The NHS Long Term Plan

NHS England has finally found a gap between Brexit crises in which to publish what was in danger of becoming its Long Awaited rather than Long Term Plan (LTP). While the preceding plan, the Five Year Forward View (5YFV), had the feel of a new leadership setting out its vision, the LTP unsurprisingly feels a bit more box-ticking: it followed NHS England securing £20bn in additional funding over five years from a government which then wanted to know what it was going to get for that ‘extra’ money. I put ‘extra’ in inverted commas, because the settlement only takes the level of funding back up towards more typical rates of NHS funding increase after years in which most health economists regarded the NHS as under-funded, and in which social care funding has fallen.

The 130-plus rather dense pages though, are full of specific actions, including some very positive indications of how the NHS’s thinking about communities, and community organisations, has evolved from the 5YFV. That plan set out a compelling vision for communities, but it was light on tangible actions in that area. The prose here is less lyrical, but the actions are there, and they should make a difference.

Most important are the headlines taken from the forthcoming Comprehensive Model of Personalised Care. It’s not a very snappy title and it’s a programme still under the radar for much of the NHS, but it should prove to be as big a change for long term health care as the personalisation reforms have been in social care, and it uses some of the same mechanisms. By 2024,

  • 200,000 people will have a personal health budget, meaning they, rather than doctors, can decide how they want to be supported with a long term health condition
  • 900,000 people will have access to over 1,000 social prescribing link workers. These workers will be part of local primary care networks, which will bring together GP practices with, the plan says, councils and community groups.

These are large numbers of people – and represent a different way to spend large amounts of NHS money, which could help to change local health economies. These reforms may have learned from the personalisation of social care, where personal budgets were found to be more effective ways to change things for groups most able to advocate for themselves: the social prescribing link workers should help a wider range of people to make informed choices. We’re expecting a lot more detail on personalised care next week.

In the Joint VCSE Review, we argued that VCSE organisations need to be at the heart of both planning and delivering health and social care. We said that this was essential if care was ever to be redesigned around people’s lives, getting people out of hospital, and keeping people out of care homes for as long as possible. In particular, co-designing services with communities and community organisations is the only way to reduce the inequalities which people from black and minority ethnic communities, and other marginalised groups, encounter when they try to use health services which are still designed by commissioning teams in which white men remain over-represented. (See our concise action plan).

The Long Term Plan says Continue reading

Niche

The NHS will publish its 10 year Long Term Plan soon. There can rarely have been such pressure on a planning process: the NHS has been offered more money than it currently receives at a time when government is still reducing public spending. By 2023, the NHS will receive £20bn more a year than it does now, although this could be offset by reductions elsewhere, such as in the social care or Public Health budgets.

Big strategic planning processes usually follow a pattern. The more high profile and high pressure they are, the more they tend to be carried out at speed, by a small group of very clever people operating in relative secrecy. This was how many areas produced their Strategic Transformation Plans (STPs) which were the planning process local NHS management systems were immersed in for a while last year. It was why some of those plans weren’t as transformative as they needed to be.

Hundreds of groups have fed their views into the Long Term Plan over a short period. I have been feeding in the messages from the Joint VCSE Review which I chair, and which gathered views on its Action Plan earlier this year. I’ve been arguing that the Long Term Plan needs to set out a long-term investment in our communities, not just our health services. Now all of those messages are in the hands of a small group somewhere in Skipton House, who have to whittle them down to a manageable report, which will be expected to cover the big areas of political concern: cancer, mental health, waiting times and so on.

It’s easy to see how some kinds of message tend to survive this high-pressure, high-speed approach to big plans and some don’t. In Continue reading