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From the Queen’s Speech to the next election: what now for the government’s agenda?
From the Queen’s Speech to the next election: what now for the Government’s agenda?

Archive for the ‘NHS’ Category

Stamping out “waste and wokery” – the task at hand for the new NHS Chair

Stamping out “waste and wokery” – the task at hand for the new NHS Chair.

Richard Meddings, a former banker with over 40 years of experience in the financial sector in both public and private sector roles has recently taken over as the new Chair of NHS England. Meddings has been brought in to be watchful over “any waste and wokery” of NHS resources and help deliver the Government’s ambitious agenda of reform for NHS England. The ongoing pressures on the NHS were well documented prior to the pandemic, and concerns over the sustainability of its funding are seldom absent from political discourse. So, is Meddings’ appointment in keeping with Sajid Javid’s ambitions for the NHS in the coming years, who is he, and what can we expect from him?

Who is Richard Meddings?

Those who have worked with him report that he is forensic, exceptionally detailed and pragmatic in his approach to his work. Whilst serving as a Chair at TSB, Meddings was known for navigating them through a turbulent year of crises and restoring public confidence in the bank significantly. It is no surprise these qualities endeared him to Sajid Javid, who sought a skilled operator with experience of reforming and influencing change at the highest levels of business as his ministers have taken a harder stance on holding managers to account for improving services within the NHS.

Others have expressed concern over his lack of experience in the health sector, and the Health and Social Care Select Committee were not unanimous in their decision to appoint him. Meddings countered critics by stating that there was ample sectoral experience in the board already, and his merits would be to bring “to bring fresh insights, strong experience of board governance, digital and financial skills, and courage in adversity and strategic leadership”.

What can we expect from him?

Meddings enters his role with a challenging brief already in front of him. He will quickly have to showcase his understanding of NHS England’s DNA to win over any sceptics in the organisation. Whilst his appointment was unashamedly based on his experience in finance, he will among other things, have to adequately manage the redirection of an expanded workforce back to the day-to-day delivery of services, as well as ensuring NHS boards align with the Government’s wider integrated care ambition.

Overseeing the change from CCGs to ICSs in July will be a significant stress test of his Chairmanship. Across the country several clinicians will end their roles as CCG Chairs, thus creating a large exodus of clinical experience. Without his own established network throughout NHS England, Meddings will have to quickly understand what life is like at the coal face to get an acute sense of the pressures at a local leadership level. Clinicians are typically not engaged in managing systems and overseeing budgets, so in order for Meddings to achieve his ambitions of better managing NHS finances and reducing waiting lists he must ensure that under the new ICS structure they are engaged at all levels of decision-making.

The Government has stated £800m needs to be made in savings across its health departments this calendar year and as such funding for several programmes has been pulled back already. Whilst it seems unlikely that this ambitious target will be met, a more accurate metric of Meddings’ success will be whether he can balance cost savings whilst also producing tangible results for patients.

What does his appointment tell us?

The Government is eager to demonstrate how the NHS can be run cost-effectively, and how it can be reformed to improve the way it works in addressing the significant backlog it continues to face. It is no coincidence that Meddings’ appointment is one of three recent major Government appointments of officials with backgrounds in finance, with Samantha Roberts (formerly at Legal and General) appointed as the Chief Executive of NICE, and Ian Dilks (formerly at PwC) as Chair of the Care Quality Commission. Given the Secretary of State’s previous experience both in finance and in his previous role as Chancellor, it is unsurprising he is looking to those with a history in the financial sector to support the delivery of his ambitious reforms.

His appointment also reminds us that Javid will need to demonstrate to the Chancellor that Meddings is the man who will deliver tangible improvements to NHS England’s efficiency and value for money to substantiate the controversial health and social care levy introduced in April this year.

