After months of anticipation, the Government launched its NHS 10-Year Plan (“Fit for the Future”) with much fanfare. Whilst the founding principles of the NHS are preserved, the details of the Plan express high ambitions for a radically transformed health service. Three shifts frame the policy document: moving more care from hospitals to communities, making better use of technology in health and care, and focusing on preventing sickness.
Alongside these three shifts, there’s no denying the Plan’s underlying message of urgency for tackling the NHS’s recovery issues – the rising demand for healthcare from a population that is both ageing and in poorer health; the growth of government spending on health at the same time more investment is needed to improve access, quality and productivity; and people’s daily experiences of undeniably long waits for GP, A&E and hospital services.
“Fit for the Future” is clearly a plan for the NHS. Nevertheless, Wes Streeting, the Secretary of State for Health and Social Care, has publicly acknowledged that achievement of the Plan’s ambitions will depend on a stable, well-funded social care system. NHS services operate within a broader ecosystem, made up of interlinked elements, and improvements in individual and public health are closely tied to the social care system, which plays a key role in addressing people’s needs. The success of the Plan is contingent on progress in social care reform.
Yet, we are at a crossroads, waiting for Baroness Casey’s Commission to offer both interim and long-term solutions. The independent commission on adult social care is not expected to report back to the Prime Minister until 2028. That leaves only the NHS Plan as a driver for change. And this government is in a hurry to deliver tangible results.
As leaders in social care research and policy, we have examined “Fit for the Future” to identify the opportunities for social care and how the sector can make the most of them. We also wanted to assess the implications of the Plan for people who draw on care and support, asking: Will the Plan enable people to live their best lives, with independence, choice and control?
With the three shifts guiding our analysis, we have collected our thoughts about the opportunities for the social care sector within the Plan, as well as our questions and concerns. We also make the case for drawing on lessons from previous NHS reforms, especially initiatives that sought to improve the interface between the NHS and social care, to align NHS and social care budgets and to integrate services for a “seamless” experience of care. We don’t have to start from scratch.
From hospital to community:
In keeping with the Plan’s stated aims of a more integrated, equitable system, “Fit for the Future” first describes moving more care from hospital to community, with key developments within primary care focused on neighbourhood health services. These include delivering a GP-led preventative model of care that will reduce health inequalities and, in some instances, bring primary, community, Mental Health and allied services together under one roof in bricks and mortar neighbourhood health centres. The neighbourhood services will be rolled out though a national development programme, starting with an initial 42 places.
What else is included? Greater use of integrated multi-disciplinary teams (MDTs) is expected to support people with complex conditions and reduce demand on hospital care. Other proposed changes include a move towards a plurality of local providers, including the voluntary and community services. A re-design of the Better Care Fund (BCF) is referenced within the Plan with few details, other than an expected increase to the NHS contribution. The new BCF will likely continue to target post-discharge care at home and in the community, along with targets for avoiding hospital admissions.
These proposals describe social care primarily as an enabler of NHS recovery: post-discharge care to support intermediate care and reablement, involving social care professionals in MDTs and overall better care coordination through integrated services. However, the Plan lacks clarity about how local government and social care leaders (not to mention people with lived experience of care and caring) can contribute to, influence or co-design local services.
Lessons from previous integrated care pilots and place-based care arrangements, including the NHS Vanguards and the BCF, offer useful steer for local leaders – whether at system level, operational level or at the front-lines of care. However, the mechanisms of shared governance, financial flows and joint incentives are left unaddressed. Achievability of the hospital to community vision may also be limited if the promised rebalancing of NHS funding is not realised. The stated timeframe for moving resources to primary, community and other settings out acute hospitals is 2035. In addition, the reduction in the number of Integrated Care Boards leaves the NHS’s commissioning responsibilities further away from local leaders and accountability.
One option for government could be setting out a national framework or set of objectives for how leaders of neighbourhood health schemes and ICBs should be working with local government leaders. A good place to start would be building on the evidence from the Integration Pioneers evaluation. This analysis suggests practical support with digital infrastructure, shared records and integrated performance systems are important enablers of successful MDTs. Unfortunately, these challenges still exist between the NHS and social care providers.
Learning from the past has also found that integrated care initiatives are subject to being overwhelmed with too many goals, and that these can derail the relationship building that leads to better patient experiences and outcomes. Integrated care on its own cannot resolve the ongoing resource challenges across health and social care, release savings or tackle inequalities (Miller, Glasby & Dickinson, 2021). Unfortunately, the Neighbourhood Health Schemes have the same risk of trying to do too much all at once.
