During a six-month sabbatical to Loughborough University, I explored how stakeholders were engaged in reform planning for the National Health Service (NHS) in England. I interviewed 25 people, who produced or participated in the planning process, drawn from health services, local government, think tanks, the civil service, charities, and academia.
“Let’s get to it.” This was health secretary Wes Streeting’s call to action in Fit for the Future, a ten-year plan (10YP) for reforming the NHS, published in July 2025. Significant stakeholder engagement had informed it during Keir Starmer’s Labour government’s first year. Labour’s medical adviser, Lord Ara Darzi, was commissioned to investigate the state of the NHS, and a national public “conversation” ran from October 2024 to April 2025, receiving over a quarter of a million responses. The plan spoke to three shifts in care: hospital to community, analogue to digital, and sickness to prevention.
Great expectations
What struck me most from the interviews were the positive energy and high expectations around debating the NHS’s future with staff and the public. During the “national conversation,” one hospital leader recalled organising a lunchtime webinar, expecting fifty or so staff: “five hundred and twenty people rock up.”
One song kept returning to me as I read the transcripts: Pulp’s 1995 hit Disco 2000, which fantasizes about meeting an unrequited childhood love in a future age. The song evokes the “Cool Britannia” era of New Labour’s rise under Tony Blair in 1997, perhaps the nostalgic teenage years of Labour as a centre-left party. Labour’s 2024 return under Starmer meant they had, in a sense, arrived at the year 2000. The fantasy could be realized. But, like the love interest in the song, the context had changed and the world had moved on. A government seeking a more hopeful future by reconnecting with the past was met by a “damp and lonely” present: strained public finances, a post-Covid health system in which services and the workforce remained under strain, and little appetite for slow or incremental improvements among stakeholders in the system.
Nostalgic engagement
The 10YP’s engagement process was presented triumphantly as the “biggest ever conversation about the NHS”, following a Labour tradition in which size mattered: each round since 2000 was reported as bettering the last. Links with the past were also forged by involving civil servants, ministers, and advisers from the New Labour years. One effect of this looking back, according to an interviewee, was the reemployment of a “theory of change” “that applied in the early 2000s” yet was now “alive... in 2026,” though, they added, “I don’t think that in many cases it is making touch with that [present] reality”: a reality that offered neither the new money nor political patience of the early 2000s.
Earnestness
Stakeholders approached the opportunity to engage in earnest. The openness of the process was widely praised: “workshop in a box” facilitation materials let groups run their own local sessions, drawing out voices not orchestrated centrally. One interviewee described the exercise as “real intent from all sides,” adding that a genuinely open process would “do a lot worse than simply copying a lot of what went on with this”.
Stakeholder groups also tailored evidence to whichever policy leaders were in post: some “really like storytelling” while others are “like show me the numbers, I want to see a graph.” One charity embedded audio of older people’s accounts of care into a written report: hearing someone’s own words “does cut through in a different way” than data alone. Another described a video clip of schoolchildren discussing health in their own neighbourhood, filmed at a parliamentary event, which drew hundreds of views within an hour and brought “passion and energy” into a room of politicians.
Underpinning these tactics was the slower work of developing policy relationships: one charity representative described years spent “nurturing and managing relationships with civil servants”, ever watchful of rotating roles and when influence had to be renewed. Such antecedent relational work carried informal influence, with trusted stakeholders phoned for advice as policy reports were being written.
Political impatience
The government was under pressure to demonstrate rapid progress from the media, the electorate, and its own party. It had allocated a full year to develop the 10YP; yet quick results from major health reform are often hard to come by. As one interviewee put it, “there’s always the analogy of the levers, like you pull a lever and nothing happens.” The desired characteristics of potential levers were tightly defined. Participants in the “policy development” working groups were bound to the three shifts while being asked, paradoxically, to “think radically” by proposing novel ideas that were “cost-neutral or cost-saving”; as one participant reflected, “those two things are not easy to combine.”
When the fantasy meets the present
For some critics, the engagement exercise was largely “performative”: it lent legitimacy to government to pursue predetermined proposals with little effect upon their design. The plan itself, one interviewee claimed, “got written by a group of people who were not connected to the working group” in which they had participated. Others pointed to scale. By April 2025, those running the process were perceived to have reached “saturation point” for absorbing further contributions.
Just 23 quotations from the public or staff appeared in the published plan, fewer than one in 10,000 of the contributions. One interviewee found the specific needs raised in his working group’s sessions “airbrushed out” of the write-up in favour of generalities. The novelty of the three shifts was questioned. Thematic analysis had compressed a quarter of a million responses into broad themes that had “dominated every single” NHS plan of the past twenty years. Health policy ideas were being recycled, yet often presented as though new, constraining acknowledgement of challenges with implementing lessons past.
It is 2.26pm on 20 May 2026. Wes Streeting is standing up in parliament to speak about his recent resignation. He does not mention the 10YP, but does refer, fleetingly, to progress against NHS targets: waiting lists down, ambulance response times improved, among others. His mantra in government had been to “never waste a minute.” He could not say the same of his own party, which “does not have time to waste in government treading water.” At 2.45pm, Streeting closes with, “the Labour party was elected to deliver real change. We still can,” before sitting down.
This parliamentary scene distils, in nineteen minutes, the temporal problem that ran through the whole exercise: a plan written for ten years, informed by a year of listening, yet judged in months by media, electorate, and governing party, all communicating an apparent urge for more visible, more radical results. Notwithstanding debate about the efficacy of the plan, a perceived effect of parliamentary turmoil is to stall progress on implementation.
Concluding thoughts
A health plan had been defined for ten years; the health secretary who advocated its co-design with the public had departed within ten months of its publication. Given the attention and cost such exercises absorb, their value should be measured by their effect upon policy design (what surprises emerged from listening, and changed the plan’s course), not by the size or pace of the process. None of this suggests the conversation lacked value. Several interviewees pointed to a “ripple effect” beyond the plan: conversations that gave voice to people rarely present in policy spaces, where having a voice was “an outcome in itself.”
The 10YP’s stakeholder engagement was caught between two temporal movements: a nostalgic stretch back to a past in which reform was felt to “have gone well”, yet remained an incomplete project grasping for a future, and a present so contracted by political impatience that, like the encounter proposed in Disco 2000, the promised future rapidly faded away when confronted by the unimagined evaluative structures of the present.
It’s July 2026. With talk of local buses and football, conversations had in pubs and outside Greggs, Labour’s newly elected leader is addressing his party. The past is evoked again in the longing for a more hopeful future. Plans will be revisited. Stakeholders in health are very real, ever willing to engage, but understandably tired. Tales of longing remain.
Simon Turner
July 2026
The author
Simon Turner is Associate Professor in the School of Management at the University of los Andes, Bogotá, Colombia. His visit to Loughborough University was kindly hosted by Professor Justin Waring, Dean, School of Social Sciences and Humanities, from January to June 2026. He is grateful for the help of Paddy Smith, Senior Public Affairs Manager in the University’s Policy Unit, for help with identifying and approaching interviewees, and wishes to acknowledge all those who gave of their time to participate in the study. Hearing their perspectives on stakeholder engagement was a privilege. Simon can be reached at s.turner@uniandes.edu.co.