Guidance

Change NHS: help build a health service fit for the future

Updated 18 November 2024

Applies to England

This GOV.UK page gives an outline of the questions asked for public reference.

How to respond

Go to the Change NHS online portal to give your views on how we can make a health service fit for the future.

If you prefer to submit your response in another format, for example in a video in British Sign Language or by written email response, email changenhs@thinksinsight.com.

You can also send a response by post to:

Thinks Insight and Strategy
West Wing
Somerset House
London
WC2R 1LA

If you’re completing the easy read version of the survey, you can send this by email or post.

Overview

The 10 Year Health Plan is part of the government’s health mission to build a health service fit for the future.

The first step in the process was Lord Darzi’s independent review of the NHS in England to understand the true scale of the challenge facing the health service. That was published on 12 September 2024. Now that we have the results of that investigation, the government is working to develop a plan to tackle the challenges it identifies.

The plan will set out how we will deliver an NHS fit for the future, creating a truly modern health service designed to meet the changing needs of our changing population. The government will co-develop the plan with the public, staff and patients through a detailed engagement exercise.

To do this, we have launched ‘Change NHS: help build a health service fit for the future’. This is a national conversation to develop the 10 Year Health Plan.

As part of this, we want the public and health and care staff in England to share their views, experiences and ideas at the Change NHS online portal. The portal opened on 21 October 2024 and will run for several months.

It doesn’t matter whether you have a little or lot to say. The online portal is open to everyone, whether you’re a member of the public or someone who works in health and care in England. There is also an area of the portal dedicated to responses from organisations. This area is an early opportunity for organisations to share insights as we begin an extensive programme of engagement to develop the 10 Year Health Plan.

This is just the beginning. Over the coming months there will be a series of events for people across the country to share their ideas and views. This includes a number of regional ‘deliberative events’ with the public and health and care workers to hold more detailed discussions on how we can fix the NHS.

The Department of Health and Social Care (DHSC) is leading this work, alongside NHS England. It is the combined role of these organisations to support, protect and improve the health and wellbeing of populations in England.

DHSC has commissioned Thinks Insight and Strategy to deliver the ‘Change NHS online portal’ through the website GoVocal. Thinks Insight and Strategy is an independent research agency adhering to the Market Research Society Code of Conduct.

DHSC is also working with Kaleidoscope Health and Care who are providing expertise on workforce engagement, acting as a champion for staff voices. The Institute for Public Policy Research (IPPR) is also providing expertise on policy and implications, ensuring the engagement is informed by latest evidence.

As part of the engagement, some members of the public will be receiving letters from Thinks Insight and Strategy inviting them to register their interest in taking part in these deliberative events, having been selected at random to ensure a representative sample. If you receive one of these letters, please follow the instructions given to register your interest. If you are not invited to take part in the in-person events, there will be other opportunities where you can be involved in the discussion.

The privacy notice for the deliberative events is available on the Change NHS: help build a health service fit for the future page.

About the online portal

The government has made it its mission to develop a 10 Year Health Plan, but we cannot do it without the help of the people who use and work in the NHS. We need to learn from your experiences and perspectives and hear your ideas. The Change NHS online portal will help us to do that.

The portal opened on 21 October 2024 and will run for several months. Everyone over the age of 16 living in England can take part.

Some questions are aimed at those working in the health and care sector to ensure they can share their views and experiences. Other questions are written specifically for those who use services.

Staff and the public will both have unique insights about what needs to change in the NHS.

Go to the portal to:

• give your views on the NHS and health and care
• tell the government what you feel is working well and what needs improving
• share your experiences
• post your ideas for improving health and care in the future

The site is interactive and gives you the opportunity to engage with other people’s ideas too.

As the 10 Year Health Plan develops, we’ll be feeding back ideas and initiatives as they emerge from our work and asking you to comment and challenge our thinking and ideas. 

You can register for updates so you do not miss new content you can get involved with.

A privacy notice for the online portal is available on the Change NHS: help build a health service fit for the future page.

Confidentiality

Most responses will be kept confidential and will be anonymised in analysis and reporting.  

The only section where responses can be viewed by other people is ‘Your ideas for change’. You can choose to leave an idea without leaving your name, but your username will be visible if you respond here.

You can also view other people’s responses in the ‘Your ideas for change’ activity. We encourage you to read these, leave comments and vote on them. Responses to all other activities will be private and not visible to other people.

The ideas that you contribute will be considered alongside those generated through a wide range of other engagement over the coming months, including hearing from people who are less able to engage online and lots of other groups.

Alternative formats

See the easy read version of the Change NHS survey.

Watch the British Sign Language (BSL) version of the Change NHS survey:

BSL version of the Change NHS survey

Questions

The questions on the portal are grouped into sections:

• Start here
• Your experiences: public
• Your experiences: workforce
• Your ideas for change
• Organisational responses
• Feedback on the engagement

The questions in each section are listed below.

You’ll need to register your name and email address to answer the questions. All questions are optional.

Start here

Changing the NHS is going to involve everyone. The government promised to put in place a 10 Year Health Plan to fix the NHS in England.

