Labour’s 10 Year Health Plan: familiar ideas could be frustrated by familiar problems

Let’s start with the good news. For all the talk about change, there is an essential and highly welcome continuity with the aim of NHS policy for at least the past decade (and arguably for much longer). That is for far better integrated care.

Indeed, anyone wanting to know what the vision for the NHS is could save themselves time by reading the rather more elegantly written 41-page Five Year Forward View from 2014 ⁹ https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf  rather than the slightly clunkier 168 pages of this week’s Fit for the Future. ¹⁰ https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future/fit-for-the-future-10-year-health-plan-for-england-exec…

Integration by any other name

Some of the terminology differs but the ideas are the same. Care closer to home, either at home or in new Neighbourhood Health Centres. The possibility – likelihood – of a big hospital taking over the whole of its area's health budget, primary and community care included, in the belief it will spend it better: an Accountable Care Organisation in the 2014 paper’s (somewhat American-inspired) language, an Integrated Health Organisation in this one. 

Also trailed are a big upgrade in prevention and public health, patients given more control over their own care, and the promise – yet again – that spending on primary and community will grow faster than spending on hospitals. These are all entirely good things, and many follow the Institute’s recommendations.

Plans for an AI ‘doctor in your pocket’ app could be transformational

The one big difference between the two documents is the huge weight in Fit for the Future being put on the NHS app and on artificial intelligence to transform the patient experience – neither the app nor anything seriously recognisable as AI being around in 2014. The app will, readers are told, include a “doctor in your pocket”, full access to one’s medical record, the ability to book appointments and choose where to go (informed by league tables of NHS performance), plus the ability to self-refer for local tests and services and communicate directly with health professionals. 

That would indeed be transformational – if it can be achieved, and if the resources are there both for that and for the long-promised (and yet again promised) single electronic patient record that patients and staff can view from any setting.

Both will require capital, and the question of capital haunts the document. The NHS app and the Neighbourhood Health Centres are the document’s core, and the latter will “require new infrastructure in the community”. Yet NHS capital is being frozen from next year and while the plan talks hopefully about new forms of public/private partnership to fund these new centres, such ideas have yet to get past a sceptical Treasury.

The new plan revives several old ideas, and puts forward some odd new ones

As with Labour in the 2000s and the coalition in the 2010s there is, yet again, an aim to get all hospitals to foundation trust status, this time by 2035. It will be a “re-invigorated and re-invented model”, with the document displaying no curiosity as to why the target of “every trust a foundation trust” failed before, or, indeed, why the latter’s freedoms became progressively curtailed. Important questions remain about just how this new model will operate. ¹² https://nhsproviders.org/resources/ministers-are-promising-to-reinvigorate-fts-here-s-what-they-need-to-think-about

There are plenty of good ideas, not many of them new. There is another attempt to introduce a “best practice” tariff so that hospitals are paid for the quality of their work, not just for activity. There are promises of longer-term financial planning, and of new financial flows that will help get money out of hospitals and into the community, including possibly a “year of care” payment for individual patients. All potentially good stuff, but stuff that has yet to be devised.

There is the odd dotty idea. A pilot is planned in which patients will be contacted after their treatment to be asked whether it was good enough for the hospital to be paid the full cost of the procedure. What could possibly go wrong with that? Fortunately, as a pilot, it will be possible quietly to forget about it. And what is, of course, massively missing is any reform of a desperately underfunded social care system on which the NHS relies.

There is some risk that history may repeat itself

Nevertheless, the 10-year plan deserves a fair wind, even if much work is still needed on how these changes will come about in practice. That “how”, however, is having to be drawn up not just the department but by an NHS England that is in the process of being abolished, halved in size and merged into the Department of Health and Social Care. Similarly, the local health bodies that will have to implement at least some of this – the Integrated Care Boards – are also losing half their staff as their role changes. 

In the 2000s, some real progress towards better integrated care had been made but this was knocked way off course by Andrew Lansley’s mighty 2013 reorganisation of the NHS. Streeting’s revamp of the NHS superstructure is not as big as that. But it must carry a risk that it will both divert attention from these grand plans and slow them.