The 10-Year Health Plan: A win for community pharmacy?

By Samantha Semmeling

The government’s 10-Year Health Plan outlines a major shift in NHS priorities, aiming to move care closer to communities, emphasise prevention, and harness digital tools. Central to this vision is an expanded role for community pharmacy, raising questions about how the sector will adapt and whether it is equipped to meet these ambitions.

The government’s 10-Year Health Plan sets out an ambitious transformation for the NHS underpinned by three major shifts: hospital to community, analogue to digital, and sickness to prevention. At the heart of this transformation is the proposed development of a ‘Neighbourhood Health Service’, where pharmacy is set to play a vital role.

The plan outlines a clear transition for community pharmacy, from a predominantly dispensing to a more clinical, preventative and digitally-enabled role. Over the next five years, the government proposes that community pharmacies will:

Manage long-term conditions such as obesity, high blood pressure and high cholesterol
Deliver more preventative services, including vaccinations and screening for cardiovascular disease and diabetes
Support complex medication regimes and offer independent prescribing
Be linked into the Single Patient Record, enabling more seamless service delivery

These proposals build on the success of existing services like Pharmacy First and hypertension case-finding, both of which demonstrate the value of pharmacy in improving access and early intervention. However, this success hinged on public awareness, strong pharmacy leadership, and swift IT integration – which must be central strategies if ambitions for the sector are to be realised.

Pharmacies are critical for prevention as they are well-embedded in local communities, but particularly so in underserved areas that often face the highest burden of chronic disease. However, pharmacies must be equipped with the right tools and training. Innovative diagnostic technologies, such as point-of-care testing, can support early detection and intervention. Although there have been some promising pilots, they are not yet used at scale. Deploying such tools in tandem with workforce training will be essential to delivering preventative services in community pharmacies.

Public Policy Projects (PPP) has previously advocated for a more integrated role for community pharmacy, parity across primary care and a broader understanding of the sector’s role beyond clinical services and medicines optimisation.

Community pharmacies are hyper-local, highly trusted and universally accessible, offering huge potential to deliver social value. From providing culturally sensitive health advice, supporting marginalised populations, or acting as an informal hub for wellbeing, community pharmacies are ideal settings to form part of the emerging Neighbourhood Health Service.

However, unlike general practice, community pharmacies do not hold registered patient lists and often serve individuals who move across geographical boundaries. As such, new services must be designed around the needs of patients, not tied to artificial catchment areas. Primary care contracts which are complementary and integrated by nature, allowing providers to collaborate, not compete, will be essential to seamless service delivery.

The 10-Year Health Plan marks a pivotal moment for community pharmacy. It recognises many of the sector’s often overlooked strengths and proposes a more strategic role for pharmacies in health and care delivery. However, these opportunities must be matched with sustainable funding, contractual reform, and meaningful collaboration across all system partners.

Next steps

To further explore the implications of the 10-Year Health Plan and engage with PPP’s Pharmacy and Medicines work, please contact: Samantha Semmeling, Policy and Programmes Manager, Public Policy Projects (samantha.semmeling@publicpolicyprojects.com)

New report launched to improve productivity measurement in healthcare

By Integrated Care Journal

The report calls on the NHS to adopt multi-faceted measures that better reflect long-term investment, patient outcomes and workforce resilience, alongside greater evaluative and technical integration to bridge the gap between local insights and national decision-making.

A new technical report on Measuring Productivity in Health Care has been published by NHS Arden & GEM Commissioning Support Unit (CSU). Commissioned by the Health Foundation, the report provides an in-depth examination of how productivity in the NHS is currently assessed and how it should evolve to meet the growing challenges facing the health system.

Set against a backdrop of increasing demand, constrained resources and post-pandemic recovery, the report looks at how we measure, and how we should measure productivity in such a complex system as the NHS.

Katie Fozzard, Senior Economist at the Health Foundation, said: “The government has placed significant emphasis on increasing NHS productivity – setting a stretching target for the health service to deliver 2 per cent annual productivity growth. The way productivity is measured, and whether it captures what matters most, is therefore of crucial importance. This report is a vital resource to help us understand the different ways that productivity is measured and areas for improvement.”

Drawing on a wide body of literature and engagement with stakeholders across government, academia, NHS England and local health systems, the report explores the current strengths and limitations of existing productivity metrics, also looking forward to recent developments in productivity measurement, as set out in the ONS recent Public Services Productivity Review. It highlights persistent challenges such as fragmented data, inconsistent coverage across settings, and a lack of tools to evaluate long-term investment, preventative care and workforce resilience.

Rose Taylor, Executive Director Health and Care Transformation at Arden & GEM said: “Understanding and improving NHS productivity is essential to delivering high-quality care with finite resources. This report provides a fresh lens on how we measure productivity in such a complex system, highlighting where current metrics fall short and where new approaches can drive meaningful change.”

The report highlights the breadth of reasons for measuring health care productivity and corresponding approaches. It proposes a new classification framework to better align metrics with their intended use, whether for system-level planning, local service improvement, evaluating resource allocation or national financial accountability.

Among its key areas for development, the report calls for:

The adoption of multi-faceted measures that better reflect long-term investment, patient outcomes and workforce resilience, to strengthen how measures align with future service needs
Greater integration of micro-level evaluative and macro-level technical approaches to bridge the gap between local insights and national decision-making
Investment in metrics that account for the value of preventative care beyond short-term costs
Improved tools to measure productivity across evolving care pathways and system partners, including social care and the independent sector

The Health Foundation will build on these findings in future work to support better long-term decision making across health and social care.

The full Measuring Productivity in Health Care report is available here.

