A summary of the 10YHP's proposals

The government’s ambition over ten years is for ‘high autonomy’ to be the norm for providers across the country: 

• The FT model will be 'reinvigorated and reinvented for a modern, integrated health system', introducing "a modern form of earned autonomy: where local providers perform well, they will have greater autonomy and flexibility to develop services free from central control."
  
  
• Starting this year, FT flexibilities will be restored to existing FTs, "where their performance on outcomes, access, quality and financial sustainability merits it. We will authorise a new wave of FTs in 2026."
  
  
• New FTs will need authorisation. Deauthorisation is also possible. Autonomy that is 'earned' might also be taken away. Authorisation, deauthorisation (and reauthorisation) will be undertaken by a new function within DHSC, overseen by an independent panel. 
  
  
• Authorisation criteria are that providers "will need to have demonstrated excellent delivery on waiting times, access, quality of care and financial management, as well as higher levels of productivity than their peers. They will also need to demonstrate a proven track record of, and commitment to, working in partnership to improve health outcomes."
  
  
• New FTs will 'not be required' to have councils of governors, but should have more 'dynamic arrangements' in place to 'take account of patient, staff and stakeholder insight.'
  
  
• While the FT authorisation powers will be held centrally, ‘NHS regions will use a rules-based process to determine where intervention and support to address poor performance is needed.’ We assume this is referring to NHS oversight framework assessment. The regions will step in using regulatory powers to support improvement and/or address poor performance. 
  
  
• The very best 'new FTs' ('that have shown an ability to meet core standards, improve population health, form partnerships with others and remain financially sustainable over time') can be Integrated Health Organisations (IHOs), holding 'the whole health budget for a local population'.