1 July 2025
By Deborah Rozansky, Director of Policy, Research and Information at SCIE.
The government has put great stock in the NHS 10-Year Health Plan (the Plan), especially the three shifts for adapting the NHS to a health service fit for the 21st Century: hospital to community, sickness to prevention and analogue to digital.
The drip-feed of media speculation has heightened public awareness that big changes are planned. We know from the recent Spending Review in June, however, that one aim of the Plan will be to extract greater public value out of the NHS’s £215 billion budget.
With the Plan’s launch imminent, a critical review of its impact on the social care sector is warranted. Rather than being viewed solely as a partner to the NHS, social care must be recognised as a central force for promoting population health and supporting people to live better lives.
To get beyond the rhetoric and the headlines, at least three deep dives are initially required. Will the Plan create positive opportunities for social care, including:
-
- fairness and equity for people who draw on care and support;
-
- a wider preventative role for social care that extends beyond managing hospital discharges and patient flow;
-
- clear mechanisms for shifting resources from acute services to the community, including funding and incentives for better joined-up health and social care.
First test: the Plan’s approach to addressing inequalities
Early media reports suggest the Plan may target investments to address health inequalities in local areas with higher rates of deprivation. This is laudable, but from our research at the Social Care Institute for Excellence (SCIE), we know that deprivation alone is a poor proxy for tackling inequalities for people who draw on social care. I would be concerned if the Plan ignores other systemic causes of inequalities. SCIE’s work has shown that tackling inequalities requires a broader lens, one that reflects people’s lived experiences. Personalisation, co-production and community-based support are essential to reducing disparities in access and outcomes, particularly for disabled people and those with long-term care needs.
Factors like ethnicity, age and disability, especially when combined, contribute to problems in accessing services, poorer outcomes and experiences, and exclusion of people who draw on care and support. Mortality data from the Covid-19 pandemic provides a stark reminder of the compounding effects of multiple disadvantages on older people, people living with dementia and those with learning disabilities.
Second test: what the Plan expects from social care
We will want to assess the extent to which social care’s role in prevention is recognised and supported within the Plan. A sole focus on health interventions would be narrow-minded – as would a “digital first” approach to improving access to care and support. We have good evidence linking social care’s role in supporting people’s independence with enabling people to manage their own health and wellbeing.
Early support from social care can also enable people to live independently and for longer in their own homes. As SCIE has argued, social care should not be relegated to a discharge function. It has a proactive role in helping people maintain independence, avoid crisis, and contribute meaningfully to their communities. The potential to expand reablement services for preventative purposes – e.g., to reduce unplanned hospital admissions- remains untapped.
The digital investment promised in the Plan needs to take account of people’s digital skills, the affordability of broadband and kit, and other access issues. Joint planning with local government will be essential. That’s because digital exclusion disproportionately affects individuals with lower incomes, older people, people with disabilities and not in employment – in other words, many of the same people who draw on social care. As the Plan invests in innovation, it must also build digital confidence, invest in local partnerships, and safeguard face-to-face options for those who prefer or need them; we need to ensure the NHS works for everyone, especially people with complex health and care needs.
Other details about how the new NHS will interface with social care remain unknown. For instance, we will be eager to understand the expectations of local government for influencing Integrated Care Boards’ strategic commissioning, as well as the opportunities for integrating social care within neighbourhood health services. If ICBs are to deliver truly integrated support, then social care, and local government, must have meaningful influence in strategic planning and resource decisions. Media reports about the abolishment of HealthWatch create a gap for local accountability, one which local government can also fill. Another important area worth probing is the role of voluntary and community services and the critical services they are expected to provide. Many of these services provide social care and support.
Third test: a close analysis of the balance of power within the Plan
Previous attempts to transform the NHS, starting with the Blair reforms in the early 2000s, have all expressed the goal of bringing services closer to home to reduce demand for high-cost emergency and acute care. Successive visions and NHS plans have also attempted to reorganise the system’s structures and to devolve powers, especially to primary care. But the real power has remained firmly within acute hospitals, where the majority of NHS funding resides.
The underlying principle is that there are more efficient ways of delivering better care. We will try to discern what the government believes is truly important, and that means clarifying how and where the Plan allocates funding and who holds the power and the purse strings to make the necessary strategic investments.
In this new Plan, we expect to hear again about the value of virtual wards, the expectations for neighbourhood health services and the role of a re-launched Better Care Fund. NHS leaders refer to this as the “left shift”. We will want to assess how well the NHS’s funding streams align with these ambitions. Because existing funds support core services, we fear it will continue to be difficult to move money out of hospitals, let alone create incentives for better coordinated care in the community or at home.
“People power” is another anticipated theme of the Plan, but it is unclear if this means a true re-balancing of power and genuine support for co-production. Beyond the boldness of the language, the real test of success will be whether the Plan delivers better personalised care and support. We don’t have to start from scratch to make these judgements. The Making It Real “I” statements offer a useful framework, starting with: “I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals.”
Ultimately, actions speak louder than words. We will pay close attention to how the Plan “wills the means” to rebalance the power within the NHS and in relation to social care. There’s no doubt that these ambitious policy reforms present a unique opportunity for leveraging the leadership, resources and untapped potential of the social care sector.