Measuring success

Meddings’ first year will be critical in defining whether Javid’s gamble to appoint a rank outsider has paid off. Javid’s optimism in the new Chair’s previous experience to address any “waste and wokery” and see through his reforms may be well placed, but Meddings must be careful to ensure that ruthless focus on finances does not come at the expense of patient outcomes and quality of care.

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From the Queen’s Speech to the next election: what now for the Government’s agenda?

The Queen’s Speech on 10th May will be one of the Government’s last opportunities to set out its policy agenda ahead of the next general election.

With the Conservatives trailing in the polls and expected to lose seats in this week’s local elections, will Boris Johnson take the opportunity to reset and galvanise his premiership, or will rising inflation and the cost of living mean that the Government continues to lose ground as the general election approaches?

WA’s new report on the Queen’s Speech takes a close look at the Government’s latest legislative agenda, assessing where its priorities are likely to lie in the coming months and what that will mean for businesses.

You can download the full report here:

Queen’s Speech 2022: A look ahead (PDF)

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Are women finally being heard?

Women in the UK are becoming increasingly vocal about the challenges they face in their healthcare and the unjust variation in access to services. When the Government opened their consultation to inform a Women’s Health Strategy in Spring 2021, over 110,000 respondents took the opportunity to make it known that the system does not work for them. Following years of campaigning, it comes as no surprise to women and those in the women’s health community that an overwhelming 84% of people felt their voices are simply not being heard when they seek health care.

By demonstrating an interest in women’s voices and their experiences, recognising failures in the system, and committing to developing a Women’s Health strategy, the Government has taken a positive initial step, albeit an ambitious one. There is no disease-specific focus and no target patient population, unlike other policy areas. This challenge affects 51% of our population and includes natural, life course events that women have, for many years, been told to just live with. With publication of the strategy imminent, the Government now need to demonstrate that they are willing to not only listen to women’s voices but to implement action based on what they are saying.

Women continue to face challenges when it comes to choices about their own bodies. Ongoing variation in access to abortion care, a full range of contraceptive choice, and a holistic range of menopause treatment options, all impact on women’s freedom to choose the treatments that work best for them. The Government’s commitment to prioritising the menopause in the upcoming strategy and cutting prescription costs for Hormone Replacement Therapies (HRT) in response to the Menopause Revolution campaign is hopeful. However, the Government’s initial attempt to reverse progress made in at-home abortion during the pandemic despite women citing a clear preference for this to continue, suggests more need to be done to prioritise women’s voices, choices and rights in practice.

In addition to not being heard, a fragmented system and the pandemic backlog have resulted in services that are increasingly difficult to navigate, leading to the most vulnerable falling through the cracks. Upcoming system reforms focusing on the integration of care offer opportunities to take a patient centered approach and reduce inequalities in outcomes. The Government is also expected to advocate for the establishment of ‘women’s health hubs’, which aim to enable access to all required care in a one-stop shop, in line with calls from advocates including the Primary Care Women’s Health Forum and Royal College of Obstetricians and Gynaecologists. Despite the promise of better integration locally, fragmentation is continuing at a national level. Abortion has been removed from the Women’s Health Strategy and is expected to feature in the upcoming Sexual Health Strategy. With a wider interest in health inequalities, the Government must recognise the connection between these elements of healthcare and align planning nationally to support local areas to integrate care.

Committing to a women’s health strategy is a promising step in the right direction for this Government and has offered women long overdue hope. Action in response to prominent campaigns, such as the Menopause Revolution, to change the way women can interact with the system allow us to believe that the challenges women have faced for far too long could be overcome within their lifetime.

The Government have a real opportunity to ensure women have their voices heard. To do this, they must recognise the challenges they face, capitalise on system reforms to integrate care, collaborate with the women’s health community, and most importantly, commit to funding appropriate and immediate action. In a health system and economy designed by and for men, the time for meaningful, impactful change, is now.