Holding our nerve: Making the ‘left shift’ a reality in health and care

By David Duffy

At a recent dinner hosted by Public Policy Projects and HealthPathways, senior NHS executives and leaders gathered to reflect on one of the most urgent challenges in health and care today: how to deliver a meaningful ‘left shift’ – moving care out of hospitals and into community settings, as outlined in the forthcoming 10-Year Health Plan. The conversation offered a candid look at the structural barriers that continue to impede progress, while also spotlighting the leadership, collaboration, and bold action required to overcome them.

The discussion was chaired by Len Richards, who stepped down as CEO of NHS Mid Yorkshire Teaching Trust in April 2025. With executive leadership experience in healthcare systems across both the UK and Australia, Richards has been a consistent advocate for integrated system working and for modernising health services through partnership-driven reform.

As Richards noted at the outset, much has changed in recent months. Financial pressures have deepened across the board, with providers and systems increasingly asked to deliver more with fewer resources. Meanwhile, major structural reform looms, including the anticipated merger of NHS England with the Department of Health and Social Care, and a sweeping review of the core functions of integrated care boards.

Despite these developments, many long-standing challenges remain unresolved. Hospital congestion and ever-growing waiting lists continue to plague the NHS, despite multiple central reorganisations. These pressures have fuelled a crisis in public confidence and severely undermined staff morale.

Drawing on his leadership experience in Australia, Wales, and the UK, Richards emphasised that real progress depends on genuine system-wide change. He highlighted his longstanding use of HealthPathways as a practical tool to support integration – a model that draws on clinical expertise, community knowledge, and patient experience. For Richards, HealthPathways’ system-wide approach to care pathway redesign has consistently delivered clarity, confidence, and hope during times of change.

This sentiment feels more poignant than ever, as the system now requires a whole-of-system approach to left shift – one that builds additional capacity, boosts productivity, and firmly places patients at the centre of care.

The reality of the left shift

Despite years of policy promises and widespread rhetorical backing, there was a shared acknowledgement that the shift towards community-based care has yet to take meaningful form. System leaders expressed frustration that, while the vision is widely accepted, progress on the ground remains slow. With funding still disproportionately directed toward hospitals, acute care continues to be treated as the default care setting, despite decades of political commitments to reallocate resources toward prevention and community services.

The message was unmistakable: the current approach is falling short – and in some cases, actively worsening outcomes for patients. Long waiting times, increasing health-related anxiety, and ongoing challenges in mental health services are eroding public trust. Transitioning to a community-based, preventive, and integrated model of care is no longer just an aspiration – it is fundamental to the sustainability of the NHS.

Yet, under the weight of existing system pressures, achieving this transformation feels increasingly out of reach. There was a strong call in the room for political rhetoric to be matched by bold, system-wide action, and for local leaders to be genuinely empowered to make decisions that reflect the needs of their communities.

A system that still thinks in silos

Leadership, risk, and public trust

Some leaders did highlight that large sections of the public still maintain that the hospital is the safest and most effective place within the sector to receive care. It is up to leaders, political and otherwise, to have a frank conversation with the public to address this trend and clearly articulate how health and care services can be accessed.

Leaders must be clear of purpose, instil confidence, and perhaps most importantly, hold their nerve in the face of political and institutional pressure. But bravery cannot stop at the hospital board room.

Several attendees emphasised the need for political courage at the national level. Without it, the system will remain risk-averse and locked into a cycle of short-term performance management at the expense of longer-term transformation.
There was strong consensus that DHSC needs to be brave in redistributing resources away from acute settings, even when these efforts run counter to entrenched assumptions or public sentiment.

Rebuilding public trust is paramount, and confidence in the NHS is closely tied to waiting times and access. When people don’t know how long they’ll have to wait or to whom to turn, anxiety grows among the public. Leaders present at the dinner stressed the importance of clear, honest communication with the public – explaining not only what is changing, but why. People want simplicity, not bureaucracy; certainty, not confusion.

Reimagining metrics and accountability

A fundamental rethink of how success is measured was also discussed. Many of today’s key performance indicators are designed for performance monitoring, not for meaningful change. Attendees called for metrics rooted in health economics, place-based outcomes, and patient experience, rather than just ‘activity focused’ hospital throughput or financial balance.

The discussion also explored wider issues of financial governance. Some questioned whether systems should be permitted to run short-term deficits in order to unlock longer-term savings and improved outcomes. Others highlighted the pressing need for greater clarity and transparency in place-based spending—an area where the NHS still falls short. What became clear is that NHS financial structures remain rigid and poorly suited to support innovation or invest in preventative approaches that may not yield immediate performance gains, demand reduction, or visible returns. There is still discomfort within the system when benefits are not directly or immediately felt by the organisation itself.

Stop talking. Start doing

The dinner closed with a sense of urgency. The opportunity presented by the 10-Year Plan is real, but so too are the risks of continued inaction. Siloed thinking, limited risk appetite, and cultural inertia are holding the system back. Leaders agreed that it’s time to stop talking about integration, co-production, and shifting left, and time to start doing them.

This means creating space for genuine community engagement, sharing risk across sectors, and aligning incentives to patient outcomes rather than institutional survival. It means trusting others in the system to deliver value, even when they sit outside the NHS’s traditional structures. Above all, it means holding our collective nerve.

The NHS efficiency dilemma: Is AI really the answer?

By Peter Corpe

Despite the major digital transformation efforts ongoing across the NHS, money alone will not solve the challenges the health service faces. Neither will simply bolting AI solutions onto outdated processes, writes Peter Corpe, Industry Leader, UK Public Sector at Appian.

