Engagement insight report appendix: 10 Year Health Plan for England
Published 17 December 2025
Applies to England
© Crown copyright 2025
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/engagement-insight-report-appendix-10-year-health-plan-for-england/engagement-insight-report-appendix-10-year-health-plan-for-england
Introduction
This appendix contains background information on the findings in the engagement insight report. It includes:
- a glossary of terms used in the report
- information on the demographics of participants and the methodology used
- a summary of the responses received from campaign organisations to the Change NHS website
- a summary of the ideas submitted on the Change NHS website
This document 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.
To deliver Change NHS, the Department of Health and Social Care 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
1. Glossary of terms
Below is a glossary of terms used in the report.
Community engagement participants
Participants in the community engagement strand that took place between November 2024 and February 2025 (specific audiences are referenced where possible).
Core20PLUS5
Core20PLUS5 is a national NHS England approach to inform action to reduce health inequalities at both national and system level. The approach defines a target population - the ‘Core20PLUS’ - and identifies 5 focus clinical areas requiring accelerated improvement.
Health and care staff or ‘staff’
Staff participants across all strands of engagement.
Health system leaders
Participants who attended system leader events held by the Department of Health and Social Care (DHSC).
Participants in the nationally representative survey
Participants who completed the 2 nationally representative surveys.
Due to the self-selecting nature of the Change NHS website participants and to provide a point of comparison, elements of the Change NHS website questions were included in 2 online surveys of a sample of English adults aged 18 and over, who were representative of the population in terms of age, gender, socio-economic background, region and ethnicity.
Partner organisations
Partners who responded through the submission process on Change NHS or a roundtable.
Public Change NHS website participants
Public participants who took part on the Change NHS website between October 2024 and April 2025.
Public deliberative event participants
Public participants who took part in one of the 7 regional deliberative events in November and December 2024.
Public or staff summit participants
Public and staff participants (184 and 74 participants, respectively) from the deliberative events who took part in the national summit held in London in April 2025.
Seldom heard audiences
Audiences across the public and community engagement who are often seldom heard in government consultations. These are closely aligned to NHS England’s Core20PLUS5 framework.
Shared patient record
A digital system that allows authorised healthcare staff to access patients’ health records and medical information across organisations to help deliver better care.
Staff Change NHS website participants
Staff participants who took part in one of the 7 regional deliberative events in November and December 2024.
The public
Public participants across all strands of engagement.
Workshop in a box (WIAB)
Workshop materials developed to support local, place based, community conversations. The materials provided training and workshop guides to support organisations to hold their own events.
2. Background, objectives and methodology
2.1 The NHS is in critical condition, but its vital signs are still good: independent investigation into the NHS
The independent investigation into the NHS by Lord Darzi (2024) stated the National Health Service (NHS) is in trouble. The public are struggling to access NHS services, from GPs to dentists and from mental health to elective care. Many are living for longer in ill health and inequalities are growing (read more about patterns of illness in England). This places even more pressure on the health system. Public satisfaction with the NHS has fallen from a record high in 2009 to an all-time low. Find out more about public satisfaction with the NHS and social care.
Within the NHS, there are chronically high levels of staff vacancies (read more about staff shortages in the NHS). Around 1 in 3 staff (34%) say there are not enough staff at their organisation for them to do their job properly and around 2 in 5 staff say they have felt unwell due to work-related stress (find out more about the 2024 NHS Staff Survey results). There has been a long-term lack of focus on and investment in capital expenditure. For example, in contrast with other sectors, the NHS is still in the early stages of digital transformation. All of this has a detrimental impact on the productivity of the system.
Despite the many challenges, however, the investigation found that the NHS’s vital signs remain strong. This sentiment has been echoed by the Secretary of State for Health and Social Care, who has described the NHS as “broken but not beaten”. Read the full press release from the Health Secretary inviting the public, staff and experts to share their experiences. The British Social Attitudes survey (linked to above) found that the commitment of staff to deliver excellent care for patients and public support for the core principles of the NHS remain. There is a strong and widespread desire to turn the NHS around and ensure it is ‘fit for the future’.
2.2 The 10 Year Health Plan
In response to these challenges, the Secretary of State for Health and Social Care announced that the government would publish a 10 Year Health Plan in summer 2025. This will be part of the wider government mission to create an NHS that is fit for the future. The 10 Year Health Plan sets out how to deliver 3 big shifts for which there is support across organisations and individuals in the health sector.
Firstly, to move more care out of hospitals and into the community. This means delivering more tests, scans and treatments nearer to where people live. This could help people lead healthier and more independent lives, reducing the likelihood of serious illness and long hospital stays. This would allow hospitals to focus on the most serious illnesses and emergencies.
Secondly, to make better use of technology. This might include better computer systems so patients only have to tell their story once, video appointments, artificial intelligence (AI) scanners that can identify disease more quickly and accurately, and more advanced robotics enabling more effective surgery.
Thirdly, to focus on preventing sickness, not just treating it. This includes spotting illness earlier and tackling the causes of ill health, which could help people stay healthy and independent for longer and take pressure off health and care services.
The 10 Year Health Plan focuses on how to make the NHS fit for the future. It sets out policies intended to begin to address the wider determinants of health. It also covers elements of where social care and the NHS interact most closely, with more conversations expected on social care as part of the Casey Review.
2.3 Change NHS
To ensure its long-term success, the Secretary of State for Health and Social Care wanted “patients and staff to have their fingerprints all over” the 10 Year Health Plan through the biggest national conversation on the future of the NHS. This required meaningful dialogue with patients, the public, staff working in health and care, system leaders and other partner organisations to inform the vision for and delivery of the 3 shifts. This engagement exercise was called Change NHS. In total, we received over a quarter of a million contributions from members of the public and NHS staff.
It was important that Change NHS felt different from other engagement. It was designed to be wide-reaching and inclusive of those who do not typically participate in engagement. It also sought to leave a legacy of increased confidence and capability within the NHS to carry out meaningful engagement at a local level in the future.
The objectives of Change NHS were to:
- engage a large and diverse sample of the public and health and care staff in England
- understand what success for the 10 Year Health Plan looks like for the public and staff
- understand the views of the public and staff on some of the big questions and trade-offs within each of the 3 shifts
- create a sense of energy, momentum and hope for the future of the NHS among the public and staff
2.4 Overview of Change NHS and the programme of engagement
Thinks Insight and Strategy, Kaleidoscope Health and Care and DHSC designed an ambitious programme of engagement. The different components combined to create a programme that reached large numbers of people, engaging the widest range of groups and voices among the public, patients and staff and partner organisations.
Change NHS launched on 21 October 2024 and concluded on 14 April 2025. We received over 250,000 contributions.
change.nhs.uk
change.nhs.uk was a website to hear from the public, staff and stakeholders. It ran from October 2024 to April 2025 and was open to all audiences.
The overall purpose of the Change NHS website was to:
- be the homepage of Change NHS
- allow anyone in England to take part in the engagement, ensuring it reaches a wide range of the public, staff and partner organisations
- host a range of research and engagement activities over the life of Change NHS - surveys, discussion spaces, ideation opportunities - open to anyone who wished to take part
- share materials to support the community engagement and provide a space for insights to be shared back
- host a blog where DHSC shared insights and ideas as they emerged
- provide updates to those participants who signed up to receive them, in addition to invitations to further participation, and ongoing contact with DHSC and the project team
Phase 1 activities of the Change NHS website were designed to understand:
- the public and staff’s experiences with the NHS - what they think is working well and what challenges they face
- priorities and ideas for change
- what the public and staff saw as the biggest opportunities and concerns for each of the 3 shifts
Phase 2 activities of the Change NHS website were designed to:
- collect insight from the public and staff on emerging policy questions, as the policy development shifted from the vision to enabling working groups
- illustrate the progress being made on the 10 Year Health Plan
- promote and maintain public awareness of Change NHS and the 10 Year Health Plan
Public and patients
Seven regional public deliberative events were held in November and December 2024. The aim of the events was to hear from a cross-section of the English public in depth, over 8 hours of conversation to understand what the public feel are the biggest opportunities and things they would not accept (or ‘red lines’) for each of the 3 shifts, setting the goals and guidelines for policy development.
A deliberative event with children and young people (aged 7 to 18 years) was held in February 2025. The purpose of the event was to understand children and young people’s vision of success for the 10 Year Health Plan and the 3 shifts.
Health and care staff
In November and December 2024, 15 online events took place with health and care staff. The purpose of the online events was to hear from a wide range of staff across roles, sectors and settings, and understand what staff feel are the biggest opportunities and concerns for the shift. The events also aimed to understand staff views on what is preventing these shifts being delivered at the moment.
Seven regional staff deliberative events took place in February and March 2025. The purpose of the deliberative events was to hear from a diverse sample of staff in depth through 6 hours of conversation to understand their experiences relevant to the 3 shifts, and what staff think the 10 Year Health Plan will need to take into account to ensure success.
In March and April 2025, 8 additional events were held with staff to ensure all staff have the opportunity to share their experiences, thoughts and ideas to inform the development of the 10 Year Health Plan, including those who were under-represented in the in-person staff deliberative events. They also explored emerging tensions in the engagement in detail.
Public and staff
The national summit was held in April 2025 to reconvene public and staff who took part in the regional deliberative events for a day of in-depth conversation together. The purpose of the event was to showcase the impact of public and staff contributions on the development of the 10 Year Health Plan at that stage and give an opportunity to discuss and deliberate remaining questions, tensions and policy ideas to feed into the development of the 10 Year Health Plan.
Community engagement was held between November 2024 and February 2025 to support local systems, communities and the voluntary, community and social enterprise (VCSE) sector to run their own workshops with members of the public and staff. The purpose of the community engagement was to hear from groups who are often seldom heard in engagement, such as health inclusion groups, and to ensure engagement happens at a hyper-local level.
Charities, patient groups, health system leaders, industry and other partners
Health system leader engagement ran between October 2024 and December 2024 to gather insight from leadership staff in each of the 7 NHS regions to support the development of the 10 Year Health Plan.
Partner engagement ran from October 2024 to April 2025 to gather insight from organisations with an interest in the 10 Year Health Plan. Any organisation was welcome to submit their answers to 5 questions through change.nhs.uk by 2 December 2024. DHSC also conducted roundtables with a smaller number of partner organisations to hear their views in more depth, including their priorities for change and the 3 shifts.
2.5 Methodology for each strand of engagement
change.nhs.uk (the Change NHS website)
The Change NHS website served as an open digital channel to collect views from the public, staff, stakeholders and local communities. The Change NHS website was designed to be dynamic and iterative. As the engagement progressed, emerging findings were tested and information about the engagement shared to promote transparency.
The Change NHS website was launched on 21 October 2024 with a call to action for everyone to join a national conversation about the NHS by sharing their experiences, views and ideas for change. There were over 115,000 individual submissions and over 130,000 responses from 6 campaign organisations at the conclusion of the engagement in April 2025, totalling around 250,000 submissions.
The Change NHS website hosted several activities for anyone to complete and share their views. Specifically, it included:
- the ‘Start here’ survey launched in October 2024, which explored what the public and health and care staff think is working well and less well about the NHS, priorities for change, and their responses to the 3 shifts
- a space for public and workforce to share their experiences of the NHS, both positive and negative
- an open forum to suggest ideas for change - ideas were open for all to see and vote on
- the ‘Your priorities for change’ survey, which launched in February 2025 and collected insight from the public and health and care staff on emerging policy questions and gaps in policy development
As the homepage for the Change NHS engagement, the website:
- served as a public source of information on the 10 Year Health Plan and wider engagement, with blog posts and information
- hosted an expert video library where participants could interact with views about the 3 shifts
- hosted the community engagement page - the ‘workshop in a box’ - allowing local systems, community groups and the VCSE sector to facilitate conversations with their local communities (methodology in detail below)
- hosted space for organisations to submit their feedback about the 10 Year Health Plan and the 3 shifts
The response numbers for each Change NHS website activity are shown in table 1.
Table 1: response counts for Change NHS website activities
| Change NHS website activity | Response count |
|---|---|
| Start here survey | 76,730 |
| Public experiences | 5,049 |
| Workforce experiences | 3,674 |
| Ideas for change | 11,886 |
| Your priorities for change survey | 21,436 |
Accessibility
To ensure the engagement reached a truly diverse set of audiences, it was essential to make the Change NHS website accessible.
Actions included making British Sign Language (BSL) and easy read translations of the Change NHS website content available and shared with relevant organisations and giving offline response options (for example, paper and telephone surveys).
The Change NHS website was also fully accessibility tested, with continuous updates to ensure adherence to best practice guidelines.
We also received responses from 6 campaign organisations. Due to the volume of participants included in each submission and slight differences in the questions asked, these have been analysed separately and summaries are in section 4 below.
The Change NHS website was publicised across a range of channels including:
- radio
- television
- social media
- online advertisements
- word of mouth
- email newsletter
- print media
- events and community gatherings
- websites and blogs
- GP surgeries
- hospitals
In addition, emails were sent to all those who registered to the Change NHS website encouraging them to take part in the available activities.
It is important to note that, despite the large number of responses to each element of the Change NHS website and the extensive efforts to publicise it widely, participation was voluntary. As the sample of respondents was self-selecting, results from the Change NHS website activities reflect only the views of those who took part and are not representative of any wider population.
Nonetheless, the sheer volume of responses reflects the importance of this issue to the English public generally, and the views of those who chose to spend their time engaging are worth understanding in and of themselves. Many of the broad themes and viewpoints raised by Change NHS website participants reflect those identified in many other studies using a range of different methodologies and sampling approaches (including work commissioned by DHSC and NHS England).
Nationally representative comparator survey
In light of the self-selecting nature of the Change NHS website participants and to provide a point of comparison, elements of the Change NHS website questions were included in 2 online surveys of a sample of English adults aged 18 and over, representative of the population in terms of age, gender, socio-economic background, region and ethnicity. Both surveys were hosted by Yonder, with respondents recruited from Yonder’s market leading panel.
The 2 surveys were:
- survey 1: a point of comparison for the ‘Start here’ survey on the Change NHS website - an online survey of 2,025 adults, conducted from 13 to 17 December 2024
- survey 2: a point of comparison for the ‘Your priorities for change survey’ on the Change NHS website - an online survey of 2,015 adults, conducted from 17 to 20 March 2025
Where results from the Change NHS website activities diverge significantly from the results of the representative survey, these have been noted in the analysis that follows.
For more detail on the demographics of those who registered and/or responded to the Change NHS website, see section 3.1 below.
Public deliberative events
We delivered 7 deliberative events with 730 members of the public, plus in-depth interviews and mini groups with an additional 25 members of the public, in November and December 2024. One event was delivered in each of the NHS regions:
- North East and Yorkshire (Middlesbrough), 16 November 2024
- Midlands (Wigston), 23 November 2024
- South West (Taunton), 24 November 2024
- East of England (Ipswich), 30 November 2024
- South East (Folkestone), 1 December 2024
- North West (Preston), 7 December 2024
- London, 8 December 2024
The purpose of the regional public deliberative events was to engage a cross-section of the public in depth on the development of the 10 Year Health Plan. The timing of the events in autumn 2024 meant that they provided an opportunity to inform and shape early policy thinking (as opposed to testing specific policies that might be in the 10 Year Health Plan). Specifically, the events provided insight into:
- what success for the 10 Year Health Plan looks like for the public
- public responses to the 3 shifts
- what opportunities the public identify within the 3 shifts and what they feel should be prioritised for policy development
- any red lines which policymaking should aim to avoid
As part of this process, the public discussed questions which were pertinent to the policymaking process. These included:
- what are the public’s hopes and fears for a digitally enabled NHS?