With MDTs central to achieving the vision of Neighbourhood Health Services, it is worth assessing what’s required for them to deliver more coordinated, personalised care. The Plan describes their role as bringing together practitioners from across health and social care to collaborate and proactively support the needs of individuals. SCIE has collected a long list of evidence about what enables MDTs to work effectively. At the heart of MDTs is relationships – between professionals and with patients and carers. The funding flows can work against forging these relationships. The Plan does not address key issues with social care, such as charges and the chronic lack of front-line social care workers.
Another assumption underpinning MDTs is their ability to support people’s needs out of hospital, especially to avoid unplanned hospital admissions and save NHS costs. The evidence about this remains equivocal. The evaluation of three national integrated care programmes in England, which included MDTs, found only a “gradual” reduction in hospital admissions and only after five years. Perhaps a better way to measure progress and success would be metrics that capture people’s lived experience: are their lives improved as a result of all these changes?
From analogue to digital:
Following the vision for moving care closer to home, “Fit for the Future” then turns to technology as the engine for change, promising a digitally transformed health system powered by AI diagnostics, genomic screening, and app-based services. Yet here, as elsewhere, the emphasis is on what will be deployed rather than how it will be designed, governed, and made to work for people in reality. A few key issues spring to mind.
First, social care seems to be left out of digital investment. The Plan centres NHS infrastructure, with no commitment to upgrading basic digital capacity in care settings. While more data and technology can bring benefits, they can also bring risks. Social care data systems must be built with clear consent, ethical oversight, and inclusive governance from the outset – if at all. Yet there is no mention of investment in basic digital capability for social care providers, let alone the safeguards to make such systems accountable and trustworthy. This imbalance is something that social care leaders fear dooms it to failure (SCIE, 2025; Care England, 2025).
Second, innovation is framed around tech, not relationships. Tools like remote monitoring or AI triage are presented as solutions. But in practice? They can add burden. Care workers report ‘patching’ clunky apps that don’t fit real workflows (Hamblin, Burns & Goodlad, 2023). Too often, these tools are developed and deployed without meaningful engagement from the people they are meant to serve, turning care into a series of transactions rather than relationships. There are also safeguarding risks. s Dixon et al (2025) found during COVID-19, safeguarding’ depend on trust, observation and human connection – not just on data. And when services go digital-first, people can feel compelled to trade privacy for access. Without co-design and adequate accountability mechanisms, digital tools risk becoming tools of control rather than support.
Third, digital exclusion is not clearly addressed. ‘Digital inclusion’ is about people, not just technology. Many remain offline – whether through choice, due to lack of confidence or for other reasons – and risk being shut out if services go ‘digital by default’. In the UK, nearly one-third of people over 75 do not use the internet at all (Age UK, 2024). Many of the people who most need joined-up health and social care (including older people, those with learning disabilities, and people with mental health conditions) are least well served by digital pathways. The promotion of the NHS App as the ‘front door’ to care raises an obvious question: who gets left outside? Yet the Plan offers no clear strategy for those who are not digitally connected. ithout this, digital expansion could deepen, not reduce, health and care inequalities. Digital by choice, not by default, must be the guiding principle (Hamblin and Black, 2023).
The social care workforce is also overlooked. The Plan sets out support for NHS clinicians, including AI tools to cut admin and digital assistants for diagnostics. For the social care workforce? Almost nothing. This is a major oversight, given care workers are central to integrated care in homes and communities. The Plan talks about tech-enabled care ‘closer to home’, but how are homecare workers or family carers supposed to deliver that without the tools, time, or support to do so. Many are already supporting things like virtual wards, often with no training or involvement in design (Mistry, 2024). This is not just a skills gap, it’s a policy gap. Policy and commissioning must reflect how digital tools are actually used in real care settings, and the fact that care workers are often improvising under pressure. Given the pace of technological change, plans need built-in review and adaptation.
In addition, there is no meaningful commitment to co-production. Last year, disabled people gave evidence to Parliament calling for genuine involvement (see for example Voiceability, 2024). The Plan, however, offers no structures to embed that voice beyond initial consultation. Feedback is framed narrowly – rate, react, move on – rather than co-design. True accountability means being at the design table, not simply responding once services are built.
A final concern is that evaluation and governance go underaddressed. Tools like Oxevision have raised concerns about surveillance and consent (Oppenheim, 2022), yet the Plan lacks a framework for ethics or opt-outs. Public mechanisms like the Algorithmic Transparency Recording Standard have been (and may remain) underused (Ada Lovelace Institute, 2025), which risks undermining scrutiny. And the NHS has a longstanding problem with ‘pilot-itis’: launching technologies without follow-through. Big announcements (digital health checks, HealthStore app expansion, ‘My Companion’ generative AI feature) arrive without clarity on how outcomes will be measured. If so many care-tech pilots never scale or prove impact (Whitfield and Hamblin, 2022), is that innovation, or just experimentation?