Despite the Government’s commitment to ‘bring the NHS into the digital age’ in its AI Opportunities Action Plan, healthcare organisations overwhelmingly still rely on legacy systems that aren’t fit for purpose. The recent State of Digital Government Review from the Department for Science, Innovation and Technology (DSIT) highlighted, the technology resource gaps that continue to derail work, waste time and delay essential services.

This is not just an inconvenience – it’s a growing crisis. A recent UK Public Sector Efficiency Survey revealed that NHS employees lose an average of five hours per week to clunky, inefficient systems. That adds up to a staggering 7.5 million hours of wasted work every single week. These valuable hours could be reinvested in treating patients, improving safety, and providing a better service. By addressing these systemic inefficiencies, we can improve healthcare services and enhance patient outcomes.

The UK Government announced the much needed £3.25bn Transformation Fund to boost public service efficiency in its latest Spring statement. It’s poised to drive productivity in public services, including the NHS, at a time when efficiency is under immense scrutiny. Backing a range of initiatives, the fund will include the introduction of AI tools to revolutionise front line service delivery.

But if we are serious about modernising the NHS, money alone will not solve the problem – we need targeted, measured reform. AI and automation are rightly gaining momentum in the sector. However, AI is not a magic solution on its own. Its effectiveness depends on the quality of the data it receives, and how well and quickly we act on insights. If we aren’t prepared to act on its findings quickly, we create bottlenecks instead of breakthroughs. Without the right groundwork, AI risks producing noise instead of value. AI must be embedded into well-designed processes to ensure it delivers real economic benefits.

I am often asked what are the biggest technology challenges in healthcare today, and what are the opportunities and barriers for the sector to use AI effectively. My response typically focuses on the following areas:

Manual services and outdated processes

Despite ongoing digital transformation efforts, most departments still rely on manual processes. The DSIT report reveals that 45 per cent of NHS services lack a fully digital pathway, with very few eliminating manual processing entirely.

The impact of outdated processes is felt directly by patients and healthcare workers alike. When services remain paper-based or rely on fragmented systems, productivity suffers, and resources are stretched thin. The functioning of these fragmented systems relies on ‘human glue’ – workers manually bridging siloes of data and process, which prevents recognition of the core deficiencies.

Streamlining these processes through digital transformation is not just a matter of convenience. It’s essential for improving efficiency, reducing administrative burdens, and ultimately enhancing service delivery for the public.

Process modernisation and automation is the most powerful lever available to drive service reform for such tasks. A process orchestration solution can automate time-consuming tasks such as data entry, appointment scheduling, progress tracking, compliance, and reporting. Automating these actions would enable a shift towards time spent on value-driven activities that can improve both internal efficiency and service delivery.

Fragmented and underused data

When data is scattered across multiple outdated legacy systems, information access and related processes slow down for everyone. This impacts productivity and the ability to resolve case work at speed. This lack of data integration also limits the potential of AI, machine learning, and advanced analytics. These data-driven technologies can only work with seamless access to high-quality data, to drive innovation and improve decision-making.

For the NHS to be truly AI-ready, the data must be in order. Solving this starts with adopting a platform that connects data and processes woven into a single framework. A data fabric, for example, creates a virtualised layer that links data across systems without needing to migrate it.

With advanced data management, organisations can train, refine, and deploy AI models more effectively, transforming vast amounts of information into valuable insights. High-quality data is the fuel AI needs to enhance decision-making and drive efficiency. Without it, the potential of a modern digital NHS will remain out of reach.

The future of AI-driven processes in the NHS

Optimism about AI is growing within the healthcare sector. 64 per cent of NHS workers have some or high confidence in AI’s potential to improve their organisation’s efficiency.

The key to unlocking AI’s full potential is embedding it within existing processes. Process is where actions happen. It’s where healthcare professionals make decisions, allocate budget and resources, serve patients, and move things forward. When AI operates within processes, it gains purpose, governance, and accountability – all vital to delivering value from AI.

While organisations are under pressure to integrate AI, its success depends on strong data infrastructures and human oversight. AI should be a partner, not a replacement, ensuring efficiency and innovation without compromising security or accountability.

To sustain long-term growth, healthcare organisations must invest in agile platforms that adapt to rapid AI advancements with process orchestration technologies. A platform approach can streamline operations, enhance decision-making, and improve service outcomes. Embracing these tools isn’t just about modernisation, it’s essential for efficiency, stability, and better healthcare service delivery.

Now is the time for the NHS to seize the opportunity. Every part of our health service runs on processes – from patient referrals to hospital workflows. When we improve these processes with automation technologies like AI and process orchestration, we create better working environments for our healthcare workers, improving service delivery for our NHS, for the betterment of patients.

NHS reform: Language has changed, objectives remain the same

By David Duffy

How strategic commissioning will transform services was central to discussions at Public Policy Projects’ (PPP) Integrated Care Delivery Forum, held last Wednesday in Birmingham. David Duffy shares some initial insights from the Forum’s System Transformation Theatre.

The cycle of health system reorganisation seen over recent decades has accelerated under Keir Starmer’s Labour government, marked by the scrapping of NHS England, major reductions in system levers, and a fundamental remodelling of integrated care board (ICB) purposes. But, as stakeholders at the Forum noted, the more things change, the more they stay the same. The key for health conferences such as this, is to analyse how the delivery of integrated care will change.

Naomi Eisenstadt argued that there remains a lack of a shared understanding of what integration is fundamentally. She largely welcomed the strategic direction outlined in the ICB Model Blueprint last week, with its focus on population health, health inequality and the important role of ICBs in managing contracts with providers and determining the flow of resources. However, further clarification as to the role of neighbourhood teams is needed and further emphasis on the 4th aim of ICSs (social and economic development) would be welcome.

