Research and analysis

Partner engagement insight report: 10 Year Health Plan for England

Published 17 December 2025

Applies to England

Summary

As part of the 10 Year Health Plan engagement it was essential to hear from organisations that are part of, engage with, or represent groups that have contact with the NHS or social care services. These organisations have rich insights based on many years of expertise and knowledge. Partner engagement included an open call for submissions, supported by more detailed discussions through roundtable events and the Partners’ Council meetings.

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.

Process

We heard from 1,650 partner organisations through submissions on the Change NHS website, 17 roundtable discussions and 4 Partners’ Council meetings. For this report, partner organisations are organisations that are part of, engage with or represent groups that have contact with the NHS or social care services.

Our engagement with partners aimed to:

• understand what partners wanted to see in the 10 Year Health Plan
• seek ideas for change
• canvass views on the barriers and enablers to deliver the 3 shifts
• hear from a broad spectrum of voices from across the system
• amplify and better understand the views of seldom heard audiences

Overview of insights

Partners told us that the status quo is not sustainable. We heard that:

• infrastructure is outdated
• staff are burnt out
• patients are not getting the timely, high-quality care they need

Broadly, partners supported the principles of the 3 shifts: from hospital to community; from analogue to digital; and from sickness to prevention. They believed that these shifts represented important steps to make the NHS fit for the future.

However, there was concern about the scale of the shifts and scepticism that they were realistic or deliverable - particularly where similar proposals have failed in the past. Supporting the workforce, long-term funding and working more effectively across boundaries were seen as important to successful delivery of the shifts.

Throughout the engagement process, partners saw the 10 Year Health Plan as a critical opportunity to address health inequalities - both geographically and for groups that do not receive equitable access and outcomes. The 3 shifts were seen as having the potential to reduce inequalities - but only if they were implemented with care and in partnership with local communities.

There was optimism that increased local decision making would allow local organisations to better meet the needs of their community. Partners demonstrated a willingness to support the changes needed to make an NHS fit for the future, as long as they are empowered and supported to do so.

Introduction

10 Year Health Plan engagement

Making the NHS fit for the future is one of the government’s key missions. The 10 Year Health Plan is the roadmap for delivering this vision. The engagement exercise was the biggest national conversation about the NHS in its history and sought views on the 3 shifts that this government will deliver and how these should be prioritised. 

As well as receiving over 270,000 contributions from members of the public and staff we sought views from partner organisations on the NHS, its future, and priorities for change. 1,650 (see note 1 below) partners’ organisations views were canvassed through submissions on 5 key questions, with groups of partners engaged in more detail through 17 roundtable discussions and 4 meetings of the Partners’ Council. 

A substantial number of partner organisations represent people with certain conditions or specific professional groups - this naturally is reflected in their responses to engagement. This report will set out the key themes that emerged across the collective analysis. Policy-specific insights have been shared with central policy teams to inform their work. Quotes have been used to provide examples, demonstrate sentiment or better illustrate points that we heard.

Note 1: while the website received 1,800 submissions this was reduced to 1,650 following quality assurance, where they were appropriately categorised (for example, members of the public and staff responses were passed to Thinks for analysis; duplicate and spam responses were removed).

Who we engaged with

For the purposes of this report, partner organisations are defined as organisations (not individuals) that are part of, engage with, or represent groups that have contact with the NHS or social care services. This includes, but is not limited to:

• charities
• community interest companies
• education institutes
• government agencies
• healthcare providers
• local councils
• NHS trusts
• patient groups
• private sector organisations
• professional bodies and regulators
• research institutes
• royal colleges
• think tanks
• unions

Approximately one-third of partners we heard from were from the charity sector, one-sixth were from the private sector and staff representative groups, and nearly a tenth were from healthcare providers. The remainder came from a variety of organisations including local councils, royal colleges, universities, think tanks and research institutes. A detailed breakdown of partners and their areas of interest can be found at annex A.

Two ministerial engagements were undertaken to learn from other countries’ health systems and experiences. Attendees included former health ministers, CEOs, academics and regional health leaders. 

How we engaged

The engagement aimed to build a wide-reaching dialogue with the public, partners and NHS staff and leadership to inform the development of the 10 Year Health Plan. Engagement with partners ran from October 2024 when the website opened and concluded in June 2025 with the fourth Partners’ Council meeting. Insights from submissions were shared with teams developing policy ideas, while international discussions showed how other health services work, overcome challenges, and deliver high quality care. Deliberative events and round tables enabled us to consider policy ideas more deeply, with space for detailed discussions and nuanced reflections.

Submissions

Organisations were invited to submit responses to 5 prompts on the Change NHS website from 21 October to 2 December 2024. The prompts posed were:

• what does your organisation want to see in the 10 Year Health Plan?
• what does your organisation see as the biggest challenges and enablers to move more care from hospitals to communities?
• what does your organisation see as the biggest challenges and enablers to making better use of technology in health and care?
• what does your organisation see as the biggest challenges and enablers to spotting illnesses earlier and tackling the causes of ill health?
• share specific policy ideas for change

While submissions were guided by specific prompts, partners often used their responses as an opportunity to promote their distinct goals and priorities for government. These have been shared with central policy teams to inform future policy development and enrich the understanding of partners’ views on specific areas. 

The Partners’ Council

The Partners’ Council was a forum for stakeholders to hear updates on the 10 Year Health Plan’s development. The primary aims of the council were to: 

• provide partners with an overview of the full engagement and policy cycle for plan development
• enable partners to better understand and position their input into the process
• provide key updates over the course of the engagement exercise

The council met 4 times between November 2024 and June 2025. The initial session provided an overview of the 10 Year Health Plan’s objective, scope and opportunities for involvement, while subsequent meetings were used to share, discuss and challenge developing policy ideas. More detail on the Partners’ Council can be found at annex B.

