Briefing: NHS Long Term Plan

Following Theresa May’s announcement in June 2018 that the government would allocate an extra £20bn to the National Health Service, the government finally launched the NHS Long Term Plan on 8 January 2019. The plan broadly seeks to prepare the NHS for the future, identifying how increased funding can be efficiently spent, following consultations with staff, patients and other professionals. Detailed local strategies for 2019/20 will be released in April, and five-year local strategies by October.

This briefing summarises some key points in the plan, followed by some responses from civil society health and social care experts. Additional resources and the plan in its entirety are referenced at the end of this document. If you have any queries then please contact Maisie or Kristiana at policy@acevo.org.uk.

Key points

The plan is highly ambitious, increasing funding in a number of areas and committing to preventative strategies to improve services. Many of you will have read the plan in full; if not, the two page summary provided alongside the report is very helpful. Some takeaway points include:

  • Mental health: allocating additional phased funds over the next five years, totalling £2.3bn per year by 2023/24. 24-hour crisis support will also be introduced, and care for two million more people.
  • Health and social care: funding for primary and community care will increase by at least £4.5bn. Preventative strategies aim to prevent 150,000 cases of heart attacks, strokes and dementia. A green paper on adult social care has been delayed, but is forthcoming. A prevention green paper has also been promised for publication in 2019.
  • Support for carers: the plan promises to improve the services for carers themselves, 61% of whom experienced a deterioration in physical health since they became a carer, and 70% of whom report mental health problems due to the pressures of delivering care.[1]
  • Digital: the report hopes that the NHS app will become the ‘doorway’ to NHS care, with the introduction of online GP appointments and outpatient care, as well as tools to monitor ongoing conditions. Centralised management of patient records will also be improved.
  • Volunteering: the plan proposes to double the number of volunteers within the NHS and contribute at least £2.3m to the Helpforce programme in order to scale volunteering opportunities.
  • Reducing health inequality: the plan promises to improve the direction of funding to the communities with the widest gaps of health inequality, contributing an extra £1bn to these communities and releasing measurable goals to combat the issue (which is estimated to cost the NHS £4.8 billion per year due to increased hospitalisation alone).[2]

Responses from civil society organisations outlined what they welcomed from the plan, any concerns it raised, and how to most effectively move forward with its implementation. Some of these are summarised below.

What has been welcomed?

Civil society leaders welcomed the breadth of topics covered in the plan. As the NHS enters its 70th year, mental health was seen as a particularly important issue, in light of a history in the health service of misunderstanding and stereotyping mental health conditions. Mental Health Charity Mind emphasised in its report Transforming mental health that an increase in funding for this area had the potential to “revolutionise mental health services and wider support for people experiencing mental health problems”, and its response welcomed the funding increase the plan promises, and the potential it offers to improve care for thousands.[3]

The notion of collaboration and community connectivity was also well-received. The King’s Fund response described the focus on integrating care systems as “a welcome signal that NHS organisations need to work with local authorities and other partners to deliver improvements in the health of local populations.”[4] In July 2018, the King’s Fund stated that “the centrepiece of the new plan should be a commitment to bring about measurable improvements in population health and to reduce health inequalities”, and a focus on integrated local care has significant potential for reducing health inequality, estimated in the report to cost the NHS around £4.8bn per year.[5] The Richmond Group, the coalition of 14 leading healthcare charities, welcomed the promise “to bring together the clinical and non-clinical, to make care more personalised, less disjointed, and more effective in helping us to stay well”.[6] There was also a broad appreciation of the renewed attention to integrating care, recognising that, if delivered efficiently, these developments could have significant impacts.

Causes for concern

Many organisations expressed concern that while promised funding was a positive step, translating money into effective frontline care needed careful planning and efficient delivery which was missing from the plan. The Mental Health Policy Group emphasised the continuing importance of cross-governmental policy reforms, highlighting housing, benefits and social care as intersecting issues in need of further attention. The Richmond Group has previously identified the important relationships between the three pillars of the NHS, social care and public health, explored in this report. In light of this, while investment in the NHS is a welcome development, the group identified the lack of plans for long-term strategic investment in public health and social care – highlighted by the delayed green paper on adult social care – as significant cause for concern.

The King’s Fund cautioned against underestimating the true demands of delivering the plan, noting that the lack of certain decisions on hospital waiting times, for example, “indicat[es] that trade-offs and difficult choices lie ahead.” While recognition of certain areas in desperate need of funding was welcomed, responses were unanimous in the need for further clarification of delivery, as well as how a connected healthcare system will work without increased funding across the board. In the Age UK response, Caroline Abrahams explained that “it will be terribly sad, as well as a shocking waste of public money, if ongoing ministerial dithering on social care means the very positive initiatives the plan sets out to help them cannot be put into effect”.[7]

Moving forward

Charities need clarification on several practical policy issues in the coming months. Firstly, the repeatedly delayed green paper on adult social care must be released as soon as possible. This should happen in advance of the April 2019 deadline for local strategies, allowing care providers to be fully informed when designing meaningful collaborations in their areas.

Secondly, while increased spending on the NHS is promising, the Richmond Group felt that the 2019 spending review should re-assess social care and public health, so that local plans can address the three vital elements of health provision when planning integrated care systems.

Making these collaborations truly meaningful requires support for the NHS workforce, and a clarified immigration policy in relation to Brexit is essential to resolve questions of staffing. As the plan aims to double the numbers of NHS volunteers and draw more meaningfully on their contributions, full engagement with civil society organisations is essential. The Richmond Group said committed collaboration with “voluntary and community organisations who have so much evidence, insight and experience in service planning and provision” should be a defining feature of local strategies, harnessing the potential of a connected approach from the outset.[8]

Further resources

As local plans are released and methods of delivery become clearer, charity and social enterprise leaders can assess how their organisation might collaborate locally, and areas where the NHS plan has relevance for them. Alongside the reports linked to in this briefing, the following resources could be helpful to inform your thinking.

NHS long term plan: Full report
The Health Foundation response, January 2019
SCIE response, January 2019
Age UK response, January 2019
NCVO: Blog, January 2019
BBC: What the plan means for you

[1] Richmond Group of Charities, July 2018, Priorities for the plan: The long-term NHS plan and beyond – views from leaders in charities and voice organisations https://richmondgroupofcharities.org.uk/sites/default/files/priorities_for_the_plan.pdf p. 24

[2] NHS Long term Plan, January 2019, https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf p. 33-36.

[3] Mind, Transforming mental health, p. 3

[4] Press team, January 2019, The King’s Fund response to the NHS long-term plan
https://www.kingsfund.org.uk/press/press-releases/kings-fund-response-nhs-long-term-plan

[5] Professor Sir Chris Ham and Richard Murray, June 2018, The NHS 10-year plan: how should the extra funding be spent? https://www.kingsfund.org.uk/publications/nhs-10-year-plan

[6] The Richmond Group of Charities, January 2019, NHS long-term plan: lots to welcome but implementation will be its litmus test https://richmondgroupofcharities.org.uk/news/nhs-long-term-plan-lots-welcome-implementation-will-beits- litmus-test

[7] Caroline Abrahams,January 2019, Age UK’s response to the NHS plan https://www.ageuk.org.uk/latestpress/ articles/2019/january/new-page/

[8] The Richmond Group, NHS long-term plan: response

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