National Wellbeing Service

A view from 2035

Today in 2035 a strong community spirit around health and wellbeing has emerged across the South West. Somerset has been at the heart of this since the early 2020s where the 'One Somerset Workforce' strategy and other areas such as Fit For My Future Somerset health and care strategy was developed, aimed to support the health and wellbeing of people by changing the way services were planned for, paid for and provided. Emerging from a decade-long series of radical reforms of services to improve, maintain and restore the health of individuals and communities, Prevention, Protection and Public Confidence have become the watchwords.

Over ten turbulent years the 20th century National Health Service has slowly given way to a 21st century National Wellbeing Service.

From the outset in 2023, Somerset was an aspirational place to be. Chief Medical Officer Dr Bernie Marden in the ICS Primary Care Strategy set the course :

Over many years, Somerset has regularly performed above average, for instance in People Promise indicators compared with the South West Region and with England as a whole.

Somerset has recognised even further the importance of developing an agile and flexible workforce, one in which capabilities rather than outmoded and more limiting role-defined characteristics created capacity for workforce development and delivering positive outcomes.

The relationship between people and service providers swung from the dependency dynamic of the first part of the 2020s which had an over reliance on services operating reactively to illness, to the opposite extreme of independence and self-reliance by the late 2020's.

This swing of the pendulum initially had its own pitfalls in terms of undiagnosed illness and safety. However, by 2035 this dynamic has now settled into a more realistic relationship between people and services, characterised by a model of interdependence in which people, communities, and the state work together to maximise wellbeing in communities.

In 2026, a range of new Wellbeing Hubs were created across the South West Region for clinicians, social care staff, volunteers, and families. These Hubs were created to provide advice on self-care and personal resilience and to help staff to recognise their own 'warning signs' of mental ill-health. Somerset's recognised approach, where the NHS Foundation Trust was recognised as Mental Health Trust of the Year in 2021, has been avant garde in influencing the development of positive approaches to mental health across the region and beyond.

Following the extensive and protracted Covid-19 pandemic Public Inquiry which began in 2022, there is a growing acceptance and appetite from the public to take more responsibility for their own health. A rebalancing of rights and responsibilities led the public to see health and wellbeing as a key lifestyle pursuit. The Inquiry exposed serious flaws with the decision-making processes through which the pandemic was handled at pivotal moments throughout 2020 and 2021, and this resulted in clear areas for change that were accepted and built upon by future governments.

The long-term mental health consequences of the pandemic amongst both the health and care workforce and the general public have been addressed as a policy priority since late 2024. As a result, the spectre of a post-Covid mental health Pandemic has been, to a large extent, mitigated thanks to a change in political, social, economic and technological developments. In Somerset, support from the Mental Health Alliance with Open Mental Health providing 24/7 access to support had been in place since the early 2020s and provided a platform for building caring and supportive approaches.

'Stories of Covid', a campaign by the BBC to highlight the impact of Moral Injury and PTSD in the workforce, led to the 'National Covid-19 Recovery and Restoration Hearings (CRRHs) of 2024. These hearings allowed Health and Social Care staff, individually and collectively, to give voice to the trauma of the UK's Covid pandemic and to distil learning for the future. In the South West, local and regional CRRHs enabled staff holding unresolved feelings and trauma from the experience of 2020/21 to be heard as a way to support recovery as a shared societal activity. A collective sense of restoration was experienced and the narrative of Covid as a period of psychological growth as much as trauma became a shared framing of the Covid years.

As a result of the National CRRH, individually tailored wellbeing programmes were mandated and funded for every NHS and social care organisation. In the South West these were embedded in annual appraisals such that today in 2035 there is an accepted and personalised focus on staff wellbeing across all organisations.

We have been on an impressive journey over the last 13 years. In the early part of the 2020s there were many challenges. Following on from the pandemic, further social and economic unrest emerged. Along with the Russian invasion of Ukraine in 2022, the cost of living crisis emerged, creating inflation at a 40 year high, and resulted in significant industrial action across the public sector, with health and care staff lining pickets across the country for fair pay and acceptable terms and conditions of service.

However, following eventual pay settlements in 2023 and the Russian capitulation to Ukraine in early 2024, a period of relative stability made way for a new approach to be taken following UK Government elections in 2024. As a result of the challenges in the early part of the 2020s, it now provided an opportunity to create a new political narrative which was quickly adopted in the mid 2020s, with political and health leaders beginning to truly grapple with a regional health system that really encompassed the improvement of the social, economic, and environmental conditions in people's lives.