Roundtables

Between January and May 2025, 17 thematic roundtables were held to gather insights from a broad range of voices from across the health system. Some roundtables focused on a specific issue, exploring these in the context of the 3 shifts, while others examined cross-cutting themes. These were a valuable opportunity for ministers and senior officials to hear from people who will be directly affected by the plan.

Nearly 300 partner organisations attended one or more of the roundtables. This included organisations from small voluntary and community groups to large NHS trusts, professional bodies and national charities. We also heard directly from service users, including children and young people, armed forces veterans, carers, and those living with long-term conditions and disabilities. More detail on the roundtables and attendees can be found at annex C.

International engagement

On 6 March 2025 a roundtable was convened by the World Health Organisation’s regional office for Europe in Denmark. Countries represented included: Portugal, Belgium, Hungary, Denmark, the Netherlands and Germany. On 19 March 2025 a roundtable was convened by King’s College London and the Institute of Development Studies. Countries represented included: Brazil, Chile, Costa Rica, Canada, India, Japan and New Zealand.

Attendees were asked to share their experience of leading health system reform, using the 3 shifts as a framework for the discussion. The conversations focused on how to implement health reforms and system change effectively. An overview of the operational recommendations that came from these sessions can be found at annex D.

What we heard

This report sets out an overview of the key insights gathered from partner organisations to support the development of the 10 Year Health Plan. The partner engagement programme explored partners’ thoughts on the government’s 3 shifts: from hospital to community; from analogue to digital; and from sickness to prevention. Alongside this was consideration of ideas for change and what should be prioritised in the 10 Year Health Plan.

This report sets out what we heard about 4 key themes:

• patient experience
• designing the NHS of the future
• workforce
• digital and data

Patient experience

Across all engagement, partners said that improving patient experience was vital, both in terms of their health outcomes and how satisfied patients feel about their care. This chapter sets out the main themes we heard about access, health inequalities, patient choice and patient responsibility.

Access

Improving access to care was an important issue for partners throughout the engagement. It was hoped that the 3 shifts would support better access to services:

• hospital to community could improve the quality and timeliness of in-person access
• digital solutions could provide 24/7 advice, supporting self-care and appropriate triage
• focus on prevention could reduce the prevalence or severity of illnesses, reducing pressure on waiting times for urgent, acute or specialist care

Many partners acknowledged access challenges across the NHS - particularly in primary care. Throughout the engagement we heard concerns that moving care to the community without increasing primary care capacity could compound access issues. Some partners said that without action to improve primary care capacity now, there was a risk that the shift from hospital to communities would be undeliverable. A small number of partners highlighted the potential to broaden the range of professionals in multidisciplinary teams working in the community to support improved access.

The growth in primary care workload has not been matched with proportionately increased resources, which leads to untimely primary care access, knock-on delays to diagnosis, and negative patient experience… The 10YHP must therefore lay out a plan for increasing primary care capacity to reliably deliver timely access.

(Cancer Research UK - submission)

We are also aware of the general, serious concerns about the capacity of primary care services at present. We urge the Government to address these concerns as a priority.

(Mencap - submission)

Most partners thought that well designed and funded digital services and tools have the potential to improve access to care. Some partners said that booking and managing appointments online would allow access to fit around other commitments, such as work and caring. Digital service provision could increase capacity within the system and support quicker access to care, such as through virtual appointments, online therapy, telehealth support and virtual wards. Digital service provision was thought to have particular benefits for people who may struggle to access in-person services or those who might be more comfortable accessing services online.

Barnardo’s is supportive of a shift towards the improved use of technology in health care. For many children, young people and families, it is both appropriate and effective for them to receive or access services through online platforms and other technology.

(Barnardo’s - submission)

Members spoke of the opportunities provided by telehealth platforms, whether in providing virtual ward support, diagnostic services or virtual appointments for primary care clinicians, therapists or community care providers. They foresaw an environment where patient choice can be enabled and supported through digital consultations, appointment booking through mobile apps and access to health information and support.

(Independent Healthcare Providers Network - submission)

While the potential for technology to improve access was heard strongly, respondents were clear that technology should support - but not replace - face to face interaction with healthcare providers. Partners said that technological advances should be used to free up clinicians’ to spend more time with patients, and that patient-clinician relationships are vital for high-quality, personalised care. This came through particularly strongly in engagement with partners focused on mental health, children and young people and older people.

People with Parkinson’s, their carers, and health professionals were very clear that digital health technologies should not replace interactions with health professionals but should be used to improve the quality of care and free up more time to care for patients…

(Parkinson’s UK - submission)

The government needs to guard against the wider use of technology being seen as a shortcut to NHS improvement or as a way of avoiding boosting NHS funding; it should complement investment in the workforce rather than replace it.

(UNISON - submission)

Health inequalities

Addressing health inequalities was raised by partners as a priority across all 3 shifts. Partners reflected that this is an enduring issue rooted in social healthcare determinants, that demands a response beyond the remit of the healthcare system. Many roundtable discussions focused on the impact of inequalities and highlighted how intersectionality can entrench them. Without addressing this fundamental issue, partners said that the most vulnerable groups will continue to be disenfranchised, experience poorer outcomes, more ill-health and earlier mortality. 

The main focus of the Health Plan should be the social determinants of health, and a clear commitment to tackling health inequalities by improving the social, economic and environmental conditions of the least well-off people in our society. The better off people are the better their health - this is a clear and well-established causal relationship.

(Association of Directors of Adult Social Services, Association of Directors of Environment, Economy, Planning and Transport, and Association of Directors of Public Health (joint response) - submission)

These [social] needs are often underpinned by persistent and stubborn population health inequalities that haven’t shifted for decades. Progress towards the government’s ambitions will be difficult to achieve without a greater focus on ensuring people’s basic needs are met in the community and addressing underlying health inequalities.

