UHUK response to the NHS Change consultation on the 10-year health plan

In submitting its response to the consultation on the NHS 10-year plan, UHUK is urging the government to grasp this opportunity to fundamentally transform how care is delivered and received across the UK, embracing the mission-driven principles of social enterprise organisations to create an NHS which is equitable, sustainable, and truly patient centred.

UHUK CEO Conor Burke said: "Our members provide digitally enabled services covering two-thirds of the UK population. They provide neighbourhood services out-of-hospital, in the home and in the community, and are at the very heart of what the Darzi diagnostic is trying to achieve. 

"It's a model we know works. By embracing true collaboration with purpose, integrating systems and technology, providing specialised workforce training in the community, and redesigning funding mechanisms, it's a model which can be scaled to radically transform the delivery of care to patients across the country"

Read the full response below (10 minute read):

NHS Consultation Response

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

The 10-year health plan presents an opportunity to fundamentally transform how care is delivered and received across the UK, creating an ambitious vision for an NHS which is equitable, sustainable, and patient centred.

UHUK’s members provide urgent, integrated, out-of-hours and out-of-hospital care to two-thirds of the UK population, something they have done for over 20 years without ever going into financial deficits or needing financial bailouts. This includes handling over one million out-of-hours and 111 calls every month, delivering more than 14 million patient consultations
each year, and making more than 250k home visits: services that are at the very heart of what the Darzi diagnostic is trying to achieve. Our members’ social enterprise model, which has consistently reinvested surpluses to enhance local services, could be scaled up further with appropriate recognition and support, to deliver more out-of-hospital, community care, with a focus on prevention.

We believe the 10-year plan should include a specific strategy to recognise, incorporate, and appropriately fund social enterprise as a crucial and trusted delivery partner for the NHS, reducing red tape, bureaucracy, and needless tendering. This would ensure continuous reinvestment into local health services, a strengthening of resilience, and improved health
equity. Services would be delivered that are appropriate in each locality rather than a one-size-fits-all approach, ensuring that underserved communities are included. The NHS would benefit from our members’ local networks and local knowledge. Our members would maintain their flexibility and agility to respond rapidly to changing requirements. 

UHUK members are some of the most digitally enabled organisations within the sector. With a proven track record in real-time data sharing and AI-driven Triage, reducing pressure on stretched NHS services, they lead digital innovation and transformation and should be recognised as the trusted assessor of the ‘digital front door’.  Digital transformation should be prioritised within the plan, with investment to progress a single patient health record and real-time data sharing between care settings. The speed at which social enterprises can adapt to adopt new technologies, allows for rapid piloting and scaling of innovations that can reduce
demand on acute services, particularly in underserved communities.

Integration will be key, and a clear strategy to further integrate urgent, primary and community care to support neighbourhood working and create seamless 24/7 care pathways will be vital. As providers of NHS111, GP out-of-hours services, Urgent Treatment Centres and more, UHUK members help reduce pressure on ambulance services, A & E Departments and GPs, by providing advice and treatment at home and in the community. Investment in scaling up this work will be a key enabler.

We would like to see the introduction of specialised training and career pathways tailored to urgent and primary care, with specific strategies developed for recruitment, retention, and workforce wellbeing, with access to NHS training and development programmes for clinical staff not directly employed by the NHS.

We advocate for the development of an estates strategy, which allows for appropriate investment into community facilities where these are needed and facilitates the expansion, equipping and resourcing of Urgent Treatment Centres, Clinical Assessment Services, hospital-at-home/virtual wards, and other health ‘hubs’ within the community. 

To embed the changes, the plan will need to allow for investment in leadership development, and staff engagement and training. In addition, a national public education campaign, co-created with community stakeholders, will be essential to reshaping expectations around healthcare delivery, building trust in community-based services, and encouraging proactive engagement with digital solutions.

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

The biggest challenges are: 

Funding: Traditionally funding flows to acute trusts. If care is to move into the community, then funding must also flow that way. Establishing the facilities, workforce and technology for community-based care models will require upfront investment. This cost should be weighed against the potential for future savings as pressure and demand on acutes is reduced.

