Can the NHS shift from treatment to prevention? What healthcare bosses think

Imagine a healthcare system where preventing illness is just as important as treating it. This is the vision for the English NHS – but right now, it’s still far from reality. To become more sustainable and better serve patients in the long run, the NHS needs to shift its focus from reactive care to proactive, preventative support.

On July 3 2025, the UK government published its Fit for the Future: Ten-Year Health Plan for England, laying out a blueprint to rebalance the health service toward prevention, digital transformation and localised care. The plan includes:

• expanding up to 300 neighbourhood health centres to bring preventative services closer to communities

• digitising services with 24/7 access through the NHS app, AI triage – the use of artificial intelligence to help prioritise and assess patients more efficiently, particularly in high-demand areas like emergency departments, GP surgeries and outpatient care – and robot-assisted surgery

• tackling chronic illness earlier, including more support for obesity, smoking cessation and mental health

• integrating prevention into everyday care, with a shift in national performance targets to better reflect long-term health outcomes.

Prime minister Keir Starmer described it as a shift “from a sickness service to a health service,” marking a deliberate move away from crisis response toward early intervention and community-based support.

But making this vision real won’t be easy.

System still isn’t built for prevention

In my research, I’ve looked at what good leadership should look like in the NHS – especially within England’s new integrated care systems (ICSs). A key part of these systems is place-based partnerships.

These are local collaborations between NHS services, councils, charities and community groups, all working together to improve people’s health. The idea is to better join up care in each area and tackle the broader issues that affect health, such as housing, education and access to support.

I spoke to NHS leaders, including chief executives of major health organisations, on the basis of anonymity, who agree that the system needs to change. But many of them say it will face major obstacles – especially financial constraints and fragmented funding models that continue to reward reactive care, such as A&E. As one NHS leader put it:

All the things that come down from NHS England and the Department of Health and Social Care respond to the now, rather than where we are going.

While the ten-year plan lays out ambitions for rebalanced funding, existing financial mechanisms won’t support this shift. The NHS can overspend during emergencies, but local authorities – who fund most social care and public health – must stay within strict budgets.

This undermines integration and creates unequal footing between services. One senior leader noted"

Local authorities will never consider us as a partner until we get our act together on finance… you’ve got to sit back and look at what impression that gives them – that we’re not equals.

The ten-year plan acknowledges these disparities but offers limited detail on how to resolve them. Without concrete reform of funding flows and accountability structures, prevention may remain a priority in name only.

In 2024, the health and social care secretary, Wes Streeting, described the NHS as “broken” and called for a review to expose the “hard truths” needed to fix it. He has been outspoken in championing both prevention and better integration with social care, viewing these as key to reforming a system overwhelmed by rising demand and worsening outcomes.

Improving housing, social care, education, and jobs can reduce reliance on costly hospital treatments and significantly enhance overall health. In 2022, the NHS took a structural step toward this by merging health and social care services into “integrated care systems”, aiming to better coordinate services across sectors.

However, it has now been more than a decade since key targets for emergency care, hospital waiting times, or cancer services were met – raising questions about whether structural changes alone are enough.

The COVID pandemic deepened these pressures. Waiting lists for treatment surged, while NHS staff faced soaring stress levels. Many healthcare leaders describe the current moment as a perfect storm, in which long-term planning is increasingly difficult while trying to meet immediate needs.

Why risk and measurement matter

Preventative services, new technologies and integrated care models carry uncertainty. Leaders are understandably hesitant to shift resources away from acute services when “hospitals get the headlines.” One told me:

We’re shuffling public service delivery cash around and not thinking through how we develop something fundamentally different.

National performance frameworks also reinforce this inertia. Most targets still focus on wait times, emergency response, and treatment outcomes. As one executive put it:

We manage what’s measured… If we were made to look at deprivation figures and elective recovery figures based on postcode and ethnicity, that might change the conversation.“

The ten-year plan promises new indicators and better data sharing, but it remains to be seen whether these tools will actually shift behaviour at scale.

Listening to communities?

An effective shift to prevention requires more than structural reform – it needs genuine community engagement. One of the aims of integrated care systems was to involve local people in decisions about their health. Most leaders I have interviewed support this principle, but many admit that public involvement remains limited: "We’re not doing enough to listen… We’re not giving people opportunities.”

The ten-year plan reiterates the importance of local voices and promises a stronger focus on “co-produced care,” but delivery will depend on time, trust and cultural change within the system.

My research suggests that the NHS won’t be fixed by continuing to treat illness after it happens. It must evolve into a service that prevents poor health at its root – in homes, schools, workplaces and local communities.

The government’s ten-year plan offers a renewed opportunity to make this shift. But if the plan is to succeed, it will require more than bold promises. It demands redesigned funding, rebalanced risk, shared power with communities – and, above all, the political will to change the system before it collapses under its own weight.

Lisa Knight is affiliated with Mersey and West Lancashire NHS Trust as a Non-Executive Director