The 10 Year Health Plan for England ('10YHP' or 'the plan') is part of the government’s health mission to build a health service fit for the future. The plan describes 3 shifts to reinvent the NHS: from hospital to community, from analogue to digital and from sickness to prevention, supported by a wider set of system changes to improve population health and make the NHS fit for the future.

This impact statement explains the rationale for, and potential effects of, a number of measures outlined in the plan. It broadly follows the same structure as the plan and should be read alongside that document to understand the proposals and their context more fully. The plan sets the overall strategic direction for the whole NHS and individual proposals are at different stages of development and specificity - many of them to be designed and implemented locally. Therefore, at this stage, a full costings and benefits assessment is not feasible, and this document is not intended as a full options appraisal. Further assessment of detailed national-level policy and legislation will be set out at the appropriate times.

P.24 Healthcare system costs, benefits and risks
The plan sets out a range of proposals aimed at supporting people to make healthier choices by giving consumers more information about the health risks of alcohol consumption. Alcohol is also a risk factor contributing to 200 health conditions, including cancers, cardiovascular conditions, depression and liver disease. Where the initiatives are effective in reducing alcohol intake there could be associated health system benefits through reduced demand for services associated with alcohol consumption. For example: • studies have estimated that between 10% and 16% of all ambulance contacts and between 21% to 35% of emergency department attendances are alcohol-related, increasing to 70% of A&E attendances at peak times on the weekends (between midnight and 5am). In 2023 to 2024, an estimated 1,018,986 hospital admissions were from conditions related to alcohol consumption in England, which was 6% of all hospital admissions that year.

P.26 People and patients - costs, benefits and risks
Increased prevention activity is likely to reduce inequalities across population groups. For example, people in working class communities are currently more likely to be diagnosed with a preventable health condition earlier in their life; they are more likely to die prematurely - that is, before age 75 - and they are more likely to suffer severe economic harm after the onset of a new health condition. Several proposals are designed to support getting more people into work in poorer areas, delivering improvements in health inequalities and other benefits, for example improving prosperity. People remaining healthier for longer will also reduce welfare costs, increasing opportunities for government expenditure on other priorities. Proposals for the expansion of Individual Placement and Support (IPS) schemes are also intended to help people with substance dependency and severe mental illness to find good work. In August 2024, 38,704 people had accessed the IPS service for severe mental illness in the previous 12 months. For alcohol and drug treatment IPS, full rollout was anticipated in 2024 to 2025 with the aim of supporting 13,000 people per year. For example: • a study from January 2024 evaluated the cost-effectiveness of IPS for both groups. Based on the randomised controlled trial outputs, researchers estimated there was a 52% probability that IPS was cost-effective for participants with alcohol dependence, with a 97% probability of cost-effectiveness for the ‘other drug’ dependence group. However, IPS was found to be ineffective for the opioid group finding employment and insignificant in cost-effectiveness for this group. 
While prevention overall is expected to narrow health inequalities, it is not a given that all public health initiatives will reduce inequalities. There is the potential that, for some initiatives, technological or health literacy could widen inequalities under certain circumstances, while still improving outcomes for all. The plan aims to mitigate issues that would widen health inequalities through measures such as App Ambassadors and trialling, giving wearable technology to those in deprived areas at no, or low, cost.

P.29 Alcohol consumption
UK trends in alcohol-related harms are going in the wrong direction, such as:
• while the average rate of premature death and ill-health due to alcohol-related liver conditions decreased over the last 30 years for most of Western Europe, the UK rate has increased by 70%. In England, the death rate due to alcohol is the highest on record.
• alcohol has become increasingly affordable over time in the UK, being 91% more affordable in 2023 than in 1987. The estimated cost of alcohol harm to society in England is £27.4 billion per year (2021 to 2022 prices), the equivalent of 1.22% of GDP in 2022. This includes an estimated £5.1 billion to the wider economy due to lost productivity. The following evidence illustrates how the proposals relating to alcohol may reduce consumption. The evidence linking these policies to improved health outcomes is less well-established.
Mandated alcohol label content would ensure important information is available to consumers at the point of purchase and consumption, going beyond existing requirements. There is evidence that health warnings increase knowledge of health impacts, which could slow the rate of alcohol consumption. No and low alcohol products could help to reduce alcohol harms if consumers substitute these products for standard strength alcoholic drinks. The evidence base for such impacts is limited as this is a newly emerging policy solution for tackling alcohol related harms.

P.31 Smoking
The harms of smoking disproportionately fall on deprived communities, for example:
• research of weekly expenditure and income for 5,000 UK households using 2016 to 2017 Living Costs and Food survey data found that smoking exacerbates poverty in low-income households. The study proposed that it is the pivotal factor behind why an estimated 230,000 UK households live in poverty.
• there are also large geographical variations in rates of smoking during pregnancy from below 2% in parts of London to over 10% in parts of Lincolnshire.

P.32 Further work is needed to understand the longer-term impacts that the policies relating alcohol might have on alcohol sales and producer and retailer revenue. The introduction of warning labels on alcohol containers would incur one-off familiarisation, redesign and printing costs for producers, plus one-off and ongoing costs of calculating nutritional information. Further work with industry is needed to understand adequate lead in times as well as exact costs incurred by producers. Mandatory health warnings and nutritional information could result in an associated reduction in revenue from alcohol sales, but this could be offset if consumers switch to different products, which producers could encourage through reformulation or new product innovation. 
Smaller manufacturers and retailers will be impacted by the proposals that incentivise people to buy fewer unhealthy products such as sugary drinks and alcohol. The extent that these changes affect profits for retailers depends on consumer behaviour in terms of switching consumption to other products and the relative profit margin of these products compared to the basket of goods each business sells. These impacts will be fully
assessed prior to implementation.