(British Red Cross - submission)

Many responses highlighted socio-economic groups that already face longer waits, worse experiences and poorer outcomes. These included: people experiencing homelessness, minority ethnic groups, non-English speakers and people with learning disabilities or autism. The reasons given for this disparity were varied, but included structural racism, unequal geographic investment in services and wider social determinants (such as poverty, poor housing conditions and unemployment). Inequalities of provision, care and outcomes were raised with specific reference to maternity, mental health, learning disabilities and dementia care. A small number of respondents stressed the importance of cultural competency training and care being sensitively tailored to different groups.

More effective support is needed for groups that report worse outcomes from healthcare, e.g. racialised communities, LGBTQIA+ communities, people with learning disabilities and autism and other health inclusion groups, taking a designing from the margins approach to ensure services meet people’s needs and target resources effectively.

(MIND - submission)

Those from an ethnic minority communities experience more negative impact of their diagnosis than white respondents.

(Cancer 52 - submission)

Black women are almost four times more likely to die in pregnancy or childbirth.

(Birthrights - submission)

Several partners raised concerns that the benefits hoped for through the 3 shifts and 10 Year Health Plan could entrench inequalities unless action is taken to address existing disparities. Moving care from hospital to community was thought to potentially make access harder for some groups, notably the elderly or those without a stable home environment. Some partners thought shifting services into the community would improve access for rural and coastal communities; while others cited concerns that it would compound existing inequalities.

While providing better care for everyone outside of hospital should be the aim, hospital care will continue to be a significant part of the care the NHS provides to people facing homelessness and other inclusion health groups for the foreseeable future. This means that maximising the benefits of a hospital stay, to set people on a trajectory towards better health and connected to community-based services, will be an important part of this shift.

(Pathway - Homelessness and Inclusion Health - submission)

Partners said that the shift from analogue to digital must tackle digital exclusion head on. Digital poverty, including a lack of affordable devices, internet access or safe spaces to access the online services were reported as major barriers. There were concerns that digital exclusion could widen existing health inequalities for groups including: older people; low-income households; people in rural areas with poor digital infrastructure, non-English speakers and people with learning disabilities or autism. These concerns were reflected in discussion at roundtables.

While technology may bridge some of these gaps, many underserved populations face digital exclusion, leaving them less likely to benefit from certain technology advancements. Additionally, we have recognised that limited internet access in rural areas for people receiving care via a virtual ward has impacted quality of care received. Therefore, the plan will need to ensure inclusive service design and enhanced digital access in under-resourced areas.

(Care Quality Commission - submission)

Another challenge is the digital exclusion faced by many people with learning disabilities. While the pandemic led to an increase in the use of digital tools among this population, the evidence suggests that it has not translated into improved skills for accessing services online or using digital health platforms. Many people with learning disabilities face specific barriers to using technology independently.

(Learning Disability England - submission)

Equity of access and outcomes were also highlighted in discussions around prevention. Respondents reflected that vulnerable or marginalised groups often find it harder to access preventative services at the right time, resulting in poorer outcomes. Overcoming this will require bespoke, culturally-sensitive preventative services that better reach minority communities.

Collaborative efforts between technology developers, healthcare providers, patients and families are essential in creating solutions that not only address health inequalities but also pave the way for a more equitable health future.

(Kidney Research UK - submission)

Patient choice

Partners told us patients having a choice - in terms of how, when and where they access services - was important. Partners wanted services to be designed to reflect the needs of the populations they serve, using co-production to make sure barriers are understood and mitigated. Changes in the way services are delivered - such as increased community or digital provision - should be balanced with hospital and analogue provision where these better meet patient needs and preferences.

Digital transformation and solutions must be co-produced with all parties involved. Technology does not work for everyone, and people can find themselves digitally excluded for multiple reasons. It should involve all those with a stake in care and support data, especially people drawing on care and support.

(Social Care Institute for Excellence (SCIE) - submission)

The Health Plan must mandate that choice be available for every service user accessing any mental health service. Recognising that choice increases service user satisfaction and outcomes.”

(British Association for Counselling and Psychotherapy - submission)

Some organisations, most notably those focused on maternity health, feared that a shift to community services would reduce patient choice. Several respondents were concerned that financial benefits might drive changes to service delivery, rather than the focussing on clinical efficacy and patient need.

The Sands and Tommy’s Joint Policy Unit have said that service design must be based on clear evidence as to how it meets the needs of women and babies - rather than fit into a general policy ambition for the NHS to move care into the community.

(Sands - submission)

The importance of educating people on community health pathways must also be looked at, to ensure people’s needs and choices are put above a desire to move demand out of hospitals.

(Healthwatch England - submission)

There was broad support for the NHS app and online resources. These tools were seen to have the potential to increase patient agency through helping people to actively manage minor ailments, improve self-care and support those with long term conditions. Roundtable discussions on women’s health and children and young people highlighted that often people turn to less reliable sources of information - such as social media - if NHS information is not easily accessible and understandable.

Some organisations saw a greater role for digital services in the future, including personalised support, symptom tracking, self-help apps and interactive digital tools like chatbots. However, partners emphasised that maintaining non-digital options and in-person services are vital to provide real choice for patients. Several organisations noted how important clinician-patient relationships are to good care, and how these could be diminished by an over-reliance on digital tools.

While digital interventions may be helpful for some young people, it must be a choice and form part of a personalised care pathway. Some young people require a trusted relationship with a trusted adult, and limiting them to digital services may increase disengagement, disillusionment, and make it less likely that they’ll reach out for help in future.

