Special report: NHS unveils 10-year Long-Term Plan

Overview of the latest government publication, which puts technology, health and wellbeing, and joined-up services at the heart of the NHS

The Long Term Plan sets out how the NHS will fund and improve services over the next 10 years

The Government’s recently-announced 10-year plan to secure the future of the NHS has been described as ‘ambitious’ and ‘a unique moment in NHS history’.

But critics and healthcare analysts have warned that ‘significant pieces of the jigsaw are still missing’ and ‘difficult choices lie ahead’.

The comments come after NHS England chief executive, Simon Stevens, launched the eagerly-awaited NHS Long Term Plan on Monday.

This is an ambitious plan that includes a number of commitments which, if delivered, will improve the lives of many people

Following the Government’s earlier announcement that it would invest £20.5billion a year in real terms by 2023/24; the 136-page document provides a blueprint showing how to best use that funding to ensure that the NHS is fit for the future.

The report is split into seven key areas covering new service models for 21st-century prevention and health inequalities; progress on care quality and outcomes; NHS staff; digital and technology; taxpayer investment; and next steps.

Tackling staff pressures

It states: “We must keep all that’s good about our health service and its place in our national life. But we must tackle head-on the pressures our staff face, while making our extra funding go as far as possible.

“And, as we do so, we must accelerate the redesign of patient care to future-proof the NHS for the decade ahead. This Plan sets out how we will do that.”

Simon Stevens

Following its unveiling, Prime Minister, Theresa May, said: “The NHS has always been the country’s most-beloved public service – there to provide outstanding care to us all whenever it is needed.

“The launch of the NHS Long Term Plan marks an historic step to secure its future and offers a vision for the service for the next 10 years, with a focus on ensuring that every pound is spent in a way that will most benefit patients.

“This will help to relieve pressure on the NHS while providing the basis to transform care with world-class treatments.”

We must keep all that’s good about our health service and its place in our national life. But we must tackle head-on the pressures our staff face, while making our extra funding go as far as possible

But industry commentators are concerned the figures do not add up and that more needs to be done to lay the groundwork for the ‘ambitious’ changes laid out in the plan.

A spokesman for leading health think tank, The King’s Fund, said: “This is an ambitious plan that includes a number of commitments which, if delivered, will improve the lives of many people.

Personalised care

“NHS leaders should be applauded for focusing on improving services outside hospitals and moving towards more-joined-up, preventative and personalised care for patients.

“But, while NHS leaders have done what was asked of them within the constraints of the funding settlement provided by the Government, some significant pieces of the jigsaw are still missing.

“A number of decisions, notably on hospital waiting times, have been postponed, indicating that trade-offs and difficult choices lie ahead.”

And he added: “Whether the plan can be delivered relies critically on tackling workforce shortages.

“While the plan recognises this, commitments to increase international recruitment depend on decisions about immigration policy and we will need to wait for solutions until a new workforce plan is published later this year.”

In addition, he said further integration was desperately needed between health and social care services.

He warned: “The NHS and social care are two sides of the same coin, yet publication of the social care green paper has been delayed yet again.

“And, while commitments for the NHS to do more promote public health are welcome, cuts to local government funding for public health services underline the need for a more-consistent approach across government to the population’s health.

This will help to relieve pressure on the NHS while providing the basis to transform care with world-class treatments

He concluded: “We strongly support the ambition to establish integrated care systems in every part of the country by 2021.

“The plan sends a welcome signal that NHS organisations need to work with local authorities and other partners to deliver improvements in the health of local populations.

“In short, while today’s plan is a significant step forward, a number of questions remain unanswered. There should be no illusions about the scale of the challenge ahead.”

Key to the successful implementation of the plan is the widespread adoption of innovative technologies to streamline and replace largely-paper-based back-office functions.

Technology investment

The document states that a ‘wide-ranging and funded programme’ will enable the NHS to upgrade technology and digitally-enabled care.

“These investments enable many of the wider service changes set out in this plan,” it adds.

“Over the next 10 years they will result in an NHS where digital access to services is widespread; where patients and their carers can better manage their health and condition; where clinicians can access and interact with patient records and care plans wherever they are; where predictive techniques support local integrated care systems; and where secure, linked clinical, genomic and other data supports new medical breakthroughs and consistent quality of care.”

While the plan is a significant step forward, a number of questions remain unanswered. There should be no illusions about the scale of the challenge ahead

This focus on the role of technology moving forward has been widely welcomed.

Speaking to BBH, Dr Simon Wallace, chief clinical information officer at speech recognition software company, Nuance Communications, said: “This year, the NHS must demonstrate how it can encourage a culture shift to ensure that technology is being used to effectively boost efficiency, improve patient care, and reduce the stress and burnout seen across the healthcare profession.

