How charities can help support the 10-Year Health Plan

The NHS cannot deliver the 10-Year Health Plan alone: to make the step change it envisages, it will need assistance from other bodies, including the charity sector.

The plan, released in July, makes it clear the government recognises both the current role the voluntary sector plays in delivering services and what it could do in the future. Charities already provide some NHS-commissioned services, ranging from supporting patients who are ready to leave hospitals to offering activities to those who are at risk of social isolation. Many now work alongside both trusts and integrated care boards and focus on providing the sort of holistic care that does not always fit easily into an NHS model focused on episodic illness.

But the 10-Year Health Plan could offer a chance to step up that work and make a difference to more patients, as well as those at risk of becoming patients. It calls for more integrated working between the NHS, local government and the voluntary sector and points to evidence that this can save money, with a recent study showing a 6 per cent reduction in costs and a 6 per cent improvement in patient outcomes from integrated care.

The plan suggests neighbourhood health centres will co-locate NHS, local authority and voluntary sector services, improving access to services for patients and driving more integrated working. The centre – which will increasingly be the Department of Health and Social Care as NHS England is abolished – will form partnerships with voluntary organisations.

The plan builds on Lord Ara Darzi’s September 2024 report on the NHS. He outlined three shifts – from hospital to the community, from analogue to digital, and from sickness to prevention. These shifts may offer opportunities for charities, provided they can navigate the pitfalls of dealing with an overstretched and resource-poor NHS.

Many larger charities believe they could swiftly scale up solutions that have been used successfully in smaller areas. Lisa Hollins, British Red Cross, executive director, UK operations, points out that those solutions are very much evidence-based. “Our work is very focused on people and ensuring that they get the best life possible,” she says.

“Our teams see firsthand how wider social factors affect people’s health,” she adds. “We have taken people home from hospital to begin recovery, only to find they have no food or heating. From our work with people who need to make frequent [emergency department] visits, we know there is a clear link between deprivation, inequalities, and people reaching a crisis point in their health.

“Providing care closer to home through neighbourhood health centres has the potential to be transformative for people.”

However, achieving this may require a change in how the NHS views and contracts with charities. “We feel charities are still very underused and often undervalued within the health system,” says Charlotte Nicholls, head of influencing at the Richmond Group, which represents larger charities. They are often seen as a “nice to have” rather than integral to service delivery, she adds.

“I think it’s a big mindset shift for the NHS and also for commissioners,” says Ms Hollins. “A lot of commissioners don’t know what the voluntary sector does.”

This HSJ immersive feature, in association with the British Red Cross, will look at what charities can offer through the lens of each of Lord Darzi’s three shifts and some of the challenges in building sustainable long-term relationships between the NHS and the third sector.

Secondary prevention – reducing a condition’s impact and stopping it from deteriorating – can be as important as preventing people from developing those conditions in the first place. 

This is an area where many charities come into their own, perhaps focusing on supporting those with a particular condition or offering services aimed at elderly people who may be susceptible to numerous health conditions.

The Richmond Group is calling for routine and ongoing referral to the charity sector to be embedded in patient pathways for long-term conditions from the point of diagnosis. Personalised support could reduce pressure on primary care from newly diagnosed patients, it argues. It suggests this approach could be piloted before being rolled out widely.

“It’s at the time of diagnosis that people are most vulnerable,” says Ms Nicholls. “Charities can connect them with other people who have had that condition. They have the space and expertise to take a step back and look at the whole of people’s lives.”

This support can take various forms. Macmillan Cancer Support has specialist nurses manning a phone line, for example. Parkinson’s Connect offers support after diagnosis and can help people who are waiting for a follow-up appointment, encouraging self-management and a better understanding of their condition.

Ms Nicholls points out that helplines and peer support groups can help people live well with their condition outside of a clinical setting and sometimes offer a more holistic approach than the NHS can.

“The reality of the future patient is that we will be seeing more people living longer periods of their lives with health conditions,” she says. “Charities are fundamental in helping people manage that.”

Meanwhile, the British Red Cross is introducing a community health worker model in Torridge, Devon. This involves getting to know a small community and working with a caseload of people. Trust and understanding of the community’s needs are vital.

The community health workers can suggest activities and groups that will improve the general health and wellbeing of individuals who are otherwise likely to drift into needing healthcare and help them build networks to combat loneliness and offer mutual support.

