In this feature, Thoreya Swage, Healthcare Consultant, explains the process for developing the 10-year NHS Plan.

Background

In June 2018, the then Secretary of State for Health and Social Care, Jeremy Hunt, secured extra funding as a 70th birthday present for the NHS in England. This funding (£20 billion) is to cover the next five years. In return, the NHS was asked to develop a plan for the health service to cover the next 10 years. The plan was to be developed from the bottom upwards with wide consultation including the involvement of patients and the public, be “clinically-led” and to be ready for November 2018. This article describes the latest progress in the development of the plan.

There is an expectation that the plan would be simple in its ambitions such that the tasks identified are deliverable and continue on a course of integration. Annual milestones, such as development of patient records or reduction in trust/CCG deficits will be sought to demonstrate progress. The NHS is also encouraged to make suggestions as to how the legislation could be changed to permit continued development of services, eg through the development of integrated care systems.

What are the overall priorities?

When announcing the extra funding, the Prime Minister identified the following priorities to be covered in the plan.

  • Delivering the performance standards, ie the A&E, cancer and referral to treatment (RTT) waiting times.

  • Securing the progress made in the quality and safety of care.

  • Improving cancer care outcomes so that they are the best in Europe.

  • Ensuring parity of esteem between physical and mental health through better access to mental health services.

  • Enhancing integration between health and social care ensuring that patients do not lose out when transferring across the different systems.

  • A renewed focus on helping people to have longer and healthier lives through the prevention of ill health.

In addition, five financial tests were set for the NHS to demonstrate how it would be put onto a more sustainable footing. These include:

  • enhancing productivity and efficiency

  • provider deficits to be eliminated

  • reducing variation in the system so that consistently high standards are delivered wherever people live

  • better management of demand for services

  • better utilisation of investment in capital.

How is the plan being developed?

There is an expectation that as many stakeholders as possible have an opportunity to have their say on the content of the 10-year NHS Plan so that they are able to shape the future of general practice, mental health services and acute care in England.

What are the areas to be covered within the plan?

The settlement covers NHS care only. In early August, a briefing from NHS England’s Long Term Plan Engagement Team was published, which detailed the different working groups that have been set up to address specific areas. The working groups comprise local and national system leaders, partners and stakeholders, who have been brought together to inform the final plan.

There are three working groups which cover:

  • life-course programmes

  • clinical priorities

  • enablers.

Working group

Topics covered

Key questions/issues concerning the topic

Life course programmes

Health prevention and inequalities and personal responsibility

  • Top priority for health prevention activity over the next 5 and 10 years

  • Top priority for tackling health inequalities over the next 5 and 10 years

  • Action to reduce preventable deaths, burden of preventable disease, better life expectancy and prevention within the NHS

  • Examples of innovative/good practice which could be applicable across England

  • Using personalised approaches to reducing health inequalities, eg patient activation, health literacy and personal health budgets

  • Measuring and monitoring the progress of health prevention and personalisation activities

Children and maternal health

  • Reducing stillbirths and infant mortality

  • Specific conditions, eg cancer and complex conditions/needs

  • Tackling childhood obesity and mental health

  • Ensuring that children with complex needs are not excluded or disadvantaged

Personalised and integrated care for people with long-term conditions and frail older people (including dementia)

  • Enabling people with long-term conditions to participate more fully in managing their health

  • Building proactive community multidisciplinary teams to enable people with complex conditions to remain well and to slow down the progression from moderate to severe frailty in older people

  • Defining good crisis care to prevent hospital admission

  • Identifying measures for good outcomes for people with various degrees of frailty

  • Better conversations on individual priorities and wishes at the end of life with patients and their carers

  • Challenges to improving support for people and their carers following a diagnosis of dementia

  • Top priority for support following a diagnosis of dementia

Clinical priorities

Mental health

  • Top priority for meeting mental health needs over the next 5 and 10 years

  • Identifying gaps in services and actions to deal with these

  • Ensuring that people with mental health needs have their physical problems addressed and similarly for people with physical needs having their mental health problems managed

  • Improving support for people with mental health needs

  • Ensuring that people with mental health needs have better control and choice in the decisions about their care and support

Learning disability and autism

  • Further actions to enhance the lives of people with a learning disability and/or autism such that they are happy, healthy and are enabled to live independently

  • Enhancing the experiences of people with a learning disability and/or autism such that they can access the full range of services they require in the NHS

Cardiovascular and respiratory conditions

  • Further action to reduce the incidence of cardiovascular and respiratory diseases

  • Priority actions over the next 5 and 10 years to improve cardiovascular and respiratory disease outcomes

Cancer

  • Top priority for improving cancer care and outcomes over the next 5 and 10 years

  • Tackling the variation in access to diagnostic services, treatment and care for cancer