- how should we make best use of a multidisciplinary NHS workforce to improve timeliness and quality of healthcare in the community?
- how should the NHS support people approaching the end of life?
- which services, currently delivered primarily in hospital settings, do the public want to see delivered in their community in future?
- what are the public’s responsibilities to manage their health and stay healthy?
- what support do the public want from a proactive government that recognises the value of good health?
The public deliberative events were divided into 2 stages.
Firstly, a warm-up event consisting of either a 2-hour online workshop delivered through Zoom or a one-hour telephone interview. The approach depended on participants’ needs and preferences.
The purpose of the warm-up events was to share more information about the engagement and the challenges the NHS is facing, as well as hear about participants’ experiences of the NHS. In addition, the warm-up events were an opportunity for participants to meet the facilitation team and each other before the face-to-face event and ask questions about the process. This helped to build confidence and comfort ahead of the in-person event.
Secondly, a full-day (6 hour) event. The majority of participants attended in person, but each regional event had at least one virtual table where participants who wished to take part but for any reason were not able to attend in-person dialled into the workshop through Zoom. The purpose of the event was to understand what success looks like for the 10 Year Health Plan and to develop recommendations for the 3 shifts.
High-level summary of the agenda
Warm-up event
To understand what the public feel is working well about the NHS and what the challenges are. The event shared information about the challenges facing the NHS and why a 10 Year Health Plan is needed and understanding the public’s priorities for change.
Expert library
Twenty videos of experts in the health sector were made available to participants through the Change NHS website - each expert shared their views on the challenges a shift is trying to address, what impact the shift might have and things the public should bear in mind.
Full day event morning session 1
To understand what success would look like for the 10 Year Health Plan: what would be different about the NHS in 10 years? What would be the same?
Full day event morning session 2
To share information about each of the shifts and discuss each shift including the perceived benefits, opportunities and concerns for each.
Full day event afternoon session 1
The room was split into 5 groups, with each set of tables focusing on one shift:
- technology
- hospital to community - the role of GPs and a multidisciplinary team
- hospital to community - services that could be delivered in the community
- hospital to community - end-of-life care
- prevention
At the conclusion of the discussion each table developed a set of recommendations, priorities and any red lines for the delivery of the shift.
Full day event afternoon session 2
Participants swapped tables to hear recommendations from another group - there was opportunity to ask questions, challenge and refine recommendations.
Inclusion
The deliberative events were designed to be as inclusive as possible
We took a number of steps to widen participation.
We took a dual approach to recruitment of the public deliberative events, where one-third of the sample was recruited purposively to ensure representation of seldom heard groups. This included Core20PLUS5 audiences who are more likely to experience worse health outcomes, those who interact more with the NHS, such as those living with multiple long-term health conditions and frailty, and those who are politically disengaged, such as those who do not typically participate in civic activities or say that they feel government does not listen to people like them.
We provided the offer of telephone interviews for anyone who could not take part in the online warm-up event on Zoom. Thirty participants took part in a telephone interview instead of attending the online workshop.
We hosted a virtual table at the full-day events where participants who were unable to attend in the room (for example, due to being immunocompromised, being a new parent or due to mobility issues restricting travel) were able to participate alongside the main room. Across all 7 regional events, 98 people participated online.
Individual depth interviews were offered with participants who were unable to take part in extended group discussions. The interviews followed the same structure and format as the group engagement. Nine people took part in an individual in-depth interview in place of the extended discussions. Seven took place over the phone and 2 were conducted in different languages (on Zoom).
All in-person events were hosted in fully accessible venues. Materials and questions were shared in advance with participants who required extra time to process information and 28 carers attended alongside participants (and were compensated for their time).
We used 2 channels to recruit the 755 participants.
Firstly, two-thirds of the sample were recruited through Sortition to be representative of the population by age, gender, ethnicity, location, disability, highest level of education attainment and by index of multiple deprivation.
Secondly, one-third of the sample was recruited to boost audiences who are typically seldom heard in engagement.
A full sample breakdown can be found in section 3.2 below.
The nature of deliberative events is that conversations take place in mixed groups. This is appropriate, given the focus on debate, learning from those with different experiences and reaching consensus. However, a consequence of this is that our ability to make robust sub-group comparisons from the deliberative events is limited. When discussing this element of the engagement in the report we have therefore reported primarily at the level of ‘participants at the deliberative events’ and made reference to differences between participants only when they were clearly expressed and identifiable from the data. Such differences should be seen as indicative.
Deliberative event with children and young people
We delivered a deliberative event with 27 children, young people and their parents. The event was held in London on 15 February 2025.
The purpose of the event was to engage children and young people in depth on the development of the 10 Year Health Plan. The overarching question for this event was ‘what do you want from the NHS in the future and what does success for the 10 Year Health Plan look like?’. Specifically, we explored:
- what is the NHS and healthcare
- what do children and young people expect the NHS to look like in 10 years’ time and what would success look like for the 10 Year Health Plan
- what do children and young people think about the 3 shifts
- what opportunities do children and young people identify within the 3 shifts and what do they see as the challenges
The event was held in person and was tailored to different age groups. Each key stage participated for a different length of time:
- participants in key stage 2 participated for 2 hours
- participants in key stage 3 participated for 3 hours
- participants in key stage 4 and post-16 education participated for 4 hours
Discussion questions and information materials were tailored to each key stage to ensure it was age appropriate and accessible.
We worked with specialist groups to design the event, including:
- The Children’s Commissioner
- Association for Young People’s Health
- The Royal College of Paediatrics and Child Health
- NHS young board members
We have provided a high-level summary of the agenda below.
High-level summary of the agenda
Welcome and introductions
To introduce children and parents to the workshop purpose and format, get children and young people comfortable working in small groups and share information to ensure children and young people understand the context and background to the discussion.
Exploring the 3 shifts
Sharing information to build a picture of understanding of each of the 3 shifts and exploring views and expectations on each shift, including benefits, concerns and opportunities.
NHS fit for the future
Exploring children and young people’s expectations of the healthcare system and what success would look like for the 10 Year Health Plan.
Inclusion and accessibility
There was a strong focus on inclusivity and accessibility for the children and young people deliberative event.
We created bespoke agendas and materials for each age group, with separate breakout groups for each, to ensure information shared and the questions explored were age appropriate. We also recruited children (except those aged 16 and over) in friendship pairs, enabling participants to feel comfortable and confident attending.
We asked participants to share views in a variety of different ways, including answering questions, filling in worksheets and working in pairs, to ensure participants were able to engage in at least one way that worked for them. We also used projective and enabling techniques such as responding to pen portraits to allow participants to respond to different stimulus.
We recruited 27 participants using a purposive sampling approach. We included quotas to ensure a diverse sample by age, gender, ethnicity and engagement with the NHS.
Participants in key stages 2 to 4 were recruited in friendship pairs and children under the age of 16 were accompanied by their parents.
A full sample breakdown can be found in section 3.3 below.
Online health and care staff events
We delivered 15 online events with a total of 2,537 health and care staff between 19 November and 3 December 2024.
The purpose of the online events was to engage a large number of the health and care workforce about the perceived benefits and barriers to delivering the 3 shifts. The purpose of the online events was to engage a large number of the health and care workforce about the perceived benefits and barriers to delivering the 3 shifts. Specifically, the events aimed to:
- understand staff’s current experiences of working in the NHS - what makes them proud and what gets in the way of doing great work
- understand staff’s views on the benefits of each shift, including testing ideas from the Change NHS website
- understand staff’s perceptions of the barriers to delivering the shifts
- understand what needs to change in the short and long term to ensure the shifts are a success
The events:
- lasted 90 minutes
- were delivered through Microsoft Teams and used Mentimeter (an interactive presentation software) to capture and share responses in real time
- focused on one shift per event (for example, 5 events focused on analogue to digital, 5 on hospital to community and 5 on prevention)
- included an ongoing live panel discussion with 2 staff members to reflect on the emerging insights from Mentimeter
We used Mentimeter, rather than a live group discussion, to collect data due to the size of the events. Each event was attended by between 100 to 250 members of staff. Having a live discussion (either in the chat or discursively) would not have been practical. This means the quotes from staff from the online events are often shorter and explanatory compared with the in-person events.
High-level summary of the agenda
Welcome and about you
To collect demographic and role information from participants and understand their experiences of working in the NHS, including what makes them proud and what gets in the way of doing their best work.
About the shift part 1
Sharing information about the shift and examples of where good practice is happening in the NHS already to understand views on the benefits of the shift, including rating ideas from the Change NHS website to understand which they thought had the greatest potential to achieve change.
About the shift part 2
To understand, based on staff’s experience, what barriers there are to delivering the shift, including examples of what has got in the way in the past and what staff think needs to change to make the shift successful, and what could change in the short term to deliver a significant impact.
Accessibility
Staff online events were designed to be as accessible as possible to a wide range of staff.
We ensured that events were delivered at different times across the day and on different days across the week to enable staff to choose the sessions they could.
Events were also widely publicised through bulletins and to all workforce participants on the Change NHS website.
We recruited the 2,537 participants through a range of channels, including:
- NHS England programme networks and targeted communications from chief professional officers
- professional and stakeholder body networks and communication channels
- targeted communication to members of the health and care workforce registered on the Change NHS website
The full sample breakdown can be found in section 3.4 below.
Health and care staff deliberative events
We delivered 7 day-long events with a total of 541 health and care staff between 11 February and 14 March 2025. We delivered an event in each of the NHS regions:
- North West (Liverpool), 11 February 2025
- North East and Yorkshire (Sheffield), 13 February 2025
- Midlands (Sutton Coldfield), 18 February 2025
- South East (Reading), 20 February 2025
- London, 25 February 2025
- East of England (Peterborough), 27 February 2025
- South West (Taunton), 4 March 2025
The purpose of the regional staff deliberative events was to engage a diverse range of staff working across health and care settings (including social care and local authorities) in depth on the development of the 10 Year Health Plan. Specifically, we explored what staff think the 10 Year Health Plan will need to take into account to ensure success (for each shift) and what staff think about cross-cutting issues on recruitment, retention, structural and cultural issues.
There were 2 components to the health and care staff deliberative events.
Firstly, a pre-event briefing consisting of an hour-long event on Microsoft Teams. The purpose of the event was to introduce staff to the 10 Year Health Plan, the 3 shifts, the agenda and discussion topics. We ran 3 briefings in total and attendance was optional. Staff were also able to access a website that contained this information if they preferred to do so.
Secondly, a full-day (6 hour) in-person event. The purpose of the event was to work in small discussion groups with a mix of staff roles and settings. Each group focused on a different shift. Staff were given the opportunity to prioritise which shift they wanted to discuss ahead of the events. Where possible, staff were then allocated by preference, while ensuring there was a diverse mix of staff discussing each shift.
High-level summary of the agenda
Deliberative event morning session 1
Sharing information about the shift to build collective understanding before moving into the detail of deliberation.
Deliberative event morning session 2
The second morning session was split between the 3 shifts.
Firstly, the groups focusing on analogue to digital had a discussion on getting the basics right: what would this mean for staff in their role? What should be prioritised and what the barriers are to achieving this? They then discussed the future potential and innovation in technology, including the enablers and barriers that staff face in their roles. Breakout groups discussed one of either:
- how can the NHS mirror other industries to become more digitally driven?
- how should the NHS embrace AI and what are the risks and your fears?
Secondly, the groups focusing on hospital to community had a discussion on the impact of moving more care into communities: what would this look like for staff? What are the benefits and risks, and how could these be overcome? How can staff be recruited, and retained, in community settings? They then discussed building trust and shared risk management between hospital and community services and understanding the challenges of moving patients between hospital and community settings and how the transfer of patient care between organisations and settings can be improved.
Thirdly, the groups focusing on sickness to prevention had a discussion on supporting patients to access preventative services. Breakout groups discussed at least one of the following:
- what helps to improve patient uptake of preventative services?
- how they would feel about the NHS more proactively encouraging access to prevention services?
- how can we better support marginalised groups to access preventative services?
- if funding is shifted from acute care to prevention, what should the NHS stop doing?
Deliberative afternoon session 1
The first afternoon session was split between the 3 shifts.
Firstly, the groups focusing on analogue to digital had a discussion to understand how this shift can be achieved while ensuring inclusion for staff and patients and addressing health inequalities.
Secondly, the groups focusing on hospital to community had a discussion on shifting to a model with greater emphasis on generalist skills. Breakout groups discussed either:
- what would encourage specialist clinicians to build their generalist skill sets or entice early-career staff to pursue a generalist route?
- how can non-clinical staff play a greater role in the co-ordination and delivery of care?
Thirdly, the groups focusing on sickness to prevention had a discussion on training and support for the workforce. Breakout groups discussed either:
- engaging patients on preventative services
- what does a culture of prevention look like in practice?
Deliberative event afternoon session 2
Staff shared their perspective on 2 cross-cutting issues. All groups covered at least one of the following:
- what does the NHS need to do differently as an employer, to be a great place to work?
- should areas in the country that struggle to recruit get additional funding to offer higher salaries?
- what cultural change is needed to deliver change across the shifts?
- what would need to be true to enable you to innovate or change things in your role?
Inclusion
We designed the event to be as inclusive as possible.
Steps included working with NHS regions to select locations that were conveniently located for staff to attend and providing financial support to release staff across health and care to attend the events.
We also held pre-event information drop-in sessions for participants and shared the materials ahead of the events.
Overall, 541 members of staff took part in these discussions. We used a purposive approach to recruitment to ensure a broad representation from across different staff types, care settings and communities, reflecting the diversity of the workforce. This included a spread of:
- professionals across acute, community, primary care and mental health
- professionals across each region aiming for representation across each ICS
- professionals working in urban, rural and coastal communities (where relevant)
- pay bands and roles
The specification was shared with each NHS region, who returned nominations which met the criteria. All nominations were checked by the Kaleidoscope Health and Care team before being invited to the event.
A full sample breakdown can be found in section 3.5 below.
Additional staff events
We delivered 8 events with 634 participants. The events were held between 21 March and 7 April 2025. There were 2 strands, each serving a different purpose:
- one set of events with 317 staff, focusing on engaging staff about the 3 shifts
- another set of events with 317 staff, held with groups who were under-represented in the in-person deliberative events, to ensure their views were captured in the engagement
Additional events focused on the 3 shifts
We ran 3 events, one focused on each of the 3 shifts. The purpose of these events was to ensure staff have the opportunity to share their experiences, thoughts and ideas to inform the development of the 10 Year Health Plan. In the events we also shared back what we heard from staff and the public in the engagement to gain their perspective. Finally, we explored emerging themes and key tensions related to each of the 3 shifts from the engagement and understand staff perspectives in more detail.