(Young Minds - submission)

vCreateNeuro is a web-based service which allows individuals and their carers to quickly and securely share videos they have recorded with their doctor or nurse. Videos are uploaded to a secure cloud and can only be accessed by the clinical team… This video service has allowed people to send essential information to their specialists relating to their seizure patterns to support improved outcomes for diagnosis and treatment.

(Epilepsy Action - submission)

The need for informed decision making about personal data and information was raised in discussions about digital services. Partners throughout the engagement highlighted the challenges in balancing better data use with concerns about data security and privacy. There was a strong consensus that patients should ‘own’ their patient record, rather than the GP, to prevent clinicians being the ‘gatekeepers’ of personal medical data.

Data security: many apps will be storing data that is extremely personal to the user. There have also been incidents of deliberate unethical practice: with app providers selling personal data on people with mental health problems.

(Mental Health Foundation - submission)

Patients as partners

Partners explored the role people play in the management of their health, care and treatment, how patients and healthcare professionals can collaborate more effectively, and what that would mean for delivering the government’s vision for the future of the NHS. 

Some partners said that the attitudes and actions of the public and patients will be critical in delivering the shift from hospital to the community. Many people see hospitals and A&E as the ‘default destination’, or the safest place to receive care, particularly when accessing primary care is difficult. Others said that some patients would always prefer to see a GP even if other community services could provide the same care.

Without doubt the general public do not know where to turn for their health and care needs in a very fractured system. This results in making way to the two locations traditionally understood - hospital emergency departments and general practices, even when current alternatives are available. This is particularly acute in the mental health system for children and adults and in meeting the needs of homeless persons who are ill.

(Faculty of Public Health - submission)

The prevention shift relies heavily on the public taking supported, long-term action to improve their health, including health checks, screening, lifestyle choices and reliably taking medication. This can be supported by digital services that increase patient knowledge and expertise on their condition and allow greater autonomy to manage their conditions well. Responses suggested that if services were to engage when people are more receptive to lifestyle changes, this would improve uptake - as would more clearly recognising patients as experts in their own condition. However, a strong message came through that it is harder for some groups to self-care effectively, due to socio-economic or personal factors.

The waiting period leading up to surgery could be used as a ‘teachable moment’ for healthcare professionals to deliver individualised health messages. This has been shown to embed long-term behavioural change, with 46% to 75% of patients in prehabilitation programmes reporting positive lifestyle changes, including 48% to 75% increasing physical activity, 43% stopping smoking and 40% reducing alcohol consumption after surgery.

(Royal College of Anaesthetists - submission)

Some patients raised that there is a personal responsibility for patients to care for themselves, through means such as ensuring they have a good diet or regularly exercise. However, patients also recognised that a person’s ability to self-care may be limited by social determinants of health.

(Patients Association - submission)

… A culture that places women at the centre of their care, listens to their questions and concerns, understands what they want and need and tailors’ services accordingly. Giving women the time to discuss and consider the options available to them and empowering them to make their own decisions must be the golden thread that runs through all these policies.

(Royal College of Midwives - submission)

Designing the NHS of the future

Partners considered what a new model of care could look like in the NHS. Many acknowledged that the status quo was unsustainable. Discussions on new models of care predominantly focused on the hospital to community shift, but also touched on elements of the digital and prevention agendas. This chapter sets out what we heard about bringing care closer to home, integration, meeting local needs, reducing demands on acute services and transition.

Care closer to home

Partners said that conveniently located services could help people get the right treatment at the right time, allowing earlier diagnoses and better management of conditions. Seven days a week provision and co-located services in the community may support better care and treatment.

Women’s Health Hubs offer great potential to support those with endometriosis and menstrual health conditions, supporting and speeding up the diagnosis process by providing a local’ one stop shop’ to access the scans, blood tests and other support needed to get a diagnosis.

(Endometriosis UK - submission)

Shifting the focus of healthcare delivery to a patient-centred model allows for personalised, flexible, and convenient care in community settings.

(techUK - submission)

Some partners also believed that increased community service delivery could lead to more efficient and cost-effective care. Examples cited included the potential to reduce pressure on secondary care services through better management of conditions in the community, minimising acute admissions and enabling patients to be discharged efficiently.

Neonatal outreach services enable babies to be discharged earlier whilst under the care of their neonatal team. This is particularly important as the provision of neonatal outreach services is associated with cost savings as a result of fewer care days in hospital.

(Bliss Charity - submission)

It is approximately 100 times cheaper to treat a young person in the community than as an inpatient (GIRFT Report, 2022), but community mental health infrastructure is severely lacking both in CAMHS and across the voluntary sector.

(YoungMinds - submission)

Integration

Improved integration within the NHS is a longstanding aim - but many partners were frustrated with fragmented and uncoordinated services that cause safety risks, poorer outcomes and, at times, emotional trauma for patients having to repeat their stories multiple times. The impact of poor integration was explored in greater detail in the roundtables on maternity, children and young peoples’ mental health and cancer.

Fragmented referral systems, siloed data, and poor interoperability hinder care coordination. This results in patients experiencing delays, duplication of efforts, and gaps in care.

(National Association of Primary Care - submission)

One significant barrier to moving care from hospitals to community settings is the poor coordination between acute, primary, and community-based NHS services. This lack of integration often results in substandard care, missed opportunities for timely community-based interventions, and additional pressure on mental health hospitals.

(Centre for Mental Health - submission)

However, many partners reflected an ambitious vision for integration that goes beyond primary and secondary care and aims to work holistically with the care sector, voluntary sector and local authorities. A broad approach to integration was thought to potentially support the delivery of whole-person care and mitigate the wider determinants of ill-health such as housing, education, employment and social isolation. 

