Guidance

Terms of Reference for VfM Thematic Review on Care Models to Deliver the Left Shift

Updated 6 February 2026

1. Background

NHS resources have become increasingly concentrated in hospitals, creating a fragmented and siloed system. The 10-Year Health Plan aims to deliver the ‘left shift’ to bring care closer to home through three key shifts: hospital to community, analogue to digital, and sickness to prevention. This review focuses on shifting care to the community, while recognising its success depends on progress in the other two areas. Investing in community care has the potential to deliver better value for money and greater overall savings, as well as significant non-financial benefits, than equivalent spending on acute services. To realise these benefits, this review will strengthen our understanding of how to effectively deliver and scale this shift across the healthcare system.   

2. Objectives

Work is already underway through the NHS 10-Year Plan to shift activity and investment from hospitals into community and primary care, including testing new financial flows and delivery models at selected sites. This review will strengthen that effort by improving the evidence base on how best to implement this shift, focusing on areas with high potential for impact, such as the provision of out-of-hospital urgent and emergency care, and including the interface between health and adult social care. While there are positive examples of progress, previous reviews have also highlighted the challenges with realising anticipated benefits. The review will therefore aim to identify the support mechanisms and incentives needed for successful implementation, alongside strategies to reduce the cost of community services. The findings will support DHSC in redesigning care to reduce hospital demand, reallocating resources toward community services, and scaling these changes nationally - enabling a strong evidence-led case for SR27 and future spending reviews.

3. Scope

The review will focus on the following areas:

3.1 UEC Resource Allocation and Benefits Realisation

 Assess resource use in out-of-hospital urgent and emergency care—neighbourhood teams, care coordination, and integrated services—to maximise efficiency and support the left shift.

3.2 Data and Evaluation Framework

Ensure neighbourhood health approaches have robust monitoring and evaluation frameworks in place to effectively evaluate the impact of left-shift interventions over time.

3.3 Supporting the ambition to further reallocate resources from acute to community at SR27

Consider how the left shift and neighbourhood health objectives set out in the NHS 10-Year Plan can be best supported and scaled through shifting resources from 2028–29 onwards, to inform decisions at SR27.

4. Governance

The review will primarily report to the Secretary of State for Health and the Chief Secretary to the Treasury, while also reporting to the Secretary of State for MHCLG, as required, on matters relating to social care. At official level, it will be conducted by a virtual DHSC, MHCLG and HMT team with regular cross-departmental communication and information sharing, overseen by a steering group that includes No.10 representation. The review will also bring in external expertise.

5. Timetable

The review will commence in January 2026 and is expected to conclude ahead of preparations for SR27. The final output will provide recommendations to inform SR27 planning and decisions on how the left shift and resource reallocation can be further progressed within SR settlements. Interim findings will be shared with the Steering Group and Oversight Board as the review progresses and ministers will meet at least twice; once part-way through the review to discuss progress and emerging findings of the review, and a second time, to sign off the final conclusions and recommendations from the review.