Professor Patrick Vernon, Chair of Birmingham and Solihull ICB, acknowledged the “mixed” impact of ICBs so far, but stressed that significant work had been done to break down silos in the Birmingham and Solihull area. Vernon also pointed out that many of the actions outlined in the model framework are already being delivered through practical ICS working. But with providers facing persistent resource constraints and ICBs set to merge into even larger footprints, progress is likely to remain uneven.

Enhancing the role of strategic commissioning

Strategic commissioning, now at the heart of ICSs’ role as outlined in last week’s model ICB blueprint, will define how these systems operate going forward. But do we fully understand what’s being asked? And how is this different to previous approaches to commissioning? Eisenstadt, Chair of Northamptonshire ICB and Non-Executive Director at the Department of Health and Department for Education, spoke about the enduring challenges of collaboration and silo breaking.

There’s still a lingering mindset in parts of the system that “if only there were more of me, then everything would be alright,” she noted, perhaps a symptom of fragmented culture, not a lack of strategy. “I think we forget why the silos persist,” reflected Eisenstadt, “they remain because vertical accountability is far less complicated than an integrated approach.”

Danielle Oum, Chair of Coventry and Warwickshire ICB was keen to highlight the opportunities of ICBs having more streamlined priorities and a greater focus on strategic commissioning: “What this means now is that we can accelerate the pace of change,” Oum reflected.

She continued: “The blueprint helps set out how ICBs will the shift from transactional and operational oversight, with a focus on performance management, towards a far more strategic and informed approach to commissioning, using their purchasing powers and their role as contract holders to drive improvement across population health.”

Speaking on the same panel, Victoria Underhill, Director of Integrated Care for Optum, noted the subtle differences between strategic commissioning and previous approaches: “I think strategic Commissioning puts population health management at the heart of strategy…ICBs have a critical role as strategic commissioners that will enable neighbourhood working, whether that’s through creating the sort of right conditions through technology enablers, data sharing, financial flows, commissioning across a pathway or for a population.”

Clear from the day’s discussion was that the best integration still happens on the frontline, when different teams are given the means to collaborate effectively together to deliver care.

Reform fatigue

Christine O’Connor reminded attendees of a hard truth: “Reorganisations do not improve the delivery at the point of care and are often disruptive to it.” Despite the promise of structural reform, what matters to frontline staff and service users is whether delivery actually improves.

ICSs were established to enable a more integrated approach to commissioning and delivering services. Yet meaningful engagement with key system partners remains inconsistent.

Nowhere is this clearer than in social care. The conference took place in the context of yet more deflating news for the sector. Nadra Ahmed, Chair of the National Care Association, powerfully highlighted the ongoing marginalisation of social care. “We put £68 billion into the economy with a 1.7 million-strong workforce, but we cannot get a seat at the decision-making table, locally or nationally.”

David Morris, PwC’s UK Central Market Head, bluntly summarised the disconnect between rhetoric and reality regarding integration: “We have a long way to go before integrating properly.”

Cllr David Fothergill, Deputy Chair of the Local Government Association, was keen to point out that, while we are in the middle a significant period of reform for the health sector, local government is going through a once in a generation period of change following the Devolution White Paper last year. “There are 317 councils across England, about 170 of those are awaiting reorganisation,” Fothergill continued. “We recognise the scale and urgency of the challenges currently facing health services, but we must not miss the opportunity to rewire change together. Integration and joint work in a system, place and neighbourhood is vital if we are to design and deliver services that put citizens at the heart of everything.”

Optimising financial flow to unlock transformation

Financial flows will be key to enabling this new approach to commissioning and to empowering providers to transform services on the ground. Andrew Moore, Joint Chair of University Hospitals of Northamptonshire NHS Group and University Hospitals of Leicester NHS Trust, highlighted the contrast with the retail sector, where financial and workforce control mechanisms are far stronger. In health and care, however, over-reliance on agency staffing and weak grip on costs make transformation harder to deliver.

Technology remains an underused lever. Alex Crossley, Director of Transformation and Finance at NHS England, called for deeper partnerships with industry and smarter use of tech to overcome persistent productivity challenges. Strategic commissioning must include strategic deployment of digital tools.

A familiar destination despite the new language

There is a risk that ‘strategic commissioning’ turns out to be just commissioning with the word “strategic” tacked on. Policy leaders have a remarkable ability to rename old ideas and repackage them as innovations.

This tendency can frustrate frontline professionals and system leaders alike. Yet, as PPP Chair Stephen Dorrell noted in his closing remarks, it also suggests consistency in the direction of travel that should be built upon. The structures and language may change, but the core goals of integration, prevention, and efficiency remain. The challenge, as ever, is in finally delivering them.

You can read select insights from the Integrated Care Delivery Forum Medicines and Care Pathways Theatre here.

For more information on the Integrated Care Delivery Forum, please write to david.duffy@pppinsight.com.

Nearly half of trusts scaling back activity amid cuts, say trust leaders

By Integrated Care Journal

Cuts to clinical and non-clinical jobs will have consequences for frontline care according to survey of trust leaders, who will face competing priorities boosting performance while trying to balance the books.

NHS trusts are determined to protect patient safety as a new survey by NHS Providers reveals services are being scaled back and jobs cut as the demands of the NHS financial ‘reset’ become clear.

With the NHS looking to recover a predicted financial shortfall that reached nearly £7bn this year, trusts have been asked to drastically reduce running costs while improving performance against key targets.

