In this paper, Health for Living sets out the key elements of 2025-26 planning guidance that relates to our primary focus of preventive care. The guidance from NHS England reinforces the importance of a Neighbourhood Health Model which is essential to the mission of shifting the emphasis from a sickness to a prevention service and care closer to home.
In a related document, Neighbourhood Health Guidelines, NHS England goes into much more detail about what it expects from Health systems and providers in terms of system transformation in this regard.
While Health for Living welcomes the continued focus on the need for preventive care, not least to relieve escalating pressure on NHS resources, we do not see the guidance needed to achieve this robustly and on the scale required. It’s a shift that requires a complex response from an NHS which is geared to different priorities and while it needs to be delivered locally, there are some aspects that need to be shaped at system and even regional if not national level.
We remain hopeful that the NHS 10-year Plan, due later this year, will provide more insight into the governance and accountability challenges that a substantive shift to preventive care requires.
Meanwhile, there is much by way of preparation that can be done, particularly by ICBs and larger provider organisations that recognise the importance and potential advantages of a substantial initiative in preventive care.
Siva Anandaciva at King’s Fund has an interesting take on the funding challenge: When It Comes To Prevention Spending In The NHS, ‘Some Is Not A Number, Soon Is Not A Time’ | The King’s Fund.
1. NHS England: 2025-26 priorities and operational planning guidance
The planning guidance sets out a daunting challenge for NHS ICBs and providers: to “live within its means” while improving productivity, meeting a more limited number of explicit goals and innovating for a “better future”. It offers a “reset moment” with more autonomy, flexibility but greater responsibility and accountability.
It refers to Lord Darzi’s investigation into the NHS in England which “makes clear that, despite the efforts of our dedicated staff, the NHS is facing major challenges in meeting the growing needs of an ageing population. Individuals are spending an increasing proportion of their lives in ill-health and too many patients cannot access timely care. To address these challenges and make the NHS sustainable now and for future generations, systems need to agree and deliver plans within the resources allocated that maximise productivity and start to implement the reforms needed to improve services for patients, shifting the system from hospital to community, analogue to digital, and sickness to prevention.”
The guidance notes that “by helping people to spend more years in good health, the NHS will also enable more people to stay in and return to work, supporting economic growth.”
A Neighbourhood Health Model to address inequalities and shift towards prevention
NHS England expects ICBs to drive more integrated care through the development of neighbourhood health services, as well as planning the arrangement of acute services to maximise productivity and value. It expects ICBs and providers to “focus on preventing long and costly admissions to hospital by making full use of digital tools, addressing inequalities and shifting towards secondary prevention.”
The ambition is for all ICBs to set the foundations for a neighbourhood health model through a consistent approach to population health management, patient segmentation and risk stratification. A shift towards prevention will help to address inequalities and the leading causes of morbidity and mortality such as cardiovascular disease and diabetes.
2. Neighbourhood Health Guidelines
In this separate document, NHS England goes into much more detail about they expect to be achieved through this aspect of NHS transformation in 2025-26.
Why a new approach is needed
- More care at home or closer to home is required to improve access, experience and outcomes – and to ensure the sustainability of health and social care delivery as more people are living with multiple and more complex problems. People of all ages can live healthy, active and independent lives longer while improving their experience of health and social care, and increasing their agency in managing their own care.
- An integrated response from all parts of the health and care system is required to reduce fragmentation, delays, duplication and suboptimal care. Systematic, cross-team working is required: from all parts of the NHS in collaboration with carers and VCSE organisations.
- We can build on existing examples of local approaches to integrating health and social care make progress on the foundations ahead of the 10 Year Health Plan.
NHS England regional teams will be working with health and care systems to agree locally what impacts they will seek to achieve during 2025/26. As a minimum, these are expected to include:
- improving timely access to general practice and urgent and emergency care,
- preventing long and costly admissions to hospital and
- preventing avoidable long-term admissions to residential or nursing care homes.
Making a start on delivery
Local NHS and care systems are expected to develop momentum behind a neighbourhood health approach in order to ensure the ongoing sustainability of health and social care delivery. Systems are asked to do this by:
- standardising 6 core components of existing practice to achieve greater consistency of approach
- bringing together the different components into an integrated service offer to improve coordination and quality of care, with a focus on people with the most complex needs
- scaling up to enable more widespread adoption
- rigorously evaluating the impact of these actions, ways of working and enablers both in terms of outcomes for local people and effective use of public money
The focus in 2025/26 should be supporting people with complex health and social care needs who require support from multiple services and organisations. This cohort has a disproportionate impact on secondary care resources and multiple benefits are envisaged:
- avoiding or slowing health deterioration, preventing complications and the onset of additional conditions, and maximising recovery whenever possible to increase healthy years of life
- streamlining access to the right care at the right time, including continued focus on access to general practice and more responsive and accessible follow-up care enabled through remote monitoring and digital support for patient-initiated follow-up
- maximising the use of community services so that better care is provided close to or in people’s own homes
- reducing emergency department attendances and hospital admissions, and where a hospital stay is needed, reducing the amount of time spent away from home and the likelihood of being readmitted to hospital
- reducing avoidable long-term admissions to residential or nursing care homes
- reducing health inequalities, supporting equity of access and consistency of service provision
- improving people’s experience of care, including through increased agency to manage and improve their own health and wellbeing
- improving staff experience
- connecting communities and making optimal use of wider public services, including those provided by the VCFSE sector
The guidance cites the elements of partnership working that are critical for effective implementation of neighbourhood health:
- a mechanism for joint senior leadership in each place
- a collaborative high-support, high-challenge culture,
- shared values, outcomes, clear lines of accountability
- clear definitions for how services are organised at place and neighbourhood level
- visible clinical and professional leadership and management
- working in partnership with communities (including carers and local third sector organisations
- effective processes; training and workforce development to enable collaborative working
- making best use of all funding arrangements
- a strong evaluation framework
- a ‘test and learn’ approach
Next steps
ICBs and local authorities are asked to jointly plan a neighbourhood health and care model for their local populations that consistently delivers and connects the initial core components at scale, with an initial focus on people with the most complex health and care needs. More mature systems will be working to develop an integrated neighbourhood delivery plan that includes:
- improving collaboration and enabling effective ways of working
- agreeing commissioning models, new funding flows and contractual mechanisms between the NHS and local authorities
- workforce planning and development
- evaluation
- exploring the use of neighbourhood buildings across all partners, including local government, following on from recent ICB-led estates strategy work
Further details of a national implementation programme will be published over the coming months.