On the cusp of what could be a transformative era for health care in the United Kingdom and the United States, two ambitious plans are vying to reshape the landscape for some of society’s most vulnerable communities. In England, a parliamentary committee is urging the government to seize a “golden opportunity” to overhaul mental health services, while in North Carolina, state officials are seeking $1 billion in federal funding to revolutionize rural health care delivery. Both initiatives, though thousands of miles apart, reflect an urgent push to bridge longstanding gaps in access, funding, and outcomes for those most at risk.
According to a report released on December 2, 2025, by the UK’s Health and Social Care Committee, England stands at a crossroads. The committee’s findings, as reported by the House of Commons, paint a stark picture: mental health services are currently overburdened and poorly designed, failing too many individuals and their families. Yet, amid these challenges, a glimmer of hope emerges in the form of six pioneering 24/7 Neighbourhood Mental Health Centres. Inspired by a model from Trieste, Italy, these centres are designed as holistic, one-stop shops—offering not just mental health support, but also advice on housing, employment, and other essential needs without requiring a referral.
Layla Moran MP, chair of the Health and Social Care Committee, did not mince words in her assessment. “This report lays bare how an overburdened, poorly designed system is failing too many people and their families. But there is hope. We urge the Government to not shy away from reimagining this broken and fragmented system, and to embrace this golden opportunity to radically improve mental health services,” Moran stated, as cited by the House of Commons. She emphasized the potential of the 24/7 centres, calling their early results “nothing short of miraculous.”
However, the future of these centres hangs in the balance. The Department of Health and Social Care (DHSC) has not guaranteed funding beyond April 2026, putting the pilot program at risk. The committee’s report is unequivocal in its recommendation: extend funding for at least another 12 months to allow for proper evaluation of the centres’ impact. This extension, the report argues, would provide the data necessary to scale up the model nationwide—potentially transforming mental health care delivery across England.
At the heart of the committee’s concerns is a troubling trend in funding. While mental health accounts for over 20% of demand on health services, it is forecast to receive just 8.7% of NHS expenditure in 2025/26—down from 8.78% the previous year. This marks the first time since 2016/17 that mental health spending has not risen as a proportion of overall health spending, breaching the Mental Health Investment Standard. NHS England confirmed in November 2025 that proportional increases will not occur between now and 2028/29, with only flat real funding growth planned. The committee warns that this could threaten the government’s commitment to achieving parity between mental and physical health care.
Workforce shortages, particularly among mental health social workers, add another layer of complexity. The report calls for these professionals to be included in the NHS’s forthcoming 10 Year Workforce Plan, with specific projections to increase staffing. It also highlights the need for culturally appropriate care, especially for racialized communities who face disproportionate detention rates and poorer outcomes under the Mental Health Act. Embedding the Patient and Carer Race Equality Framework as a statutory duty is recommended as a step toward greater accountability and equity.
The urgency of these reforms is underscored by sobering statistics. At the end of 2024, 664,412 adults with severe mental illnesses—such as bipolar disorder or schizophrenia—were accessing support from community mental health services in England. Between 2021 and 2023, more than 130,000 premature deaths were recorded among this demographic, a stark reminder of the stakes involved.
Across the Atlantic, North Carolina is charting its own course toward health care transformation. On December 1, 2025, the state’s Department of Health and Human Services submitted a 61-page proposal to the federal Centers for Medicare and Medicaid Services (CMS), seeking $1 billion through the Rural Health Transformation Program. This initiative, created under the One Big Beautiful Bill Act signed by President Donald Trump, is part of a $50 billion federal effort to improve health outcomes in rural communities nationwide.
Governor Josh Stein captured the spirit of the proposal in a statement: “North Carolina is on the cutting edge of technology and innovation, and our application for the Rural Health Transformation Program shows that we’re ready to continue our leadership in rural health care.” If approved, the state would receive $200 million annually over five years, with funds distributed through six regional ROOTS hubs (Regional Organizing and Operational Transformation Support). These hubs would coordinate care across hospitals, primary care practices, behavioral health providers, EMS agencies, and social service organizations in North Carolina’s 85 rural counties.
The plan’s ambitions are sweeping. The hubs would oversee care coordination, data sharing, prevention programs, crisis response, and workforce recruitment. They would also address nonmedical factors—such as food access and transportation—that profoundly influence health outcomes. Debra Farrington, the department’s deputy secretary of health, expressed optimism about North Carolina’s chances, citing the state’s large rural population and existing infrastructure. “We feel like we’re deserving of a higher percentage of the dollars compared to some other states,” Farrington told North Carolina Health News.
Central to the proposal is the idea of sustainability. The state aims to build an infrastructure that can endure beyond the five-year federal funding window, leveraging existing partnerships and programs. The plan also draws on lessons from the Healthy Opportunities Pilot, a Medicaid-funded initiative that provided food deliveries and transportation to rural residents but was shuttered due to lack of legislative support, despite evidence of cost savings and improved outcomes.
Other highlights include expanded behavioral health services, new crisis centers, mobile units for opioid treatment, school-based mental health programs, and enhanced maternal health services. The plan also seeks to stabilize financially vulnerable hospitals and clinics with value-based payment models, and to bolster digital infrastructure for telehealth.
Patrick Woodie, president and CEO of the NC Rural Center, praised the proposal’s collaborative approach. “They recognize it takes a village, so to speak, to meet the needs of rural citizens and rural families where they live,” Woodie said. Still, he cautioned that sustaining momentum after the initial funding period will be a “daunting task,” urging legislators to keep rural health priorities front and center.
As both England and North Carolina await crucial funding decisions, the stakes could hardly be higher. For the hundreds of thousands living with severe mental illness in England, and the more than three million rural residents in North Carolina, these plans offer a rare chance to close gaps that have persisted for generations. Whether these golden opportunities are seized—or allowed to slip away—will shape the future of health care on both sides of the Atlantic.