With the 10-Year Health Plan due to be published in the coming months, nearly half of trust leaders (47 per cent) surveyed warned they are scaling back services to deliver tough financial plans, with a further 43 per cent considering this option. Virtual wards, rehabilitation centres, talking therapies and diabetes services for young people are among services identified at risk, demonstrating the extremely tough choices being faced by NHS leaders.

More than a third (37 per cent) said their organisation is cutting clinical posts as they try to balance their books, with a further 40 per cent considering this option. With trusts told to halve corporate cost growth, 86 per cent of trust leaders said their organisation is going to have to cut posts in non-clinical teams – such as HR, finance, estates, digital and communications – potentially risking efforts to deliver services, innovate, and improve productivity.

The scale of job cuts is becoming clear with a number of trusts aiming to take out 500 posts or more and one organisation planning to cut around 1000 jobs.

The interim Chief Executive of NHS Providers, Saffron Cordery, said “It’s really worrying to hear trust leaders tell us highly valued staff and services including vital work to address health inequalities and prevention could be among the early casualties of budget cuts. These decisions are never taken lightly and will always be a last resort.”

With further reductions to temporary staffing costs (91 per cent) and a recruitment freeze (85 per cent) also on the cards, the impact of these changes on hardworking and overstretched front-line teams is a major concern for trust leaders. More than nine in ten (94 per cent) said the steps needed to deliver financial plans would have a negative impact on staff wellbeing and culture at a time when morale, burnout and vacancies are taking their toll, and disquiet over pay and conditions is rising.

Now trust leaders have called on the government to recognise the difficult decisions and competing priorities trusts face as they try to improve patient services while trying to balance the books.

The survey by NHS Providers, which represents hospital, mental health, community, and ambulance services also found:

More than one in four (26 per cent) said they will need to close some services (a further 55 per cent are considering this)
45 per cent are moderately or extremely concerned their actions will compromise patient experience
Close to three in five respondents said patient experience (61 per cent) work to address health inequalities (60 per cent) and access to timely care (57 per cent) were most at risk of being impacted
Nearly nine in ten (88 per cent) said they don’t have enough funding to invest in prevention

Saffron Cordery added: “Trust leaders will always put patient safety and quality of care first. They’re acutely aware of pressures on the public purse, the scale of the challenge they’re facing and their duty to make the most of every pound that goes into the NHS. They’re working hard every day to find efficiencies, cut costs and make savings without compromising safety. They’re at the forefront of efforts to shift care from hospitals to the community, from analogue to digital and from treating sickness to preventing ill-health.

“Trust leaders have also heard loud and clear that overspending will not be tolerated and have made major inroads in tackling the huge financial deficit facing the NHS.

“But let’s also be clear: cuts have consequences. NHS trusts face competing priorities of improving services for patients and boosting performance while trying to balance the books with ever-tighter budgets. National leaders must appreciate that makes a hard job even harder.

“[Trust leaders] are committed to working with the government to build a better health service but fear immediate financial pressures could undermine plans to transform the NHS.”

Data solutions to solve the South West’s patient discharge crisis

By Professor Christos Vasilakis and Dr Zehra Onen Dumlu

Professor Christos Vasilakis, Founding Director of the Centre for Healthcare Innovation and Improvement – CHI²) and Dr. Zehra Onen Dumlu from the University of Bath discuss the IPACS project – a collaborative, data-driven approach to improving patient flow.

Delayed discharges, often known as ‘bed blocking’, is a serious operational challenge for NHS managers across the country. According to NHS England data, in February 2024 there were between 13,200 and 14,200 patients remaining in hospital each day who did not meet the criteria to stay. This accounts for more than one in eight general and acute beds in England.

While patients are deemed medically fit for discharge, they remain in hospital due to complexities in arranging necessary social care or community nursing support for a safe transition. The knock-on effects are significant, placing immense strain on acute bed capacity and negatively impacting patient flow and their experience.

The IPACS project: A collaborative, data-driven approach

To address the issue, the Improving Patient Flow between Acute, Community, and Social Care (IPACS) project was launched in 2020. This significant three-year initiative received funding from Health Data Research UK (HDRUK), an independent charity focused on using health data research to address major healthcare challenges.

IPACS brought together a diverse team, combining academic expertise with frontline NHS operational knowledge. Collaborators included the University of Bath, the University of Exeter Medical School, and significantly, the Bristol, North Somerset, and South Gloucestershire (BNSSG) Integrated Care Board (ICB).

The goal of the project was to develop an open-source computer simulation model capable of analysing the complex dynamics of patient flow. This tool would offer a potential blueprint for healthcare organisations nationwide grappling with delayed discharge pressures.

Central to the project was the application of Operational Research (OR) techniques – using advanced analytical models to dissect and solve complex systemic problems. Several team members brought extensive OR experience, with affiliations to The Operational Research Society, demonstrating the project’s robust methodological foundation aimed at enhancing healthcare efficiency.

A multidisciplinary, team-driving innovation

The success of IPACS hinged on its multidisciplinary collaboration. BNSSG ICB’s Head of Modelling and Analytics, Dr Richard Wood, and University of Bath Research Fellow Dr Paul Forte provided essential insights into real-world healthcare operations and ensured the project outputs were relevant and accessible to NHS decision-makers.

Academic leadership came from Professor Christos Vasilakis (founding director of the Centre for Healthcare Innovation and Improvement – CHI²) and Dr Zehra Onen Dumlu at the University of Bath, working alongside Professor Martin Pitt and Dr Alison Harper from the University of Exeter Medical School. This combined team undertook the intricate task of designing, developing, and validating the simulation framework.

