Continuity not change is the order of the day. The much-anticipated Long Term Plan is perhaps less of a bold new vision for a new century of healthcare but a reassertion of NHS England’s direction of travel since 2014. There has been widespread coverage in recent days of many of the more tangible improvements in the patient services the Government hopes to secure with its £20.5 billion investment. Whether it’s in extending access for and guaranteeing new access standards for mental health services, greater postnatal maternity care, quicker access to cancer tests or more tailored support to help people tackle smoking, obesity or alcoholism, the Long Term Plan promises something for everyone. But beyond the rhetoric of the Government’s “retail” offer for the public, the detail of The Plan takes the logic of the Five Year Forward View to its next inevitable stage to population health management based on integrated care models and aggressive preventative health.
The vision of care for the future set out in The Plan builds on many of NHS England’s greatest hits, such as the Vanguard Programme and Sustainability and Transformation Partnerships. Primary care services will be boosted by £4.5 billion in investment and new primary care networks covering 30-50,000 people. A new Urgent Treatment Centre model will be rolled out alongside digitalised outpatient services. The Diabetes Prevention Programme will be extended, and Rapid Diagnostic Centres will be created. The Quality Outcomes Framework and CQUINs will be modernised, GIRFT and RightCare enhanced, more Global Digital Exemplars launched. Integrated Care Systems will cover the whole country by 2021 backed by new accountability frameworks and governance structures.
Yet for all the depth and detail of the shopping list of initiatives contained within The Plan there has already been much speculation on what is missing. Improving waiting time performance for A&E and elective service gets scant mention. Recent months have seen some questions over whether the current waiting time standards are still appropriate for a new era of population health. The Plan also says little about how the social care funding quandary might be resolved. The workforce strategy is also delayed. Knowing that it will be on the hook for delivery, NHS England has set provisos on sufficient staffing and adequate social care funding being made available if all the commitments in The Plan are to be met.
Ahead of its publication there were reports that some in the Treasury were concerned that The Plan did not go far enough in stating how it would deliver real value. Despite the delays in the publication there have been claims that The Plan has been rushed through Whitehall without sufficient scrutiny. Certainly, reforms to funding flows to deliver financial balance and incentivise prevention and integration will be revealed “beyond 2019/20”. NHS England also throws down the gauntlet to those in Westminster that want more from the NHS by spelling out clearly how the Health and Social Care Act could be revised.
The Long Term Plan sets out clearly where the NHS has come from in recent years and what the next few years will look like, but might provide only some insight to what the NHS might look like on its 80th birthday. While genomics and AI are featured, robotics, regenerative medicine and gene editing fail to get a mention. The Plan is more clearly focused on adjusting to the short term transitions in the design of acute settings rather than the long term need to embrace exponential technology change. With its litany of abbreviations, The Plan is the tour de force of NHS England’s direction of the health service since Simon Stevens came into post. It sets out what his legacy will come to be. But before its 80th birthday the NHS may well need a new vision for the future.
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