A Familiar Vision, a Critical Moment
Every few years, the NHS invites us to imagine a new future for health and care. The latest NHS 10-Year Plan promises nothing less than a reimagining of the system - a bold transformation designed to shift resources into communities, focus on prevention, and harness digital innovation. It speaks of “change or bust,” pledging to move us towards a future where care is local, integrated, and person-centred.
The ambitions are striking: neighbourhood health centres in every community, AI-powered tools and wearables supporting self-care, and a renewed emphasis on prevention to tackle stark health inequalities. Strategic authorities are being given new responsibilities, devolution is reshaping power and funding, and we are promised a health service better aligned to the needs of its people.
And yet, for all its ambition, we’ve been here before. Over the past two decades, successive strategies - the Darzi Review, the Five Year Forward View, the NHS Long-Term Plan - have all painted similar pictures. Each aimed to rebalance care towards communities, strengthen prevention, and “join up” services. And yet health inequalities persist, social care remains underfunded, and community infrastructure is patchy at best.
This raises a critical question: is this truly a moment of transformation, or just another promise of change without the tools to deliver it?
From where I sit, leading an organisation embedded in communities, supporting hundreds of voluntary groups and thousands of local people, I believe we face a unique opportunity - but only if we are willing to do things differently this time. That means putting communities, charities, and lived experience at the centre of health creation, rather than treating them as an afterthought.
The NHS 10-Year Plan: Big Shifts, Big Promises
At its heart, the plan focuses on three radical shifts:
- From hospital to community - moving services closer to where people live, ending “hospital by default.”
- From treatment to prevention - tackling the social and economic determinants of health and empowering people to stay well.
- From analogue to digital - using technology to personalise care, improve access, and connect systems.
These ambitions are to be delivered through a Neighbourhood Health Service: multi-professional, co-located teams serving populations of around 30,000–50,000, supported by neighbourhood health centres that act as “one-stop shops” for health and care. In theory, this will break down barriers between NHS providers, councils, and community organisations.
There’s a strong focus on reducing health inequalities. Areas with the lowest healthy life expectancy will be prioritised for new investment, and resources are set to shift from hospitals to communities over the next three to four years. By 2027, 95% of people with complex needs should have a care plan, co-created with them and their carers. By 2030, one million people are expected to have a personal health budget to choose and manage their care in ways that suit them.
Digital transformation is another pillar. The NHS App will become the “digital front door” to health services, integrating access to GP appointments, test results, care plans, and even remote monitoring via wearables. AI-driven tools will support triage, personalised advice, and proactive care planning.
On paper, the plan is ambitious, wide-reaching, and optimistic. But delivery will be difficult without addressing some deep structural challenges - many of which are not new.
Why This Feels Familiar - and Why It Matters
For all its bold language, the 10-Year Plan draws heavily on ambitions set out by its predecessors. We’ve been talking about integrated, preventative, community-focused care since the early 2000s. Yet despite repeated reforms, investment has not kept pace with ambition.
Past attempts at neighbourhood hubs stalled because funding was fragmented, social care reform lagged behind, and integration was often more theoretical than practical.
This time, unless we confront the root causes of failure, we risk repeating history:
- Underinvestment in prevention: Community services have consistently been deprioritised when NHS budgets are tight.
- Adult social care fragility: Without reform, neighbourhood models will buckle under unmet need.
- Leadership churn: Every new structure disrupts relationships just as they’re starting to work.
Communities know this story all too well. They’ve been promised investment, partnership, and influence - but too often end up plugging gaps created elsewhere in the system.
If we want this to be different, the answer lies not in more strategy, but in shifting power and resource closer to people’s lives.
Communities as the Engine of Health Creation
The plan talks about “empowering communities” - but our experience shows that real change happens when people, places, and systems work together - when communities are seen not as passive recipients of services but as active creators of health and wellbeing.
Take Luton, just a short distance from us. In 2023, the council became the UK’s first Marmot Town, working in partnership with the UCL Institute of Health Equity to tackle health inequalities at their root. Rather than creating a new standalone programme, Luton embedded Marmot principles — fairness, prevention, and reducing inequalities — into everything it does: housing, education, skills, sustainability, and health.
This isn’t about spending vast sums of new money. It’s about spending smarter by aligning existing budgets and priorities around prevention and wellbeing. There’s tangible evidence of systems change: strategies are being rewritten around health equity, governance structures are in place, and resources are being redirected towards interventions that make the biggest difference to people’s lives. While measurable impacts on life expectancy will take time, Luton has laid the foundations for long-term, sustainable change.
For communities like ours, Luton offers an important lesson. Change doesn’t always require huge new investment or complex new programmes. It requires clear priorities, aligned leadership, and the courage to act together.
That’s where CVSs like Communities 1st come in. We’re uniquely positioned to:
- Connect community voice with system priorities.
- Mobilise local assets - from volunteers and grassroots groups to neighbourhood networks.
- Help partners design solutions that work with people, not just for them.
If the NHS wants its 10-Year Plan to succeed, it must treat communities as equal partners in creating health, not simply as service users. When we embed prevention, co-produce solutions, and align resources, the results speak for themselves - as Luton is already beginning to show.
Devolution and Strategic Authorities: Opportunity or Risk?
