By Accountable Care Journal-
The NHS Long Term Plan (LTP), published today, aims to save half a million lives through prevention and early intervention strategies while refocusing on the young, elderly and mental health issues.
With an overarching aim to make the NHS ‘fit for the future,’ the LTP outlines how investment will be used to address ‘killer conditions,’ including genomic tests for every child with cancer. In addition, the plans will seek to prevent 150,000 heart attacks, strokes, and dementia cases with over three million people benefiting from improved stroke, respiratory and cardiac services over the next ten years.
Placing a focus on the use of digital technology and early detection, new tools will be used to prevent 85,000 premature deaths, annually. This will include making digital GP consultations available to all.
In a first for the NHS, the plan will guarantee that investment for primary, community and mental health services will grow at a faster rate than the NHS budget as a whole. Through a new funding model, £4.5 billion will be used to support ‘joined-up’ care services in partnership with local government.
The LTP will also invest £2.3 billion a year in mental health services by 2023/24, delivering support to over two million more people suffering from anxiety, depression and other mental health issues over the next decade. This will include support for new parents and ensuring NHS 111 offers round the clock access to crisis care for mental health issues.
Responding to this commitment to mental health services, Sean Duggan, chief executive of the Mental Health Network, said: “The Long Term Plan represents vital progress towards parity of esteem for mental health services and has come through genuine and meaningful engagement with the sector. ”
Simon Stevens, chief executive of the NHS, commented on the plan, saying: “It sets a practical, costed, phased route map for the NHS’s priorities for care quality and outcomes improvement for the decade ahead. ” This, he says, will help tackle the “head-on the pressures our staff face. ”
The plan, situates itself in response to the ‘three big truths’ from NHS England: Pride – in the NHS’ enduring success and shared social commitment, concern – about funding, staffing, increasing health inequalities and growing pressure from an ageing population, and optimism – about medical advances and improving health outcomes for the future.
The NHS Long Term Plan will also:
- Open a digital ‘front door’ to the health service, allowing patients to be able to access health care at the touch of a button
- Provide genetic testing for a quarter of people with dangerously high inherited cholesterol, reaching around 30,000 people
- Give mental health help to 345,000 more children and young people through the expansion of community-based services, including in schools
- Use cutting-edge scans and technology, including the potential use of artificial intelligence, to help provide the best stroke care in Europe with over 100,000 more people each year accessing new, better services
- Invest in earlier detection and better treatment of respiratory conditions to prevent 80,000 hospital admissions and smart inhalers will be piloted so patients can easily monitor their condition, regardless of where they are
- Ensure every hospital with a major A&E department has ‘same day emergency care’ in place so that patients can be treated and discharged with the right package of support, without needing an overnight stay.
The plan outlines the expansion of the Diabetes Prevention Programme, bringing mental and physical health services closer together for young people and the introduction of a healthy living and exercise programme for 100,000 patients with heart problems. However, it does not ignore the growing pressures placed on services by older people, by also vowing to deliver more care in people’s homes.
Ian Dalton, chief executive of NHS Improvement, commented on the structural implications of the plan, which, he says, “means breaking down organisational barriers to take a more holistic approach to how care is delivered and paid for, embracing new and existing forms of technology, recruiting and retaining the right number of staff, and shifting the focus away from hospitals to prevention and care in the community. ”
The full plan can be read online here.
The overarching gist of the Long Term Plan seeks to steer it towards greater integration of services. That is both the aim and the means by which to the NHS will achieve the improved health outcomes it strives for. Aside from setting the target of expanding the Integrated Care System (ICS) model so they are seen everywhere by April 2021, the Long Term Plan will set about bringing together primary, secondary and specialist care with local government, across all aspects of care delivery, through the use of new technologies and frameworks aimed, above all, at reducing pressures on the acute sector.
The focus on ‘place’ will likely manifest itself in all aspects of health and care policy, bringing the accountability for ensuring wellness, as well as treating illness, as close to the patient as possible. This said, one of the major concerns expressed in the plan is the extent to which it can influence factors outside NHS control, such as social care.
As such, much of the success of the LTP will hinge upon the contents of the Social Care Green Paper, originally due to have been released in 2017. Cllr Ian Hudspeth, Chairman of the Local Government Association, described this as a ‘missed opportunity’ to release a green paper in conjunction with the Long Term Plan and said: “The current system of social care is unsustainable and will buckle under the weight of demand unless the Government urgently invests in these essential services, which protect health, prevent sickness and are the surest way to reduce hospital admissions. ”
As England manages an increasingly ageing population with multiple conditions, more and more pressure is placed on social care services as well as healthcare that treat people when they get ill. This, in part, falls on the prevention and integration agenda to deliver but redesigned services must also account for how they work with services outside of the NHS.
Can this plan actually be delivered?
According to analysis from the Nuffield Trust, the extra funding that has been allocated for the NHS ‘falls below the historic average,’ reinforcing concerns over the deliverability of the plan given its ambitious nature. While it is crucial that the NHS is given the support and funding it requires, social care and public health must not be neglected as health and care systems become increasingly integrated and therefore dependent on one another. The promised £4.5 billion increase in primary and community care services is crucial. However, the government should also be looking to reverse the £600 million in reductions to council public health grants.
Currently, there are 100,000 vacancies across the NHS with analysis from the King’s Fund, Health Foundation and Nuffield Trust predicting a workforce shortfall of 250,000 clinical staff by 2030. The NHS LTP introduces a host of measures to create a more accessible environment for those in training and education looking to join the clinical workforce. This is in addition to creating part-time options and more flexible working arrangements in general. These range from clinical apprenticeships to the introduction of new courses designed to create additional routes for people to start a career in the NHS.
Internal disagreements have resulted in the announcement of the government’s planned workforce strategy being delayed until later this year. As such, many details on addressing the workforce crisis beyond education are largely absent from the LTP. Without action, the workforce crisis is only set to deteriorate further due to Brexit and the reliance on health and care services on staff from the EU and abroad. The NHS planned workforce strategy needs to be delivered as soon as possible.
How has the plan been received?
Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges looked at the implications of the plan, saying: “we, that is everyone who works in the NHS and patients who use the service, must all play our part if we are to make it a success. ”
Commenting on the steps outlined to tackle heart disease, Simon Gillespie, chief executive of the British Heart Foundation, said: “The plan’s strong focus on improving prevention and detection of heart and circulatory diseases and their risk factors has the potential to make a huge difference,” but noted that “it’s now essential that work gets underway on making this transformational plan a reality. ”
Paul Farmer, chief executive of Mind, welcomed the £2.3 billion of funding set aside to mental health services: “This is the kind of sustained investment we need to see to put mental health on an equal footing with physical health. ” However, the absence of a coherent workforce plan did not go unnoticed with Farmer highlighting the need to “develop the workforce needed and to deliver these plans. ”
Meanwhile, Lynda Thomas, chief executive of Macmillan, expressed delight that “cancer has continued to remain a high priority,” with the plan creating milestones aimed at “improving survival and ensuring high-quality personalised care for every patient. ”
Professor Russell Viner, President of the Royal College of Paediatrics and Child Health said: “Today’s announcement lays the foundations for an NHS with infants, children and young people at its core. ” However, as was a common theme, Viner expressed concern that the plan “cannot be achieved without significant investment and expansion in the child health workforce. ”
Dr Chaand Nagpaul, chair of the British Medical Association Council, expanded on this theme, calling for the NHS to “get the basics right, such as the workforce. ” Referencing the...