The 10 Year Health Plan: what do we know about public perceptions of the three shifts?

Summary

• The 10 Year Health Plan is set to outline three significant shifts that the government wants to make in health and care – from an analogue system to a digital one, from care in hospitals to care in the community, and from a system that treats sickness to one that prevents ill health.

• Ipsos’s work clearly shows that there is appetite from the public for the three shifts that the government is proposing.

• However, there are tensions within each shift:

  • the public support greater use of their data to improve the delivery of health services, but have considerable concerns about the data-sharing beyond direct care

  • the public are supportive of more care being delivered in the primary and community sectors, but are anxious about reductions in local hospital services

  • the public recognise the role of government in helping people to be healthy, but there is no consensus about the role for the NHS in providing more preventive services.

• The King’s Fund is supportive of the three shifts, but to be realised, they will require some difficult decisions, particularly around where funding is spent.

• These difficult decisions should feature in the open and honest discussions the government has started with the public. And crucially, these conversations need to be sustained.

• This is a challenging time to be doing this work, because the government’s proposed shifts do not directly address people’s current priorities for the NHS: getting into A&E, getting a GP appointment and not having to wait a long time for planned care.

• For the government to deliver an improved and more sustainable health service, it must demonstrate how the three shifts will lead to a service that better meets people’s needs.

The NHS's digital decade: perspectives on the analogue to digital shift

What is the shift from analogue to digital?

One of the significant shifts the government will set out in the 10 Year Health Plan is the shift from analogue to digital. This means moving health and care services away from paper-based systems and making better use of digital technologies to improve services, patient experience and outcomes.

Policies promoting digital health records, remote monitoring using wearable technology, online consultations and digital access to services are likely to feature prominently in this shift. These digital advancements will aim to improve efficiency, accessibility and patient empowerment within the NHS.

How receptive are the public to a more digital NHS?

Perhaps more than the other two shifts, this is the one that the public expect to be happening and represents a direction of travel they have seen for themselves over the past decade, both in the NHS and in their wider lives. The public are using digital tools more and more, and they are open to using technology to help them manage their mental and physical health.

The GP Patient Survey, which collects feedback on GP services from more than 700,000 people annually, shows that around 7 in 10 have used an online GP service in the past year. Use of online GP services has risen significantly over the past decade. For example, in 2015, 6.8% of those surveyed said they had booked an appointment online; by 2024, the figure was 41%. And a recent survey by Ipsos for the NHS Confederation highlights the public’s increasing appetite for using technology to self-manage their care. Notably, nearly 4 in 5 say they would be happy to use technology to manage their health if recommended by the NHS, and more than 7 in 10 say they would use technology to avoid a hospital admission.

This applies to both physical and mental health, though the public are twice as likely to be using wearable tech or apps to monitor their health information to support their fitness or physical health (34%) as to support their mental health (18%). 

What do people need to support a more digital system?

The public’s receptiveness to a more digital NHS is clear. However, Ipsos research also highlights some of the potential challenges involved in shifting to a more digital approach. To successfully implement this shift, the government will need to address some key considerations.

People want to be able to choose how they access services

Although the convenience and accessibility of virtual care works well for some people, some of the time (especially for routine check-ups or minor ailments), many still prefer the traditional in-person experience. For example, when Ipsos asked the public what was important when booking a GP appointment, alongside getting a GP appointment quickly, the next most important consideration was having a face-to-face appointment.

Some people are particularly concerned that digital health care will lead to a less personal and empathetic experience, and that diagnoses may be missed. Ultimately, the public value choice in how they access and use health care services digitally. Recent deliberations with the public by Ipsos, exploring changes to primary care in London, underscored this. Once again, the data showed that digital access to NHS services was conditional on ensuring that patients have a choice around whether or not to take this route.

Providing reassurances around getting a face-to-face appointment or talking to a clinician when people need (or choose) to will be a crucial enabler for this shift.

People want reassurance about how their personal data will be used

Using digital technologies requires some level of data-sharing between patients and services. The public recognise the extensive benefits of digital health care, and most people are keen for services they use to have access to the right data about them. In fact, they expect their records to be joined up, and accessible to those who need that information to support the delivery of safe and efficient care.

Many people are surprised at how little information about them is shared across services within the NHS, and they see this as evidence that the NHS is fragmented and inefficient. This leaves many people feeling frustrated at having to piece their care together and repeat their stories over and over again. This is a persistent theme in discussions with the public about sharing their health and care data (see, for example, the Ipsos report on the OneLondon Citizens’ Summit held in 2020). This is significant given that we know how technology can support the integration of services.