Focusing on the critical ‘Discharge to Assess’ service

A key focus for the IPACS project was the transition of patients from acute settings into community care, specifically via the ‘Discharge to Assess’ (D2A) service. Optimising this service is key to improving hospital throughput. The project modelled the three core D2A pathways:

Pathway 1 (P1): Enabling patients to return home with domiciliary support.
Pathway 2 (P2): Providing bed-based rehabilitation for those needing more intensive recovery support post-discharge.
Pathway 3 (P3): Catering for complex care assessments, frequently leading to long-term care placements.

The IPACS model aimed to help optimise capacity planning and resource allocation across these vital pathways.

The BNSSG region: A relevant testing ground

The Bristol, North Somerset, and South Gloucestershire (BNSSG) region, serving approximately one million people, served as a practical case study. Its demographic mix and blend of urban and rural environments reflect challenges common across the NHS. The region’s D2A pathways were experiencing significant pressure, with high occupancy and discharge delays, providing a rich, real-world dataset and demonstrating the urgent need for the solutions IPACS explored.

Operational Research and simulation modelling in practice

Professor Vasilakis and Dr Wood pinpointed the core management challenge: the complex interdependencies between acute, community, and social care services. Bottlenecks in community and social care inevitably impact upstream services, contributing to emergency department pressures and ambulance handover delays.

The IPACS team used real-time data on patient occupancy and discharge delays to build their model. This allowed them to establish baseline performance and, critically, to run “what if” scenarios, varying parameters like length of stay and arrival rates to understand potential impacts of service changes.

Computer simulation modelling, a cornerstone of OR, was central to this. The model allowed the team to:

Simulate patient journeys through the D2A pathways in detail.
Test potential interventions virtually to assess their likely impact on flow and delays.
Analyse how best to allocate resources to mitigate discharge delays.
Account for time-varying demand patterns.

Built using the open-source ‘R’ programming language, the model prioritised accessibility and transparency.

Demonstrating real-world impact and future potential

The IPACS model provided valuable quantitative insights. Outputs clearly demonstrated the potential benefits of achieving target pathway splits and reducing lengths of stay within the D2A service. Significantly, estimates generated by the model were used to support a £13 million business case for enhancing the local D2A system – highlighting the project’s tangible value in informing strategic investment decisions.

The team acknowledged the model does have some limitations. It doesn’t yet capture every element of discharge, such as specific social care inputs, palliative care routes, or detailed post-D2A placement dynamics. Data completeness also needs some ongoing attention. Future work could involve expanding the model’s scope to incorporate social care elements more deeply, analyse the impact of acute capacity constraints, optimise home-based care models, and potentially develop faster analytical tools.

The ongoing challenge and strategic steps forward

Tackling delayed discharge requires effective strategies, and the IPACS project highlights the value of OR. Using OR methods such as simulation modelling allows NHS managers to better understand complex discharge pathways, evaluate potential solutions before implementation, and make more informed, evidence-based decisions about resource allocation to improve patient flow and reduce delays.

*Dr Zehra Onen Dumlu, Assistant Professor, University of Bath*

*Professor Christos Vasilakis, Founding Director, Centre for Healthcare Innovation and Improvement – CHI²*

Acute Care, Community Care, News, Secondary Care, Systems April 10, 2025

Embedding social prescribing in secondary care: A toolkit from Barts Health

By Gabriel Blaazer

Barts Health NHS Trust and its partner organisation, Transformation Partners in Health and Care, have released a toolkit detailing their pioneering work embedding social prescribing in secondary care and specialist acute pathways. The toolkit aims to help providers address unmet social needs, improve patient outcomes and reduce demand on acute services, shaping a holistic, prevention-focused model for the future NHS.

Social prescribing attempts to address the social determinants of health. These are the non-medical factors influencing 84 per cent of a person’s total health, with clinical care impacting the remainder. Social determinants of heath include income security and employment, education, housing and food insecurity, or social isolation.

Introduced in England in 2018, it typically involves signposting or referrals to appropriate services, but can also include emotional and mental health support for people experiencing social isolation or low-level mental health issues. Social prescribing is a holistic, person-centred and preventative approach and as such, is a key enabler of the government’s efforts to shift more care into the community and bolster prevention initiatives.

Emerging evidence suggests that social prescribing is an effective, yet low-cost, preventative intervention. However, its implementation has been more frequent in primary and community care, compared to secondary care. In 2023, Barts Health NHS Trust (Barts Health), one of Europe’s largest acute healthcare providers, started implementing social prescribing across multiple pathways, using different integration models to support a whole system approach to prevention and personalised care.

These services, delivered by social prescribers in collaboration with clinical and wider multi-disciplinary teams, support residents with their social needs while aiming to reduce demand on high-pressure services, including cardiovascular (CVD), renal, emergency care, and children and young people’s (CYP) services.

Encouraged by positive outcome data, the Trust and its partner organisation, Transformation Partners in Health and Care (TPHC), have developed a toolkit to help secondary care services embed social prescribing, public health and other community-led prevention initiatives within their specialties and pathways. The toolkit serves as a practical guide and checklist for secondary care providers looking to implement social prescribing and explore integrated, whole-system approaches to prevention.

Addressing unmet needs

While NHS England has established a standard model for embedding social prescribing, this has primarily focused on integration within primary care. In 2023, Barts Hospital’s Endovascular Team, led by Vascular Surgeon Dr Tara Mastracci, identified a high prevalence of unmet social need among patients in the hospital’s cardiovascular pathway – a well-evidenced correlation. Given that CVD disproportionately affects socially deprived populations, Dr Mastracci theorised that integrating social prescribing could benefit those at highest risk, simultaneously alleviating pressure on the pathway and improving patient outcomes.