The events lasted 90 minutes and were delivered through Microsoft Teams and used Mentimeter to capture and share responses in real time. Each event focused on one shift and included a live panel discussion with 2 specialists to respond to, and reflect on, the emerging insights from Mentimeter.
High-level summary of the agenda
Welcome and what we’ve heard so far
To collect demographic and role information from participants, remind them of the 10 Year Health Plan and engagement participants so far and understand the perceived benefits, opportunities and concerns for each.
Focus on the perceived benefits, opportunities and concerns for each
Sharing information about the perceived benefits and concerns for the shift from engagement participants to understand views. Panel discussion to answer and share perspectives on responses from staff in the online event.
Focus on the areas of tension or dissonance from the engagement
Sharing information about an area of tension or dissonance from the engagement to understand views on the tension or area of dissonance and have a panel discussion to answer and share perspectives on responses from staff.
Inclusion
We designed these events to be as inclusive as possible.
We held the events online and over a lunchtime to maximise staff participation.
We recruited the 317 staff to these events by inviting the 4,700 staff who had previously registered for the online events delivered in autumn 2024. In total, participants covered 13 sectors and 16 role types.
The full sample breakdown can be found in section 3.6 below.
Additional events held with groups who were under-represented in the in-person deliberative events
We identified 5 groups that were under-represented in the deliberative events. They were:
- porters
- healthcare assistants
- primary care support staff
- nurses and allied health professionals (AHPs) in training
- staff from ethnic minority backgrounds
We ran a total of 5 events with these audiences (one event per audience), with a total of 317 participants. The purpose of the events was:
- firstly, to ensure staff that were under-represented in the deliberative events had the opportunity to share their experiences, thoughts and ideas to inform the development of the 10 Year Health Plan
- secondly, to share back what we heard from staff and the public in the engagement and gain their perspective
All events lasted 90 minutes, and the format of the event was tailored depending on the audience. For porters and healthcare assistants, the events were delivered in-person at hospital sites, and for primary care support staff, trainees and staff from ethnic minority backgrounds the events were held online using Microsoft Teams.
High-level summary of the agenda
Introduction to the 10 Year Health Plan and the 3 shifts
Firstly, to collect demographic and role information from participants and remind them of the 10 Year Health Plan and engagement so far. Secondly, to understand to what extent the barriers to change resonates with staff experiences, what might be missing and the biggest challenges to achieving the shifts successfully.
What is needed to help staff innovate and change things in their role
Sharing information about staff perspectives on this topic to understand views on inefficiencies they see in day-to-day work and what would enable staff to innovate and change things in their role.
What would the NHS need to do differently to be a great place to work
Sharing information about staff perspectives on this topic to understand views on perspectives from engagement so far and what would attract people to work in community settings, or how the NHS can reduce instances of racism, sexism, bullying and discrimination.
Inclusion
We designed these events to be as inclusive as possible.
All materials, including slides, were provided to participants before and after sessions to read in their own time. When delivering face-to-face, we selected locations that were conveniently located for staff and met accessibility needs.
We held online events at a range of different times and days to provide a range of options for staff to attend a session that best suited them.
We used a tailored approach to recruit these audiences.
Firstly, for porters and healthcare assistants, we worked directly with specific NHS trusts to reach out to staff in their workplace.
Secondly, for primary care support staff, trainees and staff from ethnic minority backgrounds, we shared details through professional and stakeholder bodies and NHS England networks, and opened up registration to staff that had registered for the online events in November 2024 and relevant staff registered on the Change NHS website.
The full sample breakdown can be found in section 3.7 below.
The national summit
We reconvened 258 public and staff participants from the regional events to a national summit on 4 April 2025.
The national summit session was the culmination of Change NHS. The purpose was to:
- showcase the impact of public and staff contributions so far to the delivery of the 10 Year Health Plan
- give an opportunity to discuss and deliberate remaining questions, tensions or policy ideas to feed into the development of the 10 Year Health Plan
- provide robust representation of the public and NHS workforce from each region of England, including seldom heard voices
Notably, the summit shared a new model of care with participants if all 3 shifts were implemented successfully. Participants worked through the model using deliberative pen portraits to share their feedback and concerns.
The summit was delivered in-person in London. It consisted of a full-day (6 hour) session with 184 public participants and 74 staff participants. Participants took part in small group discussions on mixed tables (including both public and staff) to hear a diversity of perspectives.
High-level summary of the agenda
Welcome and introductions
Welcome participants back to the national summit as the culmination of the engagement.
What we’ve heard so far
Sharing back the key findings of the engagement to date and exploring views and reactions of participants, including exploring differences in staff and public views.
Personalised care
Introducing the concept of more personalised care in the NHS in the future, and what this might look like. Exploring views on delivering more personalised care in the NHS, how this will work in practice and expectations for the future.
Inclusion and accessibility
We designed the event to ensure public and staff could attend the large-scale national summit and that it was as inclusive as possible.
We ensured that the venue was fully accessible. We offered BSL interpreters and hearing loops to those who may need them and provided easy read stimulus to ensure everyone could engage with the materials.
We covered travel costs and provided accommodation for those who lived further from the venue and would not be able to attend without an overnight stay. Chaperones or carers were allowed to support those who needed them.
As noted above, all participants who attended the national summit had previously attended either the public or staff regional deliberative events. We designed an ideal sample for the 300 participants who would attend the summit.
This included 200 public participants, of which 150 were to be nationally representative by age, gender, ethnicity, region, highest level of educational attainment and index of multiple deprivation. We also recruited 50 participants to ensure there was good representation of groups who are seldom heard in engagement.
We recruited 100 health and care staff participants to reflect the diversity of region, roles, settings and pay bands in the system.
To recruit participants to the national summit, we contacted all participants by email to express an interest in attending the national summit. We then selected from those who expressed interest to match the ideal sample criteria - others were placed on a waiting list and invited to attend if there were dropouts.
Full demographics can be found in the section 3.8 below.
For public participants who wanted to take part in the national summit, but were unable to attend an all-day, in-person event, we offered a virtual drop-in session. This 2-hour online session was attended by 11 participants and was an opportunity to hear a summary of the key findings from Change NHS and get a flavour of the discussions that happened on tables in the summit. All participants in the drop-in were able to give their views on key questions through Mentimeter, with support offered by facilitators to use this tool for those who wanted it.
Community engagement
We delivered a large-scale programme of community engagement. In total, 658 workshops were delivered in local communities between 18 November 2024 and 14 February 2025, reaching a total of 17,601 participants.
There were 2 main purposes of the community engagement.
Firstly, to reach audiences which are often seldom heard in engagement exercises, including the Core20PLUS5 audiences, such as people with multiple long-term health conditions, people from ethnic minority backgrounds and those with learning disabilities and/or autism.
Secondly, to add a place-based dimension to the engagement - we did this through supporting community organisations to engage people in the places they live and congregate, ensuring these individuals had the opportunity to have their voices heard.
There were 3 stages to the community engagement.
Design
We worked with a co-creation group organised by NHS England and DHSC to design a ‘Workshop in a box (WIAB). Members of the co-creation group were drawn from local systems across England. The design of the WIAB was based on the design of the public deliberative events (see section 3.6). As with those events, it aimed to understand:
- what success for the 10 Year Health Plan looks like
- responses to the 3 shifts
- opportunities, priorities and any red lines for the delivery of the shifts
Materials were hosted on the Change NHS website.
Briefing
To support dissemination of the WIAB, we ran 23 briefing sessions, each lasting one hour. A total of 595 people attended these briefings from a wide range of groups including but not limited to:
- representatives of integrated care boards (ICBs)
- representatives of VCSE organisations
- members of the NHS workforce
- MPs and/or their teams
Delivery
Any individual or organisation could run their own workshop in their local community. Although it was open to anyone, we strongly encouraged local health systems to run workshops with seldom heard audiences where possible - for example, health inclusion groups and Core20PLUS5 audiences. Workshop facilitators then shared insights back through the Change NHS website.
Accessibility and inclusion
To achieve the objective of meaningful engagement with seldom heard audiences, there was a strong focus on accessibility and inclusion.
For example, the WIAB was provided in easy read and BSL.
Health system leader engagement
DHSC led engagement with 650 health system leaders in each of the 7 NHS regions. This included NHS regional staff, ICB and trust leaders and senior system partners.
The purpose of the health system leader engagement was to gather feedback and insights that will support the development of the 10 Year Health Plan and facilitate open and meaningful debate about each of the 3 shifts.
Partner engagement
DHSC led engagement with partner organisations who have an interest in the 10 Year Health Plan. This included (but was not limited to) charities, community interest companies, education institutes, patient groups and think tanks. In total, over 1,800 partners shared their views.
The purpose of the partner engagement was to understand organisational (rather than individual) perspectives on the NHS and priorities for change and understand views on the 3 shifts, including the biggest opportunities and barriers in each.
There were 3 components to the partner engagement.
An open submissions process
Any organisation with an interest in the 10 Year Health Plan was invited to answer 5 questions on the Change NHS website between 21 October and 2 December 2024. A total of 1,650 organisations responded.
Questions were designed to explore views on what organisations wanted to see in the 10 Year Health Plan, and the biggest challenges and enablers they associated with each of the 3 shifts.
The Partners Council
DHSC met with partners from across the health and care sector. There was a total of 240 organisations in the Partners Council. The council met 4 times between November 2024 and June 2025.
Meetings involved DHSC sharing updates on the engagement process and seeking more detailed insights on findings from partners.
Roundtables
DHSC led thematic roundtables with organisations between January and May 2025. There was a total of 17 roundtables, and nearly 300 organisations attended at least one roundtable. Organisations ranged from small voluntary and community groups to large NHS trusts, professional bodies and national charities.
Some roundtables focused on a specific issue, exploring these in the context of the 3 shifts, while others examined cross-cutting themes.
3. Engagement sample
3.1 Change NHS website
‘Start here’ survey: public
See below tables setting out the demographics of the Change NHS website public participants who responded to the ‘Start here’ survey, compared with nationally representative data from Office for National Statistics (ONS) Census 2021.
Note: the Change NHS website was not targeted at under 16s as it was not possible to gain parental consent, so no data from under 16s is included in the analysis. Direct comparisons with the 2021 Census for disability and carers should also be treated with caution because question design differs.
Table 2: public participants who responded to the ‘Start here’ survey, by age
| Age | % of this segment | % of general public |
|---|---|---|
| Under 16 | 0% | 19% |
| 16 to 24 | 3% | 11% |
| 25 to 34 | 10% | 14% |
| 35 to 44 | 13% | 13% |
| 45 to 54 | 18% | 13% |
| 55 to 64 | 26% | 13% |
| 65 to 74 | 21% | 10% |
| 75 to 84 | 8% | 6% |
| 85 and above | 1% | 2% |
Table 3: public participants who responded to the ‘Start here’ survey, by sex
| Sex | % of this segment | % of general public |
|---|---|---|
| Male | 33% | 49% |
| Female | 65% | 51% |
Table 4: public participants who responded to the ‘Start here’ survey, by gender
| Gender | % of this segment | % of general public |
|---|---|---|
| Identify as their sex registered at birth | 96% | 93% |
| Do not identify as their sex registered at birth | 2% | 1% |
| Did not answer or prefer not to say | 2% | 6% |
Table 5: public participants who responded to the ‘Start here’ survey, by ethnicity
| Ethnicity | % of this segment | % of general public |
|---|---|---|
| White | 81% | 92% |
| Asian or Asian British | 10% | 3% |
| Mixed or Multiple ethnic groups | 3% | 2% |
| Black, African, Caribbean or Black British | 4% | 1% |
| Other | 2% | 1% |
Table 6: public participants who responded to the ‘Start here’ survey, by disability or long-term illness
| Disability or long-term illness | % of this segment | % of general public |
|---|---|---|
| Yes - any | 46% | 17% |
| Long-standing illness | 27% | n/a |
| Physical or mobility | 12% | n/a |
| Mental health condition | 11% | n/a |
| Sensory | 5% | n/a |
| Neurodivergent condition | 4% | n/a |
| Learning disability or difficulty | 2% | n/a |
| Other | 1% | n/a |
| Prefer not to say | 2% | n/a |
Table 7: public participants who responded to the ‘Start here’ survey, by whether they provide informal care
| Provide informal care | % of this segment | % of general public |
|---|---|---|
| Yes | 49% | 9% |
| No | 51% | 91% |
Note: direct comparisons with the 2021 Census for caring responsibility should be treated with caution because question design differs. There is no direct comparison with Census data in terms of type of disability, so this has not been included in the analysis.
Table 8: public participants who responded to the ‘Start here’ survey, by region
| Region | % of this segment | % of general public |
|---|---|---|
| North East and Yorkshire | 14% | 15% |
| North West | 13% | 13% |
| East of England | 8% | 11% |
| Midlands | 18% | 19% |
| London | 11% | 16% |
| South West | 14% | 10% |
| South East | 19% | 16% |
Table 9: postcodes of public participants who responded to the ‘Start here’ survey (index score, compared with nationally representative data)
| Postcode area | Index versus general public (Census) |
|---|---|
| Dorchester | 165 |
| Truro | 165 |
| Cambridge | 157 |
| Brighton | 142 |
| Torquay | 135 |
| Leeds | 134 |
| Exeter | 133 |
| Hereford | 133 |
| Bristol | 132 |
| Harrogate | 131 |
| Gloucester | 131 |
| Derby | 130 |
| St Albans | 129 |
| Stockport | 128 |
| Lincoln | 128 |
| Plymouth | 128 |
| Guildford | 127 |
| York | 127 |
| Stevenage | 126 |
| Telford | 126 |
| Oxford | 125 |
| Carlisle | 125 |
| Darlington | 125 |
| Lancaster | 124 |
| Norwich | 123 |
| Worcester | 123 |
| Taunton | 122 |
| Bath | 122 |
| Southampton | 122 |
| Crewe | 120 |
| Canterbury | 119 |
| Tunbridge Wells | 118 |
| Bournemouth | 117 |
| Salisbury | 116 |
| Redhill | 115 |
| Halifax | 115 |
| Huddersfield | 115 |
| Nottingham | 114 |
| Hemel Hempstead | 113 |
| Portsmouth | 113 |
| Reading | 112 |
| Preston | 111 |
| Sheffield | 107 |
| Newcastle upon Tyne | 106 |
| Warrington | 106 |
| Stoke-on-Trent | 105 |
| East Central London | 103 |
| Milton Keynes | 103 |
| Ipswich | 103 |
| Swindon | 102 |
| Coventry | 99 |
| Kingston upon Thames | 99 |
| South East London | 98 |
| Peterborough | 98 |
| Blackpool | 97 |
| Northampton | 97 |
| Chester | 95 |
| Chelmsford | 95 |
| Bolton | 94 |
| Leicester | 94 |
| Bromley | 92 |
| Medway | 92 |
| Durham | 92 |
| Wakefield | 90 |
| Manchester | 90 |
| Colchester | 88 |
| South West London | 88 |
| Watford | 87 |
| Dartford | 82 |
| Southend-on-Sea | 81 |
| Hull | 80 |
| Liverpool | 80 |
| Teesside | 80 |
| Sutton | 79 |
| Blackburn | 78 |
| Wigan | 77 |
| Bradford | 75 |
| Doncaster | 74 |
| Walsall | 72 |
| Croydon | 72 |
| Oldham | 71 |
| North London | 71 |
| Twickenham | 68 |
| Sunderland | 68 |
| West London | 68 |
| Dudley | 67 |
| Birmingham | 66 |
| Slough | 63 |
| Enfield | 62 |
| Luton | 61 |
| East London | 57 |
| West Central London | 54 |
| North West London | 52 |
| Wolverhampton | 50 |
| Harrow | 47 |
| Ilford | 42 |
| Romford | 36 |
| Southall | 28 |
‘Start here’ survey: workforce
The tables below set out the demographics of the Change NHS website workforce participants who responded to the ‘Start here’ survey, compared with NHS Staff Survey data. Please note direct comparisons with the NHS Staff Survey should be treated with caution for all data because question design differs.
