Chapter 1: executive summary

Question 1

1.1 Introduction

Accepted Answer

The independent investigation into the NHS by Lord Darzi found that the National Health Service (NHS) “is in critical condition, but its vital signs are strong”. In response, the Secretary of State for Health and Social Care announced the government would publish a 10 Year Health Plan as part of its mission to make the NHS fit for the future. The 10 Year Health Plan was published on 3 July 2025 and set out how the government will deliver 3 big shifts:

hospital to community
analogue to digital
sickness to prevention

To ensure its success, the Prime Minister and Secretary of State wanted “patients and staff to have their fingerprints all over” the 10 Year Health Plan. This required meaningful dialogue with those who use, work in and/or have an interest in health and care. It was essential that audiences who are seldom heard in government consultations were actively included in this conversation, and that the dialogue created a lasting legacy of increased confidence and capability for organisations to deliver their own engagement in the future.

This report is not government policy, but it details the insights gained from the engagement exercise (Change NHS), which played an essential role in developing the 10 Year Health Plan. This report reflects insights gathered from 21 October 2024 until the publication of the 10 Year Health Plan in July 2025. Detailed information on the methodology and a glossary of terms used in this report can be found in the engagement insight report appendix.

To deliver Change NHS, the Department of Health and Social Care (DHSC) worked with:

Thinks Insight and Strategy, an independent research agency
Kaleidoscope Health and Care, a health and care consultancy
the Institute for Public Policy Research

Question 2

1.2 Our approach

Accepted Answer

Change NHS launched on 21 October 2024 and concluded with the publication of the 10 Year Health Plan. It was the biggest ever conversation about the NHS. We received over 270,000 contributions from the public, health and care staff, health system leaders and organisations with an interest in health and care. Participants shared their experiences of using and/or working in or with the NHS and their views on what it should look like in the future. The findings have been used to shape the 10 Year Health Plan.

There were numerous ways to shape the 10 Year Health Plan, including:

The Change NHS website

Anyone aged 16 or over could share their ideas and opinions through change.nhs.uk. More than 11,000 ideas for change were submitted and we collected over 100,000 responses to surveys about important elements of the 10 Year Health Plan. In light of the self-selecting nature of the participants on the Change NHS website and to provide a point of comparison, elements of the online questions were included in 2 nationally representative surveys.

We also received over 130,000 responses from 6 campaign organisations. Each campaign organisation structured its responses slightly differently, though most followed the outline of the survey on the Change NHS website. Responses have been analysed separately to those received through the Change NHS website and have been included in the appendix document (linked above).

Face-to-face deliberative events

These events were hosted with the public in each of the 7 English NHS regions. Some 730 people came together across these day-long sessions which were recruited to be representative of the public by age, gender, ethnicity, education level and geography, with over-sampling of groups who are often seldom heard such as those with caring responsibilities, those living in deprived areas, frail and elderly individuals, and those from ethnic minority backgrounds.

We also hosted a deliberative event with 27 children and young people aged 7 to 18 and a youth summit, where over 30 young people were invited who attended previous events.

Workforce deliberation

We hosted online and face-to-face deliberative events with just over 3,700 health and care staff recruited to represent a diverse mix of roles, specialities, pay bands and settings, across all 7 English NHS regions.

Community conversations

To support local, place based conversations, we created a ‘workshop in a box’ to provide training, materials and support to organisations to hold their own events. Some 658 events took place in communities across England with 17,601 members of the public and health and care staff using the ‘workshop in a box’ materials. Around 40% of these workshops heard from audiences too often excluded from government consultations, such as children and young people and those with learning disabilities and/or autism. Insights from these community conversations are referred to throughout this report as ‘seldom heard audiences’.

Partner engagement

We engaged with partner organisations like industry bodies, charities, patient groups and stakeholder partners through a series of events and through the Change NHS website. Detailed insights from this engagement are in the partner engagement insight report.

Health system leader engagement

We ran regional and national events with NHS leaders, who will be instrumental in delivering the changes at a local level.

National summit

The engagement culminated in a national summit where almost 300 members of the public and staff from across the country reconvened to discuss ideas for the 10 Year Health Plan. We also hosted an online drop-in summit for those who took part in the public deliberative events but could not attend the national summit for any reason.

Question 3

1.3 Key insights

Accepted Answer

We have summarised the key insights from across the engagement below. Further detail on the insights can be found in this report and the ‘partner engagement insight report’ (linked above), which examine views from that group in more detail.

