NHS 10-Year Plan: Why Prevention Must Take Priority

While the NHS has long been praised for its excellence in treating illness, long-term conditions set it back by more than £18.4 billion last year, and accounted for three quarters of its total expenditure. What’s more is that 38% of people currently on long-term sick leave are living with five or more conditions like diabetes, hypertension, cardiovascular disease, and poor mental health, many of which are exacerbated or driven entirely by poor living standards, environmental factors and socioeconomic conditions.

This is a pattern the NHS has been forced to follow, rather than take by choice. Years of underinvestment in prevention have put mounting pressures on hospitals and staff, with acute bed occupancy standing at 94.1% at the start of February this year - well over the 92% NHS England identified as necessary for optimal patient flow.

Compounding this issue is delayed hospital discharges. In January 2025, an average of 13,815 patients remained in hospital despite no longer meeting the criteria to reside there. Staff morale is also a growing concern. According to the latest NHS Staff Survey, nearly a third of workers have reported contemplating leaving their roles, citing factors such as burnout, inadequate pay and lack of support.

It’s heavily apparent that the current model, skewed towards reactive treatment, is proving unsustainable. Without a strategic shift towards preventive care, the NHS risks drifting further into deeper waters with no clear route back.

This blog looks at what preventative care is, what a rewiring of the current health and social care system could entail, what the much-needed shift to prevention could realistically involve – in both principle and practice - and what the government’s forthcoming NHS 10-year plan must do to move prevention from the sidelines to the core of reform.

Moving to a model focused on prevention requires a radical redesign of services and a major shift in mindset – one that goes from a reactive response to a proactive response, and one that recognises risks and takes the necessary steps to address them early. Doing so will enable people to stay well and independent for longer, which, in turn, will naturally reduce the need for costly interventions later down the line.

Accomplishing this involves investing in healthier environments, supporting behavioural change, and tackling the wider social and economic conditions that influence wellbeing. From poor housing arrangements and work instability to loneliness, addiction and food insecurity, these are all factors that can chip away at a person’s health long before they show up at a hospital or GP surgery.

To achieve a truly sustainable preventive model, there needs to be a more connected system. Community teams, public health professionals, social care staff, and the voluntary sector are often the first to notice when someone’s health begins to decline. Looping these services in early can help prevent hospital admissions, reduce reliance on emergency care, and reduce the likelihood of delayed discharges. Social care teams play a particularly major role here; arranging home support, coordinating care plans, or identifying short-term placements all help to ensure people aren’t left in hospital longer than necessary and beds are freed for those who need them most.

Recent initiatives reflect the government’s efforts to support this shift. For instance, neighbourhood healthcare services are already being developed with the aim of bringing primary, community, and other services under one roof. Not only will this strengthen these local ecosystems and make care more coordinated, but it will also make preventative care more accessible, particularly for people living with multiple long-term conditions.

Alongside this, longer-term reforms are now underway to reshape adult social care. The newly launched Independent Commission into Adult Social Care, chaired by Baroness Louise Casey, is expected to deliver its first recommendations in 2026. Its aim is to set out a plan for implementing a national care service that is more productive, more preventive, and better aligned with the needs of both older people and working-age adults with disabilities. The commission will explore how social care can help reduce unnecessary hospital admissions, address delayed discharges, and support the wider delivery of a neighbourhood health service.

While the shift to prevention requires cultural change, it also demands structural reform. The nation’s 42 Integrated Care Boards (ICBs) have been asked to reduce their overheads by 50% by December this year, which is likely to result in formal merges between regions or a “clustering” of leadership and functions, according to an article by HSJ. 

The Model ICB Blueprint unveiled in April elaborates on this and sets out how responsibilities such as digital leadership, primary care transformation and neighbourhood partnership development will be transferred to new “neighbourhood health providers” - frontline partnerships that bring together local health and care services.

While its purpose is to help ICBs iron out some of the deep creases in their operations, the blueprint does acknowledge that they’ve routinely struggled to shift resources toward community-based, preventive care. Not for lack of trying, but structural limitations and system pressures have meant that funding often defaults back to acute services, leaving little room to invest elsewhere.

The reforms now underway aim to correct this by empowering local providers, clarifying roles, and enabling better investment in upstream services. If done well, this could lay the foundations for prevention to become the norm, rather than the exception.

