E-scooters at a crossroads
E-scooters at a crossroads

Winners and losers from the NHS Long-Term Plan

Words by:
January 8, 2019

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.


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.


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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