It's finally here - The NHS Long Term Plan

If 2014’s NHS Five Year Forward View was a short story, then 2019’s NHS Long Term Plan is a work of non-fiction; the hard-nosed, heavily referenced 136 page daughter of its much shorter mother. The rumour was that Simon Stephens brought in a journalist to give the Five Year Forward View a strong narrative, whereas this new plan is much more a traditional Government document, with numbered paragraphs, diagrams and summary boxes. But is it the plan we have been waiting and waiting for?

The Five Year Forward View set in in motion pilots for new models of care and tentatively tried to find workarounds for the 2012 Act to enable greater collaboration and integration of care. Learning from that work has been incorporated into this new plan, which is much more overt about the limitations of the 2012 Act, even making cautious suggestions for legislative change in one of the final chapters. This is Simon Stephens using the NHS brand to lobby Parliament.

The big drive is the push to ramp up community and GP working by investing £4.5 billion within five year’s time. The aim is to help reduce pressure on hospitals. Hearteningly and sensibly this plan is predicated on assuming that hospital bed use will not decrease for three years, allowing community services to get up and running. Alongside, there will be a focus on supporting patients to make decisions by rolling out the NHS Personalised care model and what patients, carers, patient groups and charities have been advocating for years. This will include creating link workers in primary care networks who will help people to develop tailored plans and connect them to local groups and services; social prescribing is going nationwide. Matt Hancock’s yen for digital technology gets its nod by a commitment to more virtual appointments and telephone appointments. Finally, there is an aspiration that by April 2021 Integrated Care Systems should cover the whole of England.

It’s certainly clear that the engagement that has gone on publically and behind the scenes has made its mark. Lots of charities have been involved in submitting evidence; National Voices, The British Heart Foundation and the Stroke Association are namechecked and some of the initiatives they have championed are included, now to be mainstreamed.

What is missing? More and more people, particularly older people, will be living with more than one condition now and in the future and the plan is silent on the issue of how to support people manage multi-morbidities. Will greater community and GP working look and address the issue of people having multiple different appointments and having to regularly repeat their story? Some commentators have pointed out that a reduction in public health budgets and still no social care green paper will limit the success of this plan. It is possible that the shift to ICSs and community care is intended to be complementary to any social care green paper, but that might be being far too kind. With 100 000 vacancies in the NHS, the ongoing issue of training, recruiting and retaining the NHS workforce is not really addressed; that problem is left to a workforce plan later in the year.

There is also a lack of accountability and measures or targets in the plan, though there is a promise to develop measures of how well ICSs are performing, based on feedback from patients, carers and the public. However, when there are huge workforce pressures, is it perhaps wise to focus on delivery rather than developing another raft of tests for NHS staff to be measured against? There is lots to commend in this plan but the proof is in the delivery, which can take considerably longer and be more painful than writing a plan, which are often overly optimistic. Is it time to start seeing these plans as iterations of the ones that have gone before them, not fully formed sequels?