Healthy People.

Challenges

Challenges

Some of our key challenges in Devon relate to the health and wellbeing of people.

• We have an ageing and growing population with increasing long-term conditions, co-morbidity and frailty, the Devon population is older than the overall population of England we have a disproportionately small working age population relative to those with higher care needs.
• Significant inequalities exist across One Devon, with people living in deprived areas and certain population groups, experiencing significant health inequalities as a result. People living in more deprived areas have poorer health outcomes caused by modifiable behaviours and earlier onset of health problems than those living in the least deprived communities. This leads to lower life expectancy and lower healthy life expectancy in these communities, coupled with higher and earlier need for health and care services. The proportion of the population providing unpaid care is increasing, with higher levels of the One Devon population caring for relatives, both the physical and mental health of carers can suffer as a result. 
• Our population experiences poorer than average outcomes in relation to some measures of mental health and wellbeing.

Strategic objectives

To address these challenges, we have set the following strategic objectives:

• People (including unpaid carers) in Devon will have the support, skills, knowledge and information they need to be confidently involved as equal partners in all aspects of their health and care.
• Population heath and prevention will be everybody’s responsibility and inform everything we do. The focus will be on the top five modifiable risk factors for early death early and disability
• Local communities and community groups in Devon will be empowered and supported to be more resilient, recognising them as equal partners in supporting the health and wellbeing of local people
• Children and young people (CYP) will have improved mental health and well-being
• Children and young people will be able to make good future progress through school and life.
• People in Devon will be supported to stay well at home, through preventative, pro-active and personalised care. The focus will be on the five main causes of early death and disability.
• People in Devon will have access to the information and services they need, in a way that works for them, so everyone can be equally healthy and well.
• Everyone in Devon who needs end of life care will receive it and be able to die in their preferred place

Our vision

We will create a strong, collaborative system across primary care, community services, voluntary and community organisations, and independent social care providers. Our goal is to build a resilient, high-quality general practice that meets demand, ensures timely access, and operates at scale.

We will expand NHS dental provision, reducing inequalities and targeting those most in need. Community pharmacies will play a greater role in delivering care, increasing access, safety, and service quality.

By integrating these services within neighbourhood health models, we will strengthen primary care, improve patient outcomes, and ensure sustainable, high-quality care for all.

What Devon will see

1. Resilient, sustainable, high quality and patient valued General Practice and Community Pharmacy services as part of an integrated neighbourhood health service offer.                                       
2. Improved dental offer with expanded NHS offer that has materially reduced baseline inequality gaps.       

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
We will develop a collaborative approach to working across communities. By 2026, we will have effective collaborative mechanisms in place for primary care, community services, voluntary and community services and independent social care providers.	x
We will have an integrated, neighbourhood approach focussed on PCN boundaries. By 2026, we will have developed integrated ways of working that encompass primary care, community services, mental health, social care, voluntary and community services and acute services working as part of a multi-disciplinary team to jointly deliver services	x
By 2026, we will develop our same day services so they can consistently meet people’s urgent needs and avoid emergency admission to hospital. This includes pro-actively identifying people at high risk of admission, virtual wards, timely access to general practice and community pharmacy services, urgent community response, social care support and access to specialist support.	x
During 2025/6 we will test and evaluate 4 different models of PCN delivered Primary Medical Services, and achieve upper decile performance at ICB level against core identified access performance indicators.	x
During 2026/7, and supported by transfer of funding towards General Practice, we will start meaningful rollout of revised models of Primary Medical Services at PCN level. By 2027, we will have reduced variation and aggregated upwards such that all PCN levels core access measurements place Devons PCNs within the upper quartile nationally.		x
By 2028, we will have resilient, sustainable and high-quality general practice which is able to meet clinically appropriate demand, offer timely access, operate at scale and have a planned approach to managing change. By 2029/30 we will see upper quartile performance for all PCNs against national patient survey indicators.			x
We will start work on building greater resilience among our community pharmacy contractors, including increasing the supply of local enhanced services from them by 40%. During 2026/7 we will evaluate work undertaken designed to improve contractor resilience and build a formal resilience programme for community pharmacy.	x
By 2027/8 we will commission local enhanced services from community pharmacy providers that are 100% above baseline. We will maximise the potential of pharmacy services; by 2028 we will have increased service resilience and improved patient access, safety and quality of care. By 2027/8 we will commission local enhanced services from community pharmacy providers that are 150% above baseline.		x	x
During 2025/6 we will make a number of contractual and delivery changes that increase NHS dental supply in Devon by 10%. During 2026/7 we will start rebasing contracts and redirecting released funding towards identified populations such that we start addressing dental inequalities.	x
By 2027/8 a combination of our urgent, stabilisation and rebasing programmes will have increased dental activity by 25% against baseline. By 2028 the ICB will have commissioned sufficient dental services to ensure all disadvantaged groups have access to a routine dental check-up, every 24 months for adults and 6-12mths for children, as well as enough capacity to meet demand for urgent care.		x
By 2029/30 a combination of our urgent, stabilisation and rebasing programmes will have increased dental activity by 40% against baseline.			x
Ensure delivery of Core20+5 deliverables (including adult and CYP) in line with national reporting requirements.	x	x	x
Implement co-ordinated prevention plans in priority areas including CVD, diabetes and respiratory.	x	x	x
Take on formal delegation of specialised commissioning functions.		x	x

