Healthy, sustainable system.

Challenges

Some of our key challenges relate to how we work together as a system

• There is an immediate requirement to stabilise the financial position and recover activity, to improve operational performance, access and quality of care. In order to achieve both, we need to transform the way we work together across our system so that it is healthy and sustainable in the future.
• The financial challenge facing all our health, social care and wellbeing partners is significant. Lower salaries and higher housing costs, with rising bills for energy, fuel, food and other costs in the One Devon area will increase the impact of the cost-of-living crisis. People and communities already experiencing higher levels of poverty will be disproportionately affected. 
• An older age profile and more rapid population growth in Devon, coupled with the impacts of the Covid-19 pandemic and current ‘cost of living’ crisis, are contributing to increased demand for health and care services. The greatest increased demand is for unplanned care and mental health services, with those living in disadvantaged communities and clinical vulnerability likely to be most severely impacted.

Strategic objectives

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

• We will have a safe and sustainable health and care system.
• People in Devon will know how to access the right service first time and navigate the services they need across health and care, improving personal experience and service productivity and efficiency.
• People in Devon will only have to tell their story once and clinicians will have access to the information they need when they need it, through a shared digital system across health and care.
• In partnership with Devon’s diverse people and communities, Equality, Diversity and Inclusion will be everyone’s responsibility so that diverse populations have equity in outcomes, access and experience. 
• We will make the best use of our funds by maximising economies of scale and increasing cost effectiveness.
• We will have enough people with the right skills to deliver excellent health and care in Devon, deployed in an affordable way.
• Local and county-wide businesses, education providers and the VCSE will be supported to develop economically and sustainably.
• We will improve quality, equity, access and performance including by shifting the focus from hospital to community and sickness to prevention.
• We will together make the best use of collective system assets to deliver clinical, workforce and financial sustainability.
• We will strengthen organisational leadership capacity and capability.
• We will prioritise performance and financial improvement so we can exit NOF4 sustainably breaking the cycle of moving in and out of escalation.

Clinical service change

Our vision

We will reshape healthcare delivery across Devon, shifting more care into the community while strengthening hospital services. By managing demand effectively, we will reduce unnecessary hospital reliance, address secondary care fragility, and develop new acute care models that improve health outcomes and reduce health inequalities.

Through clinical service change and transformation, we will stabilise acute services, remove duplication, and ensure people receive the right care in the right place. Our approach will prioritise efficiency, sustainability, and patient-centred care, to ensure high-quality, sustainable services across Devon.

What Devon will see

1. A shift towards a home-first approach, reducing reliance on hospital care.
2. Integrated care pathways between primary and secondary services, improving patient journeys and experience.
3. Interoperable digital solutions, enabling seamless information sharing and improvements in productivity and service efficiency.
4. Targeted interventions available for high-risk and vulnerable groups, particularly those with mental health disorders,  long-term conditions,  and those facing access inequalities.
5. A new acute care model, designed to improve productivity, increase service stability and improve patient outcomes.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Complete the design of a new model for Out of Hospital delivery.	x
Implement the new model for Out of Hospital delivery.		x	x
Stabilise services identified as fragile across the Peninsula.	x
Development of the New Model for Acute services.	x	x	x
Delivering the recommendations of the Dementia Strategy.	x	x
Development of 24/7 Mental Health Community response.	x
Explore digital options that may be able to support people to remain at home rather than be admitted to hospital.	x

System-wide productivity and efficiency

Our vision

We will undertake financial planning and resource allocation collaboratively to maximise value for money. Our focus will be on high-cost, high-impact services, making the best use of system assets to build NHS capacity and reduce reliance on the independent sector.

By driving system-wide efficiency, we will support Devon’s financial recovery, ensuring those on waiting lists are more likely to be seen by NHS providers. Every investment will be targeted to maximise impact, reduce health inequality, and deliver sustainable improvements in care while securing the future of local NHS services.

What Devon will see

1. This priority will contribute to the financial recovery of the system.
2. Those that are on waiting lists will be more likely to be seen by an NHS service than by an independent sector provider.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Repatriate activity from the Independent Sector back to the NHS. Future objectives still to be defined	x
Review of all ICB investments to ensure delivery of value for money.	x
Identification of a digital solution to enable greater efficiency within the AACC team.	x
Development of a system wide approach to commissioning placements.	x	x

Integrated clinical support services

Our vision

We will transform Radiology and Pathology services to make the best use of resources and deliver better outcomes for patients. Standardised diagnostic processes and service redesign will enhance efficiency, ensuring faster, more effective diagnostic reporting.

By improving access to high-quality diagnostics, we will support earlier and better-informed clinical decision-making, leading to faster treatment times and improved patient care.