A key data point supporting the use of social prescribing in secondary care was the gender split between typical users of social prescribing services and those presenting with acute cardiovascular issues. While 84 per cent of patients within cardiovascular pathways were men, 60 per cent of social prescribing users were women. Research has shown that women consult primary care services 32 per cent more frequently than men, suggesting that secondary care could play a central role in engaging men, who might otherwise remain underserved by traditional social prescribing models.

“Overall, we have found that we encounter a different group of patients compared with those who access social prescribing in primary care.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

This reinforced Dr Mastracci’s belief in the merit of social prescribing within secondary care – clearly, more effort was needed to engage men, particularly for CVD patients who could benefit from greater social support.

Building a collaborative approach

Several specialties within the Trust had also identified unmet social needs as a key driver of service demand, and had begun implementing social prescribing programmes within their pathways. However, these initiatives were siloed, staff-led and reliant on temporary funding or fixed grants. To enhance collaboration and sustainability, Dr Mastracci established a multidisciplinary network of staff across primary and secondary care to drive a more integrated and formalised approach.

Finding limited guidance on implementing social prescribing within secondary care, Dr Mastracci’s CVD team set out to develop a replicable model for implementing it as part of secondary care pathways. Keen to apply the same rigorous standards as with a medical intervention, the team partnered with health economists at the University of East London. They incorporated EQ-5D instruments and QALY (quality-adjusted life years) metrics to evaluate the potential impact of social prescribing on both patients and the wider health and care system.

Recognising the need for greater institutional knowledge and community expertise, the team also partnered with the Bromley by Bow Centre (now Bromley by Bow Health), a leading VCSFE (Voluntary, Community, Social, and Faith Enterprise) community health organisation. This collaboration led to the embedding of a social prescriber within the hospital’s heart attack pathway, screening patients entering the pathway for financial or other social needs.

Implementation and outcomes

Once identified, social prescribers provided patients with six to eight support sessions, connecting them to local services and community groups tailored to their specific social needs. Beyond financial deprivation, patients received support for needs including housing, talking therapies, and healthy lifestyle support such as smoking and alcohol cessation, or physical activity and weight management – all of which play key roles in determining a person’s risk of developing CVD-related conditions.

The social prescribers were drawn from diverse backgrounds and communities, to work in collaboration with clinicians and consultants from secondary care, patient advocate groups, VSCFE organisations and others. This multidisciplinary approach facilitated a holistic and patient-centred approach. The experiences and lessons from creating the CVD social prescribing pathway were later used to inform other specialties as they implemented similar services within their pathways.

“We believe strongly in the importance of ‘place’ and thus many of our social prescribers meet patients in the community where they live to engage and provide support.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

Dr Mastracci acknowledges that it will take years to fully assess the impact of Barts Health’s social prescribing programmes. “We know these target groups are admitted at higher rates than their peers,” Dr Mastracci told ICJ, “but it will take years to evaluate the long-term effects.”

Despite this, early results have been promising, notably within children and young people’s (CYP) diabetes services. Led by Dr Myuri Moorthy, Diabetes Consultant and Clinical Lead for Young Adult Diabetes (YAD) at Barts Health, clinicians in the pathway had noticed a concerning increase in non-adherence to self-management protocols, often linked to concurrent financial and psychosocial issues. The service also saw high numbers of patients not attending appointments (DNAs), largely due to distress, burnout, and the intense mental health toll associated with diabetes.

Poor diabetes self-management is well known to increase the likelihood of complications. This prompted the diabetes team to adopt a co-designed and personalised model, including a multi-disciplinary team of social prescribers, youth workers and a psychologist. The aim of the YAD Social Prescribing Service was to improve patient engagement, reduce DNAs and maximise the impact of each clinical appointment.

Together with service users, the team co-developed a series of interventions, including monthly peer support meetings, a WhatsApp group and a ‘walk and talk’ group, securing funding from NHSE for two and a half years. During this time, the team successfully:

Reduced the DNA rate across the Trust from 39 per cent to 12.5 per cent
Cut diabetes-related hospital admissions of CYP by 36 per cent across all Barts sites
Generated financial savings of an estimated £62,500 per year across the Trust

More outcomes from the prevention initiatives across Barts Health, including economic and demand savings, stronger integrated community networks and improved outcomes and patient experience, can be found on pages 26-30 of the toolkit.

Gaining leadership buy-in

As with many prevention-based interventions, the impact of social prescribing on health and care systems can take years to fully assess. In its paper on integrated neighbourhood teams (within which social prescribers typically sit), The National Association of Primary Care suggests that “savings will be non-cash releasing, but this is not as issue as what is required is capacity and health improvement.” However, this long-term approach does not easily align with NHS funding cycles, which typically require demonstrable return on investment within 12 months.

Currently, all of Barts Health’s social prescribing pathways are funded individually, on an ad hoc basis. The CVD project, for example, was initially funded by NHSE, but is now supported by Barts Charity. To move towards trust-wide funding, TPHC’s Secondary Care Project Manager, Mollie McCormick, emphasises the need to develop:

Robust databases and coding frameworks to accurately track interventions and outcomes over time
Qualitative data collection from patients benefiting from social prescribing, with an emphasis on reduced need for healthcare services and thus cost savings

Bridging the gap between identifying social needs that drive demand and demonstrating short-term cost savings remains a challenge. However, securing the backing and support of senior clinical leadership is critical in building the case for long-term investment.