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Battle stations: reflections on the Government’s War on Cancer announcement

When the Conservatives were re-elected in 2019, it was on a manifesto that mentioned cancer in only two specific commitments: the expansion of the Cancer Drugs Fund and the rollout of cancer diagnostic machines across 78 hospital trusts. And yet, at the beginning of February, the Government used World Cancer Day to declare war on cancer, announcing a sweeping consultation for a new 10 Year Cancer Plan for England, designed to “radically improve” outcomes for cancer patients.

There is no doubt that the COVID-19 pandemic has had a significant impact on cancer diagnosis and care, so, despite the surprise nature of the announcement, it’s hard to oppose the Government’s decision to intervene. What isn’t clear yet is the extent to which this will be a wholesale reform backed by serious funding commitments, or a rehash of existing policies in the 2019 NHS Long Term Plan and the 2015 Cancer Strategy for England.

The announcement shows the Government’s intention of taking the reins on cancer policy, and making it political. Following months of political unrest and serious concerns about the elective care backlog, this allows the Government to set its long-term intentions. By making cancer a political priority, the Government and NHS can be held to account on the impact of reform, ensuring delivery against commitments. This is likely to be central to the purpose of the Cancer Plan and will help to give momentum to a programme of change.

It is essential that funding is adequate to achieve targets at an extremely challenging time. Patient groups, who have witnessed years of rhetoric yet insufficient progress, are cautiously optimistic, rightly concerned that years of underinvestment and understaffing will mean that however great the commitments are, the resource to achieve them will not match.

We have also witnessed this week The Treasury being more muscular on making stipulations attached to funding commitments. The tense stand-off with Department of Health and Social Care (DHSC) over the Elective Recovery Plan may indicate what’s to come with the Cancer Plan, with the Treasury not keen to loosen the purse strings for wooly ambitions.

Whether the Plan, when published, is a total reset or momentum for existing policy in a new format, the potential for real change in the diagnosis, management and treatment of cancers is certainly closer.

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NHS outsourcing to the independent sector: politicians vs the public

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What can we learn from the proposed NHS Standard Contract for 2021/22?

What can we learn from the proposed NHS Standard Contract for 2021/22?

NHS England has published a consultation on its proposed changes to the NHS Standard Contract for the financial year ahead. The final document will be used by Clinical Commissioning Groups and NHS England to contract for all healthcare services bar primary care. The focus of any changes often provides important insight into system priorities for the coming year and the strength of conviction behind them.

With 2021/22 set to be another uniquely testing year for the NHS, one might expect measures to mitigate the impact of COVID-19 to dominate the contract. Instead, there is a sense of defiant ambition, with clear signals for providers to push on with other key NHS and government priorities.

With this year’s consultation now live, here are four key takeaways for the year ahead:

 

1. Don’t get left behind as the NHS pushes on with system transformation

The Contract for 2021/22 shows that NHS England is not letting up in its push for system transformation. It includes several steps to establish more collaborative relationships between commissioners and providers, the most symbolic of which is the removal of financial sanctions for providers that fail to achieve national standards.

This is a significant step towards reversing the transactional, almost adversarial relationship that has proliferated between commissioners and providers over recent years, instead encouraging more collaborative system-level action to identify and address the causes of poor provider performance.

The cogs of system transformation are well and truly turning again so engagement with NHS leaders will need to focus on how to support the achievement of their newly framed outcomes in the most direct way. Additionally, the prospect of major health legislation is looming large for the first time in almost a decade, providing an important opportunity to think bigger picture.

 

2. Get serious about delivering ‘Net Zero’

In October, NHS England published its report on Delivering a ‘Net Zero’ National Health Service, which set out the interventions required to achieve just that, ‘Net Zero’. Yet, the report itself had no legal standing on which to enforce its recommendations or incentivise action.

The inclusion of stronger targets on the reduction of harmful greenhouses gases and air pollution in the proposed Standard Contract for 2021/22, and a requirement for providers to identify board-level officers accountable for delivering ‘Net Zero’ commitments, is a clear indication that NHS England is serious about driving this agenda forwards.