  • Further action to enhance cancer prevention, earlier and faster diagnosis, better quality of life during and after treatment and overall experience of care

Enablers

Digital technology

  • Further actions for digital technology to improve patient care and experience, help people to manage their own health and care, improve efficiency of healthcare delivery

  • Learning from other industries on the use of digital technologies

  • Encouraging people to use digital tools and services

  • Ensuring that digital technologies and services do not increase inequalities

Workforce, leadership and training

  • Identifying the size and skill mix of the future workforce to deliver service improvements over the next 5 and 10 years

  • Support to staff to enable them to deliver the service changes

  • Attracting and retaining the staff needed by the NHS

  • Actions to enhance the health and wellbeing of staff and show employers how to create healthier communities across the country

Research and innovation

  • Increasing the participation of patients and carers in research into new medical technologies, medicines, use of genomics and approaches to care

  • Promoting the diversity of patients with different health and care needs involved in research

  • Enhancing the uptake of new innovations by staff

  • Promoting research in areas that are under represented

  • Actions to continue the UK’s lead in genomic medicine

Engagement of stakeholders, including patients

  • Increase the sharing of experiences by people to provide a more robust evidence base for the actions introduced under the long-term plan

  • Enhancing the feedback by the NHS on people’s input to shaping the decisions

  • Demonstrating that the NHS is the world’s biggest learning organisation

Primary care

  • Supporting patients to remain healthy and manage their own minor short-term illnesses and long-term conditions

  • Enhancing the working between general practice, pharmacy and hospital services to meet the urgent and long-term needs of patients

  • New and different professionals who could work in primary care

  • Integrating the prevention and proactive strategies of population health management into primary care activities

In addition, there are also three overall questions which have been posed covering:

  • identifying the core values to underpin the long-term plan for the NHS

  • local examples of better ways of working or good services that should be replicated across the country

  • barriers to improving care and health outcomes for patients receiving NHS services.

How will these working groups operate?

A key aspect of the development of the 10-year plan is ensuring that the advice and experience of experts both clinical and other stakeholders, which must include patient and public representatives, is incorporated.

Securing the engagement of all these stakeholders is necessary and will be running through the three phases of development.

  1. Seeking advice from key stakeholders — this would include meetings with the leaders of key stakeholders in order to elicit initial opinions and continued input to the process.

  2. Continued engagement of stakeholders — this would involve the co-development, refinement and testing of proposals for the plan.

  3. Engagement with staff on the frontline, patients and the public through the networks associated with NHS organisations/systems and stakeholders. This is to obtain wider views and confirm priorities for the plan.

There will also be some work on creating an “NHS Assembly” comprising representatives of staff from the NHS and patients, the role of which will be to oversee the implementation of the plan.

What is the timeline for this work?

The Government has indicated that the plan should be submitted by mid-November 2018 in time for the Autumn Budget. This means that there are three months in which to do the following.

Month

Tasks

August

  • Establishing stakeholder engagement to obtain views and commitment to continuing participation

  • Setting up the working groups and preparing for policy development and programme of engagement

September

  • Working groups to continue the engagement of stakeholders

  • Conducting engagement with staff, patients and the public through established forums and stakeholder networks

  • Initial policy proposals formulated based on stakeholder engagement

October

  • Working groups to test and finalise policy proposals through continued engagement with stakeholders

  • Policy proposals to be reconciled and prioritised across the working groups and aligned with the available funding

In parallel with this process, NHS England has just finished a consultation on two areas of primary care which will feed into the NHS Plan as well as informing the discussions on next year’s GP contract negotiations. They are a review on the Quality and Outcomes Framework and the effect of digital technology on general practice payments. The latter seeks view on payment reform to reflect emerging digital models of primary care without destabilising existing services.

The deadline for responses to these questions posed by the working groups is 30 September 2018.

What is not covered by the NHS Plan?

The NHS Plan does not cover Social Care or Public Health that both come under the remit of local authorities. However, an Adult Social Care Green Paper is planned to be published in the autumn of 2018 which is expected to identify options for system reforms and funding options.

Issues that have been raised by the NHS

There is no doubt that the priorities set by the Government for the 10-year plan are ambitious and some concerns have been raised by the NHS in response.

There is a clear steer from the centre to produce a plan that will be transformative with the delivery of healthcare to be not only efficient but also with a greater reliance on digital technologies. While the vision is right for the future, the NHS still has to grapple with the day-to-day demands of delivering care today. For the plan to be successful, there needs to be a balance between directing resources to future developments and current service delivery.

There is also a need to balance the number of priorities that may come out of each workstream through the plan development process so that overall there is collective agreement on the delivery of the overall priorities.

The plan is being developed in isolation of Social Care and some aspects of Public Health as the budgets for these areas sit outside of the settlement for the NHS that was announced in June.

Last reviewed 17 September 2018