Table 10: workforce participants who responded to the ‘Start here’ survey, by age
| Age | % of Change NHS website participants | Age | % of NHS Staff Survey 2023 |
|---|---|---|---|
| 16 to 24 | 3% | 16 to 20 | 1% |
| 25 to 34 | 15% | 21 to 30 | 16% |
| 35 to 44 | 21% | 31 to 40 | 26% |
| 45 to 54 | 28% | 41 to 50 | 25% |
| 55 to 64 | 27% | 51 to 65 | 32% |
| 65 and above | 7% | 66 and above | 2% |
Table 11: workforce participants who responded to the ‘Start here’ survey, by sex
| Sex | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Male | 23% | 21% |
| Female | 75% | 75% |
Table 12: workforce participants who responded to the ‘Start here’ survey, by gender
| Gender | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Identify as their sex registered at birth | 96% | 96% |
| Do not identify as their sex registered at birth | 1% | less than 1% |
Table 13: workforce participants who responded to the ‘Start here’ survey, by ethnicity
| Ethnicity | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| White | 75% | 89% |
| Asian or Asian British | 14% | 4% |
| Mixed or Multiple ethnic groups | 2% | 2% |
| Black, African, Caribbean or Black British | 8% | 2% |
| Other | 1% | 1% |
Table 14: workforce participants who responded to the ‘Start here’ survey, by disability or long-term illness
| Disability or long-term illness | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Yes - any | 34% | 25% have a condition expected to last for 12 months or more |
Table 15: workforce participants who responded to the ‘Start here’ survey, by region
| Region | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| North East and Yorkshire | 16% | 16% |
| North West | 13% | 14% |
| East of England | 8% | 9% |
| Midlands | 19% | 19% |
| London | 10% | 10% |
| South West | 14% | 14% |
| South East | 16% | 15% |
Table 16: workforce participants who responded to the ‘Start here’ survey, by tenure of service
| Tenure of service | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Less than 1 year | 11% | 2% |
| 1 to 2 years | 16% | 6% |
| 3 to 5 years | 19% | 12% |
| 6 to 10 years | 18% | 16% |
| 11 years or more | 36% | 64% |
‘Your priorities for change’ survey: public
The tables below set out the demographics of the Change NHS website public participants who responded to the ‘Your priorities for change’ survey, compared with nationally representative data from the ONS Census 2021.
Table 17: public participants who responded to the ‘Your priorities for change’ survey, by age
| Age | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| Under 16 | 0% | 19% |
| 16 to 24 | 2% | 11% |
| 25 to 34 | 6% | 14% |
| 35 to 44 | 10% | 13% |
| 45 to 54 | 16% | 13% |
| 55 to 64 | 26% | 13% |
| 65 to 74 | 27% | 10% |
| 75 to 84 | 11% | 6% |
| 85 and above | 1% | 2% |
Table 18: public participants who responded to the ‘Your priorities for change’ survey, by sex
| Sex | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| Male | 32% | 49% |
| Female | 67% | 51% |
Table 19: public participants who responded to the ‘Your priorities for change’ survey, by gender
| Gender | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| Identify as their sex registered at birth | 96% | 93% |
| Do not identify as their sex registered at birth | 2% | 1% |
| Did not answer or prefer not to say | 2% | 6% |
Table 20: public participants who responded to the ‘Your priorities for change’ survey, by ethnicity
| Ethnicity | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| White | 81% | 93% |
| Asian or Asian British | 10% | 2% |
| Mixed or Multiple ethnic groups | 3% | 2% |
| Black, African, Caribbean or Black British | 4% | 1% |
| Other | 2% | 1% |
Table 21: public participants who responded to the ‘Your priorities for change’ survey, by disability or long-term illness
| Disability or long-term illness | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| Yes - any | 51% | 17% |
| Long-standing illness | 31% | Not available |
| Physical or mobility | 13% | Not available |
| Mental health condition | 11% | Not available |
| Neurodivergent condition | 7% | Not available |
| Sensory | 6% | Not available |
| Learning disability or difficulty | 2% | Not available |
| Other | 1% | Not available |
| Prefer not to say | 2% | Not available |
Table 22: public participants who responded to the ‘Your priorities for change’ survey, by whether they provide informal care
| Provide informal care | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| Yes | 46% | 9% |
| No | 54% | 91% |
Note: direct comparisons with the 2021 Census for caring responsibility should be treated with caution because question design differs. There is no direct comparison with Census data in terms of type of disability, so this has not been included in the analysis.
Table 23: public participants who responded to the ‘Your priorities for change’ survey, by region
| Region | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| North East and Yorkshire | 13% | 15% |
| North West | 11% | 13% |
| East of England | 9% | 11% |
| Midlands | 16% | 19% |
| London | 11% | 16% |
| South West | 15% | 10% |
| South East | 21% | 16% |
Table 24: postcodes of public participants who responded to the ‘Your priorities for change’ survey (index score, compared with nationally representative data)
| Postcode area | Index versus general public (Census) |
|---|---|
| Dorchester | 192 |
| Exeter | 187 |
| Cambridge | 177 |
| Oxford | 165 |
| Taunton | 164 |
| Worcester | 159 |
| Bristol | 158 |
| Southampton | 153 |
| Brighton | 146 |
| Plymouth | 145 |
| Halifax | 145 |
| Norwich | 145 |
| Truro | 144 |
| Canterbury | 144 |
| Torquay | 142 |
| Swindon | 139 |
| Gloucester | 137 |
| Durham | 136 |
| Reading | 132 |
| Redhill | 130 |
| York | 126 |
| Bath | 126 |
| Portsmouth | 124 |
| Crewe | 124 |
| Bournemouth | 123 |
| Preston | 122 |
| Ipswich | 121 |
| Kingston upon Thames | 118 |
| Tunbridge Wells | 117 |
| St Albans | 117 |
| Stevenage | 117 |
| Telford | 116 |
| Stockport | 116 |
| Nottingham | 113 |
| Huddersfield | 112 |
| Guildford | 112 |
| Newcastle upon Tyne | 111 |
| Lincoln | 106 |
| Leeds | 104 |
| Hereford | 104 |
| Blackpool | 102 |
| Watford | 102 |
| Lancaster | 101 |
| Hull | 101 |
| East Central London | 100 |
| South East London | 100 |
| South West London | 98 |
| Carlisle | 97 |
| Harrogate | 97 |
| Derby | 97 |
| Hemel Hempstead | 96 |
| Wigan | 94 |
| Salisbury | 92 |
| Warrington | 91 |
| Northampton | 91 |
| Sheffield | 90 |
| Colchester | 89 |
| Milton Keynes | 89 |
| Peterborough | 88 |
| Stoke-on-Trent | 87 |
| Coventry | 85 |
| Wakefield | 84 |
| Sutton | 84 |
| West London | 82 |
| Bromley | 82 |
| Leicester | 81 |
| Slough | 80 |
| Chester | 79 |
| Darlington | 79 |
| Oldham | 78 |
| Southend-on-Sea | 78 |
| Bolton | 77 |
| Liverpool | 77 |
| Medway | 75 |
| Dartford | 74 |
| Twickenham | 74 |
| Manchester | 73 |
| North London | 72 |
| North West London | 72 |
| Chelmsford | 70 |
| Birmingham | 70 |
| Luton | 70 |
| Enfield | 68 |
| Croydon | 68 |
| Blackburn | 60 |
| Walsall | 58 |
| Dudley | 58 |
| Doncaster | 57 |
| Sunderland | 56 |
| East London | 56 |
| Bradford | 56 |
| Teesside | 55 |
| Wolverhampton | 54 |
| Harrow | 49 |
| Southall | 48 |
| Romford | 45 |
| West Central London | 41 |
| Ilford | 36 |
‘Your priorities for change’ survey: workforce
The tables below set out the demographics of the Change NHS website workforce participants who responded to the ‘Your priorities for change’ survey, compared with NHS Staff Survey data.
Note: direct comparisons with the NHS Staff Survey should be treated with caution for all data because question design differs.
Table 25: workforce participants who responded to the ‘Your priorities for change’ survey, by age
| Age | % of Change NHS website participants | Age | % of NHS Staff Survey 2023 |
|---|---|---|---|
| 16 to 24 | 2% | 16 to 20 | 1% |
| 25 to 34 | 11% | 21 to 30 | 16% |
| 35 to 44 | 20% | 31 to 40 | 26% |
| 45 to 54 | 28% | 41 to 50 | 25% |
| 55 to 64 | 30% | 51 to 65 | 32% |
| 65 and above | 8% | 66 and above | 2% |
Table 26: workforce participants who responded to the ‘Your priorities for change’ survey, by sex
| Sex | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Male | 22% | 21% |
| Female | 76% | 75% |
Table 27: workforce participants who responded to the ‘Your priorities for change’ survey, by gender
| Gender | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Identify as their sex registered at birth | 96% | 96% |
| Do not identify as their sex registered at birth | 1% | less than 1% |
Table 28: workforce participants who responded to the ‘Your priorities for change’ survey, by ethnicity
| Ethnicity | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| White | 75% | 90% |
| Asian or Asian British | 14% | 4% |
| Mixed or Multiple ethnic groups | 2% | 2% |
| Black, African, Caribbean or Black British | 8% | 1% |
| Other | 1% | 1% |
Table 29: workforce participants who responded to the ‘Your priorities for change’ survey, by disability or long-term illness
| Disability or long-term illness | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Yes - any | 39% | 25% have a condition expected to last for 12 months or more |
Table 30: workforce participants who responded to the ‘Your priorities for change’ survey, by region
| Region | % of Change NHS website participants | % of general public (Census) |
|---|---|---|
| North East and Yorkshire | 15% | 16% |
| North West | 14% | 14% |
| East of England | 8% | 9% |
| Midlands | 18% | 19% |
| London | 10% | 10% |
| South West | 16% | 14% |
| South East | 18% | 15% |
Table 31: workforce participants who responded to the ‘Your priorities for change’ survey, by tenure of service
| Tenure of service | % of Change NHS website participants | % of NHS Staff Survey 2023 |
|---|---|---|
| Less than 1 year | 11% | 2% |
| 1 to 2 years | 16% | 5% |
| 3 to 5 years | 19% | 11% |
| 6 to 10 years | 18% | 15% |
| 11 years or more | 36% | 66% |
3.2. Public deliberative events
Overview of participation: all locations (Sortition)
Two-thirds of the sample were recruited through Sortition to be representative of the population by age, gender, ethnicity, location, disability, highest level of education attainment and by index of multiple deprivation. Other characteristics (such as experiencing of certain care settings or having caring responsibilities) were naturally present in this cohort.
Overall, 447 out of 755 participants who attended the events were recruited through Sortition.
[note 1] denotes missing data from some participants, hence percentages do not add up to 100%.
Table 32: characteristics of participants at public deliberative events (all locations)
| Characteristic | Target | Achieved (number equals 447) |
|---|---|---|
| Gender: male | 48.5% | 47.7% |
| Gender: female | 51.5% | 51.7% |
| Gender: other | less than 1% | 0.7% |
| Age[note 1]: 16 to 24 | 13.1% | 13.2% |
| Age[note 1]: 25 to 34 | 16.6% | 13.9% |
| Age[note 1]: 35 to 44 | 16.4% | 15.7% |
| Age[note 1]: 45 to 54 | 15.4% | 14.8% |
| Age[note 1]: 55 to 64 | 15.6% | 17.0% |
| Age[note 1]: 65 to 74 | 11.6% | 13.2% |
| Age[note 1]: 75 and above | 11.3% | 11.9% |
| Ethnicity: White | 81% | 81% |
| Ethnicity: ethnic minority background | 19% | 19% |
| Disability[note 1]: yes | 17.7% | 16.6% |
| Disability[note 1]: no | 82.3% | 81.9% |
| IMD[note 1]: 1 to 2 | 20% | 18% |
| IMD[note 1]: 3 to 4 | 20% | 21% |
| IMD[note 1]: 5 to 6 | 20% | 21% |
| IMD[note 1]: 7 to 8 | 20% | 21% |
| IMD[note 1]: 9 to 10 | 20% | 18% |
| Urban[note 1]: urban | 82.9% | 81% |
| Urban[note 1]: rural | 17.1% | 18.1% |
| Education[note 1]: none | 18.2% | 10% |
| Education[note 1]: level 1 to 3 | 45.2% | 42% |
| Education[note 1]: level 4 | 33.9% | 38% |
| Education[note 1]: other | 2.8% | 7% |
Overview of participation: under-represented groups (purposive)
A third of the sample was audiences who are typically seldom heard in engagement. This included participants from the Core20PLUS5 audiences and other groups such as participants with caring responsibilities and those who are less engaged in politics and civic participation. These groups are not mutually exclusive.
As participants were purposively recruited to these groups, quotas on other demographics (such as gender or age) were not representative. For example, women are more likely to have caring responsibilities than men.
Overall, 308 out of 755 participants who attended the events were recruited purposively. The table below shows how many participants were purposively recruited to these events.
Table 33: characteristics of participants from under-represented groups at public deliberative events
| Characteristic | Count |
|---|---|
| From an ethnic minority background | 80 |
| Living in a more deprived area - that is, IMD 1 to 2 | 53 |
| Learning disability, neurodiverse (for example, Down’s syndrome, cerebral palsy, ADHD) or with lower literacy levels | 38 |
| No formal education | 26 |
| Speak English as a second language | 23 |
| Multiple long-term health conditions and/or disabled under the Equality Act | 100 |
| Pregnant or have had a baby in the last 12 months | 32 |
| Diagnosed with cancer in the last 24 months | 19 |
| COPD or severe asthma | 22 |
| Have had a stroke in the last 3 years | 13 |
| Have accessed mental health services for a severe mental illness | 72 |
| Struggle with getting around (potentially living with frailty) | 129 |
| Often needs help completing day to day tasks (potentially living with frailty) | 107 |
| Informal carers | 78 |
| Informal carer aged 16 to 25 (included in the above) | 4 |
| Loved one in receipt of formal social care | 55 |
| LGBTQIA+ | 56 |
| Identify with a different gender from their sex registered at birth | 21 |
| Those with no fixed address | 3 |
| Digitally excluded or disengaged | 41 |
| Politically disengaged | 97 |
3.3 Children and young people workshop
Table 34: characteristics of the 27 children and young people who participated in the children and young people’s workshop in London
| Characteristic | Count |
|---|---|
| Age: 7 to 11 | 12 |
| Age: 12 to 13 | 4 |
| Age: 14 to 15 | 6 |
| Age: 16 and above | 5 |
| Sex: boys | 14 |
| Sex: girls | 13 |
| Ethnicity: White | 8 |
| Ethnicity: Asian or Asian British | 7 |
| Ethnicity: Black, African, Caribbean or Black British | 4 |
| Ethnicity: Mixed | 8 |
| Key stage 2 | 12 |
| Key stage 3 | 6 |
| Key stage 4 | 4 |
| Post-16 education | 5 |
| Have engaged with NHS services in last 12 months | 26 |
Please note: in addition to this workshop there were a further 17 events held with children and young people through WIAB events. As well a workshop led by the Royal College of Paediatrics and Child Health (RCPCH) and a youth summit held by DHSC in collaboration with Barnardo’s. In total, 239 children and young people participated in workshops and a further 2,000 were engaged through a survey by RCPCH and Child Health and Us, replicating content on Change NHS.