The NHS will increasingly expect everyone who works alongside it to demonstrate that they are also serious about reducing their environmental impact. Medicines, medical devices, services and care pathways can all be made more sustainable. Clearly communicating what you are doing in this space could start to deliver a commercial advantage as pressure builds on providers and health systems to make rapid progress.

 

3. Offer a helping hand on health inequalities

Commitments to reducing health inequalities have been somewhat of a stalwart in NHS policy over recent years. The delivery of coordinated programmes at a local level that actually move the needle have not been so common. This was brought into stark relief by the disproportionate impact of COVID-19 on people of Black, Asian and Minority Ethnic backgrounds.

To create greater accountability at a local level, it is proposed that the Contract include a requirement for each provider to identify a board-level executive responsible for overseeing their actions to address and reduce health inequalities. With broader government and public focus on health inequalities brought on by COVID-19, the pressure on these individuals to demonstrate progress will be palpable.

Those working alongside the NHS should place increasing focus on how they support providers and health systems to address health inequalities. At a time when resources are stretched, we may find that some are actually more open to industry support in delivering staff training programmes, new capacity or improvements to patient pathways, but they’ll have to be able to justify the time investment. Demonstrating how you can contribute to reducing health inequalities could help to secure support for your joint working projects.

 

4. Communicate the benefits of remote consultations and management

Following the rapid up take of video and telephone outpatient appointments during COVID-19, the NHS is now trying to cement their use into everyday clinical practice by requiring all providers to offer patients (where appropriate) a choice between remote and face-to-face consultations. The hope is that this choice will be maintained in primary care too, where uptake of remote consultations has also rocketed.

However, to truly support clinicians and patients to select remote consultations in the long-term, the NHS will need to place additional value on health technologies that support effective remote monitoring and management.

Before some slip back into old habits, the wider health sector can play a role in crystallising broad clinical support for this new way of working. Arming your field force and spokespeople with clear, real-world evidence of how your technology is reducing the need for labour intensive, face-to-face clinical interventions could provide clinicians with the confidence to continue their transformation.

 

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A viral epidemic is becoming a mental health epidemic, but does the Long Term Plan need a rethink to cope?

Just 18 months on from the launch of the NHS Long Term Plan, is it already outdated when it comes to mental health?

As the focus of health policymakers moves from coping with COVID-19 to catching-up care across all conditions, attention is increasingly turning to the mental health catastrophe we face.

The challenge is not only stark for people living with mental ill health. It also threatens the carefully-laid strategy put in place before the pandemic struck.

Improving mental health care was at the heart of the Plan, with a promise to “deliver the fastest expansion in mental health services in the NHS’s history”. The ambition to finally establish parity with physical health was supported by significant funding across acute and community support.

But COVID has moved the goalposts and cut the game time. For this reason, the NHS can’t simply pick up where it left off with the mental health aims in the Plan. Somehow now it must go much further, and faster.

The impact of COVID-19 on mental health

It is clear that the pandemic is both a cause and compounder of mental illness.

Broadly speaking there are now two groups of patients with considerable and potentially long-term needs:

Firstly, those who already had and were undergoing treatment for an existing mental illness. COVID-19 lockdown restrictions have made access to primary services, support and therapies more challenging. It is likely that this has led to relapses and more acute mental health needs.

A recent survey by Rethink Mental Illness found 80% of people living with mental illness say the crisis has made their mental health worse. Almost half surveyed have struggled to access services.

Secondly, there is a wave of new patients who have developed mental illness as a result of COVID-19 and the lockdown. Triggers are wide-ranging, including stress regarding job insecurity, grief, isolation and anxiety over the future. There are also particular concerns over the long term impact on young people.

Each group will have different needs, with a complex mix of therapies, treatments and support. But the modelling of mental health services within the Long Term Plan was not designed to cope with a spike in acute cases or for a whole wave of new ones.

Further, as the implementation of the Plan was still in its infancy when COVID struck, much of the work will have been disrupted or delayed at the least.