This sort of work is intensive – a community health worker may cover just 150 households – and may appear expensive, but a similar scheme in Brazil has decreased hospital admissions and mortality from chronic diseases, plus improved uptake of immunisations and screening.

This is an area where charities feel they can offer significant, transformative support to the NHS, and in many places already do.

Many charities are involved in hospital discharge programmes, for example. This can be as simple as ensuring that an elderly person returns to a home with the essentials in the fridge for a basic meal and hot drink, to working with vulnerable homeless people who need support with accommodation and to cope with other issues in their lives.

In other cases, charities will be involved in discharge to assess programmes where assessments of patients’ ability to function are taken at home rather than in a hospital. This can often result in patients requiring lower levels of social care input than expected. Care can be provided at home in the short term with progress monitored.

The British Red Cross works in 41 areas across the NHS in England to assist with discharges, offering support for up to 72 hours after discharge. It calculates that this helped 29,000 people last year and saved the NHS 45,000 bed days.

The potential savings for the public sector are significant – not just in freeing up beds but also by more people avoiding residential care. The British Red Cross has calculated that if such programmes were scaled up to cover 125 sites, the annual savings could be more than £24m for the NHS alone.

Some groups need a more targeted input: the British Red Cross has also worked with people who are homeless who are ready to be discharged from hospital to find them a suitable home and offer aftercare. The Homeless Out of Hospital Pathway has delivered savings of more than £500 for the NHS for each patient seen and, importantly, improved the lives of vulnerable people.

But Sharon Brennan, National Voices’ director of policy and external affairs, warns moving services into the community can be seen as a cut to hospital services if it happens without an explanation of what the benefits are. However, voluntary groups and charities are very good at putting the person at the heart of the service, she says, adding: “If it is not solving a patient problem, should you be doing it at all?”

This is probably the area where the charity sector has more to do, but the potential is still massive. 

One role it can play is in supporting and advocating for people who don’t or can’t use digital, suggests Sharon Brennan. “We don’t hear enough about what is the non-digital offer,” she says, pointing out that different cohorts of people may be unable to use the latest iteration as digital technologies advance, including those competent with existing iterations.

For some groups, there may be additional issues. For example, they may have the skills to use smartphones but not the money to keep them charged or replace them if they fail. Ms Brennan points to a similar issue with monitoring equipment, with some people unable to afford to replace the batteries on them. In some cases, charities can provide a place where patients can use digital equipment to connect with services if they don’t have a computer or internet access at home, for example.

Many charities already run online support and forum services, and upskilling people to use digital is a role many charities are happy to take on. But it takes time and effort, says Ms Brennan.

Digital services can also offer rapid upscaling and accessibility across the country, benefiting people who are less mobile and would find attending in person difficult.

An example of this is the Royal Voluntary Service’s “virtual village hall”, aimed at keeping people mentally and physically active. It offers live activity sessions every day through Facebook, YouTube and its website with an “on demand” system. It has been viewed more than 9 million times since starting during the pandemic and can be offered to those on virtual wards, awaiting surgery or through social prescribing.

Some digital offerings are more targeted – the MS Society, for example, has worked with the National Institute of Health and Care Research on a digital intervention for fatigue management for those with MS. It also has an app offering tailored exercise programmes.

Many mental health services are now offered online. Mind has a supported self-help programme that is predominantly online and offers a cognitive behavioural approach in several languages. It rapidly scaled this up in 2023 and 2024, and an evaluation has shown 85 per cent of those on the programme reported an improvement in their mental wellbeing.

Another aspect of the move to digital is access to records and information about patients, which can be used to improve the care offered. There was positive news in the 10-Year Health Plan – the NHS App will increasingly link to services outside the NHS, such as those in the voluntary sector.

“I think there [are] some challenges in that we need to see better sharing of health records,” points out Ms Nicholls. This could reduce duplication as well as ensure that records are as full as possible: she says Macmillan nurses will often do a holistic health assessment, but the lack of shared records can mean the NHS then repeats this.

An NHS spokesperson said: “Voluntary sector organisations play a crucial role in supporting people and communities and are valued partners to the NHS.

“NHS England has worked with all integrated care systems to develop a Voluntary, Community and Social Enterprise alliance which aims to share skills and resources – and we have issued guidance on how local health services can work closer with their partners in the voluntary sector.”

However, in practice, forging mutually beneficial lasting relationships is not always easy. Many charities have succeeded in doing so with the NHS – and many more would like to – but the challenges can be significant on both sides. In extreme cases, charities can feel they are being treated more like a one-night stand than a long-term partner.

