NHS ten-year plan for England: what’s in it and what’s needed to make it work
The UK government has published its eagerly awaited ten-year health plan for England, setting out how billions of pounds in NHS funding will be used to transform healthcare delivery across the country.
As anticipated, the plan is framed around the government’s three missions for the NHS: shifting care from hospital into the community, moving from analogue to digital communication, and focusing on preventing ill health rather than treating illness.
The 168-page document responds to a stark warning that the NHS is “in serious trouble”. It is remarkable for the sheer number of ideas and proposals. As well as describing major new developments to improve people’s access to local in-person and virtual NHS care and disease prevention, it sets out a blizzard of other proposals.
These include abolishing Healthwatch (a national watchdog that listens to people’s views on health and social care services to improve them), and bringing back some of the reforms of the Tony Blair era such as “new foundation trusts” and using private funding for new buildings.
From hospital to community
The big idea in the ten-year plan is a neighbourhood health service: large local health centres where people can access GP, nursing, dental, pharmacy, diagnostic and other services six days a week, 12 hours a day. These are intended to relieve pressure on hospitals and emergency departments, eventually replacing many outpatient clinics.
The idea of shifting care into the community is not new. It has been advocated for over 30 years, including in the NHS white paper of 1997, the 2006 policy paper Our health, our care, our say, the NHS five-year forward view of 2014, and the NHS long-term plan of 2019.
Some progress has been made in this direction. For example, much of the care for people living with asthma and diabetes is now provided in local general practices. Many general practices already have large teams of doctors, nurses, pharmacists, physiotherapists and other staff who offer aspects of the wider “neighbourhood care” described in the new plan.
But what has not been achieved is having larger-scale primary care teams consistently available across the NHS. The new plan proposes new contracts and shifts of funding to enable wider change, and while welcome, these will be challenging to put into practice against a backdrop of major service pressures.
From analogue to digital
The plan emphasises strongly the need to extend the role of the NHS app, with it becoming the “doctor in your pocket” and the main route into NHS services. It proposes that the app holds your full patient record, enables you to book GP and hospital appointments and becomes a key source of healthcare advice.
This sounds very attractive. However, the devil will be in the detail. There are so many NHS IT systems to harmonise, and major data security and privacy issues to overcome.
Most critically, much attention must be given to sorting out basic NHS admin systems that are too often confusing and paper-based. This will entail lots of work with NHS clinical and administrative staff, changing long-standing ways of working, introducing new technology and adapting “the way we do things round here”.
Using AI to record doctor visits, understand test results and give health advice could really change how healthcare works. But this will take lots of time and money to train staff, try out new systems and put them in place. Also, people will need clear information about what to expect from their local health services in the future.
From sickness to prevention
England is getting sicker, and there are stark inequalities between the richest and the poorest.
To achieve the plan’s goal of empowering people to make healthier choices, robust cross-government action is essential across sectors, including housing, education and welfare. While some important measures such as the tobacco and vapes bill, plans to measure supermarkets’ sales of healthy foods, and the expansion of free school meals are included in the plan, others such as minimum alcohol pricing have been notably excluded.
Integrated care boards (ICBs), the regional bodies who plan and fund NHS services in England, and local councils will be vital in enabling these public health measures to be implemented. However, this will be difficult in the short to medium term as ICBs are being forced to merge, cut headcount and reorganise their work.
Making it work
For the ten-year plan to succeed, three key elements are essential.
First, there is an urgent need to set priorities. The public expects much swifter access to on-the-day GP appointments, an end to excessive waits in accident and emergency departments, and reductions in waiting lists for operations.
The Department of Health and Social Care must guide the NHS in which aspects of the plan are to be addressed first. If everything is a priority, nothing is a priority.
Second, implementation really matters. There is only so much management capacity, staff time, funding and goodwill to introduce new technologies and services. This government has already embarked on another “redisorganisation” of the oversight agency NHS England, and now plans to axe or merge a number of other national and local NHS bodies. NHS managers are vital to implementing the plan, but need to feel valued and supported, not denigrated as superfluous.
Finally, the plan is almost silent on the two most pressing needs for government health reform. Without a properly funded system of adult social care to support older people and those living with enduring mental health needs, it is hard to see how hospital care can be transformed.
And without an urgent and significant shift of resources to general practice and community services, neighbourhood health services will remain more of a dream than reality.
Judith Smith receives funding from the National Institute for Health and Care Research for research and evaluation. Judith is Senior Visiting Fellow at the Health Foundation.