What does the response look like?

This emerging backlog and new wave of patients requiring care will exert a pressure on services that hasn’t been experienced before. The NHS therefore needs to rapidly reassess how to respond to the challenge.

For example, the Long Term Plan aimed to expand mental health support services for an extra 345,000 children and young people aged 0-25, including through schools and colleges. Following months of school closures and the risks faced by vulnerable children, that number will now need to be much higher and rolled out with greater urgency. This is an additional and complex challenge for headteachers facing already unprecedented difficulties as schools look to reopen.

The ambition to expand community and hospital services, including talking therapies and mental health liaison teams is also a core part of the Long Term Plan’s aims. This has been seen as a long-overdue measure to provide the appropriate level of care for hundreds of thousands more people with common or severe mental illnesses. But policymakers and the health service will have to consider what a best ‘new normal’ and staffing levels looks like to ensure services can provide the levels needed.

There are glimpses of positives. NHS England has brought forward implementation of a 24/7 crisis helpline and announced extra funding for the mental health charities at the frontline of dealing with the COVID fallout during Mental Health Awareness Week.

Yet the money attached to mental health in the LTP is now superseded by the new situation. Undoubtedly more will be needed.

A new generation of political leadership

While not all will agree with Luciana Berger or Norman Lamb’s politics, Parliament lost two of its biggest mental health champions in December. New parliamentary mental health champions are stepping forward and they have an important job to play.

Promisingly, beyond COVID, mental health is the key health issue for parliamentarians. WA’s January survey of the new parliament’s health priorities saw mental health care emerge as MPs’ top priority for additional NHS funding, with two thirds choosing it as an option. But despite growing awareness of the looming mental health crisis, there has been little political focus on what needs to happen next.

It is essential that the progress made over the past few years in mental health doesn’t fall to the wayside because of COVID. A rapid review of the Long Term Plan – with a COVID lens – backed up by sufficient funding and implementation, is needed to stop the viral health epidemic becoming a mental health epidemic.

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After COVID-19, what next for cancer services?

Thousands of cancer patients are missing. Many patients are having appointments delayed or cancelled, others simply aren’t seeking help. There is growing unease over the implications.

And so the direction from the centre is clear – getting cancer services back up to pre-pandemic levels is a top priority for the health service.

How this will be achieved remains to be seen, with many remaining unknowns around how, when and which services and standards will be brought back.

As the health system starts to piece together a path towards the new normal, we provide a recap of the key decisions made during the pandemic and some of the remaining questions that will be playing on the minds of those tasked with delivering the cancer recovery.

A pause on the 28-day faster diagnosis standard (FDS)

Due to be rolled out fully from April 1st, NHS England and Improvement cancer leads confirmed that implementation of the FDS would be put on hold indefinitely. While providers have been asked to continue sending data, they will not be expected to meet the 75% threshold and no data will be published until at least July.

Cancer providers will be anxious for further guidance over expectations when the NHS formally enters the “recovery” phase. With the need to maintain surge capacity alongside an anticipated backlog of pent-up demand for cancer services, there will be tough decisions to be made over how much leeway can be allowed for services that will undoubtedly continue to be stretched thin over the foreseeable future.

Maintaining impetus on early cancer diagnosis in primary care

The re-worked primary care network (PCN) contract for 2020/21 pushed back the start date for the Early Cancer Diagnosis service specification from 1 April to 1 October, while urging PCNs to “make every possible effort” to begin work earlier if possible.

This plaintive request from the centre was no doubt made against concern over the impact of the suspension of all cancer screening programmes. Together with screening, the service specification is integral for achieving the Long-Term Plan ambition to diagnose most cancers at an early stage.

It includes considerable administrative asks of PCNs, including a rigorous review of their referral practice and targeted action to improve the uptake of cancer screening services. Whether this can feasibly be done amidst the current situation remains to be seen. With no further signals on the resumption of the cancer screening programmes, much depends on PCNs’ ability to drive progress on this front.

