Time to shine

The NHS ConfedExpo Conference. I’ve been going now for 20 years and seen firsthand the ebbs and flows of ‘the big topics’, ‘the must-see plenary session’, the buzzwords of the year, the waxing and waning interest of industry, the mood of the managers and the vibe of the exhibition.

For what it’s worth, this year that entailed, in order: the Spending Review’s NHS settlement, the Ten Year Plan, neighbourhood health providers; the Streeting shifts, tech, AI (again), health inequalities (again), prevention (more notably at this conference than before); high interest from pharma; buoyant mood of the managers (generally) and optimistic vibe overall.

Suffice to say, after years of political turbulence, workforce shortages and pandemic fallout, the NHS is poised for another major strategic overhaul.

While the long-anticipated ten-year plan has yet to materialise in official form – despite early promises of a spring publication – sources suggest release is imminent.  Early indications point to a sweeping reset of NHS priorities and power, enacting key proposals from the Darzi Review while supporting Labour’s need to make swift improvements that are noticeable by voters.

What’s emerging is a health service in transition: from reactive to proactive; analogue to digital; centralised to community-rooted. There was ambition at conference: not just to “save the NHS”, but to reimagine it for a radically different, tech-enabled future.

Health Secretary Wes Streeting has been outspoken in advocating for three foundational strategic pivots: from analogue to digital delivery; from hospitals to community-based care and from sickness treatment to illness prevention. These are driving the ten-year strategy, shaping everything from service design to funding flows.

This direction has already begun to materialise on the ground, as was clear in Manchester. Across the exhibit halls and panel sessions, technology was the throughline: predictive analytics; remote monitoring; AI-driven diagnostics and risk stratification tools were not only showcased but actively discussed as near-future solutions.

The increasing prominence of exhibitors focused on early detection and prevention reflects a cultural pivot as well as a policy one – NHS leaders appear ready to shift from treating disease to pre-empting it.

Yet, embedding these shifts system-wide won’t be straightforward. Digital transformation is uneven across Trusts, community infrastructure remains under-resourced and prevention still commands only a small slice of NHS budgets. A coherent ten-year plan could provide the scaffolding for realignment – but it’ll still need the will to think, and more importantly, do, differently.

One of the more surprising features of the forthcoming strategy is that ‘commissioning’s back’ as a central organising concept.

Under the Health and Care Act 2022, Clinical Commissioning Groups (CCGs) were replaced by Integrated Care Boards (ICBs), with a mandate to integrate health and social care at a local level. Genuine co-developed plans twist them and providers suffered though, becoming little more than a set of transactions.

That led to a loss of strategic planning capacity. “There hasn’t been proper commissioning since the CCGs were abolished,” one HSJ source noted.

The new plan intends to address this gap by positioning ICBs more explicitly as ‘strategic commissioners and advance planners’, while simultaneously slimming their numbers – reducing the current 42 to around 27. This is supposed to stop duplication and concentrate expertise. Only problem is, you lose that local touch.

Nonetheless, the reframing of ICBs suggests a renewed emphasis on population-level planning, outcomes-based commissioning, more of this, less of that and integrated budgeting across providers. If done well, this could revive some of the strategic coherence that has been lost amid the biannual structural churn.

In parallel, the new plan is expected to grant providers – particularly large hospital trusts and groups – a more prominent role in system leadership. This may take the form of expanded provider collaboratives and mergers. New stakeholder map ahoy.

This rebalancing reflects a broader truth: many providers have taken de facto leadership roles during recent crises, from pandemic surge management to elective recovery. Formalising this role is seen by many NHS leaders as pragmatic – if the hospitals are doing the heavy lifting, they should help shape the blueprint.

However. If fewer ICBs oversee larger geographies and providers wield more power, how will the system ensure that community priorities and local innovations aren’t drowned out by the superprovider institutional interests? Not simple, is it.

Conference offered a real-time window into the system’s evolving priorities. Let me not underplay the sheer number of exhibitors focused on digital health, remote care and data-driven prevention.

Predictive analytics are now being “productised” for primary care, with platforms offering GP practices, communities and councils early warning tools for chronic disease, cancer, falls and mental health risks. AI-driven diagnostics, especially in radiology and pathology, were heavily featured, as was the integration of these tools into everyday clinical workflows.

A standout example was the Medicube X – a compact, AI-powered diagnostic pod dubbed by some (me) as the NHS’s very own “Diagnostics TARDIS”. Capable of screening for up to 30 conditions in under ten minutes, including hypertension, diabetes, cardiovascular risk and respiratory issues, it offered a happy emblem of the shift from episodic care to continuous, preventative monitoring.

A common refrain across panels was that the ten-year plan must not merely mention prevention – it must embed it. That means shifting financial incentives (especially for primary care), adjusting workforce strategies and reorienting care pathways for it.

Industry and NHS leaders alike spoke of a future in which pharma companies become “health partners” on this – co-developing risk stratification models, supporting earlier diagnosis and embedding real-world data into public health strategies.

This opens up new models of collaboration for life sciences, which has often been kept at arm’s length from strategic commissioning. Vibe is now: let’s hear you.

The move from 42 ICBs to 27 may sound like mere structural tidying – but it has profound implications. It suggests a concentration of power, resources and decision-making. For some, this promises stronger leadership and better coordination. For others, it risks losing local nuance and flattening innovation. A close watch will be required.

Moreover, think about the background. Those care backlogs, social care gaps and burned-out staff have not gone away.

There is also the question of how public expectations will be managed, especially if promises of prevention and digital convenience run into delivery friction – surveys are showing an all-time low in satisfaction at the moment.

But – the money. This certainly gave everyone a lift. Funding remains the critical enabler – or constraint. And the Chancellor’s recent spending review delivered a 3% uplift to the NHS budget, slightly higher than the 2.8% many had anticipated. That brings the annual NHS budget close to the GDP of Portugal. Let that sink in.

I found myself wondering how many would only be satisfied with the GDP of Spain. Or the Netherlands? Or Narnia? But in reality, with the right reform, governance and approach to healthcare transformation, this level of investment should be enough to run the system effectively. The challenge now is not just how much the NHS spends, but how wisely.

If the forthcoming ten-year plan delivers on its emerging blueprint, it could mark the most transformative moment for the NHS since the Lansley reforms.

Or even since the founding of the service itself, if now is the time when it finally moves decisively from treatment to prevention, analogue to digital, hospital to community. That would signal an ambition not just to restore the NHS, but to reinvent it.

At this crossroads, what the health service needs is cross-sector collaboration, meaningful local intelligence, ideas, data data data and sustained investment in innovation and technology.

My message to pharma would be – go for it!

Oli Hudson is Content Director at HSJ Information. Go to hsjinformation.co.uk