As early as 2024, the South West set in place plans to ensure that every person in the region and every health worker had appropriate and accessible information to protect their own health as well as the health of those for whom they were responsible.

Today, hundreds of organisations, some online and many physical centres can be found around rural (and urban) communities across the South West, including Somerset. They offer a range of health services - and the appetite is huge. The shift in thinking from the NHS as a service-based organisation to community anchor organisations has led to a complete rethink of NHS estate and purpose including the adaptation and selling of large, unfit for purpose buildings to resource new integrated community wellbeing centres. These community hubs maximise the use of technology to increase productivity and keep human resources costs to a minimum. Prescription (online) yoga, health coaches, counselling and other personalised therapies are freely available to anyone who wants them in the South West.

The private sector, through industry bodies, commit to being partners in the Community Hubs, investing business resources in shared wellbeing activities for employees as citizens. The prized, Annual Community Partner (ACP) Award given to industry partners involved in Community Hubs, grew out of a post pandemic collective commitment to rebuild the economy through rebuilding health. The ACP Award was initiated in the South West Region and was taken up as a national award in 2035. The first national award ceremony was held in Taunton, hosted by the Taunton Community Hub where the idea was first piloted.

As an area, Somerset has become a thriving place to be, a transformed area where socio-economic regeneration has resulted in benefits across towns, villages and communities. The opportunities provided by Hinkley Point C, the first nuclear power station to be built in the UK in 20 years, have played an important role in improving social mobility in the South West - making a difference to people who need support.

Today in 2035, Bridgwater has impressively outperformed major regional cities across the UK in terms of productivity and the District of Sedgemoor has seen the largest growth in household income in any area of Devon and Somerset - above the regional average and above cities like Exeter and Plymouth. 1,400 companies have been involved in building Hinkley Point C with 14,000 jobs being supported by the project. £10 million has been invested into four training facilities, benefiting local people and meeting skills shortages in the South-West and across Britain.

In turn, further confidence in Somerset as an area of growth and technological advancement flourished, for instance Tata choosing Somerset as the location for a multi billion pound electric car battery plant that created over 9,000 jobs in Bridgwater. This spectacular set of economic developments has had enormous benefits beyond the financial growth of Somerset - the knock-on effects of prosperity and development have supported traditional artisanal, creative and agricultural work, encouraged healthy tourism in a beautiful area, and given an enormous boost and sense of hope to people across Somerset, a catalyst for healthy physical and mental wellbeing across its communities.

Public confidence is high, and people feel empowered and in control of their own health and wellbeing. Technology plays a massive part in this. Accident and emergency doctors regularly consult specialists out of hours via video link. As well as potentially saving lives, this cuts staffing costs and ends the front door/back door dilemmas that beleaguered pre and post pandemic integrated care strategies. Arguments over responsibility for unscheduled care have become a thing of the past, replaced by a more responsive and collective community prevention approach which reduces illness and interrupts the cycle of crisis management that crippled the health and care system of the early 2020s.

Schools have been a hugely important influence in this seismic shift. As far back as 2021, schools in the South West set about supporting children, young people and their families to deal with the effects of the great pandemic. Leaders took their chance to reform the school experience to support pupils. Today, from primary and secondary school, there is a focus on creating environments that encourage wellbeing, and - along with this emphasis - developing the kind of analytical and empathetic skills, and emotional intelligence, that are impossible to 'automate away'.

Pupil wellbeing - both physical and mental health - is prioritised above all else, and pupils are encouraged to pursue their own interests in creative ways, with less focus on rigid curriculums. A decade on, across the South West, we are reaping the benefits with an innovative young workforce who want to stay in the South West and build a healthy future for themselves and their wider community. The local food production, leisure and tech services industries are three significant areas of economic growth in the South West that have stimulated wellbeing and integration across numerous indicators.