1.3.1 Contextual insights

Public and staff participants reported significant challenges accessing, using and working in the NHS. These challenges felt urgent and they wanted to see them addressed in the 10 Year Health Plan.

For the public, the most widespread and commonly reported challenges in the NHS relate to access. GP services were particularly affected, but long waits in A&E, for elective care and mental health services were also widespread.

Those who use the NHS more frequently and many seldom heard audiences also reported poor co-ordination and communication from NHS services. This included administrative failures where letters arrive after appointments, NHS staff not having access to patients’ medical history, lost referrals and delays to treatment, all of which damage patients’ confidence that they are receiving the best care.

Insufficient resource and capacity to meet growing demand was the challenge most commonly mentioned by staff. This challenge is compounded by poor technology, fragmented services and difficulty in accessing patient information, all of which get in the way of providing efficient, high-quality care. These challenges were also reflected in contributions from organisations representing health and care staff.

Partner organisations emphasised the importance of addressing health inequalities to ensure services work better for underrepresented or disenfranchised groups who often face the greatest barriers to accessing high-quality care.

Where elements of the system are working well, this was often felt to be ‘in spite of’ wider pressures. Public participants often felt care is delivered to a high standard, which was surprising to many, given their perception that the NHS is in crisis. They usually saw this as evidence of the resilience, skills and care of staff in the face of a very challenging organisational and financial context.

Reflecting this, staff participants were proud of delivering a positive impact for patients in challenging circumstances. Many frontline staff participants described recent occasions where they had been able to significantly help their patients. In addition, staff were proud of the way they manage to work with each other in a fragmented system which is not set up for collaboration.

When thinking about the future, there was strong support for continued commitment to the NHS’s core principles. The fact that the NHS provides healthcare to everyone who needs it, free at the point of use, was perceived as one of its greatest strengths and a source of national pride. Participants wanted this element of the NHS to remain in the future. This sentiment was shared across all strands of the engagement but was especially strong among public participants. Children and young people were also committed to these principles, despite having fewer life-changing or positive interactions with the NHS than adults.

1.3.2 The 3 shifts: overview

All audiences supported the 3 shifts in principle. Public participants across the engagement were able to identify opportunities that each shift will bring to improve their access to and experience of care. Taken together, they felt like a positive vision to aim for (albeit with some concerns, outlined below).

Staff, health system leaders and partners also supported the 3 shifts. Many noted that the analysis underpinning each shift, and the solutions put forward under each, are well established and generally accepted across the service. The challenge is implementation.

While endorsed as a vision for the future, public participants expressed the need to address the immediate challenges they experience in the NHS today. The shift from analogue to digital resonated the most with members of the public. It was clear to public participants and seldom heard audiences that poor technology slows down their care and makes it feel unco-ordinated. They felt changes such as a single patient record would help to improve their experience of and access to care.

While receiving care in the community sounds like it will be more convenient and holistic, public participants struggled to see how it would address their immediate priority of improving access. Similarly, prevention felt like an important goal, but one whose impacts are both long term and uncertain.

For the shifts to work, staff, health system leaders and partner organisations emphasised that the foundations of the NHS must be fixed. These audiences noted the challenges associated with implementing change in a struggling system. To address the foundations, they highlighted the need for:

sufficient and long-term funding
better management of resources
more integration between parts of the health system
improvements to workforce capacity and wellbeing
upgrading poor technology and equipment

The public, staff and partner organisations all agreed that a fully staffed, strong and dynamic workforce is integral to deliver the shifts. To support this, staff said changes are required to make the NHS a great place to work. For example, staff shared the need for:

policies which support flexible working and improved work-life balance
the recognition of staff through pay and positive feedback
training and development opportunities
the creation of an open and collaborative workplace culture
actions to address racism, bullying, sexism and discrimination

1.3.3 Shift 1: hospital to community

The shift to community felt very familiar to staff, health system leaders and partner organisations but was less well understood by the public.

Staff, health leaders and partner organisations understood and supported the shift. They were excited by its potential to improve access to care, improve health outcomes and to reduce inequalities. Staff also noted the shift would allow them to deliver care more efficiently and improve their working lives (for example, by delivering better work-life balance if it resulted in a move from shift work to office hours).

However, public participants had low understanding of the challenge the shift is trying to address. Many assumed hospitals are the safest place to receive care (particularly at end of life or when otherwise very sick) due to being well equipped with staff and specialist equipment. While there was an understanding that hospitals are not a comfortable place to recover, this downside often did not offset the perception of safety. In the course of discussion and dialogue, public participants came to recognise the benefits of the shift to community. This most notably included care that is more convenient, personalised and comfortable.

