15 January 2019
The recently published NHS Long Term Plan for England is intended to produce an NHS that is ‘fit for the future’ – and importantly, to allocate a reported new £570 billion funding package to best effect to meet this goal, significantly improving the population’s health and the NHS services to deliver this.
The plan is packed with positive changes to be implemented across all parts of the NHS, supported by investment in staff, technology, innovation and other infrastructure. Significantly, the plan has also acknowledged and identified actions to improve the current challenges for the NHS in terms of capacity, staffing, quality of services and unmet need, proposing system drivers for improvement through changes in operating models and funding arrangements. It is also important that in the plan the Government clearly credits the NHS, its staff and partners for the sustained major improvements in health and the provision of quality of services achieved up to now - often in challenging circumstances.
Whilst it is easy for policy documents to promise much especially in terms of significant change, the goal of changing the future provision of NHS health services is clearly demonstrated through the Long Term Plan, with measures classed as falling into five categories:
The renewed focus on prevention, person-centred care and health inequalities underpins the wider changes to how the population will be served by new NHS services such as integrated care systems, social prescribing, digital-first primary care, rapid diagnostic centres, comprehensive model for personalised care and new community based mental health services to name just a few. There is much attention to developing mainstream digitally enabled care, and the PHG Foundation’s own foresight project My Healthy Future has highlighted the opportunities and desire for these.
My Healthy Future has also highlighted many other future opportunities to improve clinical delivery and patient experiences by utilising new and emerging technologies to the best effect. As supporters of the adoption of useful genomic and other science-based tools for improved healthcare, it is gratifying to see that the plan restates the priority of targeting efforts in areas of healthcare innovation which will be transformative, such as the new NHS Genomic Medicine Service, modern molecular diagnostics and providing the support for the development and evaluation of new innovations - all measures strongly advocated by the PHG Foundation .
Inevitably, the scale of the changes to take place will feel challenging to those working in the NHS front-line, with the background of services already under strain in many areas; this has quite naturally impacted on their innovation efforts so far – delivering effective change typically takes significant effort, at many levels. It is therefore vitally important that implementation plans are developed based on local circumstances and incorporate adequate time, expertise and resources for establishing the new ways of working and make the system changes required. These should be organised in such a way that it can be done in parallel to managing the day-to-day demands of the service (and bearing in mind the ambitions to ensure that the NHS should be a good place to work for staff, as well as continue to deliver a high quality service). Otherwise there is a very real risk that the vital developmental work will be crowded out by the immediate (and undeniably pressing) needs of the population. This would be a lost opportunity, to be avoided if the Long Term Plan is to deliver the ambitious and important changes laid out.
Will full implementation of the NHS Long Term Plan be worth the additional investment of resources - yes, absolutely! Without these changes, the NHS will be less able to address the inevitable increase in demand; with the right changes, it could not only survive but improve. The key will be to ensure sustained effort, collaboration, leadership and oversight for the plan – and, crucially, sticking to the plan over the next 10 years avoiding the temptation to continuously amend the strategic direction as has been done in the past.