What Devon will see

1. Improved clinical services through enhanced diagnostics, leading to better patient outcomes.
2. Faster, more effective diagnostic reporting, improving treatment times.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Develop an optimised model of Pathology delivery across the system.	x
Transform Pathology services to deliver the new model of delivery.	x	x	x
Extension of the Shared Insourced Reporting programme.	x
Development of a clinical effectiveness programme to support clinical change.	x	x	x

Shared non-clinical support services

Our vision

We will explore the development of a single managed service for back-office functions, including Finance, HR, Payroll, and Procurement, to maximise efficiency, effectiveness, and cost savings across the system. By streamlining corporate services, we will improve resource flexibility between partners and contribute to the financial recovery across the system. Our approach will reduce duplication, increase resilience, and allow frontline services to focus on delivering high-quality care.

What Devon will see

1. Efficient use of corporate services across all health partners.                        
2. More flexible use of resource between partners.                                              
3. This priority will contribute to financial recovery.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Design of the Target Operating model and digital implementation for People Digital and Payroll.	x
Optimise shared HR and Payroll services.	x
Transition of all shared services to a single host and explore commercial opportunities.		x	x
Transitional Target Operating model for Procurement services to be delivered.	x	x	x
Optimise and deliver shared Procurement services.	x	x	x
Deliver single Target operating model for Digital and Business intelligence functions.	x	x	x
Begin Pre-implementation of the finance model.	x
Go live for the Shared Finance model.	x
Develop and deliver the full Corporate services implementation model.	x	x	x

Clinical effectiveness, research, innovation and improvement

Our vision

To build a research-positive culture across One Devon ICS that maximises the benefits of performing research for our population, our patients, our organisations and our staff.      

What Devon will see

1. Greater visibility of research and innovation projects, increased investment in research and innovation and evidence that findings from research and innovation are informing commissioning.
2. Delivery of clinically effective, evidence-based healthcare, ensuring high standards of care.
3. Devon’s NHS leading in research and innovation, using research to advance care and improve patient outcomes.            

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Strengthen research and innovation networks by increasing collaboration, mapping, and coordinating activity across localities, system organisations, and academic partners to maximise impact.	x	x
Expand research opportunities by reviewing existing commercial activity, benchmarking performance against other regions, and identifying areas of regional expertise—including within universities and NHS organisations—to better inform investment bids.   Develop joint schemes with NIHR infrastructure, supporting pump-prime investment.	x	x
Create a Regional Innovation Strategy that brings together a network of organisations and individuals in Devon to drive research and innovation.	x
Increase patient and public involvement and equity of access to research by co-designing proposals with local/national experts, raising awareness, and supporting recruitment.	x
Work with One Devon involvement networks to embed research in ongoing engagement, ensuring diverse groups have opportunities to participate.	x	x
Ensure the workforce is engaged in research by routinely sharing findings, promoting a pro-research culture, recognising the value of evidence, and facilitating research education and training.	x
Raise awareness of research opportunities for staff and patients, embedding research within the everyday work of One Devon to increase participation.	x
Strengthen leadership commitment and accountability by: Increasing the visibility of research and innovation.Appointing a named Research Champion at the executive level across stakeholder organisations.Establishing an appropriate level of investment to support research infrastructure.	x	x	x
Use research outcomes to drive service improvements, embedding learning from local, national, and international research into commissioning and delivery, ensuring people receive the most effective care.	x	x
Increase research activity annually by expanding the number of PCNs active in research within Primary Care and Community Settings.	x	x

Estates and infrastructure

Our vision

One Devon ICS is committed to ensuring that our estates and infrastructure are fit for purpose, future-proofed, and located in the right places to meet the health and care needs of our population and maximise workforce productivity. We will take a system-wide approach to estate planning, ensuring that our facilities are sustainable, accessible, and aligned with national priorities.

To achieve this, we will undertake a strategic review of the ICS-wide estate, ensuring our infrastructure supports the delivery of high-quality care. We will develop and deliver a public-facing ICS Estates Strategy, setting out our vision and priorities for investment. A five-year capital prioritisation pipeline and investment plan will provide a clear roadmap for addressing critical infrastructure challenges.

A dedicated cross-system estates and facilities team will be established to drive delivery and improve collaboration making best use of capacity and capability across the ICS. We will also develop a local framework/implementation plan to deliver with Phase 1 of the revised New Hospital Programme (NHP), ensuring that hospital upgrades and infrastructure improvements are delivered.

