Health Policy February 12, 2019
How to make the Long Term Plan work

By News Feature - Accountable Care Journal

Nick Bosanquet, Professor of Health Policy at Imperial College, speaks to Accountable Care Journal about implementing the objectives of the NHS Long Term Plan (LTP).

Professor Bosanquet has written extensively on the economics of healthcare for decades and, as an expert in this area, he is well placed to judge how feasible the NHS LTP is and what needs to change in order for its objectives to be accomplished.

In order to move away from piling pressure upon our already stretched hospital system, he identifies the first major challenge as intertwined with the changes to healthcare funding models.

A “watershed moment”

“This is the watershed moment for Acute Trusts,” says Professor Bosanquet, “They have to work for a new era of funding and service. I set out some of the new and awesome challenges and how the Trusts need to move to new kinds of collaboration. ”

He continues, “the first part of the challenge will be addressing drastic changes in the ways in which hospitals receive funding,” says Professor Bosanquet who, despite the NHS recent cash injection of £20bn, insists that, in the long term, hospitals will have to operate under ever restricting budgets due to the LTP outlining plans to reduce hospital outpatient rates by a third. Despite the fact that the budget is currently increasing by roughly 5 per cent, this increase is actually coming with a significant reduction in interest on specialised commission.


Simultaneously upgrading existing service

However funding models are eventually adjusted over the coming decade, Professor Bosanquet insists the standard of our care should not and cannot drop. The second, and he argues the biggest, challenge is how we upgrade our existing services while simultaneously investing in new ones.

“We will most certainly require a significant increase in our capacity for technical innovation, and we will require an increase in specialised staff to accommodate this,” he says. While workforce shortages across the NHS pose a significant risk to the viability of the NHS LTP, he acknowledges that the LTP has diagnosed the problem correctly and that the actions proposed within the plan will help alleviate pressure.


Looking beyond the hospital

The third priority is to join hospital services with primary care and community support services across the country to develop fully integrated models of care. While this is not a new policy, the fact that the government has reaffirmed care integration as a priority over the coming decade is a clear sign of intent.

Professor Bosanquet sees both the challenge and opportunity of this. “Trusts need to get used to being co-partners in integrated care models, and not necessarily the main player. ” That there were key areas not fully incorporated into the NHS upon its inception in 1948 are a cause of frustration for him.

“the big mistake was not having integrated trusts from the start”

“The big mistake was not having integrated trusts from the start and it was an absolute scandal that GPs were not incorporated more fully into the NHS. As a result, there was no pressure from the system to provide oversight and maintain quality for primary care until the 1990s. ”

In mental health too he recognises that there has been an over-reliance on hospital services when it would have made more sense to include other parts of the community. "While mental health is talked about more often, like many other health issues it has been suffering from hospital syndrome. Two-thirds of inbound patients are now being sectioned where several years ago this was only one third. Addressing this will be crucial for the NHS to move towards having an interconnected service. ”


UK wide collaboration

With many of its aims being based upon the principle of preventing ill health, the success of the NHS Long Term Plan will be largely based upon the capacity in which the health and care sector can collaborate with other industries that impact upon people’s wellbeing.

This is something that Professor Bosanquet is acutely aware of, and he has long called for the development of a more effective prevention agenda. “We need an all UK collaboration where people outside of the health services – such as pharmacies, fitness centres and gyms – collaborate with the aim of encouraging people between the ages of 40-60 to be much healthier. ”

Addressing these factors will help to ease the pressure on our hospitals by decreasing the number of people clogging A&E departments across the country.


Beyond additional funding

“I would describe the NHS as a ‘black sheep’ of sorts,” he concludes. “While there is a constant demand from within the system to have additional funding, we need to pay more attention to its long term progression in terms of its’ actual social and economic delivery. ” In this regard, Professor Bosanquet believes that there have been massive inefficiencies within the NHS; however, with the new opportunities presented by the Long Term Plan, there is scope for the NHS to navigate through what has been an incredibly difficult period of its history.


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