This is not to say that there are no concerns about sharing personal data. Of course, the public have expectations about the storage and security of their data, even when it is being used to support their care. But the more significant concerns arise when talking to people about sharing de-identified data for secondary purposes; they are nervous about who has access to their data, how it is being used, and whether it is adequately protected from breaches. For example, in an Ipsos deliberation for NHS London in 2022 on a new Health Data Strategy, set up to inform the design of a new Trusted Data Environment, the discussions began (as they often do) with people sharing their concerns and misconceptions about how health and care data is stored and shared.

The Ipsos Citizens Advisory Group deliberations in 2023 produced a set of public expectations around access to NHS datasets and charging for this access. For example, people wanted there to be clear and demonstrable public benefit from the request to access the data, with strict vetting processes in place.

People want to ensure that digitalising the NHS does not worsen existing inequalities

Time and time again, it is clear that reducing health inequalities and addressing inequities is important to the public. For example, when Ipsos engaged people on the topic of a digital ‘front door’ for urgent care in London, there was a recognition that digital tools could help to manage demand more efficiently, yet there was also concern about what it would mean for accessibility to health care for some groups.

Although use of digital technology to manage health is on the rise, access and experiences can vary significantly among different demographic groups. Looking at the GP Patient Survey again, 41% of those surveyed had booked a GP appointment online in the past 12 months, but only 29% of those aged 75–84 had done so. And 44% of patients living in the most deprived quintile said it was easy to contact their practice via its website, compared with 50% in the least deprived quintile.

A significant minority of the UK population lack basic digital skills, internet access or suitable devices to be able to engage with services online. People in more socio-economically disadvantaged groups, socially excluded groups, or older adults can struggle to access care. According to a Good Things Foundation report,  8.5 million adults lack the most basic digital skills, and 2.4 million households struggle to afford their mobile phone contract. Research shows that 16% of those who are offline find the internet too complicated, and 13% are concerned about data and privacy. For digital services to be truly inclusive, they must serve the populations they are designed for, work as expected, and be trusted by both users and staff.

Levels of trust around data-sharing are not equal, and some communities are less likely to trust services to have access to their data. The King’s Fund’s work Grenfell showed that where trust between services and those they serve has been broken, people are far less likely to want their data shared. This lack of trust will need to be rebuilt, and work on how to engage and work with these communities needs to be tailored accordingly.

The public know that not everyone will feel comfortable using digital tools, and that many lack confidence to do so, particularly older people. For the public to embrace digital transformation in the NHS, they need to be reassured that barriers are not being introduced or exacerbated.

Fundamentally, people want digital tools to be easy to use and consistently adopted across services

In a recent Ipsos deliberation for NHS London on primary care transformation, patients reinforced the commonly held view that digital platforms should be easy to use and high quality, as well as being delivered consistently across different NHS services and locations. People also reiterated their desire for these tools to be rolled out gradually to allow time to become familiar with new ways of interacting with the NHS.

To encourage the public to adopt digital tools, those tools need to meet people’s needs and be easy to use. Therefore, it is crucial that new technologies are developed, tested and evaluated by patients.

What are the key tensions?

• For the NHS and the people who use it to realise the benefits of digital technology and more co-ordinated services, people must agree to their data being shared. This is a challenge, given the valid concerns people have about privacy and trust, particularly for secondary uses (beyond data being used for an individual’s own direct care). Investment in infrastructure and capacity building is crucial to ensure that data systems are secure. Engagement with people and communities in local areas will be key to addressing concerns and building trust.

• Although the public are open to using more technologies, they want options for how they interact with the health care system. Patients expect some level of choice as to how they see or talk to a health care professional when they need to, whether that is booking an appointment online or in-person, or speaking to a nurse at a GP practice or in a virtual ward.

Beyond the hospital: perspectives on shifting care from hospitals to communities

What is the shift from hospital to community?

The government's plan to shift more care from hospitals to communities aims to bring tests, scans, treatments and therapies closer to people's homes. This approach aims to provide more convenient and personalised care closer to where people live, particularly for those with long-term conditions or those requiring rehabilitation. There is potential to reduce hospital stays as a result, allowing hospitals to focus on critical illnesses and emergencies.

It is not yet known what the key policies will be, but contenders are likely to include bolstering community diagnostic centres, expanding virtual wards, further diversifying community and primary care roles, and a move to a neighbourhood health service.

Although this reflects the government’s definition of moving care from hospitals to communities, other organisations, including The King’s Fund, are thinking more broadly about what this shift entails. For example, how might the voluntary sector and communities themselves be more involved in shaping the services that are delivered locally?

How receptive are people to moving more care into the community?

Unlike the shift to digital (which fits with people’s expectations of the direction of travel within the NHS), this shift is less clear to the public. Nevertheless, Ipsos research suggests that broadly, the public will be receptive to it. The story is not simple though.

Ipsos research has shown that people favour focusing improvements on primary and community care, if asked to choose. For example, in Ipsos research for The Health Foundation, 3 in 5 of those polled wanted to prioritise making it easier to access care closer to home if the NHS budget is not increased – twice the number who want to prioritise making it easier to access hospital services.