Our vision

We will commission, deliver, and develop community-based care models while strengthening health and care services at both ‘place’ and neighbourhood levels. This includes empowering the voluntary, community, and social enterprise (VCSE) sector and developing initiatives to address health inequalities.

Our aim is to support and enable communities to be strong, resilient, inclusive, and connected—where people support one another in an environment that promotes wellbeing.

This integrated neighbourhood health and care offer, which includes primary care, community services, social care, the independent sector, and the voluntary and community sector, will ensure that we meet people’s needs in a way that matters to them and that supports them to stay living safely at home in their community, retaining their independence for as long as possible, living the life they want to lead.

What Devon will see

1. Local communities and community groups in Devon will be empowered and supported to be more resilient, recognising them as equal partners in supporting the health and wellbeing of local people.                                           
2. Community partnerships will have Identified existing assets (incl. networks, forums and community activities) so they can harness these to tackle gaps in local provision.                                    
3. People have multiple opportunities to influence the decisions that affect their health & wellbeing – ‘no decision about me without me’.
4. A collaborative system that supports the VCSE and community groups to maximise the health and wellbeing of their local citizens through people led change.
5. Increased public awareness of health risks and prevention, reducing illness and healthcare costs while improving overall well-being.

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Further to the Darzi report and Neighbourhood Health Guidelines for 2025/2026, develop a pan-Devon neighbourhood health service core offer and delegate to place the specific operating and delivery models in line with local need and existing assets.	x	x	x
Using risk stratification, a personalised approach will be utilised across every integrated team, prioritising those population groups who will benefit most from the approach (e.g. end of life, frailty and dementia)	x	x	x
By 2026, we will have developed consistent, robust pathways for falls and frailty, so people are able to access the right, expert input to support them at home. This will include the development of outreach models so that hospital specialists are better able to support professionals in the community to look after people in their own homes.	x
By 2028, we will have developed an improved End of Life care pathway across Devon, where early identification, advanced care planning and care coordination are prioritised. Services will be funded equitably and there will be an evidenced reduction in unplanned care and crises for people in the last year of their life.	x	x
By 2027, we will have a consistent offer of ‘home first’, ‘discharge to re-able to assess’ hospital discharge pathways across Devon to ensure people spend no longer than necessary in hospital and the majority of people return home with little or no long-term care.	x
By 2026, there will be a range of community-based admissions avoidance offers to reduce the demand into ED, linked into the Neighbourhood Health model of care.	x
By 2026, each PCN will adopt an integrated, proactive approach, with a focus on prevention and early intervention. PCNs will use population health data to support the identification of the people that are most likely to benefit from this approach.	x
By 2026, people will be easily able to understand what community-based services are available and how to access them. By 2026, we will have implemented the consistent use of the Joy App by social prescribers across 100% of PCNs.	x
Local authorities will meet their Care Act duties by ensuring a sufficient care market.	x	x	x
Innovative extra care and supported living schemes will be developed to provide people with greater independence and support them to remain in their own homes.
Our places, called Local Care Partnerships (LCPs) will have the support and evidence-base they need to deliver change at local level and will be empowered to make decisions with their populations on an ongoing basis.	x
Develop an action plan to deliver the Anchor Institutions Strategy.  Ensure that all ICS partners are engaged in delivering as Anchor organisations.	x
By 2028, local communities, and particularly disadvantaged groups, will be empowered by placing them at the heart of decision making through inclusive and participatory processes and have an active role in decision-making and governance – ‘no decision about me without me’.	x	x
By 2028, local communities will work in partnership to bring about positive social change by identifying their collective goals, engaging in learning and taking action to bring about change for their communities.	x	x
By 2028, a community development workforce will be supported, equipped and trained to agreed standards, code of ethics and values-based practice.	x	x
By 2028, Local Care Partnerships will have integrated the role of community partnerships into their infrastructure and planning to ensure the communities of Devon are an equal partner both at system and local level.	x	x
We will develop the One Devon involvement platform to be the single online space for the One Devon Partnership, focussing on engagement and involvement with people and communities, including the One Devon Citizens Panel. This will be achieved by ensuring a Local Care Partnerships are all actively using the platform to support local engagement work.	x
Deliver inclusive involvement in collaboration with the People and Communities Strategy to support the ICB and ICS key aim of tackling inequalities in outcomes, experience and access.	x