Accelerating the roll-out of Rapid Diagnostic Centres (RDCs)

Many RDCs across the country have continued to operate during the pandemic, and NHS England has recognised their potential to support the COVID-19 response with guaranteed funding flows as required. The pandemic has accelerated the introductions of innovative approaches to manage referrals to RDCs and avoid hospital attendances, which may well continue well beyond the current crisis. At the same time however the submission of RDC management information has been paused, as has the planned national RDC evaluation exercise.

As services begin the task of bringing referral and diagnostic activity back to pre-pandemic levels, the expectations of RDCs will be high – the challenge will be to ensure that their learnings and good practice can be shared effectively across the system.

Continuing uncertainty over shielding

Little has been said officially over whether individuals who have been advised to shield during the pandemic, many of whom are cancer patients, will be asked to continue isolating in the coming weeks and months. Reports of recent communication by text message with those on the shielding list has indicated that some individuals are being removed from the list, although nothing has been announced on the rationale behind this decision or which groups will be affected.

Cancer Alliances have reported significant falls in 2WW referrals for suspected cancer, with anecdotal reports of some patients refusing to attend for fear of infection. Any continued ambiguity in the official advice will only exacerbate the concerns of vulnerable patients and will need careful management in order to ensure that cancer patients are receiving appropriate treatment and support.

Responding to the pandemic required rapid changes to cancer services and the necessary suspension of initiatives that were just gathering momentum before the crisis hit. What’s clear is that the task of piecing cancer services back up to pre-pandemic levels is just as complex, and there is a lot of remaining uncertainty as to where and how priorities should lie.

 

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What does no deal risk losing in the NHS Long Term Plan?

In launching the NHS Long Term Plan, Theresa May promised stability amidst all the instability. Key headlines include half a million lives over the next ten years to be saved through preventing diseases such as strokes and heart disease, and true efforts to bring parity to mental and physical health.

But with fears increasing that Theresa May is ‘thinking the unthinkable’ and seriously considering a no-deal Brexit, key policies within the Plan could be at risk before they’ve even begun. Here, we focus on four areas underpinning the Plan that are at risk from a no-deal Brexit:

  1. The money behind the Plan

Before the Plan came the financial commitment: £20.5 billion more for the NHS over the next five years.

But as Bank of England Chair Mark Carney said last week, “A no-deal would be an economic shock for this country.” The UK economy expanded in 2018 at its slowest annual rate in six years, and a no-deal Brexit could continue, or even worsen this. Under World Trade Organisation Tariffs, the UK could have more expensive imports, less demand for exports and potentially cause a greater reticence from the government to borrow at what will inevitably be higher rates.

Simply put, no-deal is likely to give the Treasury less spending power and flexibility.

Due to a fortunately timed windfall from higher than expected tax income, the Plan’s funding is supposed to be guaranteed. But any major hit to Treasury revenue could mean that the designated budget must be drawn from elsewhere. It will have to be raised through increased taxation, borrowed, or moved from other departmental budgets – highly contentious when other public services will inevitably have to undergo (further) cuts.

  1. Relieving pressure on hospitals by increasing care in community settings

A major pillar of the Plan is for more patients to receive care in primary and community settings, rather than in hospitals. This has been a longstanding ambition of this and previous governments but has been notoriously hard to deliver.

An extra £4.5 billion a year has been ringfenced for the increase in primary care capacity and shift to a more integrated approach. But reducing hospital care also relies on effective and complementary social care services, the often-ignored, yet critical part of the puzzle. As Simon Stevens has reiterated many times, a failure to deliver on social care will lead to a failure to achieve on the Long Term Plan.

Yet the long-awaited social care green paper has been delayed because of Brexit. Current thought is that it will land in April. But a no-deal will inevitably change the scope once again or even delay the Green Paper indefinitely.