3.4 Staff online events (December 2024)
Note: 1,771 out of 2,537 participants in the online staff events shared demographic information through Menti. Sample information is shared below.
Table 35: participants of the staff online events, by age
| Age | Count |
|---|---|
| 16 to 24 | 13 |
| 25 to 34 | 184 |
| 35 to 44 | 394 |
| 45 to 54 | 506 |
| 55 to 64 | 400 |
| 65 to 74 | 42 |
| 75 to 84 | 5 |
| Prefer not to say | 19 |
| No response | 208 |
| Total | 1,771 |
Table 36: participants of the staff online events, by gender
| Gender | Count |
|---|---|
| Female | 1,188 |
| Male | 340 |
| Non-binary | 5 |
| Other | 2 |
| Prefer not to say | 25 |
| No response | 211 |
| Total | 1,771 |
Table 37: participants of the staff online events, by ethnicity
| Ethnicity | Count |
|---|---|
| White | 1,360 |
| Asian or Asian British | 76 |
| Black, African, Caribbean or Black British | 46 |
| Mixed | 30 |
| Other | 15 |
| Prefer not to say | 34 |
| No response | 210 |
| Total | 1,771 |
Table 38: participants of the staff online events, by disability or long-term health condition
| Disability or long-term health condition | Count |
|---|---|
| No disability reported | 1,220 |
| Long-standing illness or health condition | 148 |
| Neurodivergent condition | 63 |
| Physical or mobility impairment | 44 |
| Sensory impairment | 26 |
| Mental health condition | 26 |
| Learning disability or difficulty | 19 |
| Prefer not to say | 35 |
| No response | 189 |
| Other | 1 |
| Total | 1,771 |
Table 39: participants of the staff online events, by length of time working in health and care
| Length of time working in health and care | Count |
|---|---|
| 20 years or more | 786 |
| 11 to 20 years | 423 |
| 6 to 10 years | 188 |
| 3 to 5 years | 147 |
| 1 to 2 years | 60 |
| Less than 1 year | 33 |
| No response | 132 |
| Other responses | 2 |
| Total | 1,771 |
Table 40: participants of the staff online events, by region
| Region | Count |
|---|---|
| North East and Yorkshire | 291 |
| Midlands | 288 |
| South West | 274 |
| South East | 264 |
| North West | 236 |
| London | 156 |
| East of England | 129 |
| No response | 133 |
| Total | 1,771 |
Table 41: participants of the staff online events, by role
| Role | Count |
|---|---|
| Managerial or executive staff | 299 |
| Administrative or clerical staff | 264 |
| Nurse | 240 |
| AHP | 218 |
| Pharmacist or pharmacy technician | 133 |
| Other healthcare professional | 60 |
| Consultant | 59 |
| GP | 49 |
| Psychologist or psychological therapist | 35 |
| Public health consultant or specialist | 31 |
| General practice manager and staff | 29 |
| Midwife | 27 |
| Healthcare scientist or technician | 24 |
| Other roles | 163 |
| No response | 140 |
| Total | 1,771 |
Table 42: participants of the staff online events, by type of organisation
| Type of health and care organisation | Count |
|---|---|
| NHS trust - acute | 425 |
| Integrated care system (ICS) or ICB | 280 |
| NHS trust - community | 258 |
| NHS trust - mental health | 171 |
| NHS primary care - GP practice | 117 |
| NHS arm’s length body | 116 |
| Other health and care organisation | 62 |
| Voluntary or charitable organisation | 41 |
| Local authority or council | 39 |
| Community interest company (CIC) | 33 |
| Other healthcare settings | 95 |
| No response | 134 |
| Total | 1,771 |
3.5 Staff deliberative events
Note: 455 of the 541 participants shared their demographic data through Menti during the events.
Table 43: participants of the staff deliberative events, by age
| Age | Count |
|---|---|
| 16 to 24 | 4 |
| 25 to 34 | 62 |
| 35 to 44 | 128 |
| 45 to 54 | 170 |
| 55 to 64 | 82 |
| 65 and above | 6 |
| Prefer not to say | 3 |
| Total | 455 |
Table 44: participants of the staff deliberative events, by gender
| Gender | Count |
|---|---|
| Female | 330 |
| Male | 119 |
| Prefer not to say | 6 |
| Total | 455 |
Table 45: participants of the staff deliberative events, by ethnicity
| Ethnicity | Count |
|---|---|
| White | 361 |
| Asian or Asian British | 48 |
| Black, African, Caribbean or Black British | 23 |
| Mixed | 12 |
| Other | 5 |
| Prefer not to say | 6 |
| Total | 455 |
Table 46: participants of the staff deliberative events, by disability or long-term health condition
| Disability or long-term health condition | Count |
|---|---|
| No | 386 |
| Yes - long-standing illness or health condition | 26 |
| Prefer not to say | 11 |
| Yes - sensory impairment - for example, hearing or visual | 10 |
| Yes - neurodivergent condition | 10 |
| Yes - physical or mobility impairment | 7 |
| Yes - learning disability or difficulty | 3 |
| Yes - mental health condition | 2 |
| Total | 455 |
Table 47: participants of the staff deliberative events, by length of time working in health and care
| Length of time working in health and care | Count |
|---|---|
| Less than 1 year | 2 |
| 1 to 2 years | 10 |
| 3 to 5 years | 36 |
| 6 to 10 years | 66 |
| 11 years or more | 341 |
| Total | 455 |
Table 48: participants of the staff deliberative events, by current primary role
| Current primary role | Count |
|---|---|
| Managerial or executive staff | 96 |
| Nurse | 39 |
| Public health consultant or specialist | 33 |
| Administrative or clerical staff | 33 |
| AHP | 30 |
| GP | 22 |
| Consultant | 22 |
| Social worker | 18 |
| Resident doctor | 18 |
| Pharmacist or pharmacy technician | 12 |
| Paramedic or ambulance worker | 12 |
| Other healthcare professional | 11 |
| Dentist or dental care professional | 11 |
| Public health practitioner or trainer | 10 |
| General practice manager and wider staff | 9 |
| Healthcare assistant or clinical support worker | 8 |
| Ambulance worker | 8 |
| Midwife | 8 |
| Estates and facilities staff | 7 |
| General practice nurse | 6 |
| Optometrist or optician | 6 |
| Health visitor | 6 |
| Healthcare scientist or technician | 6 |
| Social care support staff | 6 |
| Community pharmacist | 5 |
| Specialist doctor | 5 |
| Direct care worker - social care | 4 |
| Public health nurse | 4 |
| Total | 455 |
Table 49: participants of the staff deliberative events, by type of organisation
| Type of health and care organisation | Count |
|---|---|
| NHS trust - acute | 129 |
| Local authority or council | 88 |
| NHS primary care - GP practice | 50 |
| NHS trust - community | 39 |
| NHS trust - ambulance | 28 |
| ICS or ICB | 26 |
| NHS trust - mental health | 23 |
| Social care organisation | 20 |
| Other health and care organisation | 10 |
| NHS primary care - dental practice | 10 |
| Private healthcare provider | 7 |
| NHS primary care - community pharmacy | 7 |
| NHS primary care - optometry | 6 |
| CIC or social enterprise | 4 |
| Voluntary or charitable organisation | 4 |
| NHS arm’s length body | 1 |
| Government department or agency | 1 |
| Public health agency | 1 |
| Regulatory or professional body | 1 |
| Total | 455 |
3.6 Staff online shift events (March 2025)
Note: 194 out of 317 participants in the 3 shift focused online events shared demographic information through Menti. Sample information is below.
Table 50: participants of the staff online shift events, by age
| Age | Count |
|---|---|
| 16 to 24 | 2 |
| 25 to 34 | 21 |
| 35 to 44 | 52 |
| 45 to 54 | 61 |
| 55 to 64 | 51 |
| 65 and above | 5 |
| Prefer not to say | 2 |
| Total | 194 |
Table 51: participants of the staff online shift events, by gender
| Gender | Count |
|---|---|
| Female | 139 |
| Male | 53 |
| Non-binary | 1 |
| Prefer not to say | 1 |
| Total | 194 |
Table 52: participants of the staff online shift events, by region
| Region | Count |
|---|---|
| North East and Yorkshire | 29 |
| Midlands | 46 |
| South West | 41 |
| South East | 21 |
| North West | 19 |
| London | 21 |
| East of England | 17 |
| Total | 194 |
Table 53: participants of the staff online shift events, by length of time working in health and care
| Length of time working in health and care | Count |
|---|---|
| Less than 1 year | 1 |
| 1 to 2 years | 10 |
| 3 to 5 years | 15 |
| 6 to 10 years | 32 |
| 11 years or more | 136 |
| Total | 194 |
Table 54: participants of the staff online shift events, by role
| Role | Count |
|---|---|
| Administrative or clerical staff | 32 |
| AHP | 15 |
| Community pharmacist | 4 |
| Consultant | 12 |
| Dentist or dental care professional | 2 |
| Estates and facilities staff | 1 |
| General practice manager and wider staff | 2 |
| General practice nurse | 2 |
| GP | 2 |
| Healthcare assistant or clinical support worker | 1 |
| Healthcare scientist or technician | 3 |
| Managerial or executive staff | 44 |
| Midwife | 1 |
| Nurse | 31 |
| Other healthcare professional | 11 |
| Pharmacist or pharmacy technician | 6 |
| Psychologist or psychological therapist | 5 |
| Public health consultant or specialist | 5 |
| Public health nurse | 1 |
| Public health practitioner or trainer | 3 |
| Resident doctor | 3 |
| Social worker | 2 |
| Support staff - social care | 1 |
| Total | 189 |
Table 55: participants of the staff online shift events, by type of organisation
| Organisation type | Count |
|---|---|
| CIC or social enterprise | 4 |
| Government department or agency | 1 |
| ICS or ICB | 27 |
| Local authority or council | 7 |
| NHS arm’s length body | 10 |
| NHS primary care - community pharmacy | 3 |
| NHS primary care - dental practice | 2 |
| NHS primary care - GP practice | 13 |
| NHS primary care - optometry | 1 |
| NHS trust - acute | 59 |
| NHS trust - community | 24 |
| NHS trust - mental health | 24 |
| Other health and care organisation | 4 |
| Private healthcare provider | 3 |
| Public health agency | 3 |
| Voluntary or charitable organisation | 5 |
| Total | 190 |
3.7 Audience-focused online events with staff
Note: 155 of the 316 participants who attended these events provided demographic information. The sample is shown below.
Table 56: participants of the audience-focused online events with staff, by age
| Age | Count |
|---|---|
| 16 to 24 | 22 |
| 25 to 34 | 25 |
| 35 to 44 | 53 |
| 45 to 54 | 34 |
| 55 to 64 | 21 |
| Total | 155 |
Table 57: participants of the audience-focused online events with staff, by gender
| Gender | Count |
|---|---|
| Female | 137 |
| Male | 18 |
| Total | 155 |
Table 58: participants of the audience-focused online events with staff, by region
| Region | Count |
|---|---|
| East of England | 13 |
| London | 30 |
| Midlands | 31 |
| North East and Yorkshire | 9 |
| North West | 6 |
| South East | 47 |
| South West | 19 |
| Total | 155 |
Table 59: participants of the audience-focused online events with staff, by experience range
| Experience range | Count |
|---|---|
| Less than 1 year | 17 |
| 1 to 2 years | 17 |
| 3 to 5 years | 34 |
| 6 to 10 years | 24 |
| 11 to 20 years | 31 |
| 20 years or more | 31 |
| Total | 154 |
Table 60: participants of the audience-focused online events with staff, by role
| Role | Count |
|---|---|
| Administrative or clerical staff | 14 |
| AHP | 4 |
| General practice manager and wider staff | 12 |
| GP | 1 |
| Learner AHP | 31 |
| Learner nurse | 49 |
| Managerial or executive staff | 16 |
| Midwife | 4 |
| Nurse | 2 |
| Other | 6 |
| Other healthcare professional | 2 |
| Other learner | 18 |
| Total | 159 |
Table 61: participants of the audience-focused online events with staff, by type of organisation
| Organisation type | Count |
|---|---|
| CIC or social enterprise | 1 |
| Educational institution | 22 |
| Government department or agency | 1 |
| ICS or ICB | 8 |
| Local authority or council | 1 |
| NHS arm’s length body | 10 |
| NHS primary care - community pharmacy | 3 |
| NHS primary care - dental practice | 1 |
| NHS primary care - GP practice | 23 |
| NHS trust - acute | 26 |
| NHS trust - community | 30 |
| NHS trust - mental health | 16 |
| Other health and care organisation | 9 |
| Private healthcare provider | 3 |
| Public health agency | 2 |
| Regulatory or professional body | 1 |
| Social care organisation | 1 |
| Total | 158 |
3.8 The national summit
Public participants
Table 62: characteristics of public participants of the national summit
| Characteristic | Count (total number equals 184) |
|---|---|
| Age: 16 to 24 | 21 |
| Age: 25 to 34 | 26 |
| Age: 35 to 44 | 30 |
| Age: 45 to 54 | 35 |
| Age: 55 to 64 | 44 |
| Age: 65 to 74 | 13 |
| Age: 75 and above | 15 |
| Gender: man | 85 |
| Gender: woman | 94 |
| Gender: other | 3 |
| Gender: prefer not to say | 2 |
| Region: East | 23 |
| Region: London | 25 |
| Region: North East and Yorkshire | 28 |
| Region: North West | 23 |
| Region: Midlands | 22 |
| Region: South East (excluding London) | 39 |
| Region: South West | 25 |
| Location: rural | 31 |
| Location: suburban | 62 |
| Location: urban | 92 |
| Ethnicity: from an ethnic minority background | 37 |
| IMD: 1 to 2 | 34 |
| IMD: 3 to 4 | 35 |
| IMD: 5 to 6 | 36 |
| IMD: 7 to 8 | 30 |
| IMD: 9 to 10 | 29 |
| IMD: Unknown | 18 |
| Additional characteristics: neurodiverse | 16 |
| Additional characteristics: lower levels of literacy | 13 |
| Additional characteristics: speaks English as a second language | 9 |
| Additional characteristics: has multiple long-term health conditions | 14 |
| Additional characteristics: is pregnant or has experience of maternity services in the last 12 months | 3 |
| Additional characteristics: has experience of the cancer pathway in the last 3 years | 4 |
| Additional characteristics: has COPD or asthma | 10 |
| Additional characteristics: has experienced a stroke in the last 3 years | 4 |
| Additional characteristics: struggles to get around | 3 |
| Additional characteristics: needs someone to help them complete daily tasks regularly | 12 |
| Additional characteristics: informal carer | 39 |
| Additional characteristics: young carer | 4 |
| Additional characteristics: loved one in receipt of social care | 29 |
| Additional characteristics: LGBTQIA+ | 16 |
| Additional characteristics: identifies as a gender different from birth | 20 |
| Additional characteristics: politically disengaged | 19 |
| Additional characteristics: digitally disengaged | 12 |
| Additional characteristics: has no fixed address | 1 |
Staff participants
Table 63: characteristics of staff participants of the national summit
| Characteristic | Count |
|---|---|
| Region: East of England | 11 |
| Region: London | 17 |
| Region: North East and Yorkshire | 10 |
| Region: North West | 7 |
| Region: Midlands | 11 |
| Region: South East | 7 |
| Region: South West | 11 |
| Role: administrative, clerical or clerical staff | 7 |
| Role: AHP (for example, physiotherapist, occupational therapist or speech and language therapist) | 4 |
| Role: ambulance worker | 1 |
| Role: community pharmacist | 1 |
| Role: consultant | 3 |
| Role: dentist or dental care professional | 1 |
| Role: estates and facilities staff (for example, porter, cleaner or maintenance) | 1 |
| Role: GP | 3 |
| Role: health visitors | 3 |
| Role: managerial or executive staff | 17 |
| Role: midwife | 3 |
| Role: nurse | 7 |
| Role: optometrist or optician | 1 |
| Role: other healthcare professional | 1 |
| Role: paramedic | 0 |
| Role: pharmacist or pharmacy technician | 4 |
| Role: public health consultants and specialists | 4 |
| Role: public health nurse | 1 |
| Role: public health practitioners and trainer | 3 |
| Role: resident doctor | 4 |
| Role: social worker | 3 |
| Role: specialist doctor | 1 |
| Role: student or trainee in a healthcare profession | 1 |
| Type of health and care organisation: CIC or social enterprise | 1 |
| Type of health and care organisation: educational institution (for example, university or medical school) | 0 |
| Type of health and care organisation: ICS or ICB | 2 |
| Type of health and care organisation: local authority or council | 12 |
| Type of health and care organisation: NHS arm’s length body (for example, NHS England) | 1 |
| Type of health and care organisation: NHS primary care - community pharmacy | 5 |
| Type of health and care organisation: NHS primary care - dental practice, NHS primary care - GP practice, NHS primary care - optometry | 0 |
| Type of health and care organisation: NHS trust - acute | 23 |
| Type of health and care organisation: NHS trust - ambulance, NHS trust - community | 0 |
| Type of health and care organisation: NHS trust - mental health | 4 |
| Type of health and care organisation: other health and care organisation | 3 |
| Type of health and care organisation: private healthcare provider | 2 |
| Type of health and care organisation: social care organisation | 4 |
3.9 Community engagement
Note: not all of those who delivered a WIAB gave information about who was in the workshops.