Our vision

One Devon is committed to delivering excellent health outcomes for patients while reducing waiting times for elective procedures, cancer diagnosis, and treatment. We will achieve this by driving productivity through efficiency and innovation, ensuring that resources are used effectively to provide value-for-money services for the people of Devon.

Tackling health inequalities will be central to our decision-making, helping to remove barriers to care for those who experience inequalities in access. By taking a population health approach—recognising the county’s diverse demographics and rurality—we will ensure patients receive timely, effective, and efficient elective care, improving outcomes, experiences, and access. Wherever possible, we will bring elective care closer to home so that patients receive the right care, in the right place, at the right time.

NHS Devon will work closely with local partners, including councils, independent providers, and third-sector organisations, to ensure elective care is embedded in Devon’s wider social and economic development.

What Devon will see

• 92% of patients receiving elective treatment within 18 weeks.
• Faster cancer diagnosis and improved adherence to waiting time standards.
• 95% of patients receiving diagnostic procedures within six weeks.
• Optimised elective care pathways, maximising productivity through workforce efficiency, digital innovation, and infrastructure improvements.
• Fewer unnecessary follow-ups, reducing system pressure and patient inconvenience.
• Reduced health inequalities, ensuring fair access to care.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Reduce the time people in Devon wait for their elective care procedure by improving the percentage of patients waiting no longer than 18 weeks for elective treatment to 65% in line with the national objective by March 2026, and with every trust to deliver a minimum 5%-point improvement.	x
Reduce the time patients in Devon wait for their elective care and return to the constitutional standard of waits of less than 18 weeks by 2029. This will be achieved by increasing productivity, maintaining high quality services, reducing health in equalities and maximising elective capacity in Devon.	x	x
The system will continue to improve in cancer performance against the 62-day and 28-day Faster Diagnosis Standard (FDS) to 75% and 80% respectively by March 2026.	x
The system will continue to improve in cancer performance against the 62-day and 28-day Faster Diagnosis Standard (FDS) to 75% and 80% respectively.	x	x	x
Increase diagnostic capacity including Community Diagnostic Centres and return to patients receiving their diagnostic within 6 weeks.	x	x	x

Our vision

We will work together across the NHS in Devon to deliver high-quality, safe, and sustainable urgent and emergency care as close to home as possible, improving both patient outcomes and experience. Reducing health inequalities will be at the heart of everything we do, ensuring that everyone in Devon can access the care they need.

Our focus will be on making sure people receive the right care, in the right place, at the right time—first time. To achieve this, we will prioritise:

• Co-ordination – to deliver an integrated and responsive health and care system that helps people stay well for longer through proactive support, preventative interventions, and timely primary care.
• Signposting and Navigation – Ensuring patients can access urgent care 24/7 via NHS 111, where they will receive expert advice and be directed to the most appropriate service.
• Alternatives to hospital – Expanding access to safe, high-quality care closer to home, maintaining as much continuity of care as possible.
• Rapid response – Ensuring people who are seriously ill, injured, or in a mental health crisis receive the fastest and most appropriate response for their needs.
• Hospital care and discharge – Optimising hospital care from the point of admission and ensuring people can return home or to their community as soon as it is safe to do so.
• Home first – Prioritising home-based recovery, supporting people to regain independence quickly and safely following a hospital stay.

What Devon will see

1. Improved A&E waiting times and ambulance response times.                             
2. More patients treated in community settings, avoiding unnecessary hospital visits.
3. New, improved pathways for healthcare professionals, enhancing care coordination.
4. Easier navigation of urgent care services, improving patient experience.
5. Better access to community urgent care services.

