What's in the government's NHS ten-year plan?

What's in the government's NHS ten-year plan?

Theresa May outlines the long-term plan for the NHS in a speech at the Royal Free Hospital, London, in June 2018. Image: Getty

Monday, January 7, 2019

The Prime Minister will attempt to shift focus away from her Brexit woes with a major domestic policy launch today.

She will announce the NHS will save half a million lives over the next decade with the most significant reforms to the system since the turn of the millennium.

The NHS Long Term Plan for England was supposed to be unveiled by the government last year. It was put on hold as Whitehall bandwidth was swallowed up by the process of exiting the EU.

But in an effort to start the year on the front foot at home, the PM will use the plan to set the direction for the health service for the next decade in England (health is devolved, so this plan doesn’t apply to the rest of the UK).


Mental health services

Health service leaders want to reduce patients’ reliance on hospital and primary care services and put prevention first.

They plan to expand A&E departments so that same day discharge is possible in many cases - reducing overnight pressure on hospitals.

On a theme that Mrs May has consistently championed, there are major interventions on mental health provision. 

A £2.3 billion increase in real-terms funding over the next five years will go towards mental health services in schools and 24-hour mental health care via NHS 111.

Most of this money for mental health was already announced in the Budget - when Philip Hammond promised a £2 billion expansion, with £250 million of that earmarked for crisis services. 

Some experts say this is not enough. The Royal College of Psychiatrists has previously argued for a £2.5 billion increase.

There will also be new standards and targets to govern the NHS’s provision of mental health services - exactly what form these take remains to be seen. 


Improving disability care

Another headline measure is a massive expansion in personal health budgets (PHBs) - these give people with disabilities and long term health needs more control over how the NHS spends money to help them.

The number of patients on PHBs will be expanded to 200,000 - but that is still a small proportion of those who might benefit from more of a say in their treatment.

There will be a focus on technological measures too: artificial intelligence and genetic testing will be more widely used throughout the NHS to treat strokes and cancer.

NHS England also says every patient will be able to book GP appointments through an app. 

Some patients can already do this in London, for example, but local implementation needs to be developed throughout England. 


War on waste

The plan also argues for a reinvigoration of the war on waste, with a pledge to make £700 million in back office savings by cutting administration - although the details on how this will be achieved are not clear.

It was thought some organisations within the NHS - such as NHS Improvement - might be scrapped altogether, but it appears that they will instead be reorganised with the aim of saving cash.

Overall, the NHS budget will grow by £20 billion a year by 2023. That works out at annual rises of around 3.5%.

But it’s worth noting that this figure strictly applies to frontline services - other areas, such as smoking cessation initiatives run by councils - are being cut in real terms. 


Staff shortages

Watch: Norman Lamb tells Julia Hartley-Brewer that the NHS plan falls short on social care

There are a number of key areas which the plan won’t address - and several points of criticism which it arguably fails to reckon with.

The main sticking point is the issue of ‘workforce’ - staff numbers, in plain English. 

There are shortages of more than 100,000 doctors, nurses and other staff across the NHS.

That works out at 1 in every 11 posts currently vacant. 

Health Secretary Matt Hancock told the BBC: "We need to recruit more, train more and also retain the people in the NHS who are working so hard now."

Shadow Health Secretary Jon Ashworth said: "The NHS needs a credible fully-funded plan for the future, not a wish list to help Theresa May get through the coming months."

A bigger missing piece of the jigsaw is social care - identified as a priority by the Conservatives when Mrs May came to office.

Social care planning remains in stasis as the government has time and time again delayed the social care green paper - even though it pledged to publish this in 2017.

With healthcare and social care so obviously inextricably linked and codependent, that is a very substational piece of the picture to still be without.