Changes to the NHS Funding, ENIC and HMRC have often not acknowledged the impact on social enterprises. This needs to be addressed. VCFSE organisations providing services solely on behalf of the NHS should receive the same shielding from these impacts as the NHS. Funding should be distributed proportionately and the specific benefits of working with social enterprises recognised by service commissioners (i.e., not-for-profit, surpluses reinvested for
community benefit, no shareholders, agility, flexibility).

Workforce: Recruiting and retaining skilled staff in urgent care remains challenging due to the high stress environment, demanding workloads, and perceived lack of career progression. Specialised training and career pathways could alleviate this. Clinical staff such as nurses, not directly employed by the NHS should have access to NHS continuing professional development and training. Pay award decisions should factor in the implications for staff delivering services on behalf of the NHS. 

Culture: This represents a massive behaviour change programme, and changing the health culture both within the NHS and among UK population will take time and effort on behalf of all providers. Engagement, communication, and education will be vital to building trust in new technologies and alternative delivery models. 

Data Sharing: To enhance patient safety, realise efficiencies and improve productivity and patient outcomes real-time data sharing and data collection between all care providers (NHS or commissioned by the NHS) will be crucial if care is to be delivered in the community and at
home. A specific strategy for making this a reality will be required, whether through a patient-owned single digital health record or other mechanism.

Risk appetite: By this we mean a culture change and an acceptance from primary care providers and NHS Trusts that they can work together with unscheduled care providers – adding capacity to support in-hours same day access and urgent needs for primary care, or working together to manage complex patients effectively outside of hospital in a virtual environment.

The key enablers are:

Collaboration with purpose: build on existing care networks to strengthen partnerships between hospitals, GPs unscheduled care and community providers. Work with our mission-driven social enterprises to identify existing providers or infrastructure that could be employed through collaboration with purpose to deliver a greater range of services, reducing the need for additional investment in office functions and overheads, ensuring any
investment has maximum benefit in the local community. This links to: 

Localised planning: Leverage UHUK’s member networks to develop tailored solutions for local community care challenges. All provider groups should be represented at the planning stage at ICB level and within ICSs. Learn from what is working in some areas and invest where it is needed.

Digital Innovation: UHUK’s members are at the forefront of digital innovation and have a unique understanding of the healthcare system from their position between emergency care and primary care. They bring a perspective that could open up the adoption of digital innovation at scale, including remote monitoring, digital assessment, AI-driven triage,
electronic prescribing, wearable technology, virtual wards, and telehealth – providing affordable, scalable community-based care solutions.

Patient engagement: Draw on the relationships that UHUK members have with their communities to support the patient and public engagement programme, highlighting the value of accessing care closer to home, and supporting people through the transition. 

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

The biggest challenges are:

Interoperability gaps: Legacy systems, varying IT platforms, fragmentation elsewhere. These issues prevent seamless data sharing across providers. With the right security and safety procedures, digital providers should be mandated to ensure interoperability, unless there is a
clear rationale around patient safety to prevent it.

Implementation costs/short-termism/lack of funding: With short term contracts for our providers and lack of commitment, this hinders investment in innovation as the cost of innovation and implementation will not be recouped within the contract length. To encourage innovation, longer contract periods and contract certainty is required, alongside specific
innovation funding. 

Innovation decision making process: There needs to be a clear set of principles and a clear governance process for testing and piloting new technology. Development of a technology road map would help. 

Security/safety concerns: Cyber security is an ongoing issue, as is developing trust among users, particularly around AI. A technical issue, a data protection issue, and a communications and engagement challenge that can hamper uptake of digital services. Once trusted, safe
systems are in place, a significant programme of national/regional/local public engagement will be required to build trust in the use of tech and to change perception of its role within the health system.  

Digital exclusion: There are still people and communities who can’t, don’t or won’t access technology driven care. Addressing digital exclusion is critical to ensuring health equity, particularly for vulnerable populations.  Any strategy must include alternative pathways for access to care.