Ideas rumoured to be considered for inclusion, such as tax incentives for young people to save for their social care, will have to be reconsidered against what will be politically palatable and financially necessary following a hard Brexit. With this further delay, the risks grow that social care reform will once again be kicked down the road.

  1. Increasing the NHS workforce

There has already been plenty of criticism at the Plan’s lack of focus on workforce, which is understandably seen as a critical tenet of its successful delivery.

The BMA has repeatedly highlighted the risks of the high level of vacancies in the NHS’s workforce. Ruth May, NHS England’s new Chief Nursing Officer, reiterated the point in her first interview. For a sector already struggling to cope, a no-deal exit would make this challenge even more acute.

At almost 70,000 individuals, the current number of EU nationals working in the NHS is staggering. Any reduction in this number would hit services hard, and undoubtedly reduce the ability to deliver appropriate, and necessary levels of care.

Under pressure from NHS leaders, a workaround has been agreed. In the event of a no-deal, EU citizens coming to the UK will be permitted ‘temporary leave to remain’, giving them the same rights they have now.

But note the ‘temporary’ aspect, which is crucial. It grants permission to stay for just three years and with no extension ability. Applying for Indefinite Leave to Remain or a Tier 2 Visa are the only other routes, undoubtedly acting as a deterrent to many.

Even if a deal is agreed, the workforce questions are likely to remain. All eyes are on the Workforce Implementation Plan proposals, expected in early April, and the eventual full Plan within two months of the Comprehensive Spending Review.

  1. Improving outcomes for all major conditions

While improving outcomes for major conditions relies on multiple, complex factors, a key factor is to ensure patients receive the right care at the right time.

This necessitates uninterrupted access to treatments and therapies. The Department of Health and Social Care (DHSC) and NHS England have been keen to reassure the public that there will be no interruption to medical supply, no matter the exit scenario. Huge sums have been spent testing scenarios and creating contingencies by industry and government to ensure continued access to medicines. But questions remain over the ability to maintain supplies in a volatile, hard Brexit scenario.

Diabetes UK and JDRF last week published a joint statement calling on the Government to provide more detail on access to insulin in the event of a no-deal. And today, HSJ has a splash from the Royal College of Radiotherapists, saying that if a no-deal Brexit delays the import of radioisotopes NHS trusts will have to prioritise which patients receive cancer treatment, meaning some cancer treatments may be delayed.

While the necessary customs forms and transport arrangements will undoubtedly be prioritised and agreed relatively swiftly, this is unchartered territory and a no-deal Brexit will test the preparedness to the limit. The potential impact on patients in the meantime is highly concerning.

The Long Term Plan has been one of the few glimmers of domestic policy success for Theresa May’s battered government. While considered challenging to deliver, there is optimism in and across the health sector that progress can be made. However, there are growing concerns that a no-deal Brexit risks destabilising many of the Plan’s core ambitions, potentially undermining it from the offset. Providing stability amongst the instability may not be straightforward after all.

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Winners and losers from the NHS Long-Term Plan

The launch of the NHS Long-Term Plan is intended to set the direction for NHS policymaking for the next 10 years. The 134-page report signals a shift in priorities and an evolution of focus. As always, this means winners and losers.

As the dust begins to settle on yesterday’s plan, we take an early look at the beneficiaries of this plan, and areas left out in the cold.

Winners:

Primary and community care networks – the new poster child of the NHS?

In line with Matt Hancock’s own priorities, prevention was the buzzword in advance of the official launch, and the expanded role of community care was borne out in the detail. One of the centrepieces of the plan is the roll out of primary care networks (an evolution of the GP Federations) backed by £4.5bn of funding by 2023/24 to deliver meaningful integration at the community-level. Out-of-hospital care is once again the name of the game for NHS planners – although this longstanding ambition is notoriously hard to deliver on the ground.

