There are major questions facing the NHS 10 year plan
4 min read
The government is right to say that the challenges facing the health service require a long-term plan. But there is little clarity over how it will work in practice.
Public satisfaction with the NHS is at an all-time low, and it's not hard to see why. NHS services are creaking: people struggle to get appointments with their GP and face long waits for routine hospital treatment and emergency care. Other services that prevent ill health and support people to remain well and independent have been weakened or neglected. Projections that suggest the number of people living with major illness in England may grow by more than a third by 2040 add to the sense of urgency.
The government has promised to ‘deliver long-term reform’ of the NHS to ‘secure its future’. Its forthcoming 10-year plan will be framed around achieving three ‘shifts’ towards more community-based care, prevention and use of technology. But nine months into the government’s term, we know very little about what its ideas for reform mean in practice.
The overall approach looks to be recover first, reform later. NHS finances are eye-wateringly tight this year, and immediate priorities to rein in deficits, meet stretching productivity requirements and make progress on the elective waiting list look set to dominate.
NHS England – the national body responsible for the day-to-day management of the English NHS – proved an early casualty after it was abruptly abolished last month. Overall staff numbers will be cut by around half as the merger progresses. There may well be some logic in closer working between NHS England and the Department, but ultimately, this will be a massive distraction. Time and effort will be wasted redesigning processes and moving functions between bodies when it should be all hands on deck to support implementation of the government’s upcoming plan for the service.
Previous NHS reorganisations (of which there are many) have rarely delivered the intended benefits and have seen other unintended consequences, including loss of expertise and unforeseen costs. Streeting himself said the process will take up to two years and require primary legislation. History tells us that a health bill on the horizon runs a serious risk of ballooning.
The story for local leaders mirrors that of national disruption. Evidence suggests that the NHS is undermanaged, but integrated care boards – local bodies responsible for NHS planning and spending across England – have been told to cut their running costs by 50 per cent this year. Some may need to merge in the process. NHS providers have been told to cut their ‘corporate cost growth’ by the same amount. The scale of cuts required has led NHS leaders to call for creating a national redundancy fund. Emerging plans from the sector suggest it will be extremely challenging to isolate cuts to non-clinical settings.
This then, is the fragile backdrop against which the government’s long-awaited 10-year plan will land in June. The stakes could hardly be higher. What does the sector need from the plan? The list is long, but here we focus on three overarching priorities.
First, government must provide hope that things will get better. The plan should build on the NHS’s strengths and set a clear direction for change, focusing on how care will improve and how the system will change to support this. How, for example, will new approaches to assessing performance, changes to regulation, the NHS payment system, and more, evolve to support headline priorities?
Second, the plan must prioritise and make limited funding count. If current financial constraints continue, this will mean facing up to the difficult trade-offs involved in balancing priorities. Better access to general practice is the public’s top priority and should be high on the list. But the government’s headline political pledge to cut the NHS waiting list will require substantial resources and may mean slower progress elsewhere.
Third, resources. The plan needs to be backed by long-term investment through the Spending Review process. As part of this, policymakers need to strengthen the NHS’s capacity to improve, for example, by developing the capabilities needed to adopt promising service changes. In particular, improving NHS productivity will require providers to have the ability to successfully implement and use health care technologies.
Finally, the government must acknowledge that a plan for the NHS will not be enough on its own. Broader policy change to improve health — a bolder approach to the leading risk factors for ill health, a cross-government strategy for reducing England’s vast health inequalities, and urgent reform and investment in adult social care — is vital.
Phoebe Dunn is a Senior Fellow at the Health Foundation.