The key enablers are:

Integrated systems: a unified single digital health record for every patient will empower patients, giving them more control over their care, as well as allowing for real-time data sharing between care providers, ensuring that conditions are managed holistically, with no conflicts. Integrated systems will enable seamless handovers improving safety and productivity.

Proven models: UHUK members have proven models including virtual wards, remote diagnostics and AI-Driven triage that demonstrate improved outcomes while reducing hospital pressures. Members are also harnessing predictive technology to help monitor and prevent long-term conditions such as diabetes, high blood pressure and cholesterol not only at home but in the workplace.

Innovation partnerships: UHUK members worked with Warwick University to develop technological solutions to the pain points they experienced, co-creating solutions with tech providers that are patient centred, rather than working with the tech provided and trying to make it fit. Potential opportunities to broaden this work.

Training/education: Training for clinicians and other staff to given them confidence and trust in the technology, educating and teaching patients and the public how to use the technology and encourage uptake.

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

The biggest challenges are:

Funding and workforce pressures: screening and early intervention work requires upfront financial and time investment, reducing capacity for preventative work. Also, funding pots for preventative initiatives tend to create silo working that limits effectiveness.

Social determinants: social and economic conditions including poverty, housing/homelessness, education disparities, social isolation can all contribute to poor health outcomes and leave people unable to access local health services. 

Lack of integration between primary and unscheduled care providers: Greater integration and a broader remit for urgent, integrated and unscheduled care providers would enable some conditions to be predicted and prevented.

Appointment delays: delayed or cancelled appointments can hinder early detection of some conditions.

The key enablers are:

Cross sector collaboration to deliver community-based screening: Greater integration with primary care, unscheduled/urgent care, and community providers, along with cross sector collaboration with local authorities and VCFSE organisations, to identify hyper-local vulnerable people and groups and develop screening or intervention programmes to help improve health outcomes.

Public Awareness campaigns and educational activities:  Collaborative campaigns between UHUK, NHS partners and local authorities to break down behavioural barriers, promote
healthier lifestyles and encourage good health and wellbeing practices.

Data driven prevention: Harness population health data at national, regional, and local levels to identify at-risk groups and utilise UHUK members rooted in their communities to develop and deliver localised health checks.

Please share any specific policy ideas for change, including how you would prioritise these giving timeframes.

Next Year or Two:

Enhanced and Ring-Fenced Funding for Community Services:
⁠Allocate resources to scale up existing integrated urgent and primary care services, including NHS 111, UTCs, and virtual wards, investing where provision is already scales and it therefore primed to be able to support quickly. 

Boost IUC Capabilities: 
⁠Expand clinical support within NHS 111 and CASs to provide definitive advice for a broader range of conditions.

Introduce real-time integration with local CASs and UTCs with primary care and A&Es for smooth patient handovers.

Universal scaling of Virtual Care Models:
⁠Test and scale virtual care from proactive assessment to triage to delivery to better manage chronic conditions and post-acute care in community settings.

Three to Five Years:

Develop Digital Ecosystems:
⁠Create interoperable IT systems across urgent care providers to improve data flow, patient tracking, and patient outcomes.

Develop innovation specific funding programmes aligned with a policy for long-term contracts to encourage investment in, piloting and adoption of new technologies.

Invest in Workforce Development: 
⁠Investment in the workforce that is delivering NHS care, irrespective of who employs that workforce (i.e. NHS, Local Government, VCFSE organisation).

Introduce new roles, similar to "Community Care Navigators," to coordinate care across settings.

Fund training programs for advanced practice roles in urgent and primary care.

Ensure wellbeing initiatives are in place to encourage recruitment and retention and to support staff in these new working environments.

Strengthen Public Health Partnerships:
⁠Work with local authorities to address social determinants of health through joint funding initiatives.

Five Years or More:

Redesign Funding Mechanisms: 
⁠Shift towards value-based care models that reward positive outcomes in community settings, and ensure procurement regulations, and risk appetite support this shift.

Universal Health Equity Framework: 
⁠Implement national standards for equitable access to urgent and primary care services, supported by data-driven monitoring.

Sustain Digital Transformation: 
⁠Ensure all patients have access to user-friendly digital tools, with provisions for digitally excluded populations.