When the Department of Health and Social Care set out to understand what people wanted from the NHS 10-Year Plan, they did something interesting: they asked. Not through a traditional consultation that attracts the usual suspects, but through a comprehensive engagement programme, Change NHS, delivered by Thinks Insight and Strategy, Kaleidoscope Health and Care and the Institute for Public Policy Research. The programme captured a quarter of a million contributions from NHS staff, patients and crucially, seldom-heard communities. The resulting insight report, published in December with minimal fanfare, offers local government leaders something invaluable, intelligence about what their residents actually need from a prevention-focused health system.
Engagement at scale reveals truths that policy assumptions miss. When asked about prevention, respondents didn't simply endorse more screening or health education. Instead, both staff and the public said that preventing illness cannot be the NHS's job alone. They called for action on housing quality, support with healthy eating, exercise, smoking cessation, workplace interventions and cultural shifts, all domains in which local authorities have crucial influence to affect change.
The numbers tell a clear story. When prompted about who should support health and wellbeing beyond the NHS, 45% identified local government, 56% highlighted employers and 40% cited education institutions. Only 12% believed it should remain solely the NHS's responsibility. This isn't policy theory, it's what people say when we ask properly.
What makes this engagement particularly valuable for local authorities is its granularity. The report doesn't just tell us that people want community-based services, it reveals which communities need what. The methodology deliberately oversampled seldom-heard groups, producing insights that would never emerge from standard consultations. Certain ethnic minority communities identified cultural norms around exercise as barriers while economic constraints on healthy eating disproportionately affect asylum seekers and refugees. People with learning disabilities worried that the shift to prevention would exacerbate their difficulties in getting the NHS to understand the challenges they face, if not carefully implemented. These insights emerge only when you create the conditions for genuine dialogue.
The public's priorities, when properly surveyed, challenge conventional assumptions. Yes, 74% wanted easier access to tests and diagnostics, and 63% valued regular check-ins with healthcare professionals. But when the engagement moved into deliberative mode, allowing people to discuss and reflect rather than simply tick boxes, interesting tensions emerged. There was significant resistance to medical interventions like weight-loss drugs, seen as ‘quick fixes' that don't address root causes. Education, particularly from childhood, consistently emerged as the priority intervention, with mental health support from a young age running through responses as a golden thread.
For local authorities tasked with prevention, several practical implications emerge. First, public health strategies should reflect what your specific communities have told you they need, not what national policy assumes they want. Second, addressing structural barriers - housing, employment, food environments, exercise opportunities - must be central to prevention work, not peripheral. Third, education and mental health support should be designed for the long term, starting in early years. Fourth, community-based delivery isn't a nice-to-have but essential for reaching those who most need prevention services.
This nuanced understanding is precisely what local government needs as initiatives like the neighbourhood health service develop. Knowing that your residents want community-based screening is useful. Understanding that they're sceptical of medication-focused interventions and want you to tackle structural barriers to healthy eating is actionable intelligence.
The staff perspective is equally instructive. NHS employees identified specific obstacles to delivery: they want strong and coherent leadership, noting they've heard prevention rhetoric before but seen little follow-through. They emphasised workforce capacity gaps that must be filled through genuine investment, not heroic effort. They called for breaking down silos between healthcare, public health, social care and community services. This is the exact integration challenge that councils are so well positioned to address.
Critically, staff identified that current NHS structures don't incentivise prevention. Operational targets focus on acute care, so resources flow there regardless of stated priorities. This is a systems problem requiring system leadership, the kind that only place-based authorities can provide through their convening power and democratic mandate.
The investment in this scale of engagement also reveals how prevention should be governed. When a quarter of a million people take time to contribute, when deliberative events allow for reflection, when seldom-heard communities are specifically sought out, the resulting insights have democratic legitimacy that can sustain long-term change. This matters for councils whose public health work will require sustained commitment despite benefits taking years to materialise.
The report's findings on inequality are particularly pertinent. Respondents from deprived communities, those with multiple long-term conditions and marginalised groups all questioned whether prevention services would be any more accessible than existing healthcare. They've experienced being left behind before. This scepticism is the baseline councils must work from. Not to be discouraged by it, but to design differently because of it.
For council executive teams, the message is clear: the intelligence exists. A quarter of a million people have told us what prevention should look like, what barriers exist and where leadership is needed. Local authorities have the levers - housing, planning, leisure, licensing, democratic convening power - to act on these insights.
Ruth Cousens is chief executive of Thiscovery which delivers engagement and research programmes for the NHS, third sector and commercial organisations to inform healthcare strategy policy and product development
