Merron Simpson, Chief Executive, The Health Creation Alliance
The 10 Year Health Plan is almost upon us.
The initial drafts have been written, the final questions have been asked. There is great anticipation about what will emerge from the 190,000 conversations and how the insight they offer will be knitted around the three shifts that few disagree with; hospital to community, analogue to digital, sickness to prevention.But while the national conversation took place largely in the pre-Trump era, the document itself is being written in ‘different times’. The announced folding of NHS England into DHSC demonstrates determination for politicians to have their hands on some levers of change while well-evidenced approaches appear to be favoured; they do not want to face the next election with an unclean record on well-publicised mission promises, such as ‘ending hospital backlogs’[1].
We don’t yet know whether the Plan will include a shift to a health creation model of health and care. This was requested by The Health Creation Alliance (THCA) in its submission to DHSC’s ChangeNHS Consultation[2] along with a request to protect existing health creating change work; it was also the key message of the IPPR Commission on Health and Economic Prosperity co-chaired by Lord Ara Darzi[3].
Health creation, as framed by THCA, offers a purposeful path to giving more people access to the best possible health (our human social right). It provides clarity for how to work effectively with communities of geography and identity and local partners to overcome injustices that cause avoidable ill health and put in place things communities need to reduce health inequity, heathcare inequalities and to maximise health.
It is inherently ground-up and is led by leaders with learned and lived experience operating at many levels of seniority. By looking through the community lens and playing to the strengths of all partners, these individuals work to create conditions and remove barriers to give communities greater agency over their lives – so they can actively participate, with services, in maximizing their health and enhancing their access to, experience of and outcomes from healthcare. THCA’s publication Sustainability Leading to System Change points to some of this change in action in the context of the Core20PLUS Connectors Programme and shows how sustainability can be nurtured by working with local people and ‘anchor’ organisations who are embedded within communities and will always be there.
And Health Creation goes beyond prevention; it is essential for reducing the demand on the NHS and must be embedded within widely trailed neighbourhood health services[4] and future for social care[5].
So perhaps the biggest question is whether (or not) the plan will recognise, build on, invest in and support the growing efforts of many people who are embracing health creation as a sustainable route to making the Left Shift happen?
Will it:
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- Contain a new purpose to maximise health? Making health creation everyone’s business as usual alongside treating illness and preventing ill health.
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- Recognise the roles people and communities and other non-NHS partners play, in keeping people well and addressing health inequity – offering a wide definition of ‘health system’
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- Redirect resources to local communities: investing money directly into grass-roots groups that enable under-served communities to increase the control they have over their health, wellbeing, lives and environments?
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- Devolve powers effectively: set the right policy framework to enable ‘ground-up devolution’ so that people and can feel the devolution in their everyday experience
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- Require community insight to be systematically embedded in local datasets and used to drive neighbourhood health, social care and public service reform?
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- Put in place health creating policies and national programmes: such as SureStart that had a track record in improving childrens’ health and other outcomes?
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- Support systematic dismantling of barriers: including policy and system barriers that so often get in the way[6]
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- Recognise and invest in existing social movements for health: activity that helps to connect and embolden change leaders?
These will be the eight markers against which THCA will judge the likely success of the 10 Year Health Plan.
We live in hope that the Plan and ongoing reshaping of health, social care, wider public services and strategic commissioning will give the workforce the space, skills and confidence to become change leaders; to embed health creation across their neighbourhoods, places and systems and to dismantle the many barriers. And we hope that it will invest in existing change movements and ‘radical spaceholders’ rather than try to create new ‘social movements for health’ that gain attention but are rarely as good because they are not based on the right principles.
Most of all, we hope the biggest ever conversation about the NHS will not be yet another case of hitting the target but missing the point. Because in a new era in which mainstream political leaders feel the need to emulate populist rhetoric and macho world leaders, and oligarchs do deals above all our heads, we badly need to build together from the ground up on what is already strong… and there is a lot to build on.
Also see THCA’s 2024 Manifesto for whole system change.
[1] Plan for Change; milestones for mission-led government, 5 December 2024 (p.27) https://assets.publishing.service.gov.uk/media/6751af4719e0c816d18d1df3/Plan_for_Change.pdf
[2] THCA ChangeNHS Submission
[3] Our Greatest Asset, the final report of the IPPR Commission on Health and Economic Prosperity argues that ‘better health will only be possible if we move from a sickness model of health policy to a health creation one. It is achieving this shift that should define the implementation of the new government’s health mission’. https://www.ippr.org/articles/our-greatest-asset
[4] https://www.england.nhs.uk/long-read/neighbourhood-health-guidelines-2025-26/
[5] https://www.gov.uk/government/news/new-reforms-and-independent-commission-to-transform-social-care
[6] Some key system barriers were set out in the Kings Fund report, Making Care Closer to Home a Reality: https://www.kingsfund.org.uk/insight-and-analysis/reports/making-care-closer-home-reality
