How will the Long-Term Plan change the NHS?

In January 2019, the NHS long-term plan was published, outlining the key ambitions for service over the next 10 years. What are the major commitments in the plan and what does this mean for the NHS in the next decade?

As we discussed in Week 3, the NHS has experienced significant financial pressures in the last decade. Funding cuts in health and social care alongside staffing shortages, a rise in demand for services and the cost of these services have all combined and added to these pressures. This all adds up to a decline in NHS performance, with waiting time targets being missed and a squeeze on hospital finances.

In June 2018, the government announced a new funding deal for the NHS: an extra £20.5 billion, spread over the next five years. On average, this will be a 3.4% increase between 2019/20 and 2023/24, which equates to a £20.4 billion increase over this period.

To unlock this additional funding, the NHS was asked to develop a long-term plan which outlines how this money will be spent. It’s important to stress that this extra funding only applies to NHS England’s budget. This means that some important areas of NHS spending included in the Department of Health and Social Care’s budget – such as education and training – are not covered by it. Local authority public health spending and social care are also excluded. Consequently, it is a plan for the NHS, not the whole health and care system.

In the past decade, financial pressures were among the biggest challenges for the NHS. Now that these pressures have been alleviated to an extent with the funding deal, the most pressing concerns for the service are the workforce shortages. In England, there is a shortage of more than 100,000 staff and this is already having an impact on care and staff experience.

The long-term plan sets out aims to reduce the number of vacancies in a range of ways:

• increasing the amount of university and training placements available for nurses and doctors
• introducing more accessible routes into health care, such as online degrees or apprenticeships
• training more staff domestically so that the NHS is less reliant on overseas staff
• a shift towards more generalist roles to reflect the growth in patients with multiple long-term conditions
• a more diverse range of professional roles within general practice, so that other health professionals such as pharmacists or physiotherapists become part of GP teams.

Perhaps the most striking commitments in the plan relate to the focus on some particular medical conditions or services such as cancer, heart disease, child health or mental health. These were chosen for their impact on the population’s health and where outcomes lag behind the performance of other comparable countries.

• Cancer: the plan outlines the need for faster and earlier diagnosis of cancer in order to improve cancer survival rates. In 2020, a new waiting time target will be introduced which requires that most patients will get a clear ‘yes’ or ‘no’ diagnosis for suspected cancer within 28 days of referral.

• Maternity care: the plan’s ambitions build on previous policies which aimed to halve the amount of still births, death in childbirth and brain injury in newborn babies by 2025.

• Child health: increased levels of support for children with learning disabilities and autism and improvements to children’s mental health services form are some of the key commitments in the plan.

• Mental health: funding for mental health services will be protected and will increase by at least £2.3 billion a year by 2023/2024. This will help to create a more comprehensive emergency mental health service and improve therapeutic environments for patients.

• Early detection of disease: the NHS aims to prevent up to 150,000 cases of heart attack, stroke and dementia over the next decade by improving diagnosis and care in these fields.

The plan is not only focused on improving care in particular areas or for specific conditions. It is a broad blueprint for the future of the NHS and so takes in other factors such as the role of patients, new technologies and the need for a more joined-up approach to keeping the nation healthy. Over the course of this week, we’ll be discussing some of these other factors.

This article is an amended version of The NHS long-term plan explained.