For social prescribing initiatives to gain trust-wide funding in future, structural changes are needed to prioritise long-term prevention and strengthen outcomes-based commissioning. Different approaches could involve integrated care systems incentivising prevention by:

Setting realistic and appropriate prevention targets for NHS trusts to influence commissioning decisions towards the implementation of personalised care and prevention initiatives
Introducing penalties for avoidable readmissions

These targets could be assessed by monitoring readmission rates for specific condition cohorts or high-demand service areas, ensuring a measurable focus on prevention.

The toolkit: Embedding and Connecting Prevention in Specialist Pathways

Barts Health and TPHC have now published their toolkit, Embedding and Connecting Prevention in Specialist Pathways. Along with background information on the benefits of social prescribing and community-led prevention, the toolkit addresses some of the key systemic barriers that Barts Health encountered while implementing initiatives across various pathways and specialties.

Using case studies and the first-hand insights from patients, social prescribers and clinicians, the toolkit offers practical guidance for those looking to implement community-led prevention approaches, such as social prescribing, in secondary care. It also provides an overview of key Barts Health prevention networks and identifies the leaders driving this work across the Trust. The toolkit offers a valuable resource for anyone working in an acute setting wanting to embed social prescribing into their services or to prioritise the prevention of ill health in NHS Trusts across London and nationally.

Social prescribing: A key enabler of NHS prevention goals

Emerging evidence strongly supports social prescribing as a cost-effective intervention for tackling the wider determinants of health and addressing the often-overlapping health inequalities that contribute to high demand for NHS services.

Further, as the government seeks to move more care from hospitals to communities as part of its ‘three shifts’, initiatives like social prescribing will be increasingly vital. By reducing pressure on secondary care services and helping local systems meet their financial and operational goals, social prescribing plays a crucial role in shaping the future of preventative, person-centred and sustainable healthcare.

Special thanks to Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery at Barts Health, and Mollie McCormick, Secondary Care Project Manager at Transformation Partners in Health and Care, for their time and input in developing this article.

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UK digital health company launches Prevention Innovation Fund to support ICSs

By Integrated Care Journal

Holly Health has announced a £320,000 fund, offering systems access to psychology-based digital health services, enabling system leaders to move forward with prevention initiatives.

Long-term conditions (LTCs), mental health challenges, and multimorbidity rates are rising, with lifestyle risk factors the biggest cause. This is impacting system costs (£18.4 billion, or over three quarters of NHS expenditure, is spent on long-term care per year) and workplace sickness (38 per cent of people of working age on long-term sickness, report having 5 or more LTCs). The vast majority of people living with these challenges currently get no tailored support for lifestyle health improvement.

Holly Health has today announced a £320,000 Prevention Innovation Fund, offering up to four integrated care systems (ICSs) (or equivalents in Scotland and Wales) up to £80,000 credit each towards deploying a proven, psychology-based digital health coaching service, to increase self-management support across their region.

The goal of the fund is to help NHS system leaders to move forward with large scale prevention initiatives efficiently, supporting progress towards the three new UK healthcare strategy ‘shifts’, from treatment to prevention, hospital to community and analogue to digital.

Holly Health is a fully digital, yet personalised, health coaching service which supports patients to develop sustainable health habits across mental and physical health and most lifestyle risk factors.

Backed by the NHS Innovation accelerator, and with more than 200 GP practices partnerships around the UK, Holly Health outcomes show significant average health improvements across areas like exercise, mental wellbeing, weight and blood pressure. Additionally, GP appointments show consistent reductions after using Holly Health, especially in more frequent service users.

Steve Woodford, NHS Non-Executive Director at NHS England, said: “The NHS has an opportunity to shift towards a proactive, preventive and personalised care system, with the help of technology. Services like Holly Health can help to drive these changes affordably and efficiently. This is a great opportunity for ICB teams, enabling scalable self-management support for people living with or at risk of long-term conditions.”

There are two main ways in which ICSs will be able to launch Holly Health at scale. One is via traditional routes, deploying Holly Health via primary care and public health services. The second, a route fit for the future NHS, is to launch Holly Health to members of the public, via the NHS App, made possible by a brand-new collaboration between Holly Health and Patients Know Best, also announced today.

Patients Know Best (PKB) is the UK’s leading personal health record platform, enabling patients to access and contribute to their health records using the PKB website and via the NHS App. The new Holly Health and PKB integration allows the Holly Health digital health coaching service, and PKB records to ‘speak’ to each other, so that members of the public can transfer blood pressure readings and lifestyle health data into their personal records. ICS teams will also have the new opportunity to reveal access to Holly Health coaching, via PKB and the NHS app, supporting the government’s vision for a single place for people to manage their health.

Grace Gimson, chief executive at Holly Health, said: “We’re extremely excited to make this double announcement: the launch of our Prevention Innovation Fund, and go-live of our partnership with PKB. Both have the potential to drive huge systemic changes in UK healthcare, driving prevention and personalised patient care forward, at population scale.”

Mohammad Al-Ubaydli, chief executive at PKB, said: “Holly Health’s pioneering approach to preventative care, perfectly complements PKB’s mission of empowering patients with their health data. Together, we’re creating a seamless experience where patients can proactively manage their wellbeing and maintain a complete, holistic view of their health, all in one place to share with whoever they need to.”

ICSs, and their equivalents in Scotland and Wales, wishing to find out more about the Prevention Innovation Fund, and to apply, should contact hello@hollyhealth.io.

Catherine Davies, Director of Digital Healthcare Council, commented: “Holly Health’s new Innovation Fund is a great opportunity for NHS systems to deploy evidence-based solutions at scale. Their digital health coaching helps accelerate the Government’s three shifts, particularly from treatment to prevention, delivering measurable outcomes for the NHS while empowering patients to take control of their health.”