General debate on the NHS Ten Year Plan

NHS Long Term Plan

The Prime Minister asked the NHS in England to produce a ten-year plan to improve access, care and outcomes for patients, in return for a five-year funding settlement announced in June 2018. Under this settlement, the NHS England budget will grow on average by 3.4% in real terms each year from 2019/20 to 2023/24, increasing by £20.5 billion by 2023/24. The NHS Long Term Plan was launched on 7 January 2019 by Simon Stevens, the Chief Executive of NHS England, and the Prime Minister, at Alder Hey Children’s Hospital in Liverpool.

Chapter 1 of the Long Term Plan sets out how the NHS will move to a new service model to provide patients with more choice and support. This includes measures to improve out of hospital care and join up primary care with other community services.

Chapter 2 sets out action the NHS will take to strengthen its contribution to prevention and to tackling health inequalities, with a specific focus on:

• cutting smoking
• reducing obesity
• combating Type 2 diabetes
• limiting alcohol-related A&E admissions

Chapter 3 sets the NHS’s priorities for care quality and outcomes improvements for the decade ahead. The Plan builds on the NHS Five Year Forward View’s focus on cancer, mental health, diabetes, multimorbidity and dementia, and extends priorities for children’s health, cardiovascular and respiratory conditions, and learning disability and autism, amongst others.

Chapter 4 sets out how the NHS will build on existing work to recruit, train and retain more staff. It includes plans to address workforce pressure through improved working conditions and support for staff.

Chapter 5 covers how upgrades to technology will be used to enable digital access to NHS service, and improve clinical care and population health.

Chapter 6 explains how the funding settlement will be used to return the NHS to financial balance, improve productivity and manage demand.

Chapter 7 sets out next steps for reform. Sustainability and Transformation Partnerships (groups of local NHS organisations working with local councils and other partners) are expected to develop and implement their own strategies for the next five years. These strategies are due to be published in Autumn 2019 and will set out how they intend to achieve the ambitions included in the NHS Long Term Plan.

In a statement in the Commons announcing the NHS Long Term Plan, the Secretary of State for Health and Social Care noted that Baroness Dido Harding, Chair of NHS Improvement, is leading a programme to develop a ‘workforce implementation plan’. This is expected to report later this year (with interim recommendations expected by the end of March), and to cover broad themes including workforce, supply, culture and leadership.

A House of Lords Library Briefing on the NHS Long Term Plan, prepared in advance of a Lords debate on 31 January 2019, is available here.

As well as providing the following summary, the Lords Library briefing provides further background on NHS reforms since 2013, the NHS funding settlement, and reactions to the Plan:

The stated aims of the plan are to maximise the impact of the extra funding received as part of the Government’s five-year funding plan, tackle the pressures currently faced by NHS staff and take advantage of new health technologies and treatments. It includes measures intended to change the way NHS services are provided and increase the coordination of NHS services with local authorities, the care sector and the voluntary sector. The plan sets targets for improving public health; for clinical outcomes in areas such as preventing infant mortality and improving cancer survival rates; and for improving mental health services.

Although the ambitions of the long-term plan have been welcomed, concerns have been raised about the support being provided to realise these ambitions. The size of the increase to the NHS budget has been criticised as being insufficient to meet the scale of the changes planned. It has also been noted the plan would depend not only on the size of the NHS budget, but also the funding available to social care and medical training which are not covered by the five-year spending plan announced by the Government in June 2018. Organisations representing NHS staff have argued the aims of the long-term plan could not be achieved without reducing the number of vacancies in the NHS.

The Hansard for the Lords debate, on a motion moved by Lord Hunt of Kings Heath (Labour) “that this House takes note of the NHS Long Term Plan… and the case for a fully funded, comprehensive and integrated health and care system which implements parity of esteem, preventative health and standards set out in the NHS Constitution”, is available here.

The House of Commons Health and Social Care Committee is also holding an inquiry on the Budget and NHS Long Term Plan. The Committee has held two oral evidence sessions, on 15 January 2019 taking evidence from organisations including the Nuffield Trust, the King’s Fund and the NHS Confederation, and on 28 January 2019 taking evidence from the Health and Social Care Secretary, and the chief executives of NHS England, Health Education England and NHS Improvement. Transcripts of evidence and further information on the inquiry can be found on the Committee website here.

Further background can be found in the Commons Library debate briefing on NHS reorganisation, and briefing paper on NHS key statistics.

As health services are largely a devolved matter the NHS Long Term Plan applies to England.