What will Devon see

1. Implementation of the infrastructure strategy over a 15 year period
2. Cross-system estates and facilities team in place making best use of capacity and capability across the ICS
3. Phase 1 of the revised New Hospital Programme (NHP), progressing and infrastructure improvements being delivered.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Undertake strategic review of the ICS-wide health estate	X
Deliver a public facing ICS Estates Strategy – to be delivered over a 15-year implementation period	x	X	x
Develop an investment plan and a five-year capital prioritisation pipeline in conjunction with system partners and build in the interdependencies to Cornwall and the Isles of Scilly with multi boundary opportunities	x	x
Develop a cross-matrix team that can support the delivery of estates and facilities at an ICS-wide level.	x
Establish local framework/plan to address critical infrastructure needs and hospital upgrades in line with phase 1 on the revised national New Hospital Programme (NHP).	x	x	x

Workforce

Our vision

Develop and deliver a system-wide plan to improve staff wellbeing, workforce productivity and efficiency, by increasing our focus on inclusion, coordinating training pathways, supporting recruitment and retention initiatives, and ensuring sustainability through workforce transformation.

What Devon will see

1. Improved productivity and stability across System workforce                               
2. Improvements in colleague representation                                      
3. Highly productive and effective System leadership.                 

Our Objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Design and deliver workforce programmes to support System Transformation priorities, including those within the Transforming Devon Programme, to achieve the Medium-Term Financial Plan.	x	x	x
Develop future workforce models for talent attraction and development to ensure optimal service delivery and workforce sustainability.	x	x	x
Develop and implement a workforce redesign toolkit across NHS providers, aligning workforce and clinical redesign.	x
Develop and deliver talent attraction models, such as Career Hubs, to build new talent pipelines and help the ICS meet its Anchor Institution responsibilities.	x
Increase placement capacity by 20% by the end of 2025/26, expanding placement experiences by 30% and reducing under-utilisation by 30% to maximise opportunities	x
Increase domestic nursing and AHP supply through undergraduate, T-level, and apprenticeship recruitment.	x
Ensure a sustainable supply of domestic nursing, midwifery, and AHP staff to meet the long-term workforce plan. By 2025/26, Devon will increase apprenticeships by 20% and implement service redesign to expand the number of advanced practitioners by 20%.	x
Achieve 100% compliance with the Advanced Practice Governance Matrix by the end of 2025/26	x
Implement at least four components of the Student Learner Experience Charter by 2025/26, increasing the number of registrants supporting learning, assessment, and supervision by 20%.	x
Expand Oliver McGowan Mandatory Training by the end of 2025/26, increasing the number of ‘Train the Trainers’ by 50% and delivering Tier 2 training across the system.	x
Develop and deliver a comprehensive Organisational Development plan for the Devon System in preparation for the successful delivery of the NHS 10-year plan and a single operating model for Devon.	x	x	x
Support the implementation of the regional ‘Leading for Inclusion’ strategy within the Devon system and work collectively on achieving a shared vision.  Initially focussing on the six high impact actions in the NHS England EDI Improvement Plan.	x

Digital and data

Our vision

Through investment we will make the most of advances in digital technology to help people stay well, prevent ill health, provide care, better support our staff in their roles and enable the delivery of sustainable, effective and efficient services. People will only tell their story once. First contact will be digital where appropriate and more advice and help will be available online.                     

What Devon will see

• Citizens will only need to tell their story once.
• Digital tools will be empowering patients to manage their health and conditions.
• Citizens will be able to engage digitally through simplified channels.
• Our staff will be empowered with active notifications and workflow at the point of care.

Staff will benefit from connected data across the ICS.

Our objectives

ICS aims

Objective	Year 1-2	Year 3-4	Year 5+
Number of eligible citizens connected to the NHS App increased to support national target of 60%.	x
Production of standard GP practice website templates by March 2027.	x
Remaining core health and care organisations connected to the Devon and Cornwall Care Record by March 2028.	x	x
To prepare the business case for the re-procurement of the Devon and Cornwall Care Record (DCCR) and subject to approval to procure and implement the DCCR.	x	x
Additional functionality of the Devon and Cornwall Care Record scoped and implemented subject to funding.	X	x	x
Re-procurement of GP EPR clinical system completed by March 2028	X
EPRs implemented in TSDFT and UHP by 2026 including LIMS.	X
We will assure the ICS Digital Strategy delivery of data centre rationalisation as opportunities are progressed.	X	x	x
We will aim to achieve £400k of savings in 2025/26 from mobile contracts and work as a system to identify additional savings.	x	x	x
Building on the One Devon Dataset, further develop PHM data architecture and reporting by March 2026, with a focus on supporting the system prevention priorities.	X	x
Develop an ICS data platform and associated reporting, linked to EPR implementation during 2026. Optimise the use of national developments including the Federated Data Platform (FDP).	X	x	x
Work collaboratively with regional ICS teams to implement and develop the regional secure data environment to support future research	x
Implement the national Digital Inclusion Framework, working in partnership with the population health team, to increase accessibility to digital health resources among underserved populations.	x	x	x