Fit for the Future

The establishing of a neighbourhood health model as part of the new NHS 10 year plan is a unique opportunity for recovery services to integrate more closely with the NHS,  says Mark Dronfield.

For Turning Point, as a long-established provider not just of recovery services but also of mental health, learning disabilities, sexual health and smoking prevention services, the new NHS approach is a welcome reflection of our community’s needs.

In 2021 the Dame Carol Black report set out the ways in which the treatment and recovery system was  ‘not fit for purpose and urgently needs repair’. The report triggered the process of reform and investment in the From harm to hope 10 year drug plan that we’re now seeing implemented in our services. 

The NHS is having a similar moment. Lord Darzi’s 2024 Independent investigation of the NHS in England report found the same sorts of issues – long waiting lists, demotivated staff and outcomes lagging behind those of other countries. The NHS was in ‘critical condition’, he said, and must ‘reform or die’. This then led to the development of the 2025 NHS 10 year health plan, Fit for the future. 

The plan identifies that the NHS has evolved into an organisation that’s ‘hospital-centric, detached from communities and organises its care into multiple, fragmented silos’. Its solution is that by 2035 the NHS will transform from ‘only’ being a national service to also become a ‘neighbourhood health service’ – with care provided as locally as possible to people in their homes and communities as well as hospital, and with a focus on accessible, integrated and preventative care.

To turn this from ambition into reality, the NHS plan encourages integration of the approach with local areas’ pre-existing health and wellbeing plans and homelessness strategies, as well as joining up with the Joint Combatting Drug Partnerships that oversee local recovery services. 

So what will be the implications for us in recovery services? Implementing the NHS plan will have to mean a resetting of the relationship between the NHS and recovery services, as it indicates an intention to shift the way in which power and resources are distributed.

It will mean cultural change in the NHS that could bring advantages to the people who use our services, as the NHS moves beyond a top-down approach and commits to increased co-design of services as well as realising that health outcomes can only be achieved by coming into communities and working more closely with services like ours.

This approach will require a welcome shift in relationships as much as service models – currently there’s often not enough mutual comprehension between local authorities, recovery services, voluntary sector services and the NHS of how each other works and what genuine integration beyond fine words might look like.

The City of Westminster has the highest number of people sleeping rough of any local authority in the UK, with more than 1,000 people seen bedded down each quarter – many of whom come from other areas. Their poor access to health services means an increased risk of a range of preventable illnesses and an average age of death of 44 for women and 42 for men. 

The Westminster Homelessness Partnership (WHP) is a long-established partnership of local housing, substance use recovery and voluntary sector organisations, along with the NHS and the local authority. The partnership is based on a shared goal of ending the need for people to sleep rough, but experience shows that providing only one aspect of what rough sleepers need – such a housing, or substance treatment or health care alone – doesn’t work.

Joining up substance misuse treatment with offers of housing and appropriate heath care in a single plan delivered on the same day is the only way to support the most entrenched rough sleepers off the street and help them thrive in their accommodation. To achieve a joint approach like this requires compromise, with resources coordinated around the needs of the individual – not just each organisation’s pathways and priorities. 

This begins with the co-location of recovery and healthcare within homeless hostels, in day centres and in joint street outreach with housing teams. It also requires that services should be open to drop-ins and not be appointment or eligibility based; that substance issue treatment, including prescribing, is provided immediately on the day, and that every plan is a shared ‘Westminster plan’ providing all the support we as a partnership have to offer. 

At the Connection at St Martins (CSTM) homelessness centre in Trafalgar Square, this approach is illustrated by a joint project with the Dr Hickey Surgery (a local GP practice specialising in rough sleeping issues), Turning Point recovery services and Central London Community Healthcare NHS Trust (homeless health services) to provide joint services to those sleeping rough both onsite and via outreach. By providing joined-up services in the same plan at the same time, we’re looking to replicate what was done during the successful ‘Everyone In’ scheme to house rough sleepers during the pandemic. 

Preventative neighbourhood approaches should reduce demand and unlock savings that can then be invested in community healthcare – but will this shift from hospital to the community really happen at scale? Striking the right balance between a national plan and the – often complementary but different – approaches in local authority areas risks duplication and a proliferation of plans and strategies, with gaps in their implementation. 

As Dame Carol noted in her own review, a lack of resources and capacity cannot be wished away by a new approach alone – however well-intentioned. Nor can uncertainties around long-term funding and workforce planning be solved without long-term investment.

For example, for partnerships like the WHP a neighbourhood approach is not enough to overcome a countrywide lack of housing options and year-on-year increases in numbers of new rough sleepers. 

There will be a need for an alignment of incentives between local authorities and the NHS – in the WHP these incentives show up in the different geographical footprints of our local integrated care system, which overlap but don’t always match with those of the local authority and its own obligation to spend resources on the needs and priorities of local people.

How to provide integrated packages of care to homeless people who might be eligible for an NHS service in one area – but not for housing or social care – is a key challenge that will need fresh thinking and won’t be solved by one local authority on its own.

Finally there’s a risk that if the NHS plan is implemented without the cultural change needed to share power and responsibility with local communities then neighbourhood health will remain fragmented and too focused on internal NHS priorities and operational pressures. The opportunity that the neighbourhood health service represents can only be unlocked by mutual understanding and a change in relationships. 

The changes set out in the NHS 10 year plan will require cultural changes every bit as challenging as those set out by the Carol Black report. But the goal of a new neighbourhood health service focusing on integrated care, local provision and preventive approaches is one that we in recovery services have been hoping for, for a long time. The next few years will show if the NHS can change. And we will all have to play our part.