Comment Blog 7 January, 2019

The NHS Long Term Plan: different this time?

The NHS Long Term Plan is out.  For those of us of a certain age, a big NHS document brings back somewhat nostalgic thoughts of landmark NHS plans of former days.  Chatting to Dr Jennifer Dixon this morning in the Today studio (as you do), I said that the first one I remembered was the 2000 NHS Plan of Tony Blair and Gordon Brown. She trumped me with Working for Patients, all the way back to 1989, which impressed me a great deal.

This is a short blog in response.

The first point is that much of the spirit of the Plan is good and in line with thinking on NHS reform over many years, towards prevention and away from hospital-based care. Matthew Hancock will put a lot of store on the pledge to increase spending on GP services and other local services as a share of the overall budget. Similarly the plan commits to creating big, powerful GP practices that cover populations of up to 50,000, compared to the list of around 7,500 patients held by the average GP practice now. People have been arguing for such a change since the 2000s, including Reform’s most recent primary care paper.

What is inescapable, however, is that we have been here before. In October 2014, NHS England published the Five Year Forward View. That document had exactly the same vision as today’s i.e. a shift to prevention and a stronger primary care. Not a great deal has happened since. As the National Audit Office has reported, additional money for new services was swallowed by the old ones. To date, only 16 of the 44 NHS areas have sought to deliver the joined-up care envisaged in the Forward View, and it isn’t clear that those 16 are really changing the way that the Service works.

In some respects the Long Term Plan simply repeats the Forward View. One of the enablers of change would be a new funding system, which pays NHS providers according to the overall health of a population rather than levels of activity (for example, number of patients treated in a hospital).  The View promised that the NHS would provide “meaningful local flexibility in the way payment rules… are applied”. The Plan promises to “increase flexibility in the NHS pricing regime.” Plus ca change.

The question raised by all this is, will the NHS deliver on the Long Term Plan? Why should this plan get traction when the (very similar) last one didn’t?

This uncertainty may explain why Philip Hammond said some uncompromising things in his article today (“But with this financial backing – that can only be afforded as our top spending priority – comes responsibility. The leaders of the NHS must now get on and deliver.”)

It may also explain why the NHS has received much less money from the Government than it was asking for.

The NHS could take a leaf out of another Government department’s book. The Ministry of Defence published annual, independent reviews of its major strategic change at the beginning of the decade. Quarterly updates of key reform metrics would build confidence and help to show that this Plan really is different this time.