Tackling wider health issues and habits was also a priority. In 2032, Edward Hyde, the newly appointed Mayor, declared the South West as the first region in England to be smoke free, with less than 5 percent of the population in Somerset choosing to smoke tobacco, reduced from the 11% of 2023. The Smokefreelife Somerset service amongst other earlier interventions have continued a narrative where unhealthy habits such as smoking are increasingly unpopular. Of course, there are some in society who refuse to give up unhealthy lifestyles, giving rise to less tolerance and a lack of empathy for those perceived to have brought ill health upon themselves. In 2023, 62% of Somerset residents were classified as overweight or obese; this is now almost half of that figure in 2035, with improved education and affordable healthy foods being key factors for the public.

Self-management is central to reducing the need for health care services, particularly in the traditional acute hospital sector where unit costs are high. Now, user-friendly personal monitors and new technologies allow many patients to manage their conditions at home and facilitate seamless transitions between hospital and home and supported by new self-assessment and trusted assessor (for specialist assessments) approaches.

From as early as February 2023 in Somerset, initiatives such as the 'Ready To Go' Units at Musgrove Park and Yeovil District Hospitals were developed to support patents to use activity to avoid returning to hospital or the need for external care inputs.

"We want people to be as independent as possible," said Jannine Hayman, senior matron for integrated and urgent care at Musgrove Park. Initiatives such as this became catalysts for further wellbeing approaches being integrated across all communities in the South West.

More than 80% of those deemed to need care or support receive it in their homes from a range of professionals, but mostly from new Health and Social Care practitioners (HSPs), who, as part of a multidisciplinary team, keep colleagues in the loop on how patients are doing. Information transfer and communication has become the number 1 priority for Multidisciplinary teams leading, in 2030, to the establishment of a new 'Wards on the road” model to support coordination of care and handover. The reference to 'wards' was acknowledged as a bridging term between the previous hospital-based model of care and the new community-based model of care. In 2035 this language is now subject to review, as confusion between place based 'wards' and the now less familiar hospital 'wards' begins to sidetrack staff who report lack of clarity about the purpose of the communication model. This in itself is seen as an indicator of transition from hospital and service-based mindsets to community and place based mindsets, and those staff representatives who had raised the confusion now see this as a positive change indicator.

Increasing workloads mean that these new peripatetic HSPs often end up working longer hours than they are paid for or have to leave without finishing some of their tasks to the detriment of the person they are supporting. This is mitigated for many staff by the new workforce schemes, established post Covid, that recognise 'effort' alongside 'targets'. These have had a significant motivating influence on staff who, following the collective burnout of the Covid years and the significant challenges around pay and conditions, have reconnected to their own personal purpose as care providers and who feel valued and rewarded by both their employers and the public for the role they play in wellbeing.

Today in 2035, supporting communities to act for themselves, for example through community navigators and driving social prescribing, there is now an emphasis on self-assessment for staff and technology enabled portals in IT systems connecting service users, patients and professionals, and the evidence is emerging that Integrated Teams produce better wellbeing and more resilient staff, who risk share and mitigate risk together.

The need for high speed broadband services across the South West to support virtual communication and hand overs led to investment in IT infrastructure and resources in South West communities and with an upswing in connectedness, quality of life and career opportunities in the Wellbeing sector, recruitment to professional roles is at an all-time high in the South West.

The role of Artificial Intelligence (AI) has developed to provide a number of innovative ways of supporting Somerset's citizens with health and wellbeing. After the concerns of academics, the media and AI professionals were raised in 2023 relating to the dangers of AI, the UK Government, along with others across the world, created effective regulatory measures and protocols to mitigate the misuse of AI, including its use in health and care settings.

A study carried out by researchers at the University of Exeter based on early pilot schemes concluded that while a small number of older people were naturally resistant to mobile care (Mcare), self-management had the potential to save millions of pounds through reduced hospital admissions and other interventions. Each year more progress is made and risks mitigated by community navigators and community champions who have enabled digital use and reduced digital disadvantage.

Over the last decade there has been a seismic shift to proactive, social and preventive models of care rather than reactive and medical models - guided by universal care for all, a new shared purpose for wellbeing is held across all stakeholders in the South West. With growing knowledge of what wellbeing means, communities now enjoy personalised care and support planning is now at the heart of all decision-making in the South West.

As preventative and early intervention approaches gained momentum, staff and financial resources that had traditionally been used to respond to crisis interventions could now be redeployed. Significant advances had been made as a result of investment and research, with some strident developments in the prevention and treatment of cancer and other morbidities.

