The NHS 10-year plan, published on the 3rd of July, presents a long-term vision for the future of healthcare in England. The premise set out at the beginning of the plan is that the NHS needs to reform or die. Which sounds dramatic but the system, like many healthcare systems, is under substantial pressure. And so, the plan sets out a vision of a reformed system rewired to meet the modern expectations of patients while tackling the challenges the system faces. This reinvention is proposed to happen through three shifts: from hospital to community, from analogue to digital, and from sickness to prevention.

Technology and innovation as well as much greater patient choice and voice feature heavily in the document. There’s no question the vision set out in the plan will change the relationships between patients and staff - from doctors and nurses to physios and pharmacists. But how? Is it a move towards transactional approaches to healthcare? Or is this a way to rebalance power, re-forge the nature of relationships, and move to a less paternalistic system?

From Paternalism to Agency through Tech

Historically, healthcare systems have been paternalistic, largely because there were few alternatives. It takes many years of education, training, and experience to become a healthcare professional. This means that, for a long time, people were passive recipients of care. Shifts in culture, changes in public expectation and progress in technology, such as the internet, started to change this. Search tools (e.g., Google), reputable websites (e.g., nhs.uk) and forums put more knowledge and ability to act into the hands of the public.

Now the NHS 10 year plan with the analogue to digital shift will create a single patient record, an AI powered NHS App, and a HealthStore. These will put even greater levels of knowledge into people’s hands while enabling much more agency through choices like self-referral, self-care, and more. At the same time, patient-reported experience measures, reviews, and feedback are intended to create a loop of accountability for services to individuals. This represents an unprecedented increase in patient empowerment through information, knowledge, voice and choice mediated by technology.

Technology in healthcare has long been hoped to have a wide democratising effect, meaning it is assumed that technology can give information, insight, and control directly into the hands of everyone. This isn’t inherent in the nature of technology but determined by the design and functionality. Even then it’s not a guarantee…

A Shift in Dynamic, A Shift in Power

Patient empowerment becomes possible through technology but still requires patients to have the knowledge, skills, confidence, time, and means to use the technology and act upon it. Just because people can use the NHS App to self-refer or download an app as a treatment doesn’t mean they will. Just like people know they should take their medication or do their physio exercises, stretch, stay active, and eat healthily. But how often does this really happen?

The analogue to digital shift creates the possibility for more empowered individuals, but not everyone will be able to benefit. In order to move toward a system where power is more evenly distributed, where there’s greater patient empowerment and agency, and where people can act on insight rather than simply receive instruction, support must be wrapped around individuals. Support from NHS, communities and charities.

What’s being overlooked is that the technology shift must come with a transformation in the dynamic between individuals, staff, and the healthcare system - a shift in the relationships themselves.

From Command to Coaching

For everyone to benefit from the analogue to digital shift will require a new kind of relationship between patients and healthcare professionals. A change that moves away from instruction and toward partnership with patients, less “you must,” and more “let’s understand why.” This means digitally confident staff who can guide individuals at opportune moments to use the tech and data to support increasing independence and self-management at pertinent moments in their health journey. While having support in the community also.

For example, consider adherence to medication. In a traditional model, patients are told what to take, when, and how. In a new model, clinicians might work with patients to understand barriers to adherence, help them understand how their data reflects their symptoms and agree treatment needs, and then explore alternatives such as lifestyle, behavioral, or digital interventions all with support on how to use the tools and data. Perhaps most importantly is the contracting between patients and staff that is realistic, meaningful, and aligned with values to improve treatment adherence and changes in lifestyle.

The digital shift appears to be setting the stage for a transactional exchange to healthcare, and it could be. But I challenge this notion, the digital shift will fail to benefit everyone without recasting relationships in care. The digital shift must include a change in relationships to coaching and guidance if it is to be successful. So, it must be rooted in relationships based on partnership and empowerment with digital tools.

Looking further to the future, the government is placing five big bets on innovations, including genomics and predictive analytics. These predictive tools will require much more engagement and support for individuals to understand and manage their risk prediction.

The Opportunity: A Different Relationship

Ultimately, the NHS 10-year plan lays the groundwork for a technological leap forward, but for it misses out the important enabler – a shift in relationships. One that is more participatory, more responsive, and balanced between patients and staff. We must ensure that the tools are useful, that people are empowered, and that professionals are equipped with empathy and digital skills to guide, coach, support and care with tech.

This is an opportunity to use technology to re-imagine how it supports building a healthcare system where knowledge, choice, and care work together. In a system with significant workforce shortages and high demand while long-term conditions increase, there’s a need to enable more patients to be aware and in control. But this can't happen unless healthcare staff are able to support patients to use the tech and work with them to make choices that are important for them.

Will technology cast a shadow on the doctor-patient relationship, or will it cast it in a new light?

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Transparency on AI use: GenAI tools have been used to help draft and edit this publication and create the images. But all content, including validation, has been by the author.