity affects planning across the sector. Without a transparent approach to skills forecasting, staff supervision, and job descriptions, even accredited training systems struggle to keep pace with the evolving needs of their workforce.

Digital reform - Promise meets reality

The NHS App now includes:

• AI-powered triage and appointment booking

• Access to health records

• Early-warning systems in maternity services.

Yet real digital transformation requires more than new tools. It requires:

• Integrated Training Management Systems (TMS) to support skills development

• Robust Learning Management Systems (LMS) to deploy digital literacy at scale

• Reliable document repositories and secure archiving systems to support transparency and clinical safety.

Too often, these basics are overlooked in reform narratives. But without them, compliance frameworks collapse under the weight of good intentions.

Structural reform - Reset or risk?

With a new government comes a bold restructuring agenda that could redefine the health and care landscape. But while reform promises efficiency, it also raises questions about continuity, local engagement, and the future of sector-wide collaboration.

Abolishing NHS England

Labour has pledged to abolish NHS England by 2027, consolidating it into the Department of Health and Social Care. Alongside this, 201 quangos, including Healthwatch England and the National Guardian’s Office, are being dismantled.

This might streamline oversight, but it also threatens local autonomy, clinical voice, and patient feedback.

For providers, regulators, and training bodies, these changes risk disrupting regulatory alignment just as many were adjusting to the CQC’s Single Assessment Framework.

Life sciences plan still missing

Despite repeated promises, the UK Life Sciences Strategy has yet to be published. Meanwhile, investor confidence wavers, with AstraZeneca considering relocating its listing to the US. This weakens the UK's standing as a hub for research and innovation.

Regulation, rights, and the patient voice

From inspection backlogs to landmark legal reforms, the health and care system is under pressure to restore public trust, uphold rights, and put patient experience at the centre.

CQC declared “Unfit for purpose”

Following the Dash Review, the Care Quality Commission (CQC) was deemed under-resourced, digitally outdated, and slow. While reform is underway under new leadership, many services remain uninspected since before the COVID-19 pandemic, undermining public trust.

A step forward: Abortion decriminalised

Abortion is now fully decriminalised in England and Wales, regulated exclusively as a healthcare matter. This is a landmark change, but implementing such reform fairly requires clear policies and procedures, clinical guidance, and updated training.

Elevating patient feedback

The 10-Year Plan introduces:

• A Choice Charter

• A National Director of Patient Experience

• ‘Patient Power Payments’

• Expansion of PREMs and PROMs.

These efforts reinforce the need for systems that capture, analyse, and act on patient feedback, a function that any modern compliance management system must now support.

Social care - Still the fragile backbone

Despite political pledges, social care remains structurally weak:

• No cap on care costs

• No dedicated funding stream

• 131,000+ workforce vacancies

• Overreliance on zero-hours contracts.

The plan references Better Care Fund reforms, but the disconnect between NHS and social care services remains. For a truly integrated system, we must embed shared compliance processes, unified risk registers, and cross-sector training standards.

Workforce planning - Still our Achilles heel

The NHS employs over 1.5 million people, but staffing is unevenly distributed:

• GP numbers are stagnant

• Hospital consultants have increased

• Community, mental health, and social care roles remain critically under-resourced.

Training, job descriptions, and mandatory training compliance still lack consistency across regions. Furthermore, without integrated workforce dashboards or compliance KPIs, it’s hard for providers to plan effectively.

Over-relying on AI while neglecting relational leadership, well-being, and retention is a recipe for disengagement, not digital progress.

Neighbourhood health - Innovation or illusion?

The plan’s centrepiece is the Neighbourhood Health Service:

• Prioritising deprived areas

• Delivering integrated, localised care

• Supported by VCSE partners and community engagement.

But stretched general practice and community teams are already at breaking point. The strategy lacks clarity on how neighbourhood hubs will be staffed, governed, or evaluated.

Without clear policies and procedures and localised compliance frameworks, there’s a real danger this vision will falter in execution.

Digital and innovation - Big bets, big risks

The government is betting on:

• AI

• Genomics

• Wearables

• Robotics

• Interoperable data systems.

It’s also reviving the HealthStore, launching single patient records, and expanding digital tools.

But here’s what’s missing:

• Digital exclusion strategies

• Investment in IT infrastructure

• Training management to support digital uptake.

Without embedding this into a regulatory compliance software ecosystem, digital transformation will remain fragmented and inaccessible.

From sickness to prevention - An unfulfilled promise

The UK still spends £1 on prevention for every £20 on treatment. The 10-Year Plan includes:

• Screening for cardiovascular disease

• Mental health teams in schools

• Early-stage genomics

• Food sales reporting.

However, it falls short in addressing alcohol, air pollution, and broader public health integration. Health inequality gaps persist, and the goal to halve them looks increasingly unrealistic without a cross-departmental strategy.

For real change, data-sharing protocols, shared outcomes, and preventive investment must be hardwired into compliance systems.

System reform and finance - Complex and incomplete

The Plan proposes:

• Abolishing Integrated Care Partnerships

• Slimming down ICBs

• Launching Integrated Health Organisations (IHOs)

• New payment models: Year-of-Care, Best Practice Tariffs, and Patient Power Payments.

Multi-year funding and outcome-linked incentives are welcome, but success hinges on:

• Delivery timelines

• Governance protocols

• Workforce engagement.

And critically, compliance with regulatory frameworks and statutory requirements must be digitally tracked, archived, and reviewed through a robust system.

Efficiency crisis - It’s not just the money

Recent findings show:

• £166m lost to missed appointments

• Electricity costs vary by over 100%

• Nearly 300 NHS managers earn £200k+, including some from underperforming trusts.

The NHS doesn't just need more money, it needs better governance, transparency, and performance management.

Training providers, digital solution partners, and compliance leads must collaborate to reduce waste, enhance standards, and ensure that statutory and mandatory training is aligned with service outcomes.

NHS at 77 - At a glance

Table 1 - Domain, Progress and Challenges of the NHS at 77.

Where do we go from here?

To move from vision to transformation:

1. Align planning cycles - 15-year training pathways cannot be matched with annual budgets. Establish a National Health and Care Oversight Institute to align planning with financial strategy and ensure effective oversight
2. Fix social care now - End the zero-hours dependency. Integrate NHS discharge planning with social care funding and commissioning to ensure seamless coordination
3. Invest in outcomes - Expand PLICS to reward patient experience and long-term outcomes, not just throughput
4. Empower compliance-driven leadership - Train strategic managers. Tie remuneration to performance. Embed accountability through digital compliance systems.

Putting compliance into practice - Why ComplyPlus™ matters

At The Mandatory Training Group, we understand that real transformation doesn’t happen through policy alone. It takes practical tools that bridge the gap between strategy and compliance.

That’s why we’ve developed ComplyPlus™, our all-in-one regulatory compliance management software and accredited Learning Management System (LMS).

Explore the ComplyPlus™ suite:

• ComplyPlus™ E-Learning Courses (CPD-accredited online courses)

• ComplyPlus™ Compliance Centre - Live dashboards, inspection readiness

• ComplyPlus™ LMS - Sector-specific learning management system

• ComplyPlus™ TMS - Internal training tracking & CPD audits

• ComplyPlus™ Policies & Procedures - Fully editable & CQC/Ofsted-ready

• ComplyPlus™ Legal - Contracts, employment docs, and HR templates

Explore ComplyPlus™ today and become a trusted, compliant, and future-ready partner in England’s evolving NHS ecosystem.