Ipsos’ deliberative work with the public for The Health Foundation shows that this is largely driven by difficulties accessing GP services, and the belief that stronger primary care can reduce hospital demand through early diagnosis and better management of conditions.

However, this research also reveals a persistent view among some that hospital care should remain a priority due to the urgent nature of patient needs. People are deeply attached to their local hospitals, often viewing them, alongside GPs, as the core of NHS services. Even among those who favoured a greater focus on primary and community care, there was a clear reluctance to accept any reduction in quality of care in hospitals, or access to hospital services. This poses a significant challenge for implementing this shift; given the available resources, how can this be done without negatively impacting patients’ experiences of hospitals? And, if it cannot be done, how is it possible to navigate that conversation with the public to talk about short-term drawbacks to achieve better care in the long term?

Nevertheless, people are open to new models of care in primary and community services – driven in part by their desire to support the NHS through the challenges it is facing. For example, deliberative research by Ipsos to inform the design of community diagnostic centres in London found that patients broadly supported moving diagnostic services to the community to improve access and reduce waiting times. And Ipsos research exploring the role of community pharmacists shows that the public hold a high level of trust in them, and would be comfortable with them expanding into some new services – albeit with limits (for example, people are more comfortable using pharmacies for symptoms they have been before).

What do people need in order to embrace the shift to more community-based care?

People need confidence in primary and community services

These changes are being proposed against the backdrop of not just severe pressures in hospital services, but in primary and community services too. This means that this shift may be met with some scepticism by a public who have concerns about the ability of these services to cope. At the moment, people’s immediate priority is being able to see their GP.

Overall experiences of primary care have been declining; satisfaction with GP services declined from 83% in 2021 to 71% in 2023. This was largely driven by views around access, which are far worse than those about the quality of care received. Whereas 9 in 10 people still said their needs were met at their last GP appointment, 1 in 3 said they had to wait too long for that appointment.

Therefore, moving services from hospitals to the community might not feel like a positive choice, when the public perceive both sectors to be under significant strain. The challenge will be in reassuring the public that this shift will have positive benefits across the board while also improving access to GP services, which is what they care most about right now.

People want to be supported to change the way they access and use NHS services

Moving care closer to home will likely mean a greater diversity in the routes through which people can access health advice, support and treatment: district nursing, going to a pharmacist or dentist, accessing different forms of social care. However, as a nation, patterns around how we use health services have become deeply engrained over 75 years.

Ipsos research has shown that systemic issues (like lack of capacity or signposting) can push people towards services like A&E, even when other services may be more suitable for their needs. There can also be a lack of awareness of the wider primary and community services on offer beyond a GP, which acts as a barrier to access. In the deliberation by Ipsos for NHS London on primary care transformation, participants were surprised to learn about the diverse range of health care professionals within primary care, and articulated a need for public education to build trust and acceptance of receiving care from health care professionals other than GPs.

Furthermore, the people using the NHS are often feeling vulnerable, do not necessarily know what their condition is, and face a dizzying array of services. For the shift to the community to be successful, just communicating to the public about how to use services will not be enough. The policies – and, more importantly, their implementation – should consider how the system itself can be designed with patients and the public, so that people can access the right service at the right place and time, in ways that work for them.

What are the key tensions?

• The public understand that secondary care is under immense pressure, and largely support the delivery of more care in the community. But people want reassurance that hospitals will be there – and functioning well – when they need them.

• Although support and trust for primary and community services is high, satisfaction with these services is declining, and people often struggle to work out which service they should be using for their condition(s).

• The shift from hospital to community is in part designed to help with the longer-term reduction in hospital waiting times, but it will also need to address problems in access to primary care that the public have been concerned about for some time now.

• Growing investment in both primary and community services while doing the same in acute services will be difficult for the government. There needs to be a clear and honest conversation with the public about this.

Preventing sickness: public perspectives on shifting the focus from treatment to prevention

What is the shift from treatment to prevention?

One of the government’s five core missions is focused on health. This cross-government mission encompasses a range of policies focused on prevention that will require the collective action of many organisations across different sectors – including the NHS, but not exclusively.

The 10 Year Health Plan and the three shifts it will set out, is one part of the overall health mission. As such, the 10 Year Health Plan focuses more on reform of the NHS, shifting from treatment to prevention. This shift represents a potential significant change of emphasis in what the NHS is there to do, and the role it plays in people’s lives.

This shift could include policies focused on expanding preventive screening for diseases such as cancer and dementia to enable earlier diagnosis, and promoting and supporting healthier lifestyles (such as support for people to stop smoking or weight management programmes) to reduce preventable illness. Early intervention programmes for chronic conditions such as diabetes and heart disease could also be prioritised.