The old philosophical and mindset tensions which, since the inception of the NHS in 1947, had regularly impacted on ambitions for transformation are now a thing of the past. In Somerset, the Integrated Care System (ICS) from the early part of the 2020s wanted people to live longer, and in better health – helping them to live as independently as possible for as long as they could.

With the population in Somerset growing from 571,600 in 2021 to 612,300 in 2035, and with the number of people aged 75 and over doubling, this created workforce, budget and logistical challenges, yet it was recognised that around 40% of ill health could be prevented, and this became an aspirational target. This shared understanding that wellbeing is more about preventing illness and promoting good health and less about reducing use of services was a key strategic driver. Health coaching, self-management education and access to peer support with the community have been key to driving this shift.

In a speech given to the system leadership conference in 2034 by Nasim Salatian, Head of the South West's Wellbeing Service, said:

The pioneering work of Bristol City to 'Reimagine Place in the 21st Century' has led to all Health and Social Care activities happening under the umbrella of 'Our Place' and happening in our homes, community settings, businesses and public service centres.

Following, what was termed at the time,' the death of the high street' in 2020/21, new models of cities and towns began to be reimagined across the South West with the mixed use of residential and commercial centres, local well-being centres, areas designed for the safe use of prams and frames prioritised rather than cars in planning. Towns across Somerset from Frome to Minehead, and from Yeovil to Bridgwater have all benefited from a commitment to town centre rethinking, designing with the residents of communities allowing them to shape both the services and the places in which they live.

Simultaneously, transport infrastructure has improved dramatically, and in Somerset there is enhanced provision of public transport services such as regular subsidised bus services linked with direct access to the train network where there are increased, regular and fast services in the region and beyond. The cost of public transport has dramatically reduced due to reinvestment of money previously spent on crisis intervention services across the UK and a realignment of some HS2 funding into 'regions of rurality'. The commitment to environmentally responsible 'green' transport has enabled more people to enjoy a range of cultural and leisure opportunities, as well as access to services in the region and beyond. There are well-placed linkages between the Peninsula and major regional (e.g. Bristol, Cardiff metropole) and national (e.g. M4/M5 corridors) high value, technology and knowledge economies.

Acute health needs are addressed through the newly established Acute Care Centres (ACC's) which has been set up and invested in by a collaboration between UK Government, scientists and Industry to acknowledge the importance and distinctiveness of treating medical conditions differently from social and wellbeing conditions.

In 2035, there is a shared recognition of the 30/70% distinction in medical and social determinants of Health, first researched by Sir Michael Marmot in 2020. Acute Care Centres are in their infancy and in addition to infrastructure transitions to move wellbeing activities and equipment into the community, there is an ongoing change and transition programme to help staff and the public make the mindset shift to a wellbeing model of care rather than the medical model of care which the whole population had internalised from the inception of the NHS.

Hospital estates are no longer totemic symbols of health care and instead our old NHS estates have begun a 20-year programme of redevelopment built on the approach taken to the restoration of heavy industry estates across the United Kingdom and Europe where redundant industrial plants are converted into conservation and leisure areas.

Acute Care Centre work takes place in specialist regional units such as emergency units, cardiology and ICU and the bitterly fought debates about which specialism goes to which area was resolved when South West Ambulance Service proposed a radical initiative for their role in enabling Place and Wellbeing initiatives.

From 2035 transport services are split into two service areas - the transfer of patients to ACCs and the transfer of staff to community wellbeing locations (which may be in people's homes). This builds on the work of paramedics working collaboratively with social care and other teams to ensure rapid enablement at home for people at risk of escalating into an acute admission.

In twelve short years we have witnessed a massive shift in the balance of medical and social paradigms and therefore of resourcing. There is a clearer and more realistic distinction in terms of resourcing and mindset between the medical model that sits beneath acute and emergency medicine and the social model of health that sits beneath the wellbeing model.

The 2028 Act of Parliament (Bill of Health) set out a vision for the new National Wellbeing Service, with a clear distinction between acute and emergency health services and Population wellbeing. In this radical but reality-accepting Bill, the balance of Health resourcing and activity was set at 30/70% medical and social support bringing Michael Marmot's ratio of the causes of ill health formally into line with policy. (Previously, 70% of the cases of ill health were the result of social determinants but 30% of Health Funding was given to social determinants. This changed to 70% funding for social determinants and 30% for purely medical issues).