Addressing the five giants in the 10 Year Plan
I grew up on Langworthy, in Salford, with my mum and dad in a two-up two-down. In 1999, BBC Newsnight came to the area to speak to residents in one of the most challenged and poverty-stricken parts of the country. It was our local GP who suggested featuring my parents.
My dad was in his 60s when I was born and was nearly 90 by the time Newsnight arrived. He had COPD and was still active in the local community. My mum was in her late 60s and had lived with mental health difficulties for much of her life. The welfare state only partially held them. They still relied on a coal fire my dad lit each morning.
The house next door had been firebombed by teenagers, themselves struggling in that same community, and damp spread from the abandoned property into my parents’ home. This led, in the end, to my dad’s passing.
That experience makes the Beveridge Report feel anything but historic to me. The five giants Beveridge identified in the 1940s were present in my mum and dad’s lives, and they remain visible in many lives now. If we are serious about a good life for all, and about narrowing inequality rather than simply describing it, then these five still matter:
| Giant | Description |
|---|---|
| Want | Poverty and lack of financial security |
| Disease | Inadequate healthcare and health services |
| Ignorance | Lack of education and access to learning |
| Squalor | Poor housing conditions |
| Idleness | Unemployment and lack of job opportunities |
Beveridge imagined a service built around local health centres and regional administration. The government of the day chose a more centralised model. That tension still feels familiar now.
The government’s 10 Year Health Plan for England again calls for three big shifts: from hospital to community, from analogue to digital, and from sickness to prevention. It also leans into neighbourhood health, technology-enabled access and a stronger focus on population health. None of that is new.
The challenge is not whether we know the direction; it is whether we can organise, lead and change at the scale needed to make it real.
That was the argument I made at the Do OD in the NHS 2026 conference, in May. For me, this is where OD has a vital contribution to make. It was encouraging to hear Linda Holbeach speak to the need for OD to bring its collective capabilities to bear on the wider health and care system. We cannot stay in narrow lanes. We need to be broad enough to work across disciplines and deep enough to add real value.
One of the risks for OD is that we get confined to the territory of team development, individual insight and culture work detached from decision making.
Some of you will be working on the system-wide challenges of those three shifts. Others will be working inside trusts and organisations wrestling with their own delivery, culture and operational pressures. Both matter. Both are system work. And both require us to work on strategy, structure and culture together.
They also require an understanding of people, behaviour, power and sense-making in complexity as outlined in the Cynefin Model.
One of the risks for OD is that we get confined to the territory of team development, individual insight and culture work detached from decision making. When that happens, OD can be dismissed as soft or cosmetic, useful for engagement but not for changing the conditions that shape performance, equity or experience.
OD is at its strongest when it is connected to the real levers of change: strategy, process, design, governance, culture and power.
OD is at its strongest when it is connected to the real levers of change: strategy, process, design, governance, culture and power. In complex environments, that means less reliance on neat programmes and more willingness to test, learn and adapt.
Dave Snowden describes the need for “safe-to-fail” probes in complex systems: small experiments that help people see what is emerging rather than assuming the answer is already known. That feels highly relevant to health and care.
Many of the most challenging issues in the 10 Year Plan are about power: between providers and places, citizens and services, professions and institutions, national intent and local reality.
If OD is kept in a safe engagement role, it will struggle to influence those questions. If we can break out and work where power, politics and complexity meet, we can become much more useful to the future of health and care both organisationally and systemically.
Some of this requires bravery on our part, some of this requires acknowledgement from those who lead that the discipline of OD provides some real solutions to the complex challenges they face.
That brings me back to Beveridge. Beveridge and Bevan shared a moral commitment to universal healthcare, but they differed on how it should be organised.
Beveridge saw health as part of a wider social settlement shaped by prevention, population health and local infrastructure. Bevan, facing a fragmented post-war system and fierce resistance, chose central control and a hospital-led model as the fastest route to equity.
Bevan’s model won for understandable reasons. But Beveridge’s warning still matters: no health service can remain sustainable if it focuses mainly on treatment while neglecting the conditions that make people ill in the first place.
For OD and management in health and care, that is not just a policy point. It is a design challenge, a leadership challenge and, still, a moral one.
John Herring is a director of integrated care, chair of an arts sector charity and trustee for the Greater Manchester Mayor’s Charity.
