07 JAN 2019

The NHS Long Term Plan

I welcome the NHS Long Term Plan, which is wide ranging and ambitious. It rightly celebrates the successes of the NHS but is realistic about the scale of the challenge to meet relentlessly rising demand and to improve services. It acknowledges the pressure on staff as a result of the workforce shortfall and the urgent need to upgrade facilities including digital resources.

It is one of the greatest triumphs of our age that we are living longer but more of us are living with complex and long term conditions and there are widening inequalities in the degree to which both young and old are living in poorer health. There also remains an unacceptable variation in outcomes and experiences for patients from one area to the next even where that cannot be accounted for by resources or local challenges.

The Plan sets a number of priorities such as making sure that a greater share of NHS resource goes to mental health, especially for children and young people as well as to GP and wider community services. It lays out a number of proposed improvements to major areas such as cancer, cardiovascular disease, diabetes and respiratory disease as well as a welcome focus on children and young people.

I'm glad to see the Plan accept the recommendations of the Health and Social Care Committee on closer joined up working across the NHS. Not only to bring truly integrated services with social care but to break down unnecessary barriers between GPs and hospitals, and between mental and physical health. Some of these artificial barriers could be better cleared if there were changes to legislation, including to help reduce wasteful and bureaucratic competitive procurement rounds and to allow a greater priority for joint cooperative working rather than competition. The HSCC recommended that any legislative proposals should be designed by and come from those working in and alongside the NHS, rather than as top down proposals from government.

The success of the Plan will depend on having the NHS and Social Care workforce to deliver it and much will also depend on the Spending Review settlement ahead. The 3.4% average annual uplift for NHS England over the next 5 years does not include the public health grants which are central to prevention of ill health and reducing inequality, grants which this year are continuing to fall. Nor does the NHS settlement include the crucial funding for Health Education England which covers education, training and professional development.

The Plan also makes clear that it cannot deliver without a stable and realistic long term settlement for social care. The government's Social Care Green Paper is expected within weeks and it is not possible to fully assess the NHS Long Term Plan without also seeing the long term proposals, including the financial settlement, for social care.

Likewise for capital funding, which is also due to be announced in the Spending Review later this year, because this will underpin new facilities, technology and equipment as well as tackle a worrying maintenance backlog.

The Plan proposes to fund evidence-based NHS prevention programmes, including to cut smoking; to reduce obesity, doubling enrolment in the successful Type 2 NHS Diabetes Prevention Programme; to limit alcohol-related A&E admissions; and for the NHS to contribute to lowering air pollution for example. But for these to be successful there will also need to be cross government action with a willingness to be prepared to look at tackling health inequality and prevention in all areas of policy as these big issues cannot be properly tackled in isolation by the NHS.

In many ways the Plan mirrors themes and priorities that were also set out in the last long term plan, the 5 Year Forward View, many of which remain unfinished business. The last plan was undermined by the cuts to social care, public health, capital and training budgets and it is important not to see this repeated. It is also important to recognise the many important changes that did get underway and a number of successful pilots are highlighted as pointing the way ahead for what delivers better and more joined up health and care for patients. This new plan will be trying to make sure that the best care is delivered everywhere rather than as scattered examples of best practice and that Integrated Care Systems make sure that all parts of the wider health system are working together more effectively.

My view is that there will need to be access to the up-front resources to transform services in the same way as is often available to pilot projects for them to succeed, and to cover the double running costs that make sure that new facilities are in place before old services are dismantled. It is also important to allow time for changes to demonstrate an effect. In the short term new ways of working may even appear to increase costs but if in the longer term they help to prevent conditions worsening and reduce the need for more expensive treatments down the line that is in the best interests of individuals as well as reducing long term demand.

It is easy to end up talking about systems but all those tasked with delivering this ambitious Plan must above all keep the needs of patients, families and communities at the heart of everything they do.


Our daughter's local hospital in London says it cannot hire new staff, and Europeans are moving back to the Mainland. It plans to open a branch hospital in Calais, which should work, but could you approach Ms May to ask that those ambulances be given priority on the ferries, to avoid the lorry park in Kent?
- Richard

Anything to help the NHS is a positive as it is a service for all. The staff always making every difficult situation work as best they can with the resources available to them. I do however have a question Sarah..We have thousands of GP Surgeries all over the UK with good facilities why do they shut at night if they were able to stay open it would take a lot of pressure from our overstretched Hospitals also working people would be able to see a Doctor without losing time off work it does seem a big waste of a perfectly good building not used to its full capabilities.

Thanks Sarah. I think your comments on social spending are very important. In answer to S Bruus, I am a retired GP and married to one still working. Keeping GP surgeries open seems attractive but for two problems. One is staffing - we could take doctors, nurses and administration staff from hospitals to work in GP Surgeries but that would defeat the object. The second is that GP Surgeries are not trained or equipped to deal with Accidents and Emergencies. A far better solution is to improve access to GP Surgeries during the day, and leave A&E work to the experts.
- Simon Lansdown

Further to my previous comment. All the NHS Doctors (GPs and Consultants) I know are highly stressed. Numerous are retiring at the earliest opportunity (many under age 60) and many are going off sick. Opening extra clinics etc will not solve the staffing crisis. I have heard that on Boxing Day this year, there was an out of hours GP service in a local Surgery. There was only one patient booked and for that one person there was a GP, a HCA, a Nurse and a Receptionist all being paid by the taxpayer. When I was a young GP I did evening surgeries and I worked from 8am until the last patient left (sometimes as often as 10 at night). I found that quite unbearable.
- Simon Lansdown

Wouldn't it be nice if this was the last NHS reorganisation for quite a few years. I started work in the NHS in 1972 and it was being reorganised then, and it seems that about every five years the politicians come along and have another good meddle with it. The Lansley reforms tore apart a system which worked well and wasted a shedload of cash in a move designed to prepare the NHS for privatisation. Now that is being chucked out as introducing competition hasn't worked. Please will the politicians stop treating the NHS as a political football.
- Bob

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