Best thing about the NHS

In your opinion, what are the best things about the NHS? Please tell us up to 3 of the best things about the NHS today.

Biggest challenge facing the NHS

In your opinion, what are the biggest challenges facing the NHS? Please tell us up to 3 challenges.

Problems experienced

In July 2024, an independent investigation of the state of the NHS in England was carried out (the Darzi report). The findings of the investigation identified several challenges facing the NHS which will need to be addressed to improve services over the next 10 years.

Which, if any, of the following have you personally experienced?

• difficulties getting a GP appointment
• waiting to access community services (for example, district nursing, community physiotherapy, community occupational therapy)
• waiting to access mental health services
• long wait times in A&E (accident and emergency)
• long waiting lists for a hospital procedure
• delays in being referred for treatment
• poor co-ordination between different health and care services
• poor communication from health services
• poor quality care
• treatments or services not available on the NHS
• other - please specify

Priority for change

Which of the challenges selected in the previous question do you think are most important for the 10 Year Health Plan to address? Please select the 3 options you feel are most important to address.

The shifts

The next questions relate to 3 ‘shifts’. These are big changes to the way health and care services work - that doctors, nurses, patient charities, academics and politicians from all parties broadly agree are necessary to improve health and care services in England:

• shift 1: moving more care from hospitals to communities
• shift 2: making better use of technology in health and care
• shift 3: focusing on preventing sickness, not just treating it

Shift 1: moving more care from hospitals to communities

This means delivering more tests, scans, treatments and therapies nearer to where people live. This could help people lead healthier and more independent lives, reducing the likelihood of serious illness and long hospital stays. This would allow hospitals to focus on the most serious illnesses and emergencies.

More health services would be provided at places like GP clinics, pharmacies, local health centres and in people’s homes. This may involve adapting or extending clinics, surgeries and other facilities in our neighbourhoods, so that they can provide things that are mostly delivered in hospitals at the moment. Examples might include:

• urgent treatment for minor emergencies
• diagnostic scans and tests
• ongoing treatments and therapies

In what ways, if any, do you think that delivering more care in the community could improve health and care?

What, if anything, concerns you about the idea of delivering more care in the community in the future?

Shift 2: making better use of technology in health and care

Improving how we use technology across health and care could have a big impact on our health and care services in the future. Examples might include:

• better computer systems so patients only have to tell their story once
• video appointments
• artificial intelligence (AI) scanners that can identify disease more quickly and accurately
• more advanced robotics enabling ever more effective surgery

In what ways, if any, do you think that technology could be used to improve health and care?

What, if anything, concerns you about the idea of increased use of technology in the future?

Shift 3: focusing on preventing sickness not just treating it

Spotting illness earlier and tackling the causes of ill health could help people stay healthy and independent for longer and take pressure off health and care services. 

In what ways, if any, could an increased focus on prevention help people stay healthy and independent for longer?

What, if anything, concerns you about the idea of an increased focus on prevention in the future?

Your experiences: public

This section of the engagement is for anyone who wants to tell us more about their experience of health and care.

Recent experiences

Please tell us about a recent experience of health and care services in as much or as little detail as you wish.

This could be an experience where you or a family member accessed care as a patient. Or it could be about the overall performance of the health and care system.

Please tell us about any positive or negative aspects of your experience and be as specific as you can.

Your experiences: workforce

This section is aimed at people currently working in health and care.

The portal is for feeding in experiences to the 10 Year Health Plan, not providing direct feedback to individual services. However, it is important that you know you are free to speak up if you are concerned. You can find routes to speak up at NHS England’s Freedom to speak up webpage.

Best thing about your role

What are the best things about your job? Please tell us up to 3 things that are great about your job.

Worst thing about your role

What are the most challenging aspects of your job? Please tell us up to 3 things that you find most challenging about your job.

Recent experiences - workforce specific

Which of the following challenges, if any, have you experienced working in the health and care system?

Please select all that apply. If none applies, please leave blank.

• low levels of job satisfaction or morale
• problems with workplace culture (for example, bullying, racism, sexism or harassment)
• staff shortages
• high levels of staff turnover
• stressful working environment
• poor mental health or burnout
• unmanageable workload
• complex administrative processes
• poor equipment
• inflexible or antisocial working patterns
• poor training
• inefficiencies in connecting services
• growing complexity of patient needs
• other - please specify

Priorities for change - workforce experiences

Which of the challenges that you selected in the previous question do you think is the most important for the 10 Year Health Plan to address? Please select the 3 options you feel are most important to address.

Recent experience

We want to learn from your experiences of working in health and care. Please tell us about any aspects of your work that you think we need to understand as we develop the 10 Year Health Plan.

These could be things you or your team find challenging, which you think should be avoided or changed in the future.

These could also be things you or your team do differently that you think could lead to improvements elsewhere in health and care.

Please share as much detail as you can and be as specific as possible about which part of the health and care system your experience relates to.

Your ideas for change

The ideas you submit will be visible to everyone taking part, and you can browse other ideas on the portal. You can vote for those you think will be the most effective. The best ideas will form part of the 10 Year Health Plan.