“To achieve this, it is important that budget allocated to digital health is utilised in this way and not clawed back to fund other reactive needs, such as winter pressures.

“Promised budgets for digital technology must remain and, should we manage to do so, changes in management will be the next key step.

“The introduction of digital technologies will require training and support; helping trusts to ensure the technology and new approaches are embedded and adopted.

“With the proposed backing, the NHS will be able to increase the adoption of electronic patient records, integrate patient data in a meaningful way, and link with social care systems to provide a complete citizen overview; helping clinicians to provide a better services at the point of care.

The introduction of digital technologies will require training and support; helping trusts to ensure the technology and new approaches are embedded and adopted

“This time, and this announcement, also means global digital exemplar trusts, and their fast followers, have the chance to demonstrate they are the world leaders in harnessing digital technology to improve the delivery of patient care.

“This is a unique moment in NHS history.”

And James Thirkill, vice president and general manager of healthcare and public sector at supply chain management company, Virtualstock, said: “The Long-Term Plan is a great step towards the NHS’s digital future.

“However, moving our health system over to digital needs a system-wide approach.

“Properly implementing technology in the NHS requires an overhaul of everything from managing patient records and pathways, to tracking medical devices, adopting data standards and deploying interoperable technologies.

“This is an ambitious plan, but it cannot avoid the reality that the NHS must make £700m back-office savings over the next five years.

“Digital technology is critical to improving operational efficiency and core transactional services, which are just as fundamental improving quality of patient care and services as implementing the latest AI diagnostics.”

Mental health services will be bolstered under the plan

Details of the plan

Chapter 1: This sets out how the NHS will move to a new service model in which patients get more options, better support, and properly-joined-up care at the right time in the optimal care setting.

  • Over the next five years, every patient will have the right to online ‘digital’ GP consultations and redesigned hospital support will help to avoid up to a third of outpatient appointments, saving the NHS over £1billion a year in new expenditure
  • GP will receive funding to work together to deal with pressures in primary care and t extend the range of convenient local services, creating integrated teams of GPs, community health, and social care staff
  • Expanded community health teams will be required under new national standards to provide fast support to people in their own homes as an alternative to hospitalisation, and to ramp up NHS support for people living in care homes
  • While NHS leaders have done what was asked of them within the constraints of the funding settlement provided by the Government, some significant pieces of the jigsaw are still missing

  • Within five years over 2.5 million more people will benefit from ‘social prescribing’, a personal health budget, and new support for managing their own health in partnership with patients’ groups and the voluntary sector
  • Urgent treatment centres will be rolled out across all acute hospitals, increasing the proportion of acute admissions typically discharged on day of attendance from a fifth to a third
  • New clinical standards will ensure patients with the most-serious emergencies get the best-possible care
  • In partnership with local councils, further action to cut delayed hospital discharges will help free up pressure on hospital beds

These reforms will be backed by a new guarantee that over the next five years, investment in primary medical and community services will grow faster than the overall NHS budget. This commitment creates a ringfenced local fund worth at least an extra £4.5billion a year in real terms by 2023/24.

Chapter 2: This sets out new, funded, action the NHS will take to strengthen its contribution to prevention and health inequalities.

Wider action on prevention will help people stay healthy and also moderate demand on the NHS.

The plan funds specific new evidence-based NHS prevention programmes, including smoking cessation; reducing obesity; limiting alcohol-related A&E admissions; and tackling air pollution.

To help target health inequalities, NHS England will base its five-year funding allocations to local areas on more-accurate assessment of health inequalities and unmet need.

As a condition of receiving funding, all major national programmes and every local area across England, will be required to set out specific measurable goals and mechanisms by which they will contribute to narrowing health inequalities over the next 5-10 years.

The launch of the NHS Long Term Plan marks an historic step to secure its future and offers a vision for the service for the next 10 years, with a focus on ensuring that every pound is spent in a way that will most benefit patients

The plan also sets out specific action, for example to: cut smoking in pregnancy, and by people with long-term mental health problems; ensuring people with learning disability and/or autism get better support; providing outreach services to people experiencing homelessness; helping people with severe mental illness find and keep a job; and improving uptake of screening and early cancer diagnosis for people who currently miss out.

Chapter 3: This sets the NHS’s priorities for care quality and outcomes improvement for the decade ahead.

The Plan goes further on the NHS Five Year Forward View focus on cancer, mental health, diabetes, multi-morbidity and healthy ageing, including dementia. But it also extends its focus to children’s health, cardiovascular and respiratory conditions, and learning disability and autism.

By 2028, the plan commits to dramatically improving cancer survival, partly by increasing the proportion of cancers diagnosed early, from a half to three quarters.