Table 64: total number of community engagement workshops, by audience
| Audience | Count |
|---|---|
| Mixed group (workforce and public) | 155 |
| Workforce (organisations who carried out the workshops) | 138 |
| Patients, the public and their representatives (for example, VCSE) | 381 |
| People with multiple long-term health conditions | 163 |
| People experiencing digital exclusion | 79 |
| People from an ethnic minority | 94 |
| People living in coastal communities | 35 |
| People with a learning disability and/or autism | 86 |
| LGBTQIA+ community | 19 |
| People with low or no literacy | 32 |
| Victims of modern slavery | 4 |
| People in contact with the justice system | 12 |
| Gypsy, Roma or Traveller community | 14 |
| People experiencing drug and alcohol dependence | 21 |
| Asylum seekers, refugees and/or newer migrants (moved here in the last 5 years) | 29 |
| Children and young people [see note 1] | 19 |
| People experiencing homelessness | 18 |
| Sex workers | 5 |
| People accessing maternity services | 18 |
| Other | 59 |
Note 1: does not include a youth summit delivered by DHSC with Barnardo’s. See section 3.3 for more details on the breakdown of workshops with children and young people.
Table 65: regions reached from all WIABs
| Region reached from all WIABs | Count |
|---|---|
| East of England | 54 |
| London | 58 |
| Midlands | 86 |
| North East and Yorkshire | 69 |
| North West | 76 |
| South East | 83 |
| South West | 126 |
| Multi-region | 103 |
4. Summary of campaign responses to Change NHS
It is common in a high-profile engagement exercise like Change NHS for campaign or interest groups to ask their members, supporters and others to submit responses conveying the same specific views. Responses were received from 6 different campaigns, which have been analysed separately to the main engagement findings and are summarised below.
Each campaign response is structured slightly differently, though most follow the outline of main ‘Start here’ Change NHS website survey, with 2 of the campaigns (38 Degrees and Action Organise) also completing the ‘Your priorities for change survey’. Two campaigns - We Own It and Action Network - did not follow the order of the ‘Start here’ survey, with respondents sharing a set response focusing on a priority issue.
Table 66: summary of campaign responses
| Campaign | Type of survey | Number of responses |
|---|---|---|
| 38 Degrees | ‘Start here’ | 37,174 |
| 38 Degrees | ‘Your priorities for change’ | 31,777 |
| 38 Degrees | Total | 68,951 |
| Action Organise | ‘Start here | 34,501 |
| Action Organise | ‘You priorities for change’ | 18,866 |
| Action Organise | Total | 53,367 |
| Wildlife Trust | ‘Start here’ | 2,329 |
| Mencap | ‘Start here’ | 988 |
| We Own It | Email campaign | 5,033 |
| Action Network | Email campaign | 160 |
| Total campaign responses | All | 130,828 |
4.1 38 Degrees (68,951 responses)
Experiences of the NHS
In line with the wider engagement findings, responses to the 38 Degrees campaign highlighted challenges with accessing care, particularly GP appointments. Long waiting times in A&E and for hospital procedures were a concern, as was poor co-ordination between different health and care services. Overall, campaign participants were less likely to experience each of these challenges than Change NHS website participants.
Table 67: percentage of participants responding to the 38 Degrees campaign who experienced challenges when using the NHS
| Challenge | % of campaign participants experiencing | % of Change NHS website participants experiencing |
|---|---|---|
| Difficulties getting a GP appointment | 73% | 68% |
| Long wait times in A&E | 49% | 62% |
| Long wait times for a hospital procedure | 46% | 49% |
| Poor co-ordination between services | 42% | 63% |
| Delays in being referred for treatment | 41% | 53% |
| Poor communication from health services | 33% | 53% |
| Waiting to access community services | 27% | 33% |
| Treatments or services not available on the NHS | 25% | 35% |
| Poor-quality care | 16% | 33% |
| Waiting to access mental health services | 13% | 28% |
| Other | 9% | 11% |
Base: all those who answered this question in the 38 Degrees ‘Start here’ survey (number equals 29,931). The survey was live from November to December 2024.
Responses to the 38 Degrees campaign called for the 10 Year Health Plan to prioritise improving access to GP appointments and reducing waiting times for A&E, other hospital procedures and referrals. Campaign participants were more likely to call for these challenges to be addressed as a priority than Change NHS website participants. They were also more likely to prioritise improving and widening access to community services - for example, district nursing, community physiotherapy or occupational therapy.
Table 68: issues that participants responding to the 38 Degrees campaign said the 10 Year Health Plan should prioritise
| Challenge | % of campaign participants who prioritise this | % of Change NHS website participants who prioritise this |
|---|---|---|
| Difficulties getting a GP appointment | 71% | 53% |
| Long wait times for a hospital procedure | 64% | 43% |
| Long wait times in A&E | 53% | 37% |
| Delays in being referred for treatment | 39% | 31% |
| Poor co-ordination between services | 30% | 34% |
| Waiting to access mental health services | 29% | 28% |
| Waiting to access community services | 22% | 13% |
| Poor communication from health services | 14% | 15% |
| Treatments or services not available on the NHS | 14% | 9% |
| Poor-quality care | 13% | 19% |
| Other | 6% | 7% |
Base: all those who answered this question in the 38 Degrees ‘Start here’ survey (number equals 34,657). The survey was live from November to December 2024.
Feedback on the 3 shifts
Responses to the 38 Degrees campaign on the perceived benefits and limitations of each of the 3 shifts were very consistent with the wider engagement findings.
Moving care from hospital to community
Campaign responses highlighted the potential for this shift to reduce pressure on hospitals, improve access to care - both in terms of quicker access to appointments, but also removing barriers to accessing care - and build trust in the quality and consistency of care. There was also a sense that if delivered successfully, this shift has the potential to make better use of workforce capacity, skills and experience and improve relationships between staff and patients, leading to better patient health outcomes overall.
The main concern about delivering this shift was the funding and resource available, particularly in the face of ongoing system-wide pressures. Campaign responses also queried whether staff would have the right skills and training to successfully deliver care in the community, as well as sufficient capacity.
Making better use of technology
Campaign responses emphasised the potential for technology in improving health and care, specifically through the introduction of a single digital patient record, more streamlined administration and quicker and more accurate diagnosis and testing. However, this is on the condition that technology is used to enhance the delivery of care, rather than replace it: there were concerns about losing human contact if staff become over reliant on technology.
Responses also included concerns around the security of patients’ personal data, digital inclusion and poor existing IT infrastructure (lowering confidence that this shift will work in practice).
Focusing on preventing sickness, rather than treating it
Campaign responses highlighted the potential for this shift to improve long-term health outcomes and reduce pressure on health and care, with a clear role for education to successfully deliver this shift. Responses also highlighted a role for early screening and testing to identify illness sooner, and the need for a particular focus on supporting people to improve their diet and be more physically active.
Concerns largely related to the resource and funding required for a greater focus on prevention, particularly that funding and staff capacity will be diverted away from acute care. Some also expressed concerns about ‘forcing’ a preventative approach on the public, including punishing those who either don’t want to or are unable to take preventative action.
Priorities for change
Empowering people to make better choices for their own health, throughout their life
When reflecting on what would help support their physical and mental health, campaign participants called for improved access to tests and diagnostics to help spot any health issues, regular check-ins with healthcare professionals on their physical and mental health and making it easier to access their health record with personalised information about any risks to their health and how to manage them. Consistent with findings from the wider engagement, campaign responses pointed to a clear role for employers, local government and schools in helping people manage their health, alongside the NHS. However, these campaign participants were more likely than Change NHS website users to say the NHS should still have the biggest responsibility for helping the public manage their health (22% compared with 1% of Change NHS website users).
Two-thirds of those responding to the 38 Degrees campaign supported having early conversations about palliative care with a healthcare professional (66%), of which almost half (47%) strongly supported this. In line with wider engagement findings, key concerns about this approach related to a lack of information to support a conversation like this, it not feeling relevant to them at this moment in time or not wanting to discuss end-of-life care while they are healthy.
Delivering care where and when it is needed
In the majority of cases, campaign participants said they would be happy to see another healthcare professional instead of a GP, if it meant they were seen sooner - though overall were slightly less likely than Change NHS website users to say they would accept each option. This included seeing a relevant specialist (72%), a nurse to discuss a minor illness (68%), a pharmacist (63%) or a physiotherapist (61%). Just 1 in 10 (11%) said they would want to speak to a GP first. There was also broad support for receiving care from a healthcare professional in settings outside of a GP surgery or hospital, particularly a mobile screening clinic (74%), community centre (61%) or pharmacy (58%). Openness to a digital appointment was lower than for Change NHS website users (40% of campaign participants compared with 62% of Change NHS website users).
In line with wider engagement findings, there were concerns about care feeling disjointed if accessed in different settings or through different healthcare professionals. To feel more confident, participants to the 38 Degrees campaign wanted reassurance that records will be shared and updated between different settings and appointments. Responses also highlighted the importance of knowing data will be handled safely and securely, which was more important to this audience than Change NHS website users overall.
Supporting staff to deliver personalised care for patients
Consistent with the wider engagement findings, there was support for staff taking a more holistic approach to healthcare, and specifically sharing information about overall health and health risks to give broader advice. The most common concern about this approach was the belief that staff should focus on developing expertise in their specialist areas, rather than giving general advice - though more than half (53%) expressed no concerns about this approach at all.
Campaign participants were slightly more sceptical about dedicated (non-clinical) staff helping the public and patients access services and information: just under two-thirds (64%) said they would support this, though 1 in 10 (10%) were opposed.
Ways to improve health for everyone, especially those with the greatest need
Overall, responses to the 38 Degrees campaign expressed support for targeting resources on prevention and healthcare to people and areas who are more in need than others: two-thirds (66%) of campaign participants supported this. A clear majority also support incentivising staff to work where they are most needed (70%), though a notable minority are uncertain. In line with the wider engagement findings, there was a greater degree of uncertainty about people with more complex needs being prioritised for appointments.
Using technology to improve care and experience
Campaign participants were more sceptical about using the NHS App as the main way to access information and services than Change NHS website users: just 2 in 5 (38%) said they would support this, compared with 3 in 5 (62%) Change NHS website users, and just over half (56%) said they would be likely to use it.
Concerns about data sharing and privacy were the most significant barrier, along with not wanting to use an app to access NHS services, not feeling comfortable entering personal information online and feeling they lack digital skills to access information and care through the app. All of these were a greater concern for campaign participants than for Change NHS website users. In line with wider engagement findings, when it comes to rolling out a single patient record it was most important that staff can access all records to help care feel joined up. Campaign participants also saw the potential for this to save staff time and free up resources by making processes more efficient.
4.2 Action Organise (53,367 responses)
Responses to the Action Organise campaign included what participants saw as the best things about the NHS. Consistent with wider engagement findings, the fact that the NHS offers free care at the point of need, to anyone and everyone that needs it, was its most important benefit. For these campaign participants, the fact that the NHS is independent, publicly run and funded was critical. The quality of care, plus a perceived focus on research and development into new treatments, were also raised as positives.
When reflecting on the greatest challenges facing the NHS, campaign participants spontaneously highlighted issues with staff capacity and retention, waiting times, care backlogs and disjointed systems and data. Responses highlighted concerns about the impact of private companies - for example, those providing the NHS with agency staff - and privatisation of the NHS more broadly.
In line with the wider engagement findings, when prompted, responses to the Action Organise campaign highlighted challenges with accessing care, particularly GP appointments, and long waiting times in A&E, for hospital procedures and referrals. Poor co-ordination between different health and care services and poor communication from health services were also a concern, though these campaign participants were less likely to experience both of these challenges than Change NHS website participants.