Objective	Year 1-2	Year 3-4	Year 5+
Building on the excellent work in 2024/25 to bring all Urgent Treatment Centres (UTCs) in line with national specifications, we will implement the recommendations of the strategic review of Minor Injuries Unit (MIU) services across the county to further improve our out-of-hospital urgent care offer.	x	x	x
One Devon is committed to ensuring that people with urgent care needs receive treatment in the right place, first time. Building on the success of the Single Point of Access (SPOA), we will define a longer-term plan for Care Coordination and set out how it will be implemented across the county including ensuring the service enables ambulance services to increase see & treat activity.	x
Clinically Safe Alternatives to Admission: Over the past two years, our Integrated Urgent Care Service (IUCS) provider has consistently improved performance and is now recognised as one of the best in the country. We will build on this success by working with our provider to further strengthen this service.	x	x
One Devon will improve A&E waiting times and ambulance response times compared to 2024/25 with a minimum of 78% of patients seen within 4 hours in March 2026.	x
One Devon will continue to drive improvements in ambulance performance, ensuring that ambulance response times average no more than 30 minutes across 2025/26.	x
As part of our commitment to improving mental health crisis care, NHS Devon will pilot Mental Health Response Vehicles. Following evaluation, if the outcomes are positive, we will consider a wider rollout across the system.	x
To remove unwarranted variation across Devon, we will establish a system-wide approach to Discharge to Assess (D2A) and Trusted Assessors. We will work closely with acute providers to develop bespoke locality plans aimed at improving No Criteria to Reside (NCTR) rates to an agreed standard.	x	x
In partnership with Local Authorities, we will develop a long-term strategy for sustainable market management and commissioning of post-discharge care.	x
We will fully implement a ‘Home First approach’, reducing the risk of readmission by supporting more people to return home safely after a hospital stay. This aligns with the recommendations of the Darzi Review, reinforcing the shift from hospital-based to home-based care.	x	x	x

Our vision

To create an Integrated System and Care Model for Children and Young People (CYP) that supports all aspects of their health, emotional wellbeing and mental health, so that they can make good future progress through school and life. Our work spans from birth, through transition to young adults. We will work effectively in an integrated and equitable way within and across health, care and education and will achieve this by sharing information, jointly commissioning services (where appropriate), providing access to care, advice and knowledge, and adopting a strength-based approach. 

What Devon will see

1. Inclusive, accessible and sustainable services and settings where children can learn and achieve their potential in life.

Our objectives

Objective	Year 1-2	Year 3-4	Year 5+
Services for children who need urgent treatment and hospital care will be delivered as close as possible to home. There will be a recognition of the potential impact and harm for CYP and their families whilst on waiting lists for paediatrics within mental health provision, acute, community and surgery procedures. By the transformation of pathways to better prioritise the use of clinical capacity, waiting times will steadily improve across the next five years.	x	x	x
Through implementation of the neurodiversity offer, by 2027 children and families with neurodiverse, emotional and communication needs will be able to access services and be supported across health, care and education, preventing crisis and enabling them to live their best life.	x
We will improve outcomes for children with long term conditions and will reduce health inequalities by understanding differences for our Core20PLUS5 populations.  We will work to address significantly poorer outcomes for care experienced children and young people, and other vulnerable groups by tackling issues affecting access and equity of care.	x	x	x
We will fulfil our statutory safeguarding responsibilities under ‘Working Together to Safeguard Children’ (2023) and respond to the local safeguarding children partnership priorities; to ensure that the health needs of all vulnerable children are identified and met by 2028.	x	x
The Special Education Needs and Disabilities (SEND) of children and families will be prioritised across the Devon ICS. SEND reforms will be embedded across the three Local Authorities to address the weaknesses identified through the Torbay, Devon and Plymouth Local Area Inspection’s within the mandated timeframes for each local area.	x
We will improve the emotional wellbeing and mental health of children and young people through improved access to advice, guidance and help, strengthened support, and care and treatment specifically developed for mental health crisis, and eating disorders pathways.	x	x	x

Our vision

We will ensure that Maternity and Neonatal care is safe, equitable, personalised and kind, delivered through a positive culture of respect, learning and innovation. We will provide women and girls in Devon with timely, appropriate and easily accessible women’s healthcare, as outlined in the Women’s Health Strategy through collaborative working across health and care sectors.