The 10 Year Health Plan… can address environmental and social factors impacting population health, including income, education and housing, which sit far beyond NHS care. System working in its broadest sense - that is, organisations with an influence over these social determinants of health, including services provided by the VCSE and other non-statutory services - is therefore crucial to improving health, not just healthcare.”

(NHS Confederation - submission)

Integration needs to extend beyond the NHS and social care and take a place-based approach, with a collective responsibility to ensure people can lead healthy, fulfilling lives.

(Association of Directors of Public Health - submission)

A small number of respondents specifically cited the vital role of integrated care boards (ICBs) in delivering integration. With a detailed local knowledge of the local population, ICBs were best placed to provide oversight of provision, commission services where there are gaps and make the necessary local links to deliver better integration.

ICBs should ensure there is a clear, concise, and representative offer of the support provided locally, ensuring they are mapping their offer, resources and existing organisation and provision in a joined-up way.

(Children and Young People’s Mental Health Coalition - submission)

The key to success in this shift is integrating care pathways in a way that ensures patients receive timely care in the most appropriate setting. ICBs commissioning specialised services presents an opportunity to deliver joined-up pathways with care delivered closer to home and in community settings where possible.

(The Association of the British Pharmaceutical Industry - submission)

There was particular focus on the integration of services, when care users’ traverse boundaries of provision: these included from primary to secondary care, from NHS to social care and from children to adult-focused services. The transition from children and adolescent mental health service (CAMHS) to adult mental health services was mentioned frequently in both the children and young people mental health and learning difficulties and autism roundtables as an example of where integration does not currently work effectively for patients. In other responses, attendees called for better integration of mental and physical health services and between professional and volunteer service provision. 

The transition process from paediatric to adult services is often a challenging time for people affected by neurological carers and those who support them. NICE guidance recommends that young people should have a’ named worker’ to coordinate their transition care and support.

(The Neurological Alliance - submission)

Integrated care pathways: Stronger links between hospitals and community services can ensure smooth patient transitions, reducing readmissions and supporting recovery.

(UK Sepsis Trust - submission)

Meeting local needs

There were conflicting views on whether delivering care in the community would help to better meet local needs. Some partners believed that this shift should devolve more decision-making to ICBs, allowing them to tailor services to meet local needs: others were keen to emphasise the importance of national standards, strategies and oversight to minimise geographically variations in service availability. A small number of respondents highlighted the need to ensure expertise could be developed centrally, particularly in the management of rarer illness and conditions.

Importance to retain centres of excellence in all areas of mental and physical health across the 4 nations as a resource for training and for appropriate interventions when needed.

(Association of Child Psychotherapists - submission)

Implement national minimum standards for ICSs as a fundamental part of the new 10-year NHS plan to ensure that all major respiratory conditions are diagnosed and treated effectively, with under-performing ICSs held to account.

(Asthma + Lung UK - submission)

The sentiment of the Partners’ Council and some submissions were that, at present, national priorities crowd out local needs. There was ambition to better centralise decision making to reflect local need, and the role of ICBs in understanding and delivering services was considered vital. Several responses said that voluntary, community, faith and social enterprise (VCFSE) sector organisations could play a larger role in facilitating local decisions, given their unique understanding of the needs of underrepresented communities, particularly when designing services or programmes to reduce health inequalities.

The voluntary, community, and social enterprise (VCSE) sector is an invaluable partner in the healthcare ecosystem. These organisations bring innovation, flexibility, and quality to prevention and care services. Their deep connections to local communities enable them to reach populations that NHS services often overlook.

(Age UK - submission)

If ICB led commissioning is to be an enabler of greater community-based care, another significant challenge will be minimising unwarranted variation in quality of care on a national level. Implicit to devolved care aspirations is the assumption there should be greater discretion at a local level for designing services in a way that best serves the local community.

(Cystic Fibrosis Trust - submission)

Reducing demand on acute services

Some partners saw the potential of the the 3 shifts to reduce demands on acute services. Delivering services locally and digitally has the potential to signpost people to appropriate non-acute services, while effective prevention could reduce the instances of illness or allow them to be better managed (either through self-management or community care) for longer. However, a strong desire to retain centres of expertise in hospitals to deliver specialised and emergency care was expressed.

There remains a strong rationale and evidence base for delivering certain types of care within centralised settings, such as hospitals. For example, there is a well evidenced relationship between volumes and outcomes for much routine and specialised surgery…. Highly specialised care and much emergency and critical care requiring time-sensitive, multidisciplinary input and/or access to a scarce workforce is also best consolidated and co-located with other specialised care in a centralised care setting.

(The Shelford Group - submission)

Investing in these services in the community, by helping people manage their care day-to- day, can be a key driver in reducing A&E attendance and hospital admissions, with strong evidence from a survey of people living with and affected by cancer reporting significant decreases in average overnight hospital stays.

(Macmillan Cancer Support - submission)

Transition

Partners said that the scale of change needed across all 3 shifts - covering funding, resources, workforce, patient and staff attitudes - was significant. Some organisations said that while the shifts have the potential to deliver better outcomes, fully realising efficiencies would require long-term investment and continued support. Many partners highlighted concern about the transition from current practise to delivery of the 3 shifts - but particularly in relation to hospital to community. 

Realising cost savings will take time and require up-front investment in community services, alongside continued investment in the acute sector in the medium term.

(NHS Providers - submission)

Previous narratives around ‘shifting care into the community’ often centred on reducing demand for hospitals and cost savings, alongside other aims to improve patient experience and outcomes, or better integrate out-of-hospital services. However, evidence shows that developing new models of community-based care can take several years to develop and deliver results, and the impact of community-based multidisciplinary teams is mixed. With hospital capacity already overstretched, any assumptions of reductions in acute bed numbers are misplaced.

