Prevention vs Treatment — Is the NHS 10-Year Plan's Shift Actually Working?

Cardiovascular Disease — Real Gains but Reversing

The long-term story on heart disease in the UK is one of genuine success. Hospital admission rates for coronary heart disease have fallen by 46% since 2005. CVD mortality dropped from over 1,000 deaths per 100,000 in 1969 to 255 per 100,000 in 2019 — one of the great achievements of modern preventive medicine, driven by statins, anti-hypertensives, falling smoking rates and improved emergency care.

But that progress has stalled and in some respects reversed. Premature CVD deaths in working-age adults aged 20 to 64 rose by 18% between 2019 and 2023, from 18,693 to 21,975 deaths — averaging 420 a week. The BHF described this as the worst start to a decade for heart health in 50 years. The cardiovascular waiting list in England stood at 421,683 at the end of February 2025, up 82% since the start of the decade. The Darzi Report was direct: care for cardiovascular conditions is going in the wrong direction. The NAO found there is currently no effective system for commissioning the NHS Health Checks that are supposed to be the primary prevention tool.

Type 2 Diabetes — An Accelerating Crisis

More than 5.8 million people in the UK are now living with diabetes — the highest number ever recorded. A further 1.3 million are estimated to have type 2 diabetes without knowing it. The total cost to the NHS is estimated at £10.7 billion, with 60% driven by the costs of complications rather than the condition itself — a direct measure of how much earlier intervention is failing to materialise.

Between 2016–17 and 2022–23, diagnoses of type 2 diabetes in people under 40 rose by 40%, reaching almost 168,000. Younger-onset type 2 diabetes carries more severe and faster-progressing complications and disproportionately affects people from South Asian and Black backgrounds and the most deprived communities. If the trend continues, the NHS is projected to be spending nearly £18 billion on diabetes by 2035. The NHS Diabetes Prevention Programme has been shown to cut the risk of developing type 2 diabetes by more than a third in controlled conditions. The gap between what is proven to work and what is being delivered at scale is where the problem lives.

Cancer — Survival Improving, Diagnosis Stalling

Cancer survival in the UK has improved substantially over the long term. Five-year survival across all cancers has risen by 7.8 percentage points since 2005, and death rates have fallen by roughly a fifth over 50 years. The diagnosis picture is a different story. Only 54% of cancers in England are diagnosed at stage 1 or 2, against the NHS Long Term Plan target of 75% by 2028. Progress toward that target has stalled for a decade. The UK ranked 28th out of 33 comparable countries for lung cancer survival and 26th for pancreatic cancer. Early diagnosis is the single most powerful lever available and the system is not pulling it hard enough.

Mental Health — Demand Outrunning Capacity at Pace

Mental health services in England received 5.2 million referrals in 2024, up 37.9% from 2019 levels. The mental health waiting list stands at an estimated 1.7 million people. A third of respondents to the 2024 Community Mental Health Survey waited more than three months between assessment and their first treatment appointment.

Among children and young people, the picture is acute: 20% of children aged 8 to 16 had a probable mental disorder in 2023, up from 12% in 2017. The number of children in contact with mental health services has grown at more than four times the rate of the psychiatric workforce since 2016. Only 17% of very urgent referrals were seen within 4 hours in March 2025, down from 33% in April 2023.

Musculoskeletal and Neurological — The Invisible Backlog

Musculoskeletal conditions are the leading cause of disability in the UK and account for approximately 30% of GP consultations. An estimated 20 million people in England live with a musculoskeletal condition. For neurology, January 2026 RTT data shows 219,082 patients with incomplete pathways in England, with only 57% seen within 18 weeks against a 92% target. In stroke, dementia, Parkinson's and epilepsy management, time is a clinical variable — not just an administrative one.

The Verdict — Is the Shift Actually Working?

The honest answer is not yet, and not at the pace required. Two things are working against it simultaneously. The first is resources — NHS spending will grow by 2.8% a year in real terms between 2025 and 2029, below the historic average of 3.7%. The second is history — previous NHS plans have promised the same three shifts and largely failed to deliver them.

The gap between the plan's ambition and the current data is not a reason for pessimism. It is the commercial opportunity. The NHS needs implementation partners, not more strategy documents. Products that reduce hospital admissions, enable earlier diagnosis, free clinical capacity, or support patients managing long-term conditions at home are not just clinically valuable — they are strategically aligned with where commissioning money is supposed to be heading.