Staff, health system leaders and partner organisations expected that this shift would improve access for underserved populations and those from deprived areas who may struggle to access hospital-based care. However, public participants were concerned that, without appropriate investment, benefits would not be evenly distributed geographically or across patient types. This concern was raised strongly by seldom heard audiences in the community engagement who expected the shift could exacerbate health inequalities - for example, if services were not implemented fairly across the country or delivered in a sensitive way to manage stigma in communities.

When explored on the Change NHS website, there was support for measures that would redirect resources to areas and people most in need to avoid exacerbating inequalities. Over half of participants on the Change NHS website (55%) supported ‘targeting more resources on prevention and healthcare to people and areas who are more in need than others’. More than 3 in 5 (64%) respondents in the nationally representative survey felt the same.

Public participants were willing to accept the different models of care that the shift to community might entail if it improves access. In particular, they were open to seeing another healthcare professional first instead of the GP. They acknowledged this would help manage demand on the system and potentially mean faster access to care. This idea was also supported by participants on the Change NHS website and in the nationally representative survey. For example, just over 7 in 10 (72%) of those on the Change NHS website and almost two-thirds (64%) of those in the nationally representative survey said they would be happy to see a nurse instead of a GP to discuss a minor illness if it meant they were seen sooner.

For staff, health system leaders and partner organisations, if the shift to community is to be a success, challenges regarding funding, infrastructure and integration of services need to be addressed. Although many had examples of good practice, when it comes to community care a complete overhaul of the system to give more focus on the community feels very far away from the status quo.

Staff emphasised the importance of long-term funding, improving the physical infrastructure of community settings and using technology (such as the single patient record) to make the NHS more integrated.

Partner organisations noted the shift will require growing the community workforce. Staff recommended improving pay and progression, increasing familiarity with the community setting and creating a supportive environment as essential to achieve this.

Staff participants felt these points will help to address barriers to working in the community. These included:

the perception that community roles are of lower value compared with those in hospitals
the perception that working with greater autonomy means a lack of support
a lack of knowledge about community roles

1.3.4 Shift 2: analogue to digital

Public and staff participants and many partner organisations wanted the shift from analogue to digital to prioritise ‘the basics’. The basics included:

a sufficient number of up-to-date devices for all staff
reliable internet connectivity across the NHS estate and an ability to work remotely (for example, in the community)
a single patient record
fewer, interoperable systems across all services

Members of the public and especially staff, felt that before more advanced innovations, such as artificial intelligence (AI) can be implemented, the basics would need to be fixed first.

There was strong support for a single patient record across all strands of engagement. This was expected to make care feel more co-ordinated and efficient. Public participants felt a single patient record would make their experience of care feel smoother and more joined up as they would not have to repeat their symptoms to different professionals. This benefit was felt strongly by many seldom heard audiences in the community engagement who noted that retelling their story can often be traumatising and/or anxiety provoking.

Staff, health system leaders and partner organisations expected a single patient record would improve patient safety, allow staff to work more productively, speed up referrals and facilitate collaboration. The benefits to collaboration and co-ordination meant that the technology shift - and in particular the single patient record - was seen as fundamental to successful delivery of the other 2 shifts.

Staff and partner organisations expected the shift to help empower patients to manage their health. Staff and partner organisations believed that if patients had easier access to their own data (for example, through the NHS App) then they would feel more empowered to take ownership over their health, supporting the shift to prevention.

The public did not raise this as a benefit spontaneously. However, when prompted, it gained support on the Change NHS website and in the nationally representative survey. Half (50%) of participants on the Change NHS website and over 4 in 10 (45%) of the public in a nationally representative survey selected ‘easier access to your health record with personalised information about any risks to your health and how to manage them’ as one of the top 3 things which would help them stay healthy from a list of options.

Public participants saw an opportunity for a greater role for the NHS App to help them book and manage appointments and their care more widely. They were supportive of using the NHS App. Around 3 in 5 (62%) of participants on the Change NHS website and over half (54%) of participants in the nationally representative survey supported the idea of using the app as the main way to access NHS services and information. Only around 1 in 7 (14%) participants on the Change NHS website and 1 in 6 (17%) nationally representative survey respondents were against the idea.