(The Health Foundation - submission)

Partners reported that funding and its distribution will be important to effectively deliver the 3 shifts.

One of the biggest challenges is the need for increased funding and resources for community-based services. Hospitals are often better funded, and care in the community can face financial constraints that hinder its ability to offer the same level of support. Adequate investment in community services, including the voluntary sector is essential for this shift to be successful.

(Dementia Support - submission)

A commitment towards shifting resources towards prevention, and the introduction of an accounting framework to measure investment, would help ensure that funding is directed towards initiatives with the greatest impact. Shifting the system design towards adequate funding, and greater rewards, and accountabilities will be key.

(The Kings Fund - submission)

Workforce

The workforce was a priority in partner responses across the engagement exercise. Seeking insight from staff on changes and supporting them to deliver high-quality, personalised, face-to-face care was considered vital now and in the future. The workforce was a focus in discussion for all 3 shifts. This chapter sets out the key points on capacity, community workforce and care, culture and wellbeing, and long-term planning. 

Capacity

Workforce capacity was an issue that came up frequently in submissions from partners at the Partners’ Council and during roundtable discussions. There were repeated calls to boost workforce capacity, either through increasing numbers, improving integration or expanding roles and remits. However, with the exception of digital, there was less discussion about whether changing models of delivery would impact capacity requirements.

Many partners implied that workforce numbers were insufficient to deliver current priorities or the 3 shifts, while a smaller number of respondents explicitly said the size of the workforce needed to increase. 

Increasing the number of GPs, and investing in greater support for the existing workforce, will enable general practice to offer improved personalised continuity of care while improving access.

(The Royal College of General Practitioners - submission)

For community hubs and community-based birth options to succeed it is essential that they are staffed by adequate numbers of suitably skilled midwives and support staff. It is also essential that these midwives be ring-fenced and not called in to cover staff shortages in the hospital. It is therefore critical that the current shortage of midwives is addressed as a priority.

(AIMS (Association for Improvements in the Maternity Services) - submission)

Partners representing smaller professional groups and other healthcare professions (such as allied health professions and healthcare scientists) highlighted the potential for these groups to support care delivery and fill ‘gaps’ in current provision. A small number suggested that extending the fields of clinical competency or professional regulation would support capacity and recruitment for these professions.

Extending prescribing rights and PGD authorisations to osteopaths and similarly qualified AHPs would support the NHS commitment to “upskilling the workforce” as outlined in the Long Term Plan. This change would also fulfil the NHS People Plan’s aim to enable professionals to “work at the top of their license,” ensuring that qualified practitioners provide timely and efficient care across primary, community, and secondary care settings.

(The Institute of Osteopathy - submission)

Members have expressed continuing concerns about either the lack of regulation of some roles (psychotherapists and counsellors) or the potential quasi mandatory/voluntary regulation of roles (clinical associates in psychology).

(UNITE - submission)

A number of respondents said digital tools have the potential to increase efficiency and reduce staff workload, giving them more time to spend with patients. Artificial intelligence (AI) was highlighted as the tool with most potential to reduce administrative work and support diagnosis and decision making. While the benefits to the workforce of increased digitalisation were widely supported, most partners were explicit that technology should complement and support, but not replace face-to-face care.

Technology can be best used to do administrative tasks, freeing up healthcare professionals to provide care.

(British Geriatrics Society - submission)

Digital solutions should be part of a broader package of blended care, not a replacement for traditional services. While digital tools can work well for some people, especially those with strong support networks not everyone will be able to access them so they should be used to complement rather than replace face-to-face support.

(Maternal Mental Health Alliance - submission)

Community workforce and care

Several respondents reported a lack of parity of esteem between secondary care and community roles. In order for the hospital to community shift to work, this assumption needs to be challenged to increase the appeal of community roles for current and new staff.

The growth of the health and care workforce has not been aligned to delivering care closer to home, with larger growth in acute hospital sectors and worrying trends of some community workforce numbers decreasing. Culturally, working in acute settings has perceived higher status compared to primary and community services, with the career backgrounds of many senior NHS leaders concentrated in hospitals.

(The Kings Fund - submission)

Many organisations highlighted the vital role that unpaid carers and volunteers play to support patients and deliver non-clinical care. Many argued that greater recognition is needed to acknowledge the service they provide, and strongly advocated for increased support for their physical and mental health, with particular reference to young carers.

Unpaid carers are vital to the fabric of the local health and care system, so local areas should have an established plan for how they will support unpaid carers - both in their caring role and for their own health.

(Carers Trust - submission)

[The] Plan should commit to improving carer support, ensuring carers are not left isolated, and that they receive the appropriate recognition, assessment, and resources to enable them to continue their vital work. By addressing the needs of carers, the NHS can improve both the wellbeing of individuals with MND and their carers, ultimately leading to a more sustainable and effective health and social care system.

(Motor Neurone Disease Association - submission)

Culture and wellbeing

Improving the workplace culture and improving staff wellbeing was highlighted by many partners. Making real change in these areas was considered vital to improving morale and allowing the NHS workforce to deliver high standards of care. What partners believed needed to change varied, but repeated examples included improving diversity, leadership, openness, transparency and inclusivity. A smaller number of organisations reflected on the need for an environment where patient safety, discrimination or bullying and harassment concerns can be raised without fear or blame. This was discussed in roundtables focussing on cancer, nursing and health and wellbeing; it was also understandably, a priority area in submissions from workforce representative organisations, as well as regulators and royal colleges.

A sustainable, happy, and well workforce that is able to provide the best and right care for patients at the right time.

(Society of British Dental Nurses - submission)

The biggest challenge and issue that I see that actively impacts the way we deliver services negatively is the consistency and quality of leadership. I have witnessed and experienced very poor leadership skills, leaders who are not honest, deceptive and appear to be out for themselves with little regard to the core purpose of the NHS.

