Integrating and Implementing:

Thought Experiments on Health Policy Evolution in England

Following the unexpected abolition of NHS England and the mandate for Integrated Care Boards to halve their running costs, and prior to the publication of the 10 Year Health Plan, the health and care system in England entered a period of uncertainty and disruption. These policy shifts, while consistent with longer-term ambitions around prevention, community-based care and digital transformation, raised urgent questions about feasibility, equity and the risks of decentralisation. This report was created to explore the likely scenarios that could emerge and to provide a structured way for leaders, practitioners and partners to anticipate and prepare for the impacts of reform.

The report was developed by HACK through a roundtable of senior leaders across Integrated Care Boards, Hospital Trusts, primary care, and social care, supported by further interviews and discussions. Insights were synthesised into a series of “thought experiments”, structured scenarios designed to test how new policy directions might play out in areas such as population health management, specialised services, medicines, workforce, neighbourhoods, and finance. This approach provided a disciplined yet creative way to probe both risks and opportunities.

The analysis highlighted cross-cutting themes of variation, disruption and public response, and drew out potential consequences for NHS organisations, workforce morale, service delivery, and industry engagement. By surfacing these tensions and possibilities, the report equips system leaders and commercial partners to frame their own strategies and responses. Its impact lies in helping organisations anticipate unintended consequences, refine engagement approaches, and prepare more resilient pathways for patients in the face of profound change.

That much of what is included here later followed in the 10 Year Health Plan demonstrates the value of early engagement, with the right people in the right format to develop foresight and confidence.