There was support among public participants for virtual appointments, particularly if they could expediate access. However, it was consistently acknowledged that they are not appropriate for all patient groups and therefore high-quality offline options should be retained. All audiences expressed concerns about digital exclusion. Participants across all stands of engagement, including children and young people, raised this concern quickly when thinking about the shift to digital. Audiences worried that certain groups may be excluded as they are either unable to access or confidently use digital solutions. Many seldom heard audiences in the community engagement felt this concern personally.

In this context, public participants emphasised the requirement for offline, and particularly face to face, alternatives and choice about how to access the NHS. Staff highlighted the need to design digital services in a way which widens participation - for example, enabling proxy access to the NHS App for carers and loved ones.

After hearing about the benefits, the public and staff were open to the use of AI in the NHS, with important caveats. Both staff and the public were receptive to the productivity benefits AI is able to offer the NHS.

Staff and public participants saw a greater role for using AI for non-clinical care such as scheduling appointments and summarising patient records, rather than clinical uses. There was a concern that using AI for clinical care may negatively impact the patient-clinician relationship which both staff and public participants valued highly. Regardless of how AI is used, both public and staff participants agreed that final clinical decisions should be made by a human and that there need to be clear lines of accountability if something goes wrong.

1.3.5 Shift 3: sickness to prevention

The public and health and care staff participants wanted the 10 Year Health Plan to address prevention in its broadest sense, including wider societal factors that lay outside of the NHS.

While they endorsed a renewed focus within the NHS on earlier diagnosis, public and staff participants were clear that many of the determinants of good health lie beyond the boundaries of the NHS, or even of the health and care sector more broadly. As a result, they emphasised the need for a truly holistic approach to prevention across wider society, involving public sector bodies (for example, housing and education), the private sector (for example, the food industry) and public attitudes and behaviour.

All audiences supported the shift to prevention. Unlike the other shifts which were supported because of benefits that were expected to flow from them, public and staff participants felt that preventing or delaying the progression of ill health is a benefit in and of itself.

Secondary to this, public and staff participants intuitively believed a greater focus on prevention would help to reduce pressure on the NHS and potentially save money in the long run. Both the public and staff emphasised the importance of education to prevention, recommending prioritising building skills from a young age.

Public and staff participants felt that these benefits would take time to realise, and even the most optimistic acknowledged that there would be challenges in implementing such a transformation of the NHS.

Public and staff participants and partner organisations saw community-based prevention services as integral to delivering the shift successfully. Staff currently working in the community saw the potential for these services to make a positive impact if given more resource. Partner organisations highlighted the opportunity to co-locate services to drive uptake. The public also thought community-based preventative services were desirable, in particular seldom heard audiences who felt providing services in the community would allow those services to be more tailored to their health and access needs.

When asked on the Change NHS website, participants were open to numerous organisations playing a role in helping people managing their health and wellbeing, including employers (56% said they should have a role), local government (45%) and education organisations (40%).

Public - particularly seldom heard audiences - and staff participants said that the shift needs to be carefully implemented to avoid worsening existing health inequalities and stigmatising those with health conditions. Public and staff participants said the shift needs to consider the barriers people face to making healthy choices. These included financial barriers, caring responsibilities and existing long-term health conditions. Furthermore, public participants and some seldom heard audiences in the community engagement emphasised the importance of not stigmatising those who develop a health condition (for example, one associated with obesity). To do this effectively, staff - particularly those working in the community and public health - highlighted a need to engage and learn more about disadvantaged communities to ensure services are inclusive.

The perceived scale of the shift raised concerns about delivery, particularly for staff, health system leaders and partner organisations. Although all audiences shared concerns about implementation, they were more strongly expressed by staff, health system leaders and partner organisations.

These audiences highlighted more specific challenges that previous efforts to shift to prevention had failed to overcome. For example, staff and partner organisations both emphasised that sustained and long-term funding is required to ensure the shift is a success. This includes funding for increasing workforce capacity and training to deliver preventative services.

Additionally, staff and health system leaders noted that greater integration between services is required to facilitate the collaboration they believe is required to deliver prevention effectively.

Finally, staff participants emphasised the importance of leadership and strategic direction in making the shift a success. They felt that the shift to prevention needs to be led ‘from the top’ and reflected in management throughout the system. This means prioritising prevention, setting clear objectives and providing practical support.

Question 4

1.4 You said, we listened

Accepted Answer

The engagement insights were shared with DHSC and NHS England regularly throughout the process. They were used to shape the policies set out in the 10 Year Health Plan. The summary below maps the insights received from the public and health and care staff to the plan.