(Staff member - deliberative event)

The RCM ask that the process for speaking up in the NHS be strengthened, ensure staff feel safe to speak up with their concerns and experiences be heard and learnt from. Importantly we need to work to eliminate racism and other forms of discrimination listening to both staff and women and families. These create toxic workplaces, which drive staff out of the service.

(Royal College of Midwives - submission)

Many partners expressed concern that the current working environment was unsustainable, with untenable workloads and a system that is unable to deliver a reasonable standard of care. This was explored in detail in some roundtable discussions. In some cases, partners said this led to moral injury for the staff with associated emotional and mental distress - the cancer roundtable discussed the direct effect burnout is having on the quality of care provided. Attendees of the nursing roundtable shared frustration over rising workloads and limited recognition. Burnout and workforce pressures were raised as barriers to delivering high-quality care during the cancer roundtable. Many partners said that improvements in these areas would increase morale and support staff recruitment and retention. 

A 10-year Plan for the health service needs to talk about the culture of the health service, not only for people using services, but also for those working in the health service. We need to make the NHS an attractive place to work, where people can develop, work flexibly and provide person-centred care in a supportive and inclusive environment.

(Nursing and Midwifery Council - submission)

Long-term workforce planning

Effective workforce planning and training were identified as crucial to giving the workforce the right skills, competencies and tools to deliver quality care now and in the future. Most respondents called for investment to upskill the workforce, particularly around digital and community working. This was specifically referenced in discussions across all 3 shifts - as the workforce will need support to deliver preventative care in the community supported by digital tools.

We need a long-term workforce plan that matches the political and public expectation for health and social care, is fit for purpose and that addresses how the NHS will educate, train, recruit, and retain the doctors it needs to meet future demand.

(British Medical Association - submission)

We know that the public want to see more training and development for staff in healthcare, enabling them to deliver a wider range of interventions in a wider variety of settings. As part of any workforce strategy, the government must make clear how they will enable staff from across the health system to access training which expands their skills and enables them to deliver improved outcomes.

(Royal Society for Public Health - submission)

There was particular focus on the need for workforce training to support the shift from analogue to digital. It was suggested that NHS staff training needed to cover diagnostics, data analytics, AI, digital platforms and coding, and that these should form part of undergraduate and postgraduate curriculums. Some organisations highlighted that staff training should include how to identify and mitigate inequalities inherent in digital service delivery.

Building in enough time and resources for workforce education and training is essential for making best use of technology. This should include not just how staff can use particular technologies but how to incorporate them into their roles.

(The Nuffield Trust - submission)

There are not enough data professionals in the NHS and those that are in post have extremely high demands on them. For the system to effectively move from analogue to digital, the data workforce must be upskilled and expanded. Data management roles and data fluency skills in the rest of the NHS workforce should be a key part of the NHS long-term workforce plan.

(Anthony Nolan - submission)

Digital and data

The engagement revealed repeated concerns that current IT, digital systems and data use are ineffective, outmoded and piecemeal. However, overall partners were optimistic about the potential for digital and data innovations to drive improvements in delivery and integration. This section sets out partners’ views on better use of data, funding, infrastructure and interoperability, and patient experience.

Better use of data

More effective use of data, including collection and sharing, was a priority for many partners. They outlined how access to high-quality, standardised data has the potential to transform healthcare delivery, research, planning and innovation. Some respondents said that health data could improve patient outcomes and enable targeted care and resource planning - especially for minority groups, older adults and those with rare conditions.

There is a relative lack of analytical capability given the richness and potential value of NHS data.

(Royal College of Emergency Medicine - submission)

Improving access to linked patient data is essential to inform the development of new technologies, advancing our understanding of all diseases including cancer, as well as for service improvement. Lengthy, costly, and inconsistent data access processes have held back research and technology evaluation. Data linkage is also a known barrier in areas like screening and primary care.

(Cancer Research - submission)

However, partners reported that challenges like inconsistent coding, nomenclature and unstandardised formats mean NHS data remains siloed, incompatible or otherwise unusable. Organisations also reported poor quality data collection in certain areas (for example dementia, community services and rare conditions) with some demographics underrepresented or missing altogether. There was, therefore, a strong call for standardised systems, data coding and collection practices across the NHS.

The National Congenital Anomaly and Rare Disease Registration Service collects data on rare conditions via the NHS and via research activity within the NHS… This approach needs to be better funded and more routine. It is only through systematic expansion of the registration of rare conditions that this data set can match up against the impact of the National Cancer Registration Service.

(Genetic Alliance - submission)

Data collection and analysis must improve. The LeDeR programme has demonstrated the value of learning from deaths to prevent future tragedies, but we need similar systematic learning about near misses and successful interventions. This includes better recording of disabilities and intersecting identities in health records to understand and address specific patterns of health inequality.

(Voluntary Organisations Disability Group - submission)

Data access processes were described as lengthy, inconsistent and bureaucratic. Other barriers cited included the lack of a workforce trained in data and analytics and concerns about adhering to data protection and privacy legislation. A small number of respondents felt health professionals could better support patients that may be eligible for trials, to increase uptake.

Ensuring that healthcare professionals have proactive conversations with patients about the availability of research opportunities can dramatically improve access to trials and early intervention.

(Motor Neurone Disease Association - submission)

For many care providers, ensuring data privacy remains an issue as adhering to regulations such as GDPR is complex, especially given the increasing threat of cyberattacks. Navigating complex regulatory frameworks can delay innovation and implementation.