For the 10 Year Health Plan to be a success, it needs to draw on the experiences, skills and ideas of patients, carers, staff and members of the public. These could be:

• ideas about how other parts of the health and care system and other organisations in society could change to promote better health and/or improve the way health and care services work together
• ideas about how individuals and communities could do things differently in future to improve people’s health

On the portal, you can share a suggestion for what needs to change across the health and care system and then tag which topic or topics it relates to underneath. Please submit one idea at a time on the portal - you can add as many you like.

Your idea for change

What is your idea?

Title

Give your idea a short name that will help people understand what it is all about.

Description

Tell use a bit more about your idea:

• who is involved?
• what will change?

Topic area

Below is a long list of topics that your idea might relate to. Please click all the ones that you think your idea could affect:

• stages of healthcare:
  • keeping people healthy
  • diagnosis
  • treatment
  • aftercare and recovery
  • living with ill health
  • end of life care
• places:
  • GP surgeries
  • hospitals
  • nursing and residential care homes
  • hospices
  • community facilities
  • care in the home
• conditions:
  • long term conditions
  • short term illnesses
  • accidents and emergencies
  • mental health
  • planned (elective) care
• workforce:
  • caring for patients
  • pay and conditions
  • facilities and IT
  • management and organisation
• other - please specify

Would you say this idea is quick to do?

• quick to do - that is, in the next year or so
• in the middle - that is, in the next 2 to 5 years
• long term change that will take more than 5 years
• don’t know

Organisational responses

The government wants to hear organisations’ views from the outset as it begins work to develop the 10 Year Health Plan.

Organisations should submit responses to these questions by Monday 2 December 2024 at 5pm.

This is an early opportunity to share your insights as we begin an extensive programme of engagement to develop the 10 Year Health Plan.

Keep your total response to the questions to a maximum of 5,000 words. You can include links to reports or supplementary evidence as part of your response - these are not included in the word count.

Priorities

What does your organisation want to see included in the 10 Year Health Plan and why?

The shifts

The next questions relate to 3 ‘shifts’. These are big changes to the way health and care services work - that doctors, nurses, patient charities, academics and politicians from all parties broadly agree are necessary to improve health and care services in England:

• shift 1: moving more care from hospitals to communities
• shift 2: making better use of technology in health and care
• shift 3: focusing on preventing sickness, not just treating it

In answering the following questions on the 3 shifts, we would welcome references to specific examples or case studies. Please also indicate how you would prioritise these and at what level you would recommend addressing this - for example, at a central approach or local approach.

Shift 1: moving more care from hospitals to communities

This means delivering more tests, scans, treatments and therapies nearer to where people live. This could help people lead healthier and more independent lives, reducing the likelihood of serious illness and long hospital stays. This would allow hospitals to focus on the most serious illnesses and emergencies.

More health services would be provided at places like GP clinics, pharmacies, local health centres and in people’s homes. This may involve adapting or extending clinics, surgeries and other facilities in our neighbourhoods, so that they can provide things that are mostly delivered in hospitals at the moment. Examples might include:

• urgent treatment for minor emergencies
• diagnostic scans and tests
• ongoing treatments and therapies

What does your organisation see as the biggest challenges and enablers to move more care from hospitals to communities?

Shift 2: making better use of technology in health and care

Improving how we use technology across health and care could have a big impact on our health and care services in the future. Examples might include:

• better computer systems so patients only have to tell their story once
• video appointments
• AI scanners that can identify disease more quickly and accurately
• more advanced robotics enabling ever more effective surgery

What does your organisation see as the biggest challenges and enablers to making better use of technology in health and care?

Shift 3: focusing on preventing sickness not just treating it

Spotting illness earlier and tackling the causes of ill health could help people stay healthy and independent for longer and take pressure off health and care services. 

What does your organisation see as the biggest challenges and enablers to spotting illnesses earlier and tackling the causes of ill health?

Ideas for change

We’re inviting everyone to share their ideas on what needs to change across the health and care system. These could be:

• ideas about how the NHS could change to deliver high quality care more effectively

• ideas about how other parts of the health and care system and other organisations in society could change to promote better health and/or improve the way health and care services work together

• ideas about how individuals and communities could do things differently in the future to improve people’s health

Please specific policy ideas for change.

Please include how you would prioritise these and what timeframe you would expect to see this delivered in, for example:

• quick to do - that is, in the next year or so

• in the middle - that is, in the next 2 to 5 years

• long term change that will take more than 5 years

Integrated care systems

We’re asking integrated care systems (ICSs) to help develop the 10 Year Health Plan by sharing insights from their communities.

We want to build on existing activity in 3 main ways:

• national level discussions with health and care system and local government leaders
• regional events with clinical, operational, local authority and public health leaders
• local engagement through patient groups and wider system partners, supported by content developed in partnership with ICSs

In mid November 2024 we will provide a ‘workshop in a box’ to support ICSs to gather insights and share them with the government to help develop the 10 Year Health Plan. This is being designed with input from local health and care systems so that this engagement builds on ICS expertise of engaging the public, staff, under-represented groups and stakeholders, allowing ICSs to share existing and future insights.