What Devon will see

1. Reduction in number of women and birthing people presenting with pelvic floor issues postnatally due to pelvic floor muscle exercise education.      
2. A reduction in perinatal mortality, intrapartum brain injury and maternal de
3. A reduction in mortality and morbidity associated with complex social factors for vulnerable pregnant women.                            
4. Increased proportion of women and birthing people maintaining breastfeeding/exclusive breastfeeding as a result of improved support.
5. Increased awareness of birth choices, the progression of a typical birth and potential interventions, with the potential to reduce levels of psychological damage/trauma.                                               
6. Improved access to expertise to support women experiencing adverse menopause symptoms.             

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Through a 5-year maternity and neonatal delivery plan, maternity care will be delivered safely and will offer a personalised experience to women, birthing people and their families. Maternity and neonatal workforce will be inclusive, well trained and fit for the future. The Core20PLUS5 approach for women and birthing people will be implemented as part of the core programme.	x	x	x
To lead the delivery of a high performing Local Maternity and Neonatal System (LMNS), which oversees the delivery of each Trust’s national Maternity Safety Support Programme (MSSP), and that responds to the maternity and neonatal objectives within the Peninsula Acute Sustainability Programme (PASP), with a focus on those at greatest risk of health inequalities, by March 2027.	x
We will work collaboratively with System Partners to establish and deliver responsive, data led, inclusive and accessible services to meet the health needs of young girls and women across their life cycle through local implementation of the national Women’s Health Strategy.	x	x	x

Our vision

To work together to improve the mental health of our population by improving care and support for people with mental illness across Devon; we commit to improving life opportunities for people who have mental ill health. People with mental illness, carers, staff and our communities will co-produce, lead and participate to deliver our shared purpose; we commit to engage, listen and act with intent and integrity to improve the mental health and wellbeing for the people of Devon.

What Devon will see

1. People requiring support and/or treatment for their mental health will be able to access this at the earliest point of needs presenting.                            
2. Co-production will be core to service development and pathways will be co-produced so that the provision available meets and responds to the needs of those requiring support.                                           
3. Ongoing improvements to pathways for those presenting in Mental Health crisis.                                     
4. Ongoing developments to ensure that people with a severe mental illness will be able to access timely identification and treatment of any physical health needs.
5. Implementation of the Dementia Strategy to support identification (diagnosis), treatment and support for those living with dementia.               

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
More women and families get help early in development of perinatal mental health need (access to increase from 1,115 NHS Long Term Plan (LTP) target and wait time baseline to be established in 2024/25).	X	X	X
More adults and older adults with serious mental illness will have a complete physical health check which leads on to each person having a meaningful action plan and access to follow up care as needed.	x	x	x
More people (of all ages) will have access to treatment within 4 weeks (Community Mental Health- establish baseline and improvement plan of 10%, increase IAPT access to achieve the LTP target for 2023/24, 32,474) and a larger proportion of support will be delivered by VCSE (establish baseline and improvement plan of 10%).	x	x	x
People (of all ages) experiencing mental health crisis will be able to get the help they need as early as possible. In 2024/25 this includes 111 option 2 ‘going live’ (all age), increasing call handling performance for telephony-based service offers (dropped calls and hold times) and increasing access to non-ED crisis response services (establish baseline access levels to non-acute offer and increase access by 10%).	x	x
Devon will sustainably eliminate inappropriate out of area bed use for adults and older adults who need hospital admission for acute mental ill health. (zero new admissions by 2024/25)	x
People will have a timely dementia diagnosis and planned onward care and support (at least 66.7% of prevalence diagnosed and wait times from referral to treatment/ diagnosis in a specialist team will decrease)	x	x	x

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Ensure 75% of people aged over 14 on GP learning disability registers receive an annual health check and a quality health action plan. Increase the number of eligible people on the GP Learning Disability registers.	x	x	x
Reduce reliance on Mental Health locked and secure inpatient care, while improving the quality of Mental Health inpatient care, so that by March 2028 (in line with national target) no more than 30 adults with a learning disability and/or who are autistic per million adults and no more than 12-15 under 18s with a learning disability and/or who are autistic per million under 18s are cared for in an Mental Health inpatient unit. 10% reduction as per NHSE 2025/26 Operational Planning Guidance.	x	x	x
Test and implement improvement in autism diagnostic assessment pathways including actions to reduce waiting times by March 2028.	x	x
Develop integrated, workforce plans for the learning disability and autism workforce to support delivery of the objectives set out in the guidance.	x	x	x