28 Jun NHS Long Term Plan: Refresh or Reset?
Best laid plans…
In 2019, NHS England published the Long Term Plan. The plan was the policy and delivery blueprint for the NHS for the decade to come. The ambition was to transform care pathways, invest in prevention, deliver improvements in care quality, revitalise the workforce and upgrade outdated technology – all while maintaining sustainable finances.
The plan was not without its limitations – perhaps most obviously on workforce – but it was nonetheless a significant achievement, building on the approach of the Five Year Forward View and securing buy-in from NHS leadership and government.
Then a novel strain of coronavirus emerged in China.
Ctrl + Alt + Delete
Through the pandemic, the challenges facing the NHS have been cast into ever sharper relief. As the organisation tries to “recover”, there is a clear need to restart the Long Term Plan to address these challenges.
But much has changed since 2019. Simon Stevens, former NHS Chief Executive and the driving force behind the Long Term Plan, has been replaced by the more delivery focused Amanda Pritchard. Changes have been seen in government too, with Matt Hancock replaced by Sajid Javid.
There has been change too, at operational levels. New service models and technologies which might once have taken years to implement, were rolled out in days or weeks. ICS’s, a bold new idea in 2019, are now well established in practice, and only days away from legal status.
Plus ça change, plus c’est la même chose?
The question, then, is how far the refreshed plan represents a departure from what went before. A first glimpse of this was provided by the HSJ on Friday.
Most of the new “strategic developments” around which the plan is built – joined-up community care, quality improvement, enabling staff to thrive, tackling health inequalities and using every pound wisely – mirror 2019 priorities. However there are a few outliers.
First, there is no longer a strategic focus on digital. This might be taken as reflecting the departure of Hancock, an avowed champion of tech in healthcare. But given the key role of virtual clinics, remote consulting and other digital tools in the pandemic response, and the inclusion of “better use of data” as an area of opportunity, it seems more likely that data and digital transformation will instead be a golden thread running through other priorities.
The second obvious change is the inclusion of a new priority to “transform access to urgent, emergency and planned care”. Of course, the pandemic created huge backlogs of care, transforming access into the political priority for healthcare. It is almost unthinkable that any NHS strategy would not include a focus on access. Addressing access is “table stakes”, if you want to play the game of NHS strategy.
A fresh coat of paint
All of which is to say that the 2019 plan probably identified the right priorities and that, had the plan been implemented only a few years sooner, the NHS might have been in a stronger position to respond to the pandemic.
More significant than how the content of the plan is altered may be what underpins it. In short, not very much. If HSJ reporting is correct, the refresh will not be accompanied by extra funding. Concerns have been raised as to whether the plan will adequately address the scale of the workforce crisis now facing the NHS.
Perhaps, then, it is helpful to think of the Long Term Plan refresh as a rebranding exercise; an attempt by new management to make their mark, even while recognising there is little more that can be done until these core challenges have been addressed.
As for whether the new plan will meet the moment? Only time will tell.