08 January 2019

The new NHS long-term plan sets a largely sensible direction of travel, argues Chris McNulty. But by itself it will not solve the NHS’ biggest issues.

According to the NHS reform plan, the NHS of the future will care for us in an integrated, holistic way. Frustrating barriers between GPs, hospitals, and providers of long-term care will be broken down. Everyone who wants to will be able to access health services online.

This is surely the right direction of travel for the NHS, more suited to the needs of an ageing population with more chronic illness, which is also literate in using digital technology. But while this statement of intent is to be welcomed, it will take a lot more than this plan to deliver it.

The extra money for the NHS is probably not enough

The plan had a challenging remit. It needed to show how the 3.4% real-terms annual funding increase announced in June would be used to deliver a recovery of hospital performance in the face of rising demand, the reform that the Treasury believes the health service needs, and some new goodies for the Prime Minister to announce. 

This was seriously ambitious. Last year, the Institute for Fiscal Studies and the Health Foundation concluded 3.3% real-terms annual increases in health spending would only be enough to meet demand and maintain services at their current standards and nothing else: no reform, no improvements.

To square this circle, the plan promises annual cash-releasing productivity improvements of 1.1% a year. This compares to the average 1.4% a year increase that the ONS estimated took place between 2009 and 2015. But 2019 is a very different world: after eight years of spending constraint, many of the easy efficiencies have already been squeezed out.

The planned changes will take time and will not save money quickly

Two major themes in the plan are ‘digital’ and service integration. Both could deliver improved patient experience, and even savings. But neither will do so quickly. These are plans for the long term but in the meantime, existing pressures will mount.

The plan boldly dismisses cynicism of big promises about technological change, but is also overly optimistic. It claims that making online GP consultations universally available, alongside other digitally-enabled changes, will save the NHS £1.1 billion a year by some unspecified future date. But online consultations will not have immediate widespread pickup: despite the wider availability of telephone appointments only 9.3% of patients reported having a telephone consultation in 2018.

Similarly, the plan promises that Integrated Care Systems – which facilitate cooperation between different publicly-funded health and social care services (from GPs and acute hospitals to in-home social care) – will cover the whole of England by 2021. This should help make more efficient use of resources to meet the needs of local populations but joining up these services is difficult and takes time. The predecessor to Integrated Care Systems – so-called Sustainability and Transformation Partnerships – have demonstrated varied progress across the country. Even if implemented quickly and effectively, care integration may not necessarily reduce costs immediately. As the Health Select Committee has reported it is likely to uncover unmet need, and in the short term may even increase costs.

The plan is an NHS answer to broader problems

Some of the determinants of the plan’s success are beyond its remit: NHS England is not responsible for social care, public health or training its workforce, which are therefore not included in the plan. Their absence is a major flaw, but (mostly) not the NHS’ fault.

The Government is aware of the pressures that growing unmet need from the strained social care system is putting on the NHS. But it missed the opportunity to pair this NHS plan with a proper funding settlement and reform strategy for social care. The Health Secretary has said that the long-promised social care green paper will be published soon; but this will be a much lighter consultative document than the full-blown NHS plan.

The sequels will be better

The plan is not a failure in itself. But it is unrealistically ambitious about what can be achieved in a short space of time and it relies on the Government tackling the much more politically contentious area of social care.

The coming social care green paper, workforce strategy for the NHS and Spending Review will provide some of the answers for which the NHS is waiting. The plan for the implementation of the NHS long-term plan – expected in the autumn – should take these into account. Until then, the Government should be frank and realistic about what the public should expect the NHS to achieve on its own, and what the extra money can and can’t buy.

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