Table 69: percentage of participants responding to the Action Organise campaign who experienced challenges when using the NHS
| Challenge | % of campaign participants experiencing | % of Change NHS website participants experiencing |
|---|---|---|
| Difficulties getting a GP appointment | 68% | 68% |
| Long wait times in A&E | 57% | 62% |
| Long wait times for a hospital procedure | 50% | 49% |
| Delays in being referred for treatment | 44% | 53% |
| Poor co-ordination between services | 40% | 63% |
| Poor communication from health services | 30% | 53% |
| Treatments or services not available on the NHS | 29% | 35% |
| Waiting to access community services | 27% | 33% |
| Waiting to access mental health services | 21% | 28% |
| Poor-quality care | 16% | 33% |
| Other | 6% | 11% |
Base: all those who answered this question in the Action Organise ‘Start here’ survey (number equals 22,263). The survey was live from November 2024 to March 2025.
Responses to the Action Organise campaign called for the 10 Year Health Plan to prioritise improving access to GP appointments and reducing waiting times to a wide range of services. Campaign participants were more likely to call for these challenges to be addressed as a priority than Change NHS website participants. They were also more likely to prioritise access to treatments or services not currently available on the NHS.
Table 70: issues that participants responding to the Action Organise campaign said the 10 Year Health Plan should prioritise
| Challenge | % of campaign participants who prioritise this | % of Change NHS website participants who prioritise this |
|---|---|---|
| Difficulties getting a GP appointment | 65% | 53% |
| Long wait times for a hospital procedure | 65% | 43% |
| Long wait times in A&E | 57% | 37% |
| Delays in being referred for treatment | 41% | 31% |
| Poor co-ordination between services | 29% | 34% |
| Waiting to access mental health services | 34% | 28% |
| Waiting to access community services | 21% | 13% |
| Poor communication from health services | 15% | 15% |
| Treatments or services not available on the NHS | 20% | 9% |
| Poor-quality care | 13% | 19% |
| Other | 4% | 7% |
Base: all those who answered this question in the Action Organise ‘Start here’ survey (number equals 23,135). The survey was live from November 2024 to March 2025.
Feedback on the 3 shifts
Responses to the Action Organise campaign on the perceived benefits and limitations of each of the 3 shifts were very consistent with the wider engagement findings.
Moving care from hospital to community
Participants in the Action Organise campaign expressed support for delivering more care in the community, highlighting benefits such as increased convenience, quicker access to healthcare and reduced pressure on primary care. They believed that helping patients stay out of hospital will also keep them safer - by reducing infection rates - and lead to a better patient experience overall - for example, by treating them in settings that feel familiar and are closer to home.
Consistent with other campaign responses, there were concerns about the feasibility of delivering this shift without compromising the quality of care in hospitals, particularly the capacity and quality of staff, local infrastructure and equipment required. However, these respondents also had specific concerns about services being contracted to private companies to help manage resource.
Making better use of technology
Participants generally agree that technology has significant potential to improve health and care and ultimately improve patient outcomes, particularly in areas like faster diagnosis, better co-ordination of care across services and more streamlined access to patient records.
Consistent with findings from the wider engagement, the main concerns raised were about making sure that technology assists healthcare professionals in carrying out their roles rather than replacing them, the security of patient data and poor existing IT infrastructure. There were also calls to make sure that digital systems are user friendly and accessible to ensure no one is excluded.
Focusing on preventing sickness, rather than treating it
Participants strongly supported a focus on prevention to help people stay healthy and independent for longer, noting the potential cost-effectiveness of this shift by reducing pressure on health services and with more people able to work. There were calls for more widespread screening and health education to help achieve this shift, though many highlight the need to take a more holistic approach - for example, looking at housing and the cost of food - for this shift to be truly successful.
Consistent with wider engagement findings, the main concerns were about the funding, resource and staff capacity it will take to successfully deliver this shift, particularly the impact of diverting funds away from primary care. Responses also highlighted that it will be hard to set realistic targets to measure whether this shift has been a success.
Priorities for change
Delivering care where and when it is needed
In the majority of cases, campaign participants said they would be happy to see another healthcare professional instead of a GP, if it meant they were seen sooner - though overall were slightly less likely than Change NHS website users to say they would accept each option. This included seeing a nurse to discuss a minor illness (67%), a pharmacist (60%), a physiotherapist (42%) or a mental health worker (36%). However, more than a quarter (28%) say they would still want to speak to a GP first.
In line with wider engagement findings, there were concerns about care feeling disjointed if accessed through different healthcare professionals, or that patients would have to explain everything from scratch at each appointment. There were also concerns about receiving worse care, or feeling more confused about appointments and/or treatment options.
Ways to improve health for everyone, especially those with the greatest need
Overall, responses to the Action Organise campaign expressed support for targeting resources to people and areas who need it most: 4 in 5 (82%) of campaign participants agreed with this approach, of which half (52%) strongly agreed. A clear majority also support incentivising staff to work where they are most needed (72%), though a notable minority are uncertain. There were also high levels of agreement that people with more complex needs should be able to access appointments more quickly, or be given longer appointments if they need them - 9 in 10 (92%) of campaign participants agreed this was a sensible approach, compared with 63% of Change NHS website users who said they would support people with more complex needs being prioritised for appointments.
Using technology to improve care and experience
Campaign participants were asked about the extent to which they would support the NHS introducing a single health record for each patient, shared across NHS services. Views were divided: half supported the idea (49%), a similar proportion (48%) said they might support it, with assurances their data would be secure - but only 3% said they would actively oppose having a single health record.
Experiences of health and care staff
Of those responding to the Action Organise campaign, 805 said they work in health and care. They answered additional questions about the best and most challenging aspects of their role, and about specific (prompted) challenges they may have experienced in the role.
Spontaneously, in line with the wider engagement findings, these participants highlighted the pride they feel in their job and the personal satisfaction they get by helping people and being able to make a difference to patients and their families. They also highlighted the quality, dedication and compassion of their colleagues, and the way in which they support each other in the face of NHS pressures.
They also shared concerns about feeling excessive pressure to deliver care in the face of increasing levels of demand, funding and staff shortages, issues with staff retention and recruitment, low morale, poor mental health and burnout, excessive administration, poor IT infrastructure and in some cases a lack of equipment making it even harder to do their job effectively. For some, this is further compounded by issues with workplace culture, poor management, inflexible working patterns and/or pay not feeling proportionate to their role.
4.3 Wildlife Trust (2,329 responses)
Experiences of the NHS
Responses to the Wildlife Trust campaign, which ran from early January to mid-April 2025, included what participants saw as the best things about the NHS. Consistent with wider engagement findings, the fact that the NHS offers free care at the point of need, to anyone and everyone that needs it and particularly in the event of an emergency, was its most important benefit. Responses also highlighted the quality, compassion, dedication and professionalism of health and care staff.
When reflecting on the greatest challenges facing the NHS, campaign participants spontaneously highlighted issues with staff capacity and retention, waiting times, care backlogs, disjointed systems and outdated infrastructure and equipment. Many expressed broader concerns about whether there is sufficient capacity to meet levels of demand, particularly with an ageing population, and about unequal access to care and health inequalities.
Feedback on the 3 shifts
Responses to the Wildlife Trust campaign focused on the perceived benefits and limitations for 2 of the shifts: moving care from hospital to the community, and a greater focus on prevention.
Moving care from hospital to community
Participants expressed support for delivering more care in the community, highlighting benefits such as increased convenience and quicker access to healthcare and reduced pressure on primary care. They also saw this shift leading to better co-ordination of care, and stronger relationships between staff and patients - which in turn would drive better health outcomes. These campaign participants also saw the delivery of care in the community helping facilitate a greater focus on prevention for which there were high levels of support (see below).
Consistent with other campaign responses, there were concerns about the feasibility of delivering this shift, particularly the capacity and quality of staff, community infrastructure and equipment required. Many expressed concerns about consistency of care, as well as the potential for miscommunication between or duplication of services. While participants could see the potential for this shift to improve access, some concerns about barriers to access remained.
Focusing on preventing sickness, rather than treating it
Participants strongly supported a focus on prevention to help people stay healthy and independent for longer, increase a sense of personal responsibility and reduce pressure on services. There were calls for more widespread health education - particularly on diet and exercise - to help achieve this shift, though many highlighted the need to take a more holistic approach for this shift to be truly successful. Within this, they stressed the benefit of access to green spaces and the positive impact that the environment can play on health and wellbeing, specifically mental health.
Consistent with wider engagement findings, the main concerns were about the funding, resources and staff capacity it will take to successfully deliver this shift. Responses highlighted the need for multiple organisations and sectors to work together to deliver this shift: its success is not down to the NHS alone. There were also concerns about whether everyone would be able to access and adopt preventative interventions equally.
Experiences of health and care staff
Of those responding to the Wildlife Trust campaign, 189 said they work in health and care. These participants answered additional questions about the best and most challenging aspects of their role, and about specific (prompted) challenges they may have experienced in the role.
Spontaneously, these participants highlighted the pride they feel in their job, their ability to help people and make a difference, and the dedication, skill and support of their colleagues. They also shared their concerns about feeling overworked and under-resourced and unable to keep up with ever increasing levels of demand; issues with staff retention and recruitment leading to burnout and poor morale; and excessive administration, poor IT infrastructure and in some cases a lack of equipment making it even harder to do their job effectively. For some, this is further compounded by issues with workplace culture, poor management and/or resistance to change.
4.4 Mencap (988 responses)
Experiences of the NHS
In line with the wider engagement findings, responses to the Mencap campaign highlighted challenges with accessing to care, as well as poor co-ordination between services. Half of these campaign participants had experienced challenges with communication from health services - for example, appointments that were hard to understand, not getting letters in easy read or feeling that they weren’t listened to. Like other campaign responses, waiting times and care backlogs were raised as a challenge, particularly delays in being able to access community services.
Table 71: percentage of participants responding to the Mencap campaign who experienced challenges when using the NHS
| Challenge | % of campaign participants experiencing | % of Change NHS website participants experiencing |
|---|---|---|
| Difficulties getting a GP appointment | 72% | 68% |
| Poor co-ordination between services | 59% | 63% |
| Long wait times in A&E | 57% | 62% |
| Poor communication from health services | 51% | 53% |
| Waiting to access community services | 49% | 33% |
| Delays in being referred for treatment | 45% | 53% |
| Long wait times for a hospital procedure | 34% | 49% |
| Poor-quality care | 29% | 33% |
| Waiting to access mental health services | 13% | 28% |
| Other | 20% | 11% |
Base: all those who answered this question in the Mencap ‘Start here’ survey (number equals 1,005). The survey was live from December 2024 to March 2025.
Responses to the Mencap campaign called for the 10 Year Health Plan to prioritise improving access to GP appointments and reducing waiting times for A&E and treatment referrals. They also called for a focus on making care feel less disjointed between different settings and services, and were more likely than Change NHS website users to prioritise addressing poor communication from health services.
Table 72: issues that participants responding to the Mencap campaign said the 10 Year Health Plan should prioritise
| Challenge | % of campaign participants who prioritise this | % of Change NHS website participants who prioritise this |
|---|---|---|
| Difficulties getting a GP appointment | 60% | 53% |
| Long wait times in A&E | 38% | 37% |
| Delays in being referred for treatment | 34% | 31% |
| Poor co-ordination between services | 31% | 34% |
| Poor communication from health services | 29% | 15% |
| Waiting to access mental health services | 29% | 28% |
| Waiting to access community services | 18% | 13% |
| Long wait times for a hospital procedure | 14% | 43% |
| Poor-quality care | 12% | 19% |
| Other | 8% | 7% |
Base: all those who answered this question in the Mencap ‘Start here’ survey (number equals 1,006). The survey was live from December 2024 to March 2025.
Feedback on the 3 shifts
Responses to the Mencap campaign on the perceived benefits and limitations of each of the 3 shifts were consistent with the wider engagement findings.
Moving care from hospital to community
The most significant concern was whether there will be sufficient resource, staff capacity and funding to successfully deliver this shift. Responses also included questions about staff experience, skills and training, leading to concerns about the quality of care in the community being inferior to hospitals, and inconsistency in the delivery of care across England. Some expressed concerns about a lack of infrastructure and facilities in the community, their ability to access more specialist or specialised care if they need it, and barriers to access remaining, even with care delivered more locally. This campaign did not include a question on the benefits of moving care from hospital to community.
Making better use of technology
Participants acknowledged the potential of technology to reduce waste and inefficiency, especially in administration - leading to further benefits like a reduction in wait times, more joined up care and better communication between staff and patients.
However, many expressed concerns about current IT performance and infrastructure in the NHS, creating doubt about how successfully new technology could be implemented and managed - and whether staff will be given sufficient training and support to use it. As with other campaign responses, many expressed concerns about an over-reliance on technology and loss of human contact, as well as fears about data security and digital exclusion.
Focusing on preventing sickness, rather than treating it
Campaign responses suggested that an increased focus on prevention will improve health outcomes and reduce pressure on the health system long term, ultimately improving access. Participants also saw a role for other actors beyond the NHS to help deliver this shift, including schools, local authorities and other government departments.
However, like other campaign responses, they doubted how effectively this shift could be delivered, raising concerns about financial, health and lifestyle barriers to taking up preventative interventions and exclusion of some groups who may find it difficult to take up preventative interventions. They also felt it would be difficult to change people’s behaviours and habits in practice.
4.5 We Own It (5,033 responses)
Responses to the We Own It campaign were sent by email and did not follow the structure of one of the main Change NHS surveys (‘Start here’ or ‘Your priorities for change’). Instead, responses all highlighted 2 main reasons the campaign feels that the NHS is struggling: that it is underfunded and is increasingly being privatised.
Specifically, the campaign highlighted a perception that underfunding during the previous 2 governments has left the NHS significantly behind countries like France and Germany. In addition, responses set out how they believe competitive tendering has increased the private sector’s involvement in the NHS.
We Own It therefore called for a ‘fourth shift’: from outsourcing to public provision. This included 2 proposals: to bring outsourced services back into the NHS when contracts expire, and prohibiting any new contracts from being set up and awarded.
4.6 Action Network (160 responses)
Responses to the Action Network campaign were sent by email and did not follow the structure of one of the main Change NHS surveys (‘Start here’ or ‘Your priorities for change’). These responses came from those who described themselves as professionals working in prevention and called for an increased focus on preventative health measures, highlighting how funding cuts have meant that preventative services have been closed or scaled back in recent years.
Specifically, these campaign participants wanted to see the 10 Year Health Plan include several things:
- firstly, a clear and fully funded commitment to increasing preventative services outside acute settings
- secondly, increased regulation of the drivers of poor health, leading to noticeable declines in smoking rates, rates of unhealthy alcohol use, harmful gambling rates, levels or air pollution and rates of reported unhealthy eating habits
- thirdly, a workforce strategy, meaning that more staff are recruited into health-related roles outside the NHS, and that there is greater mobility between all parts of the health system as staff are supported to upskill and develop
5. Ideas for change
5.1 Overview of our approach
Part of the Change NHS website was dedicated to collecting ideas for change from members of the public and staff working in health and care. These were suggestions for what participants felt needs to change across the health and care system, including ideas about:
- how the NHS could change to deliver high-quality care more effectively and what works well that the NHS should do more
- how other parts of the health and care system and other organisations in society could change to promote better health and/or improve the way health and care services work together
- how individuals and communities could do things differently in future to improve people’s health
Those who submitted an idea were encouraged to:
- provide a short title
- provide a description of their idea
- tag which topics it related to underneath
- say if they felt their idea would be quick to implement, or a longer-term change
In total, 11,886 ideas were submitted. A summary of the most prominent themes is set out below, ordered in terms of the volume of ideas received for each theme (higher to lower).