How receptive are people towards a greater focus on prevention?

Ipsos polling for the Health Foundation shows that the public think the government has a responsibility to reduce harm to the population from threats such as air pollution, food poverty-related harms and fuel poverty. Ipsos research also shows support for a range of government interventions related to public health, such as reducing the number of retailers licensed to sell tobacco, banning advertising of unhealthy foods on TV before 9pm and online, and introducing a tax on organisations producing foods high in sugar or salt.

Although the government is seen to have a key role in prevention, how do the public feel about the NHS taking a more preventive approach? The answer to this question is not clear-cut, not least because it is not always obvious to the public what role the NHS could play in prevention.

According to Ipsos polling with The Health Foundation, the public are divided on whether the NHS should be a sickness or prevention service. Around a third of those polled think the government should put more focus on preventing ill health, even if this means there will be less money spent on treating illnesses today; but a similar proportion think it should put more focus on treating illnesses today, even if this means there is less money spent on preventing future ill health.

What aspects of the shift towards prevention will people be receptive to?

Services that focus on early diagnosis and condition management

As we have indicated in the previous sections, the public favour moving more care into primary and community settings. Ipsos deliberative work for The Health Foundation shows that one of the main reasons for this was a belief that it would relieve pressure on hospital services and therefore be a more efficient use of resources – by preventing illness , ensuring that early diagnosis is possible and intervening earlier to avoid a person’s condition deteriorating to the point of requiring hospital care. Therefore, a shift towards earlier diagnosis and helping people to manage existing conditions is likely to be widely accepted.

Similarly, in a deliberation about the use of health and care data in London, the public also strongly supported using de-personalised data for proactive care. For example, they supported using data to identify individuals at risk of developing type 2 diabetes and offering preventive support. The preventive nature of this type of care was positively received, with participants pointing to the cost savings it could deliver and time saved for health care professionals, reducing the burden on the NHS over time.

More preventive action on mental health

Mental health is widely recognised as a major health concern in Britain, impacting lives and leading to consequences such as work absenteeism due to stress. In the Ipsos Health Service survey, just over half of Britons (54%) said that mental health is the biggest health problem facing the country today, more than any other issue. Although people see their mental health and physical health as equally important (79%), there is a perception that physical and mental health are not treated equally by the British health care system. Only 25% think they are treated equally, while 54% think physical health is treated as more important.

This suggests that the public will want to see more action on supporting people with mental health. Raising awareness of available mental health support and encouraging proactive mental health management could be crucial steps in shifting towards a more preventive approach in this regard.

What aspects of the shift to prevention will people be less receptive to?

NHS interventions around promoting and supporting healthier lifestyles

Although the public acknowledge the importance of healthy lifestyles, Ipsos polling for The Health Foundation shows that people currently lean towards personal responsibility rather than state intervention: 95% of those polled said individuals have a great deal or fair amount of responsibility for ensuring that people stay healthy, compared with 75% for national government and 74% for the NHS.

In deliberative workshops held in 2018 by The King’s Fund in partnership with Ipsos (The public and the NHS: what’s the deal?), participants echoed this sentiment about individual responsibility. They were also clear that the NHS has a role to play, but this was very much focused around providing information and support to individuals to live healthier lifestyles. There were mixed views on the NHS taking a more concerted approach to promoting healthier lifestyles beyond providing information and support (eg, there was no consensus on the NHS taking a ‘tougher’ approach by limiting treatment for those who were unwell due to lifestyle choices.

In general, there seems a lot of debate about ‘lifestyle stigma’, when individuals are deemed responsible for health conditions arising from their choices, and the resulting balance between individual, NHS and government responsibilities. The public are genuinely divided. For instance, Ipsos polling in late 2024 shows that while 37% think the NHS should be offering weight loss jabs to people who are obese, even if there is an immediate cost to the NHS, 32% think the NHS should not be doing so, even if this means that people stay obese.

What are the key tensions?

• While the public recognise the role of government in helping people to be healthy, there are very mixed views on whether preventing ill health should be a key focus for the NHS.

• For patients, the public and the wider health system to realise the benefits of a more preventive approach, there needs to be a clear articulation and shared understanding of the benefits of such an approach, as well as a collective agreement about the different roles that we all play, and people’s responsibilities to stay healthy. This requires the kind of open conversation that took place in Wigan, which resulted in a deal between public services and citizens. One fundamental question is how can the NHS work with other organisations to support people to increase their own agency and health??

• It is important to the public that a move towards prevention works for everyone and does not introduce more inequalities. There are already significant inequalities in the uptake of existing preventive services, such as vaccinations and screening. How, then, will policy-makers and services ensure that in shifting to a more preventive system, these inequalities are addressed and mitigated? Key to this will be ensuring that those who are affected by health inequalities have their voices heard in this debate.