Health and care strategy.

NHS Devon’s core funding encompasses all commissioned services, including acute, mental health, and community care. Almost 80% of running costs are attributed to staffing, with the remainder covering estates and other non-pay expenses.

Despite receiving £163 million above its needs-based population allocation, the system remains financially fragile, requiring £54 million in deficit support to break even in 2025/26.

This financial imbalance limits the capacity to invest in innovation, respond to rising demand, and deliver sustainable improvements. However, the strategic redistribution of resources across Devon’s four localities is beginning to correct historical inequities, bringing planned expenditure closer to fair share allocations and aligning with the principles of the Model ICB Blueprint.

Our population of around 1.3 million is ageing rapidly, with 24% aged 65 or older, well above the national average, and growth among those aged 75+ accelerating.

This demographic shift, combined with geographic and social inequalities, creates stark contrasts in health outcomes, with up to a 20-year difference in healthy life expectancy across the county.

Rising demand across all service areas, especially the delays in accessing assessments, diagnosis, treatment and community-based support is compounded by workforce shortages, fragmented care pathways, and infrastructure risks.

The system’s IT and estates vary significantly in quality, with some facilities in urgent need of repair, posing risks to continuity and safety. Nationally, policy frameworks such as the NHS Long Term Plan and the Fuller Stocktake have laid the foundation for the expectations for the NHS to deliver.

They call for a fundamental reconfiguration of services dissolving the long-standing divides between primary, community, and secondary care, and enabling more joined-up, person-centred approaches.

At the heart of this transformation is the emerging Neighbourhood model, a nationally endorsed delivery vehicle for integrated care.

This model envisions care being designed and delivered at a local level, tailored to the specific needs of neighbourhood populations, typically serving 30,000 to 50,000 people. It brings together general practice, community services, mental health, social care, the voluntary sector, and increasingly, public health and housing working as a single team around the individual.

The Neighbourhood model is not simply a structural change, it represents a paradigm shift in how care is conceptualised and delivered. It is the mechanism through which the three strategic shifts outlined by government are being operationalised.

This Strategy should be seen alongside the NHS Devon Strategic Commissioning Intentions and full Medium Term Financial Plan

In response, NHS Devon’s strategic long-term approach will mark a seismic shift toward place-based, outcome-led delivery though a new model of care that is based around Neighbourhood Delivery.

This transformation is guided by the principles of the NHS 10-Year Plan and the NHS Medium Term Planning, which emphasizes earned autonomy, reduced duplication, and a relentless focus on productivity and value.

We aim to fully embrace the greater financial flexibility, with fewer national priorities and more local discretion to tailor services to community needs.

Devon’s strategy embraces this opportunity, aligning its financial planning, workforce development, digital innovation, and care redesign with the overarching goal of improving population health, reducing inequalities, and delivering consistently high-quality care.

This strategy is not just about recovery, it is about building a sustainable future and builds on existing work across the Integrated Care System, including the Joint Forward Plan, the Integrated Care Strategy, and local authority and provider plans. It draws on national guidance such as the NHS 10-Year Plan and the Model ICB Blueprint, which advocate for earned autonomy, reduced duplication, and a sharper focus on productivity and value.

By aligning local priorities with national expectations, Devon is embracing the opportunity to tailor services to community needs, supported by greater financial flexibility and system-wide collaboration.

Structured around new model of delivery, the strategy sets out high-level commissioning intentions that reflect a shared ambition across all services directly commissioned by the ICB.

It aims to stabilise the system in the short term, while enabling long-term transformation through redesigned care pathways, digital innovation, a stronger focus on prevention and population health, and better use of workforce and estate resources.

Operating within a defined financial envelope, the strategy supports a shift from reactive and siloed approaches to proactive, preventative, and integrated models of care placing people at the centre and ensuring that care follows the individual, not the other way around.

Achieving this vision will require a phased, pathway-led, and coordinated effort, underpinned by strong leadership and alignment across the system. 12 The strategy is anchored by four core principles:

• sustainability, through financial, operational and environmental resilience
• quality and value, by delivering effective care that maximises impact
• person-centred care, designed around what matters to individuals and communities, and an
• accessibility, ensuring equitable access regardless of location, background, or circumstance.

By looking outward to national models and inward to local insights, Devon’s strategy sets a clear direction for transformation—one that is grounded in collaboration, shaped by evidence, and focused on delivering better outcomes for all.