Joining up community services and redirecting funding streams is all well and good, but we’ll get nowhere without getting serious about data and building the right digital infrastructure to support a sustainable prevention model. Digitising the NHS is estimated to cost more than £21bn over the next five years, three quarters of which is to cover England alone.

We’re not just talking the introduction of EPRs (electronic patient records) here – full digitisation would need to account for skills and capabilities training, cyber security, Wi-Fi, cloud storage, software and hardware, in addition to annual spending for subscription renewal, general maintenance and improvements, plus ongoing education and training.

Connecting and integrating systems across health, social care, mental health, and voluntary services is no small feat but it’s paramount in ensuring care is properly coordinated, providers have the full picture and are therefore able to act sooner.

Whether this is a social care worker being able to access a person’s health updates, a community nurse receiving alerts about an individual’s repeat visits to A&E, or a GP being notified about an issue with a person’s medication or housing support – having visibility in these moments can be the difference between responding and providing care at the right time and missing a vital opportunity altogether.

While the benefits of a preventative health care system are obvious, implementing such a model doesn’t come without its challenges – two of which are funding and infrastructure. 

At the end of April this year, NHS Confed referred to a report that states how a fifth of GP practices pre-date the NHS itself, and 53% are 30+ years old. While these estates are still fully operational, many have “outdated equipment and a lack of investment in digital transformation,” according to Lord Darzi’s report on the NHS. As a result, they are not well suited for delivering or meeting the standards and demands of healthcare today.

A £3.1bn capital funding boost has been ringfenced to support acute hospitals and other areas within secondary care, in addition to £102 million to give these historic GP practices a much-needed upgrade. However, ongoing financial support will be required to maintain these sites, make essential repairs, and ensure people have uninterrupted access to care.

While funding and infrastructure are two major things to consider, the following could also act as both systemic and operational hurdles:

Workforce

Like primary and secondary care, community services are already stretched beyond their means where staffing and resource are concerned.

Prevention can’t be scaled without a sufficient amount of manpower to accommodate earlier interventions, more home-based care, and the ongoing support that keeps people well outside of hospital settings. However, with the NHS now planning to delay the release of the Workforce Plan until autumn 2025, much of how this vision will be delivered remains unclear and will do for some time.

Nevertheless, progress can still be made by investing in local workforce planning, expanding multidisciplinary community teams, and recognising the role of non-clinical support workers and the voluntary sector in delivering low-level preventive care.

Digital Immaturity

Digital transformation is a term that’s been on everyone’s lips for years, yet many trusts and providers are still behind the curve when it comes to utilising electronic patient records (EPRs), integrating systems, and training staff to use digital tools.

A 2023 paper from the BMJ found that 71% of trusts in the UK use paper of some form despite having an EPR, while 4% still rely entirely on paper notes. Delivering seamless, preventive care when basic infrastructure is still this patchy will be difficult and slow to scale – even with £21bn behind it.

That’s why we must get the basics right first. Interoperable systems, rolling out shared care records everywhere, and embedding digital training into staff onboarding will all be essential to make prevention practical at the front line.

Public Awareness and Trust

Outside of the sector, many people may not even be aware of the government’s prevention agenda - or the broader 10-year plan - given how little has been shared publicly so far. For any prevention model to work, individuals need to engage with early support, but that requires trust in the system and clarity about where to turn. Stigma, misinformation, and a lack of visible communication can all hold people back from seeking help before problems escalate.

Tech-enabled care services like Virtual Wards and remote monitoring tools like Access Assure are already helping people to stay well at home. When paired with a shift towards outcomes-based care in social care (rather than simply hours delivered), prevention starts to feel more person-centred and more practical.

That said, scaling these initiatives depends on public trust - both in the technologies themselves and the processes behind them. These models are still relatively new, and many of those who stand to benefit most, particularly older adults, often have limited experience with digital tools. To succeed, tech-enabled care must be built around transparency, reassurance, and ease of use. A clear, accessible public campaign, supported by trusted community voices - from charities to local leaders - could make a real difference in raising awareness, encouraging uptake, and improving the overall care experience.

Prevention isn’t a quick fix or a policy slogan - it’s a fundamental reimagining of how we care for people. It asks us to act earlier, work smarter, and look beyond the hospital walls. The upcoming 10-year plan is a critical opportunity to move prevention from the margins to the mainstream, but ambition alone won’t be enough. It will take sustained investment, joined-up thinking, and trust built from the ground up. The conditions are there. The need is clear. Now is the time to show we’re serious about change.