Plan for the best, prepare for the worst?

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    Friday18Jan 2019
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    Highland Marketing argues the way to understand the NHS Long Term Plan is as a response to a series of stakeholder demands; but the good news is that it recognises they...

On 7 January, prime minister Theresa May took what must have felt like a welcome break from the Parliamentary turmoil over Brexit to launch the NHS Long Term Plan.

Standing alongside NHS England chief executive Simon Stevens at Alder Hey Hospital in Liverpool, she claimed its publication was a “historic moment” that would “secure the future of the NHS for generations to come.”

But to make sense of its 134 pages, the plan is probably better seen as an attempt to keep a lot of stakeholders happy; or at least on board.

Say thank you for the birthday present  

The need for another NHS plan became evident as soon as May found a “birthday present” for the NHS’ 70th anniversary last July.

In the race of sustained lobbying, she pledged an extra £20.5 billion a year for the NHS in England by 2023-24, with matching increases for Scotland, Wales and Northern Ireland.

At 3.4% a year (reduced by adjustments for inflation, pay increases, and cuts to training and public health budgets) this was a lot less than think-tanks, professional bodies and unions had been looking for.

Nevertheless, the government set five tests for the NHS to meet in return for its cash. The first two, inspired by the Treasury, are financial.

The plan promises an “accelerated turnaround process” for the 30 worst performing trusts in the country, plus a rebooted efficiency drive, to get hospitals back into balance by 2020-21 and the NHS into balance by 2023-24.

It also commits the service to generating productivity savings of 1.1% a year. But, as journalists noted, it doesn’t meet another Treasury demand, for the NHS to start hitting waiting time targets again (an issue that will have to be revisited).

Another reorganisation is underway

The other tests were to: reduce growth in demand, which the plan addresses at length in chapter two, with its focus on prevention and reducing inequalities; to reduce unjustified variation in performance; and to make better use of capital assets.

After that, its text gives most stakeholders something. Chancellor Philip Hammond was able to announce a mental health programme in his budget, and May was able to announce primary and community care investments in the run-up to Christmas.

Health and social care secretary Matt Hancock was able to announce a “digital first” approach to GP and outpatient services that captured headlines on the day. And Stevens was able to focus on rebooting the sustainability agenda set out in the Five Year Forward View in 2014.

This aimed to reduce friction and improve efficiency by moving towards population-level planning and budgeting, creating integrated health and care services, and delivering care closer to home.

The plan says what used to be called accountable care organisations and are now called integrated care services will be rolled-out across the country by April 2021, and the number of clinical commissioning groups will be reduced to one per ICS in most cases; significantly changing the customer landscape for IT suppliers.

Technology enabled at its heart?

The need to address different, and in some cases competing agendas leave references to health IT scattered across the plan; although the good news is that it recognises that none of them will be achieved without the creative adoption of new technology.

The main tech chapter, chapter five, focuses on supporting the Forward View agenda by outlining a new model for integrated care or personal health records at a local health and care record exemplar level, from which data can be extracted for population health management, research and other uses.

Patients will be able to contribute via a care plan, while a ‘new service model’ will see them using transactional health services via the NHS App or third-party applications using the NHS Login.

The digitisation of hospitals will be addressed via an extension of the global digital exemplar programme, an “accelerated” roll-out of electronic patient records, and new cloud offers. However, key details on architecture, standards, and indeed funding are missing (or, hopefully, to come).  

Pitfalls and hard choices ahead

There are plenty of other obstacles ahead to realising both the plan and its technology ambitions. NHS performance deteriorated in December, and the attention of ministers and senior managers is being directed towards Brexit.

Some think-tanks have argued that a lack of staff is now as big a threat to health and care as a lack of money; and there was widespread disappointment that the plan was not accompanied by a social care green paper.

Overall, reaction has been that the aims and goals of the plan look right: but there will be huge challenges in meeting them. Also, that if the NHS is to have any chance of doing that, what it needs now is a detailed, costed implementation plan.

A longer version of this article has been published on the Highland Marketing website. Highland Marketing also produced a detailed briefing on the plan and reaction to it for clients and prospects, that has now been made available via an online link. Receive more analysis like this by signing up to our Healthcare Roundup newsletter.

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