The 10-year health plan and neighbourhood

While much of this can, and will, be driven at a local level, it is vital that national policymakers draw on these experiences and learnings in the forthcoming 10-year health plan. 

It will be essential that the plan recognises that progress on neighbourhood-level collaboration has been hard won at a local level and happened despite the barriers that exist. At present, the financial system, and the focus on short-term NHS performance, tend to reinforce the status quo. The 10-year health plan can remedy that and shift the dial towards delivering more care in the community. 

To succeed, the plan must set out a vision for the future of the NHS, and a practical plan for how that is achieved, and the role of trusts in doing that. There are learnings to take here from previous national plans for the NHS, which have tended to be stronger on the vision and weaker on ‘the how’.  

At the same time, there is an important balance to strike: the 10-year health plan must set a clear direction, while also leaving sufficient flexibility for local leaders to lead. It would be unhelpful for the centre to mandate one single model for the provision of neighbourhood care. For instance in some areas an ‘accountable care organisation' style arrangement, with a single body managing all services, might work best. In others lead provider contracting, which brings multiple partners together under a single contract held by one organisation, might be a better fit.  

As we set out in this recent blog, regardless of the model, trusts will play a crucial role in delivering neighbourhood health services. And, the tried and tested governance arrangements of the type that underpin trusts will ensure that integrated care is not only delivered but also sustained with appropriate oversight, risk management, and accountability.  

Alongside this, the plan offers a vital opportunity to build a financial system to support delivering more care in the community. For far too long ambitions to deliver more care close to home have been held back by under-funding. Between 2006 and 2022 the proportion of the NHS budget spent on hospitals increased from 47% to 58%, despite ambitions to deliver more care in the community. It would be positive to see the plan begin to rebalance this by restructuring the financial framework around the care of individuals, rather than specific services or activities.  

The case studies included in this report show that trust leaders are bought into the government’s vision of neighbourhood health. There is appetite to drive this forward, but a 10-year health plan focused on how trusts can deliver this, underpinned by a financial system enabling this, will be essential to success.