Introduction.

Foreword

We are pleased to publish this refreshed Five-Year Joint Forward Plan (JFP), setting out how we will work together across the health and care system to respond to the One Devon Integrated Care Strategy. This plan brings together the collective ambitions of NHS organisations, local authorities, and other system partners to ensure a coordinated and aligned approach to improving health and care services for the people of Devon.

The NHS and local authorities in Devon are working together and take joint responsibility for delivering this plan. Over the last 12 months, system partners have embedded the JFP into their planning and service delivery, strengthening alignment between health and other sectors. This plan integrates the work of individual health and care organisations, Provider Collaboratives, and Local Care Partnerships into a single, overarching plan to deliver the strategic goals of our Integrated Care Strategy over the next five years.

The last year has been a challenging time for all public sector services. NHS partners have been working hard to support both NHS Devon and partner NHS trusts in moving out of segment four of the NHS Oversight Framework. Local authorities have also been managing significant financial and operational pressures.

Our plan acknowledges these challenges and prioritises system recovery in the early years. However, it also sets out how we will balance immediate recovery and financial stability with a longer-term focus on transformation. This balance is crucial for ensuring we continue to improve outcomes for the people of Devon while securing a sustainable future for our services in years to come.

Key developments shaping this plan

Several significant developments are reflected in this update:

• The development of the system’s Medium-Term Financial Plan (MTFP), which sets out the financial parameters and key assumptions that NHS organisations will work within over the next five years.
• The launch of our Transforming Devon Programme, a multi-year, system-wide change programme structured around four strategic pillars. This programme will drive both short-term recovery and longer-term transformation.
• The recognition that the strategic context for health and care is evolving and will change significantly in the next few years, with the publication of the Darzi Review likely to shape our future direction.

In addition to these key developments, the publication of the NHS 10-Year Plan and local government reorganisation linked to English devolution are likely to have a significant impact on our work in future years, bringing changes to policy and joint delivery arrangements in Devon.

In response to this evolving context, we expect to undertake a significant review of our Integrated Care Strategy in 2025–26. Insights gathered through engagement with our communities and partners will help us refine our local plans and ensure they remain aligned with national and regional priorities.

Engaging with our communities is at the heart of how we plan and deliver services in Devon. This year, NHS Devon led a county-wide engagement programme to inform the national NHS 10-Year Plan. Gathering more than 2,000 responses from staff, people, and communities across Devon, including significant input from Core20PLUS5 communities. The insights gained from this work will not only shape national policy but also strengthen our local plans and future Integrated Care Strategy.

Through this One Devon Five-Year Joint Forward Plan, we are reaffirming our commitment to collaboration, innovation, and shared responsibility in delivering high-quality, sustainable health and care services. We will continue working closely with our partners, listening to our communities, and responding to the challenges and opportunities ahead.

Health and Wellbeing Board opinions

There has been ongoing engagement with the three Devon Health and Wellbeing Boards regarding the JFP since it was first published in 2023. Each year, as the plan has been updated, each Board has submitted a formal opinion to confirm that the JFP aligns with the local Health and Wellbeing Strategy and addresses the local population needs identified in the Joint Strategic Health Needs Assessments (JSNAs).

Introduction

About Devon

Devon is a complex system, with many different arrangements delivering functions across a unique geography. Elements of the plan are delivered across a range of provisions including:

• Two unitary authorities (Plymouth City Council and Torbay Council).
• One county council (Devon), with eight district councils.
• 117 GP practices across 31 Primary Care Networks (PCNs) .
• Devon Partnership Trust (DPT) and Livewell South West (LWSW) provide mental health services.
• Four acute hospitals – North Devon District Hospital and the Royal Devon and Exeter Hospital, both managed by the Royal Devon University Healthcare NHS Foundation Trust (RDUH), Torbay and South Devon NHS Foundation Trust (TSDFT) and University Hospitals Plymouth NHS Trust (UHP).
• One ambulance trust – South Western Ambulance Service NHS Foundation Trust (SWASFT).
• Dental surgeries, optometrists and community pharmacies.
• A care market consisting of independent and charitable/voluntary sector providers.
• Many local voluntary sector partners across our neighbourhoods.

Purpose of the Five-Year Joint Forward Plan

The JFP 2025–30 outlines how NHS Devon and partner NHS trusts will deliver the One Devon Integrated Care Strategy over the next five years responding to the 12 Devon Challenges described below. It aligns with national requirements, demonstrating how the local NHS will meet the physical and mental health needs of the population, fulfil statutory commitments, and addresses the four core purposes of Integrated Care Systems (ICSs).