5.2 Ideas
Improving access to care
In line with the public priorities for change, the highest volume of ideas related to improving and widening access to care. Many of these ideas focused on ways to increase access to GP appointments specifically, such as extending surgery hours, increasing the number of walk-in clinics, offering online or video appointments and improving appointment administration (for example, avoiding the 8am rush to secure an appointment by telephone).
Within this, there were calls to centralise appointments to offer greater flexibility in terms of where patients can access GP appointments so that they can be seen sooner (for example, getting a same day appointment, but at a practice further away). A minority also expressed an interest in paying a small fee - around £5 to £10 - for a GP appointment if it meant they could be seen sooner, or at a time that suited them better, including out of hours.
Change NHS website participants also suggested increasing the number of local and/or specialist support services to relieve pressure on GPs, and (especially when support is needed out of hours) A&E. This included minor injuries centres, a falls service for the elderly or an emergency service for those with alcohol or drug dependencies.
Ideas related to access also focused on improving access to mental health services specifically. This included the creation of more community-based treatment hubs, suggestions to improve triage and a greater focus on preventative interventions that support mental health.
A selection of ideas shared on the theme of improving access
Create an online booking system for booking GP appointments (with various categories), nurse appointments (with various categories), referral self-booking etc. Most things are not urgent, people just have to make urgent appointments because it is the only option.
(Public Change NHS website participant)
Having minor injuries units in more towns or areas of cities, and having them open later in the evenings (e.g. 10pm) would help relieve pressure on A&E for non-emergencies. Otherwise people who have had accidents in the evenings don’t have anywhere to go apart from A&E to get it treated.
(Public Change NHS website participant)
Remove the concept of “your GP”. The NHS app should have a list of available GP appointments near you which you can book through the app, similar to the original covid jab system. People can still select their usual GP but with a [shared] patient record, you can open it up so they can visit any GP in the area.
Better integration of health and care services
There were also large volumes of ideas related to the integration and co-ordination of care. Many Change NHS website users described the current health and care system as feeling siloed, with poor handovers, repeated assessments and patients or carers left to co-ordinate their own care.
The most commonly shared suggestions for making care feel more joined-up related to improving data sharing across and between NHS services and trusts, as well as improving communication between departments. This included introducing a single patient care record so everyone providing care can access their patients’ records to avoid them needing to repeat their story at each appointment. Other ideas included allowing patients to express a preference for communications (by text, email or the NHS App), re-considering sending notices by post to avoid things being missed and streamlining testing and appointments to avoid multiple visits for the same issue. Suggestions also included introducing care co-ordinators for those with more complex or overlapping health conditions.
Better integration of health and social care was called out by many as a specific idea for change. This included looking at ways to merge social care into the NHS or at least look to more closely integrate funding, planning and delivery. Related to this, there were calls for better support for unpaid carers and greater investment in community-based rehabilitation and step-down facilities (for example, convalescent or cottage hospitals) to ease the transition when discharged from hospital to home or community.
A selection of ideas shared on the theme of more joined-up care
Every medical service in the UK MUST have access to patient records. If the bank can do it, so should the NHS.
(Public Change NHS website participant)
I would like to see clinicians arrange appointments and tests so that they can be undertaken as part of a single appointment where possible. Multiple appointments are stressful and time consuming and the more that can be done in a single visit makes sense.
(Public Change NHS website participant)
Unpaid carers save the NHS millions each year. My idea is that each NHS trust or area should have an advocate that supports carers. Things like advising them what they are entitled to, mental health support, respite, and things like basic first aid skills, workshops for carers, occupational health support, and assistance with applying for things such as power of attorneys, attendance allowance.
(Public Change NHS website participant)
Recruiting, training and retaining workforce
Many of the ideas shared on the Change NHS website focused on suggestions to improve staff capacity, wellbeing and morale. Suggestions largely focused on how the NHS recruits staff, including ways to make NHS careers more attractive through better pay, free or subsidised training (including bursaries or writing off loans) or by exploring different routes into health and care roles to attract a wider range of potential applicants. This included non-degree or hands-on training routes, or ways to make it easier for people changing careers to enter healthcare roles. However, many of these ideas included the caveat that investment in staff training and recruitment should be ‘paid back’ to the NHS by workforce committing to work in the NHS for a certain amount of time.
There were also calls for wider changes to support staff in their roles, as well as incentivising them to join and stay in the NHS. These included improving benefits and conditions (for example, flexible working, more annual leave or free parking), more active support with career development and offering more mental health support. The quality, content and relevance of training was often discussed, so that staff have the necessary skills and experience to carry out their roles effectively.
A selection of ideas shared on the theme of recruiting, training and retaining staff
We also need to recognise that pay is not the only factor leading staff to leave the NHS. They need to feel valued. Little things like [free] car parking make a big difference.
(Public Change NHS website participant)
Look at nursing cadetships from 16 & 18; residential training options; a guaranteed job with the option of block release or day release funded university study if appropriate.
(Public Change NHS website participant)
I work in the NHS and it’s a constant battle to maintain efficiency, as staff and equipment shortages lead to daily considerable additional stress and delays. If there was a concerted effort to aim for zero staffing gaps, and zero equipment issues, I think this would have a tremendously positive impact on productivity. Retain staff, do exit interviews of those leaving to understand why they are leaving, implement measures to tackle the very high levels of stress. Recruit staff too (but retention is the first aim - senior staff more valuable that newly minted).
(Staff Change NHS website participant)
Reducing waste and inefficiency
Reducing waste was also a prominent theme among ideas submitted to the Change NHS website.
This included suggestions to help reduce appointment no-shows. Alongside this, many saw a clear role for education on how to use the NHS responsibly, including when it is appropriate to go to A&E and other steps to take first, or sharing itemised healthcare bills to show the real cost of care.
Many expressed concerns about the waste associated with unused drugs, typically through poor management of repeat prescriptions, and suggested that pharmacies and hospitals should be allowed to take back and redistribute unopened medications. The idea of reusing medical equipment, particularly crutches and wheelchairs and accessible or adapted furniture, was also popular.
Ideas related to reducing waste also focused on ways to streamline management structures. Many felt that there are more managers than there needs to be which is expensive and slows down decision-making. There were also calls to standardise procurement processes to prevent money being wasted through inefficient purchasing.
A selection of ideas shared on the theme of reducing waste
At the moment, any medication that is not used is simply “binned”. There should/could be a smarter way of handling this situation covering the understandable possible risk.
(Public Change NHS website participant)
There are many patients leaving hospitals with equipment such as wheelchairs, crutches, walking sticks, CPAP machines […] that are rarely or never returned. Again there needs to be control of returns with fines or charges.
(Public Change NHS website participant)
I have been a pharmacist for 22 years, half of that working in the NHS […] and strongly believe our system of prescription charges needs review. Currently, anyone over 60 gets blanket free prescriptions. This exemption also applies to many people with long term health conditions such as diabetes, hypothyroidism etc. The problem with this is the cost of drugs is rising, particularly since Brexit, and providing for an ageing population is getting more costly.
(Staff Change NHS website participant)
There are too many companies fleecing the NHS by charging extortionate rates for supplies and relief staff. This needs to be monitored and controlled.
(Public Change NHS website participant)
I work in the NHS and over many years have seen numerous items disposed of as they are “out of date”. How can a bandage, plaster, plastic syringe or metal needle in a sealed package go out of date? Another example is the Emergency Bag, a very expensive collection of equipment that in most cases are never used but are constantly being replaced as they are out of date. I recently saw boxes of alcohol hand gel being thrown out as it was out of date!
(Staff Change NHS website participant)
Making better use of technology
Consistent with the public deliberative events, most of the ideas that related to technology and digitisation were about ‘getting the basics right’. This included upgrading and standardising IT systems across health settings, digitising and streamlining triage and appointment booking systems and making better use of the NHS App (for example, patients being able to access their records, test results, correspondence and care plans through the app).
Beyond this, there was a strong sense the NHS could be making better use of new technology. For example, Change NHS website participants suggested that AI could play a greater role in triage and diagnostics as well as supporting staff with administrative tasks - as long as staff are involved in decisions about the choice and implementation of new technology to make sure it is fit for purpose, and ensuring they have sufficient training to be able to use it properly.
As above, there was also support for a single digital patient record to help staff access the information they need more quickly, and ultimately improve patients’ experience.
A selection of ideas shared on the theme of data and technology
At my local hospital, each ward/department still have a fax line. Every ward/department has two phone numbers listed on its website. When you call the first one and when nobody answers, you then try the second one and a fax machine answers. This is just wasting NHS money by paying for a fax line, everything is now done by email.
(Public Change NHS website participant)
My experience of the NHS has been repeatedly explaining my child’s medical history to doctors in different fields while they all frantically scribbled the same set of notes. The NHS app does a good job of collating medical history but doctors usually won’t have time to review it - AI could be used to provide a potted summary of a person’s medical history that could be targeted to the specific area of the doctor requesting it, reducing admin and helping care be more targeted to each patient.
(Public Change NHS website participant)
I work in the NHS and have done for a long time now. There are so many efficacies that could be made. In my last trust in North West London, there was no search function to actually search within a patient’s records. There is a lot of time wasted writing discharge summaries which could be AI generated and reviewed. It would speed up discharges and result in more beds.
(Staff Change NHS website participant)
A single EPR (electronic patient record) system across the whole NHS is an obvious enabler of efficient and effective patient care. At the present time each NHS Trust selects its own, resulting in a patchwork quilt of systems that can’t talk to each other.
(Staff Change NHS website participant)
There are several recent examples that have been publicised which show GP practices using AI to triage patients waiting for appointments. Using this they are able to drastically reduce waiting times, free up more appointments and more easily stream to other more appropriate services. Research this further and consider a national scheme to implement this.
(Public Change NHS website participant)
A greater focus on prevention
A significant proportion of ideas for change called for a greater focus on preventing illness, rather than just treating it. This included ideas about improving nutrition and access to healthy food (for example, through subsidised cooking classes), encouraging an active lifestyle through free community exercise programmes, and reduce smoking, drug and alcohol misuse. Ideas also acknowledged that successful prevention needs to focus on areas outside health, including education, housing, local development and reducing air pollution.
The importance of focusing on children and young people came through clearly, with suggestions for early intervention including annual check-ups with a healthcare professional and clinics based in schools (for example, dental check-ups, eye tests or hearing tests), as well as education on healthy habits and lifestyles more widely. There were also calls for nurses to work more consistently across primary and secondary schools so that children and young people are seen more quickly, which in turn would alleviate pressure on local health services and save parents time and money by not needing to take time off work to attend appointments.
Many of the ideas related to prevention focused on expanding screening programmes and early detection schemes, including cervical smears, mammograms and prostate screening. This included suggestions for increasing the number of tests available at home to encourage uptake. There were also calls to introduce a regular health check or ‘MOT’ - ranging from once a year to once every 5 years - to help detect illness early, including blood tests, blood pressure and body mass index (BMI) monitoring and a conversation around mental health and wellbeing.
As above, several of the ideas raised focused on encouraging the public to take greater personal responsibility for their health, from charging for missed appointments or not using A&E correctly to charging people who smoke to access treatment for smoking-related or preventable health problems.
A selection of ideas shared on the theme of prevention
I have terminal cancer. I wasn’t old enough for screening. Early detection of cancer means cheaper treatment and a better chance of recovery. The NHS should provide free home testing for any disease; it can screen for anyone of any age if requested. Frankly, I’d pay for it. It would save lives and likely lower costs.
(Public Change NHS website participant)
The NHS is a sickness service. It could be a health service if we truly invested in prevention and health creation […] At the very least every contact with the health service should enhance someone’s ability to improve their own physical or mental health.
(Staff Change NHS website participant)
If we are to prevent people getting sick it is not about diagnosing and treating as many people as fast as possible (there’s simply not enough [money] for doctors and nurses to do that). Instead, we need to create communities and environments that stop people getting sick in the first place.
(Public Change NHS website participant)
As callous as it might be to say, it’s a fact some conditions are self-inflicted due to a conscious lack of self-care or discipline or engaging damaging habits, such obesity, smoking and irresponsible drinking, which lead to preventable cancers, addictions, type 2 diabetes, etc. In cases where it can be determined that a condition is self-inflicted in this way and could have been prevented, the patient should have to pay the bill for their own care.
(Public Change NHS website participant)
Finance and contracting
There was a smaller but significant volume of suggestions for ways to manage NHS finances and contracts more effectively. Most of these related to reviewing and revising procurement processes, including centralising NHS purchasing systems to ensure different trusts are paying the same amount for the same product, and greater checks and balances on contracts to make sure the NHS is not paying above market rate (for example, for medication). This view extended to paying staff as well as buying products: there were calls for the NHS to examine the role and pay of agency staff and locums to make sure this offers as good value for money as possible.
More broadly, there were calls for greater levels of funding to be allocated to different services, including sexual health, mental health, fertility treatment and end of life care, as well as greater transparency around reporting of costs (for example, sending patients itemised statements) to increase public understanding of NHS value.
A selection of ideas shared on the theme of finance and contracting
Contractor nurses and healthcare assistants do the same job as directly employed ones but cost extra, which just goes into the pockets of the contracting firm, with no actual benefit to patients.
(Staff Change NHS website participant)
A huge amount of money is wasted on contract outsourcing. Typically with contracting, a job that can be done by staff on the books at £200 per day, is outsourced to a contracting company that charge £400 per day.
(Staff Change NHS website participant)
I think there needs to be a review of how services / goods are purchased and then how the awarded contracts are managed.
(Public Change NHS website participant)
Improving the NHS estate and physical infrastructure
A smaller volume of ideas related to improving the NHS estate, both to help drive cost savings and improve the patient experience. This included suggestions to improve energy efficiency of NHS estates - for example, introducing smart heating controls, better insultation and exploring renewable energy sources. There were also calls to update and improve hospital buildings, which felt to these participants like a major constraint on how staff operate as well as on overall efficiency.
Several ideas included suggestions for streamlining how infrastructure is managed - for example, that each trust could have its own maintenance team to avoid the need for expensive contractors, or hospital car parks could be run by the NHS rather than private companies to cap and standardise prices.
A selection of ideas shared on the theme of physical infrastructure
Many of the buildings in the NHS estate are in a poor state of repair, and can often not be fit for purpose […] Older buildings are not energy efficient, which is costing the NHS money on heating bills, using money which would be better spent on core health services. New buildings and refurbishments should aim for high levels of energy efficiency, preferably aiming targeting standards […] which drive down energy use and save money over the long term.
(Public Change NHS website participant)
I have worked in numerous NHS clinics and hospitals and all have had the same issues with outdated heating systems and broken controls. This creates an uncomfortable and often unbearably hot environment for staff and patients and wastes money. Why can’t smart heating controls (or even just working ones!) be fitted to all NHS buildings to save money and increase comfort, instead of having to let all the heat out by opening windows in winter?
The ideas submitted on the Change NHS website were exciting and wide ranging. The main themes from these ideas, and some specific ideas themselves, have been incorporated into the development of the 10 Year Health Plan.