(Skills for Care - submission)

Many organisations highlighted the importance of clear governance, transparency and public trust for the effective use of data. They noted the need for consistent frameworks around consent, use, storage and ownership, with transparent guidelines for patients on what is shared with whom, and why. Some organisations also raised concerns regarding cybersecurity and data breaches, noting that digitisation increases vulnerability to attacks. A lack of secure infrastructure, especially in community and home settings, was a major concern.

Clear guidelines on what data is shared, with whom, and for what purpose will be essential to maintain patient trust and comply with legal and ethical standards.

(Allied Health Professions Federation (AHPF) - submission)

In addition, technological advances in clinical uses need to command public confidence. The 10-year plan should consider how best to achieve innovation while putting appropriate guardrails around the way technology is used. This is best illustrated by advanced artificial intelligence (AI) which, while revolutionising many aspects of modern healthcare, remains susceptible to bias and cyber-attacks.

(The General Pharmaceutical Council - submission)

Funding

Insufficient and inconsistent funding was raised as a major barrier to digital transformation. Partners described how underinvestment has created a backlog in digital infrastructure, with budgets often redirected to cover operational costs. They also outlined how short-term funding models and procurement practices prioritise low upfront costs over long-term value, preventing adoption of effective technologies. There were repeated examples of promising pilots being abandoned and missed opportunities for innovation, prevention and efficiency. High initial costs, along with expenses for training, maintenance and integration, were seen as especially prohibitive for smaller providers. Some also reported a digital divide across regions and sectors, with social care and VCFSEs particularly underfunded.

A major limitation to systems making better use of technology is having adequate capital and revenue funding. ICSs need future funding confirmed over longer timescales to be able to strategically invest and keep pace with digital and technological innovation.”

(NHS Confederation - submission)

Procurement in the NHS is overly focused on acquisition cost rather than value. As a result technologies that demonstrably improve prevention, earlier intervention, productivity and efficiencies are lost to the NHS.

(Association of British HealthTech Industries - submission)

Organisations called for long-term, protected capital and revenue funding, alongside investment in implementation, training and support to ensure inclusive and sustainable digital transformation.

Infrastructure and interoperability

Poor basic infrastructure was seen as a major barrier to making the best use of technology. Responses reported insufficient or outdated hardware, unreliable wifi, poor interfaces, multiple log-ins and slow networks hampering the delivery of care on a day-to-day basis. Some organisations pointed out how infrastructure quality varies by location, creating a postcode lottery. Unreliable basic infrastructure leads to lack of confidence that broader digital approaches will be delivered and provide a barrier to progress in innovation and research.

All systems need to talk to each other. The dentist, hospitals and GP need to automatically update your medical records. It took the GP 5 weeks to update my records. It needs to be immediate.

(Member of the public - deliberative event)

Amongst respondents to our survey, capital investment in basic IT infrastructure was by far the most supported enabler of this shift; 60% of respondents ranked it as the number one enabler.

(The Royal College of Radiologists - submission)

Community nurses are being held back by poor IT infrastructure.

(The Queen’s Nursing Institute - submission)

A frequently cited challenge to making better use of technology was embedding interoperable systems and effective, safe record sharing. The Partners’ Council and many organisation submissions highlighted how current IT systems are fragmented, non-standardised and incompatible with one another. This means data cannot be shared seamlessly across primary, secondary and community care - or with partners beyond the NHS such as social care and VCFSE partners. In some cases, even internal data sharing within the same care pathway or organisation is challenging.

Fluid data sharing between providers can be impeded by the considerable variety in the digital systems used for processes such as care planning, medication requirements and clinical governance.

(Leonard Cheshire - submission)

Effective and safe data sharing across different parts of the system is also critical to ensuring technology uptake and better patient care. Without greater interoperability and sharing of records across healthcare settings, none of the 3 shifts will be deliverable.

(The Royal College of General Practitioners - submission)

We heard from partners that disconnected systems create inefficiencies for staff, extra stress for unpaid carers, frustration and even, in some cases, distress for patients. Beyond the personal impact, it can materially affect outcomes, disrupting diagnosis, delaying treatment and fragmenting care, especially for people with long-term or complex needs. As such, there was a clear call for improved interoperability across all systems to enable more integrated, efficient and patient-centred care. Organisations listed potential benefits of reduced duplication, faster referrals, improved safety, earlier intervention and giving staff more time to carry out frontline care. A small number of responses went further, calling for inter-agency data sharing across health, police, education and other services to provide a full, holistic picture of need and risk.

Partial and disconnected records across services leads to uncoordinated care and the potential for health or safeguarding issues to be overlooked and leaving vulnerable children ‘invisible’.

(Royal College of Paediatrics and Child Health - submission)

The absence of a unified system for information sharing across agencies hinders early intervention and coordinated care in cases of child abuse and neglect. Health, education, social care and policing often operate in silos, which prevents the development of a comprehensive understanding of a child’s needs. This can result in delayed or missed interventions, as professionals do not have access to the full picture of a child’s needs and risks.

(NSPCC - submission)

Conclusion

Through the engagement, partner organisations have connected with the 10 Year Health Plan in a productive and candid way. Our understanding has been greatly informed by the richness of partners’ insight, based on their many years of expertise and knowledge. 

We heard partners’ broad backing for the 3 shifts, examples of where current provision and systems are insufficient and a desire to build a sustainable future for the NHS. There are many insights from partners engagement that align with what we have heard from patients, the public and the workforce, such as the need to improve access, address health inequalities and provide support for the workforce to deliver high-quality care day in, day out. Partners’ views have been particularly insightful in considering the structure of the NHS, the future of the NHS and experience of previous NHS strategies.

We are grateful to all partners who engaged in this process. Continued engagement and investment from you will be vital to support the delivery of the 10 Year Health Plan. We look forward to working with you to make the NHS fit for the future.