In short, national digital investment could enable more joined-up, person-centred care – if designed well. That means listening to those who use and deliver services, embedding co-design, and putting in place clear safeguards on consent, equity, evaluation, transparency and accountability. Without these, the government’s digital mission risks becoming a top-down, NHS-first agenda that ultimately fails people at the sharpest end of the care system.
From sickness to prevention:
If the shift to neighbourhood care is about where services are delivered, and the digital commitments describe what new tools will be introduced, the Plan’s prevention commitments speak to why the system must change at all. A plan that puts prevention back at the centre – aiming to make the NHS “a health service, not just a sickness service” – is welcome. So too is the ambitious goal of halving the gap in healthy life expectancy between the most advantaged and most deprived areas of the country. There is real value in shifting prevention away from a narrow service-oriented model, or from one focused merely on providing information, toward a more systemic conception of wellbeing. In this broader sense, prevention means reshaping the conditions of everyday life: the material, social and environmental factors that determine people’s capacity to live well.
This more holistic framing is acknowledged in “Fit for the Future”, but not with the level of radicalism needed for meaningful transformation. A persistent gap remains in addressing the realities of lived experience, including poverty, precarious employment, housing insecurity, and the effects of structural inequalities. Without tackling these determinants head-on, the rhetoric of prevention risks collapsing into the familiar terrain of responsibilisation – shifting responsibilities from the state to individuals or communities. The danger? Prevention efforts may end up perpetuating, rather than disrupting, the very health inequalities they aim to reduce.
Prevention that seeks to narrow health inequalities cannot be divorced from wider social policies, particularly those addressing poverty. Over the past decade, the UK (the sixth wealthiest country in the world) has seen what has been called “a shameful increase in the level of destitution.” In 2022, an estimated 3.8 million people experienced destitution, including around one million children. That is almost two and a half times the number recorded in 2017, and nearly three times as many children. The impacts are profound: damaging physical and mental health, eroding future prospects, putting further strain on overstretched services, and placing a major barrier in the path of any serious attempt to reduce health inequalities.
The realities of people’s everyday lives, including their health and care needs, are often far removed from the priorities of retailers and private companies. Yet the Plan appears to place strategic weight on partnerships with businesses and employers. While such involvement may be positioned as pragmatic or even necessary, the scale of commercial interests raises legitimate questions: can these partnerships truly serve public health, or do they risk diluting or co-opting it? Awarding loyalty points for buying fruit and vegetables might make for good headlines, but does it represent a serious commitment to prevention? Or does it simply frame health as a matter of individual consumer choice, while sidestepping the deeper conditions that shape health outcomes?
From a social care perspective, health – and how it is sustained – is rooted in positive, solidaristic relationships. Yet the social fabric in which many people live is often marked by profound isolation. In 2018, the UK government published A connected society: A strategy for tackling loneliness, its first major contribution to the national debate on the importance of social connection. It committed to long-term action, recognising loneliness as a significant public health issue. Yet little has changed. The latest annual report on loneliness notes that, since 2018, the proportion of people aged 16 and over in England experiencing chronic loneliness has increased from 6% to 7% (Community Life Survey 2023/24). Tackling loneliness matters to everyone – individuals, employers, communities and, crucially, the NHS. Supporting people to build meaningful relationships is not only vital for physical and mental health; it is also central to any contemporary approach to prevention and to the relationships we call ‘care’.
Focusing more narrowly on the role of publicly funded social care services in prevention, the reality is that the current system meets only a fraction of demand, even for those who actively come forward for help. To think about prevention in a broader sense than simply avoiding hospital admission for older people with complex needs, we would need a more comprehensive and affordable social care system. Without that, prevention will remain rhetoric, disconnected from the realities it needs to change.
Conclusion
The Plan’s three shifts – from hospital to community care, through digital transformation, to a greater focus on prevention – are all areas where social care is essential to success. Yet, while “Fit for the Future” sets out what should change, it offers little on how these changes will be delivered, or on how social care will be equipped and supported to play its part. Without that, the risk is a familiar one: a strategy shaped around the NHS, with social care left as an afterthought.
The dependencies on other major agendas are clear. Progress will rely on the forthcoming NHS workforce plan and the recommendations of the Casey Review on adult social care, both of which will shape the capacity and resources needed to make the NHS Plan work in practice. This creates both a challenge and an opportunity: to use the momentum of “Fit for the Future” not only to improve NHS recovery but to mobilise the full potential of social care as an equal partner in improving health and wellbeing – and in doing so, give people the choice, control and quality of service the Plan aspires to deliver.
Illustrations by PJ Annand
