Health Systems in Transition: What the NHS Mandate Reveals About Global Reform

Governments worldwide are rethinking how health systems work. In high-income countries, there’s a growing push for care that is more local, digital, and prevention-focused  trends accelerated by COVID-19.

These priorities align with the World Health Organization’s pillars for strengthening health systems, including strong primary care, digital access, and prevention as central to universal health coverage.

In January 2025, the UK government released Road to Recovery: The Government’s 2025 Mandate to NHS England. While focused on England, its themes reflect broader global shifts also underway in countries like Canada, Australia, and New Zealand.

This alignment signals a global shift in health systems with wide-reaching implications beyond national borders.

A Global Pattern in Health System Reform

Despite differences in structure and funding, many countries are pursuing similar priorities:

• Care closer to communities
  General practice, pharmacy, and neighbourhood teams are playing larger roles to reduce pressure on hospitals.

• Digital transformation
  Health systems are investing in digital infrastructure, patient-facing tools, and improved data use to strengthen access and efficiency.

• Prevention
  Policymakers are increasingly focused on reducing preventable illness and promoting public health through early intervention and screening.

These themes are also central to the current NHS England mandate, which prioritises community-based services, digital access, and prevention.

Country Snapshots

Canada
Through bilateral agreements with provinces, Canada is funding family health teams, virtual care, backlog reduction, and improved health data. Equity for Indigenous communities is a stated priority.

Australia
Australia’s 10-Year Primary Health Care Plan promotes team-based care, modernised digital infrastructure, and revised GP payment models to support integration and access.

New Zealand
The Pae Ora (Healthy Futures) Act 2022 created Health New Zealand and the Māori Health Authority, embedding equity into the health system’s governance and supporting community-led care.

Global Health Implications

Reforms in high-income countries influence global health in several ways:

1. Shaping global norms
   National reforms help define what “best practice” looks like in policy, delivery, and governance.

2. Influencing funding decisions
   Donors and development agencies often reflect domestic trends such as digital transformation or prevention in their global investments.

3. Exporting technologies and models
   Tools developed in high-income settings are adopted worldwide, but without local adaptation, they may create dependency or fail to meet contextual needs.

4. Shaping global evidence
   Health systems in wealthier nations dominate research output, conferences, and benchmarking limiting space for LMIC innovations to be recognised.

5. Setting equity standards
   How countries like the UK address their own inequalities such as digital exclusion or racial health disparities influences their credibility in global equity efforts.

Looking Ahead

The NHS mandate is part of a broader trend: a shift toward more local, digital, and prevention-focused care. These are not just national reforms they shape global health thinking, funding, research, and leadership.

The full 10-Year Health Plan is still to come. Many will be watching closely to see how these priorities take shape in the UK and far beyond.