Skip to content
Citizen Infrastructure

The NHS 10-Year Health Plan engagement (2024–2025)

England’s 10-Year Health Plan is the vehicle for the UK government’s health mission, a strategy meant to reshape the NHS for the decade ahead. What makes it a participatory-policymaking case is the deliberate choice not to write it “in a Whitehall attic and wonder in five years why it wasn’t delivered.” Led from the Department of Health and Social Care by Sally Warren, it ran what is, in scale, one of the largest public-engagement exercises ever attached to a single policy.

Why do it this way

Section titled “Why do it this way”

Three drivers were given for the approach: to rebuild trust with the public and with NHS staff; to make better policy by drawing on the insight of people who use and run the system daily; and to close the implementation gap — the hope being that people involved in shaping a policy are more likely to help deliver it.

What it involved

Section titled “What it involved”

The engagement had several layers running together:

  • Mass participation. An online portal, change.nhs.uk, launched by the Prime Minister, let anyone share experiences, submit ideas, and vote and comment on others’. In its first three weeks the department reported around 800,000 visits, 400,000 unique visitors, 50,000 survey responses and 7,500 ideas.
  • Public deliberation. Seven regional deliberative events (the first in Middlesbrough), the more considered counterpart to the open portal.
  • Staff engagement. Around 30 online staff events, plus staff deliberation after the NHS winter period, and a regional roadshow with NHS system leaders.
  • A “workshop in a box.” Rather than just publishing materials, the team paired facilitation guides with live drop-in sessions from a delivery partner so local teams could actually run their own sessions, training the facilitators, not just handing over a PDF.
  • A National Summit to pull it together and make the genuine trade-off decisions the process surfaced.

What it shows

Section titled “What it shows”

Two things stand out for citizen infrastructure. First, the interplay of mass and deliberative participation: a noisy open portal that day one produced jokey suggestions (a pub in every hospital; the Health Secretary fired from a cannon) and by day two produced serious, debated ideas, alongside structured deliberative events designed to weigh trade-offs. The political choice to lean into the early jokes rather than shut the portal down was, the team argued, what made the good ideas worth it.

Second, the hardest design problem was closing the loop at this scale: reaching back to the people who signed up as the thinking narrowed, and being transparent about what was taken up and what wasn’t, in a format people could actually engage with. As with all such exercises, the real test is whether public input survives contact with a spending review and the difficult, visible choices about NHS “winners and losers” — exactly the kind of right-question, right-promise commitment that determines whether mass participation is meaningful or merely decorative.

Sources

Section titled “Sources”