Alongside the NHS 10-Year Plan, devolution reforms are reshaping how power and funding flow across our health and care system. Strategic authorities and mayors are being given greater responsibilities for improving population health and reducing inequalities, with some areas acting as “prevention demonstrators.” On paper, this offers the chance to design priorities around the needs of local places and to bring decision-making closer to communities.
In reality, though, the picture is more complex. Across our region, Integrated Care Boards are being merged - with Hertfordshire, Cambridgeshire, Peterborough, Luton, Bedford, and Milton Keynes set to fall under a single structure - while also being expected to halve the funding they receive for system leadership. This inevitably pushes decision-making further away from local places at the very moment when the rhetoric is about working “closer to communities.” For areas like ours, where population needs are diverse and inequalities vary even street by street, there is a real risk that the nuances of local experience could be lost in favour of more centralised priorities.
This is where CVSs like Communities 1st come in. We are uniquely positioned to connect the dots between policy, system partners, and communities. We convene local voices, amplify lived experience, and translate what matters to people into actionable strategies for ICBs and councils. Without strong representation from local partners, prevention budgets could be directed towards services designed primarily to improve system efficiency rather than improving lives in the places people actually live. If the vision is to create healthier, fairer communities, then communities themselves must be part of shaping the solutions, not simply recipients of whatever is decided elsewhere.
Devolution can be a force for innovation, but only if we hardwire community leadership into decision-making from the start.
Primary Care Networks: Navigating Uncertainty
Primary Care Networks (PCNs) are intended to be the springboard for delivering neighbourhood health services. New contracts for single and multi-neighbourhood providers will reshape how services are organised at local level.
But many PCNs are exhausted after years of transformation, pandemic pressures, and workforce shortages. Without significant support, leadership capacity could falter.
If PCNs cannot step into this expanded role, hospital trusts or private providers may fill the vacuum. That risks undermining continuity of care and the local, relationship-based approach that neighbourhood models depend on.
The solution lies in partnership. PCNs, CVSs, local authorities, and voluntary groups need to work together to co-design neighbourhood services that reflect local realities, not just national targets.
Prevention and Social Care: Fixing the Missing Piece
Everyone agrees prevention is key - but the NHS cannot deliver it alone. The plan’s vision of moving care upstream will fail unless adult social care is fully integrated and properly funded.
We cannot wait until 2028 for the Casey Commission to conclude its review. People need joined-up, personalised support now, particularly those living with frailty, complex needs, or multiple long-term conditions.
As the Local Government Association has warned, we need a national-local coalition to deliver the ambitions of neighbourhood working: pooling budgets, aligning priorities, and funding the support that keeps people well. Without this, we risk creating brilliant neighbourhood centres with no scaffolding to sustain them.
Innovation Beyond Buildings
Too often, integration focuses on bricks and mortar rather than systems and relationships. True transformation comes when we rethink how services, communities, and assets work together.
Take Luton, which declared itself the first Marmot Town and invested in tackling health inequalities through jobs, housing, and early years support. Or Bradford, where housing-led discharge programmes delivered £47,000 per-person savings to the NHS while improving recovery outcomes.
Communities 1st is already incubating similar innovation - from peer-led volunteering programmes to social prescribing ecosystems that link health and wellbeing holistically. With proper backing, we can scale these solutions across Hertfordshire and beyond.
Digital Inclusion: Bridging the Gap
The NHS’s digital ambitions are significant. A single patient record, wearables for remote monitoring, and AI-powered tools promise to personalise care and improve efficiency.
But digital transformation risks leaving many people behind unless we tackle digital exclusion head-on.
- CVSs are uniquely placed to help here. We can:Build confidence among people with low digital skills.
- Provide trusted spaces where people can learn to use new tools.
- Partner with libraries, councils, and health providers to make digital health inclusive by design.
If we want digital to deliver health equity, community organisations must be part of the solution.
A Call to Action: Making This Time Different
The NHS faces enormous pressures: rising demand, an ageing population, workforce shortages, and deep-rooted inequalities. The 10-Year Plan and devolution reforms offer a vision for transformation - but visions alone don’t change lives.
If this time is to be different, three things must happen:
- Shift power to place: Local voices must shape priorities and funding decisions, not just react to them.
- Invest in prevention and community capacity: Build the infrastructure - people, spaces, and networks - that keep people well.
- Treat CVSs as strategic partners: Our sector has the insight, reach, and relationships to make neighbourhood health services work.
At Communities 1st, we are ready to play our part: convening, connecting, and co-creating solutions that put people at the centre.
Because real transformation won’t happen in boardrooms alone. It happens where people live, work, and connect. It happens when we invest in community power. It happens when we stop designing systems for people and start designing them with people.
Final Thoughts
The NHS 10-Year Plan calls this an inflection point - a chance to secure the future of the health service and improve lives for generations to come. It could be that. But only if we’re brave enough to confront why past plans fell short, and honest enough to build a different kind of partnership this time.
We need to move beyond treating communities as passive recipients of care. Instead, we must see them as active creators of health and wellbeing.
This isn’t just about changing the NHS. It’s about reimagining the contract between people, places, and systems. And if we get it right, it won’t just deliver healthier communities - it will create a fairer, stronger, and more connected society.
The moment is ours to seize. Let’s make sure we do.
By Stephen Craker, Chief Executive of Communities 1st