Nuffield Trust chief executive Thea Stein believes charities of all sizes will have a role to play in helping the NHS deliver the 10-Year Health Plan.

She points to the impact of the very small-scale voluntary groups that flourished during covid, helping to supply vulnerable people with food and medicines. And often they were a way of getting into communities that were resistant to being vaccinated.

“One of the big challenges for the NHS is learning how to be humble and to be a real partner,” she says. The NHS tends to have a lot of embedded power, she adds, but it needs to understand what it means to be in a real partnership with the third sector and what third-sector organisations can bring to the table.

“When money is tight, the first place that the NHS looks to cut may be short-term and small contracts,” she says. These are exactly the ones that charities and the wider voluntary sector tend to deliver, often living hand-to-mouth. “But there is real power and influence in taking the role of the third sector organisations extremely seriously.”

She adds that charities are often culturally different and can act swiftly compared to the “leviathan” NHS. She gives the example of how small, hyper-local organisations can deliver things bigger bodies can’t – an integrated care board may want to work on children’s oral health, but it can be a small neighbourhood group serving a marginalised population that makes the difference.

The coming changes to the NHS structure could present challenges and opportunities. Ms Brennan points out that charities may need to engage with new people in fewer ICBs, and some will have adjusted their business model to dovetail with existing ICBs.

They may also need to engage at different levels as place and neighbourhood become more important concepts. In some cases, this could help – small charities that deliver services across a small area could work closely with integrated neighbourhood teams. Others, however, may be looking to engage over a wider area and may even have members spread across the country in small pockets, such as happens with travellers’ charities.

Changes to the local authority landscape may also be disruptive when councils part-fund some projects, alongside the NHS. In the longer run, greater alignment of ICB boundaries and councils may be helpful, but that benefit is likely to take time to manifest.

The current economic situation for the NHS is also challenging, creating immediate problems for some charities. Ms Nicholls says the recent rise in national insurance contributions, for example, has squeezed charities as contracts are rarely adjusted to reflect them.

The NHS’s commissioning quality can be variable, which can significantly affect how charities operate and whether they deliver what is needed. Ms Brennan recalls a group that worked with young people post-pandemic, talking to them about their mental health and other issues. But they had not set any key performance indicators and did not collect data showing the programme’s benefits, making them an easy target for cuts. They ended up being defunded. A big charity is unlikely to make the same mistake, but small local charities may not be used to working in this way.

The British Red Cross has called for a standardised outcomes framework that could assess outcomes across several areas, align to existing frameworks and metrics, and ensure transparency on measurements and standards, allowing for commissioning on outcomes.

Charities are also ideally placed to help with co-production, which can help the NHS make the changes it needs to. They often know about the practical difficulties that stop NHS changes from being more effective, such as the planned new services that are not on a bus route.

But above all, charities can help to make voices that might otherwise be overlooked heard and help the NHS to understand some of the real issues patients feel, which, in turn, impact the NHS. “Just calling in some big charities to Wellington House is exclusionary in itself,” says Ms Brennan, suggesting the NHS needs to engage more widely with the voluntary and community sector.

The 10-Year Health Plan marks a pivotal moment to reimagine care delivery in England. At the British Red Cross, we welcome its recognition of the voluntary sector as a key partner in achieving a more integrated, preventive, and person-centred health system. 

Throughout the UK, our teams support people at the complex crossroads of health and social need – whether that’s helping someone return home safely from hospital or working with high-intensity users of emergency departments. These interventions don’t just improve lives; they also reduce pressure on the NHS, delivering measurable outcomes and savings.

To unlock the full potential of partnership between the charity and statutory sectors, we must move beyond short-term, transactional commissioning. Evidence-based commissioning is essential, and rightly so. At the British Red Cross, we know what works. Our services are grounded in robust data, from tracking reductions in A&E attendances to recording improved wellbeing and increased health activation – that is, individuals’ ability and confidence to manage their own health. Yet too often, commissioning decisions are made without clear outcomes frameworks or long-term vision.

Commissioners need to place greater emphasis on services that demonstrate impact, not just activity. That means standardised metrics, shared data, and commissioning models that reward prevention and integration. It also means recognising the voluntary sector as an equal partner, bringing agility, trust, and deep community insight. With sustained investment and a commitment to evidence-led collaboration, the voluntary sector must be recognised not as supplementary, but as central to achieving the plan’s ambitions.

Kate Griffiths, UK director for health and care, the British Red Cross