Mental health services – big on ambition, but challenges remain

As heavily trailed, mental health services for both adults and children figure significantly in the NHS Long Term Plan. Parity of esteem may finally be turning from words into action. Well known to be one of Theresa May’s pet policy areas, a number of eye-catching initiatives – such as mental health ambulances and services for 0-25 year olds – make it into the plan, alongside the renewed commitment for faster growth in mental health services funding against the overall NHS budget. However, realising the ambitions the plan sets out for the sector is unlikely to be plain sailing, given funding earmarked for mental health has failed to reach the frontline in the past and deep-rooted workforce and capacity issues remain.

Theresa May – an NHS plan a day keeps Brexit away

Yesterday’s announcement was – for once – a relative success for the Prime Minister. Having had to postpone publication from 2018, this was May’s opportunity to set the news agenda with important and ambitious domestic policy. Rather than another day solely dominated by a Brexit back-and-forth, she was able to come out with a proactive and positive message which, on the whole, has gone down pretty well.

Digitised GP consultations – the gardens of Babylon

Under the Long-Term Plan, digital-first primary care will become a new option for every patient within five years, drastically increasing the availability and uptake of services such as GP-at-hand. Good news for providers, but these services are not without controversy, and this move will not go unnoticed by the small army of clinicians on Twitter who describe them as untested and unsafe. As a vocal proponent of the digital approach, the inclusion of this measure is a win for the Health Secretary.

Global health recruiters – looking further afield for NHS talent

The workforce implementation plan, due to be published later this year, will have a major focus on recruiting NHS staff from overseas. An expansion of the Medical Training Initiative to ensure clinical trainees from around the world can learn in the NHS is being considered, while the government’s Immigration White Paper also gives the NHS more opportunities to bring in new talent from outside of the EU. However, the gaps are significant and growing, and there remain major question marks around the nursing and social care workforce when it comes to international recruitment.

Losers:

NHS managers – what’s another strategy among friends?

Nigel Edwards, CEO of the Nuffield Trust, reiterated his concerns about the capacity for rolling out such wide-ranging changes in an already stretched and reorganisation-fatigued organisation. For NHS managers, the Long-Term Plan represents yet another document to be implemented, in some cases with additional checklists and bureaucracy, at a time when the integrated care systems programme was just beginning to bed in. A new set of responsibilities and targets, alongside new uncertainty over the statutory role of CCGs, does little to ease the headaches of front-line planners and commissioners.

Local authority funding – the elephant in the room

Few in local government would have been under any illusion that the NHS plan would equate to a spending bonanza on social care and public health, but for all its warm words, the document gave scant comfort. Decisions over social care and public health funding have been deferred until the spending review expected in the spring, while services are desperately struggling to cope with demand. For a plan so focused on prevention, commentators have been quick to point out that local authority public health budgets continue to be cut. Floating a possible solution of reabsorbing some public health services – such as sexual health – back into the NHS is likely to irritate rather than comfort.

The life sciences sector – limited language on innovation in treatment

The Long-Term Plan launched with two clear messages – that decreasing demand is the aim and that prevention is better than cure. Primary prevention and earlier diagnosis has taken precedent over world-class treatment, with medicines featuring sparingly in the document. Pharma is well aware that the battles on pricing and access will take place elsewhere, but for industry already feeling under pressure in the UK market, mentions of the role of innovative treatment would not have gone amiss. Still, there are green shoots for anyone involved in genomics, and nods to the growing importance of precision medicines.

2012 Health and Social Care Act – another nail in the coffin?

The NHS plan represents another step towards unpicking the Health and Social Care Act. As requested, Simon Stevens (in consultation of course) spells out exactly which parts he would most like to remove through primary legislation, should the opportunity become available. The plan describes primary legislation as having the potential to ‘rapidly accelerate’ the progress on service integration as well as cut out counter-productive and bureaucratic competition and compulsory tendering processes. In truth, a Brexit dominated 2019 makes it very unlikely that MPs will have the chance to get their teeth into a health bill, so the existing fudge will have to do.

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