This year’s JFP refresh has been a light-touch update, in line with national guidance, as the One Devon system awaits publication of the NHS 10-Year Plan. We have focused on aligning the JFP with new and emerging priorities, including the Devon Medium-Term Financial Plan (MTFP), the NHS Devon Annual Plan, and the Transforming Devon Programme, as well as updating content in response to NHS operational planning guidance published recently in February 2025.

This JFP reflects the work happening across the wider Devon system, in the health and care sectors and beyond, demonstrating how this work aligns with the strategic goals in One Devon’s Integrated Care Strategy.

The JFP consolidates various local plans across the system, including, but not limited to:

• The NHS Devon Annual Plan.
• NHS Operational Plans.
• Joint local health and wellbeing strategies.
• Plans developed at a Local Care Partnership (LCP), Provider Collaborative and NHS Provider level.
• Internal local authority plans (e.g., adult social care, children’s services).

Devon main challenges

• An ageing and growing population with increasing long-term conditions, co-morbidity and frailty.
• Climate change.
• Complex patterns of urban, rural and coastal deprivation.
• Housing quality and affordability.
• Economic resilience.
• Access to services, including socio-economic and cultural barriers.
• Poor health outcomes caused by modifiable behaviours and earlier onset of health problems in more deprived areas.
• Varied education, training and employment opportunities, workforce availability and wellbeing.
• Unpaid care and associated health outcomes.
• Changing patterns of infectious diseases.
• Poor mental health and wellbeing, social isolation, and loneliness.
• Pressures on health and care services (especially unplanned care).

Integrated Care Strategy summary

Aims:

One Devon will strengthen its integrated and collaborative working arrangements to deliver better experience and outcomes for the people of Devon and greater value for money

Developing a sustainable future

The JFP describes how the Integrated Care System (ICS) plans to deliver health and care services that meet population needs and remain sustainable, in response to the Integrated Care Strategy.

Our plan is once again structured around three themes: Healthy People, Healthy, Safe Communities, and a Healthy, Sustainable System.

Each theme is underpinned by a series of high-level delivery plans, which articulate what partners aim to achieve collectively through the JFP in the short, medium, and longer term.

Our plan sets out our vision and ambition for the next five years across a wide range of health and care services. In line with the fourth ICS purpose, our plan also articulates the work that the NHS does with its partners to support broader social and economic development.

To develop a sustainable future for the health and care services in Devon, we need to recover our system, stabilise services and deliver long term sustainable improvements.

Each section of our plan therefore describes:

• The workstream ambitions and objectives.
• The difference that delivery of the objectives will make to the people of Devon.
• Achievements and outcomes delivered in 2024/25.
• Short term objectives to improve performance and reduce costs in line with requirements in the 2025/26 operational planning guidance.
• Medium term objectives to stabilise and improve services.
• Longer term objectives to transform services for a sustainable future.
• Which of the ICS aims the activities described support, providing a golden thread throughout the plan.

The One Devon Integrated Care Strategy has not been updated this year due to the extensive work already undertaken to develop it. The case for change, which underpins the strategy, was developed through a thorough and wide-reaching process in 2023. This involved significant engagement across system partners and the public, ensuring that the priorities set out remain relevant and reflective of local need. Given the depth of this work and the fact that the case for change is still current, a further update this year was deemed unnecessary. Additionally, the upcoming NHS 10-Year Plan will require a substantial review and revision of our strategy in 2025/26. Instead, our focus this year remains on delivering against the existing strategy while preparing for the future changes ahead.

Each workstream section of the plan highlights the ICS aims it supports, ensuring a clear and consistent thread throughout.

In 2024/25, workstream leads engaged with relevant stakeholders to refresh their high-level delivery plans. These updates have been reviewed by the Joint Forward Plan Steering Group and One Devon Leadership Delivery Group (SLG) to ensure alignment current strategic and operational priorities.

There is an immediate need to recover Devon’s financial and performance position to ensure a sustainable system going forward and this need is reflected throughout our plan. This year’s JFP references the newly established Transforming Devon Programme, set up in-year to support system recovery. Each high-level delivery plan outlines both short- and longer-term objectives to support recovery and prioritises the actions we need to take individually and collaboratively to exit NOF4.

The JFP is a system-wide plan. It reflects our commitment to working collaboratively and in partnership to deliver system ambitions. However, it is important to acknowledge that statutory duties remain with individual organisations.

There are also specific statutory duties that NHS Devon must deliver as part of its legal responsibilities. These duties are incorporated throughout the plan and are referenced specifically in Appendix A.