Other gains can happen sooner, such as halving maternity-related deaths by 2025.

The plan also allocates sufficient funds on a phased basis over the next five years to increase the number of planned operations and to cut long waits.

And it makes a renewed commitment that mental health services will grow faster than the overall NHS budget, creating a new ring-fenced local investment fund worth at least £2.3billion a year by 2023/24.

This will enable further service expansion and faster access to community and crisis mental health services for both adults and children and young people.

The plan also recognises the critical importance of research and innovation to drive future medical advancements.

Technology will be a key enabler, supporting the priorities set out in the plan

Chapter 4: This sets out how current workforce pressures will be tackled and staff better supported.

NHS staff are feeling the strain, partly because over the past decade workforce growth has not kept up with the increasing demands on the NHS.

The NHS also has not been a sufficiently-flexible and responsive employer, especially in the light of changing staff expectations for their working lives and careers.

The plan sets out a number of specific workforce actions which will be overseen by NHS Improvement that can have a positive impact.

It also sets out wider reforms which will be finalised in 2019 when the workforce education and training budget for HEE is set by the Government.

These will be included in the comprehensive NHS workforce implementation plan to be published later this year.

In the meantime the NHS Long Term Plan sets out action to expand the number of nursing and other undergraduate places.

And funding is being guaranteed for an expansion of clinical placements of up to 25% from 2019/20 and up to 50% from 2020/21.

In addition, new routes into nursing and other disciplines, including apprenticeships, nursing associates, online qualification, and ‘earn and learn’ support, are all being backed, together with a new post-qualification employment guarantee.

International recruitment will be significantly expanded over the next three years, too, and the workforce implementation plan will set out new incentives for shortage specialties and hard-to-recruit-to geographies.

To support current staff, more-flexible rostering will become mandatory across all trusts, funding for continuing professional development will increase each year, and action will be taken to support diversity and a culture of respect and fair treatment.

And staff and patients alike will benefit from a doubling of the number of volunteers helping across the NHS.

Chapter 5: This sets out a wide-ranging and well-funded programme to upgrade technology and digitally-enabled care across the NHS. These investments enable many of the wider service changes set out in the plan.

Over the next 10 years they will result in an NHS where digital access to services is widespread; where patients and their carers can better manage their health and condition; where clinicians can access and interact with patient records and care plans wherever they are, with ready access to decision support and AI, and without the administrative hassle of today; and where predictive techniques support local integrated care systems to plan and optimise care for their populations.

Linked clinical, genomic, and other data will support new medical breakthroughs and consistent quality of care.

Chapter 6: This sets out how the 3.4% five-year NHS funding settlement will help put the NHS back onto a sustainable financial path.

The plan does not assume that increased investment in community and primary care will necessarily reduce the need for hospital beds. Instead, taking a prudent approach, the Government has provided for hospital funding as if trends over the past three years continue.

In order to deliver for taxpayers, the NHS will continue to drive efficiencies – all of which are then available to local areas to reinvest in frontline care.

Properly implementing technology in the NHS requires an overhaul of everything from managing patient records and pathways, to tracking medical devices, adopting data standards and deploying interoperable technologies

The plan lays out major reforms to the NHS’s financial architecture, payment systems and incentives and establishes a new Financial Recovery Fund and ‘turnaround’ process so that on a phased basis over the next five years not only the NHS as a whole, but also the trust sector, local systems, and individual organisations progressively return to financial balance.

And it shows how the NHS will save taxpayers a further £700m in reduced administrative costs across providers and commissioners both nationally and locally.

Chapter 7: This explains next steps in implementing the plan.

A new NHS Assembly will be established this year to shape local implementation, taking account of the Clinical Standards Review and the national implementation framework being published in the spring, as well as their differential local starting points in securing the major national improvements set out in the plan.

These will be brought together in a detailed national implementation programme by the autumn, taking into account Government Spending Review decisions on workforce education and training budgets, social care, councils’ public health services, and NHS capital investment.

The plan does not require changes to the law in order to be implemented, but amendment to the primary legislation would significantly accelerate progress on service integration, on administrative efficiency, and on public accountability.

The report, therefore, recommends changes to: create publicly-accountable integrated care locally; to streamline the national administrative structures of the NHS; and remove the overly-rigid competition and procurement regime applied to the NHS.

In the meantime the NHS and its partners will be moving to create integrated care systems everywhere by April 2021.

These bring together local organisations in a pragmatic and practical way to deliver the ‘triple integration’ of primary and specialist care, physical, and mental health services, and to integrate health with social care.

They will have a key role in working with local authorities to make shared decisions on population health, service redesign, and plan implementation.

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