A vision for the future of the NHS in England

After two weeks the dust is just about settling on the long awaited NHS Long Term Plan. There’s no doubt that it’s aspirational and ambitious but the Plan, which looks beyond the political cycle and towards what is best for the health of our nation, has been largely applauded for its focus on providing services outside hospitals and moving towards more joined-up, preventative and personalised care for patients.

The drive towards place-based population health will bring about a change in structure with Integrated Care Systems covering the country by 2021 and a reduction in clinical commissioning groups to one per ICS. ICSs will work on an earned autonomy basis and there is some flexibility around size and structure.  We are, of course, yet to see how social care and public health will interact with the Plan – as the Plan highlights, the NHS is only one part of the answer.

Further consultation and engagement on the Plan will take place at both a national level, with the establishment of a NHS Assembly in early 2019 and at Sustainability and Transformation Partnerships/ICS level, with local Healthwatch groups supporting NHS teams to ensure that the views of patients and the public are heard.

The Plan envisages a shift away from hospital based care towards community settings and new primary care network contracts will extend the scope of primary and community services. Supporting the integration of primary and community care will be an additional £4.5bn funding by 2023/24. 

Mental health will also get a boost in funding, in particular children and young people’s mental health services.  In addition, areas “will be supported to redesign and reorganise” core community mental health teams aligned with primary care networks. The aim is for more people with severe mental health illness to be treated within new integrated care models by 2023-24.

In keeping with Matt Hancock’s vision, technology and digital will play a central role; the NHS will offer a “digital first” approach to enable patients to communicate with clinicians and therapists via live video channels and use data to develop more sophisticated ways of monitoring patients remotely. However, a key focus will have to be on improving the infrastructure to support these aspirations, including the digitisation of all care providers.

The Plan also proposes a relaxing of procurement and competition rules, with possible legislative reform in order to “free up NHS commissioners to decide the circumstances in which they should use procurement”.

As Nigel Edwards of the Nuffield Trust puts it though, the “biggest obstacle of all is the lack of key staff”.  While the Plan provides a range of workforce ambitions, the detail is expected to be set out in a national workforce strategy, which is due to be published later this year. NHS Improvement Chair, Baroness Dido Harding is said to be leading the national workforce group.

Over the coming weeks, we will dissect some of the key legal issues arising out of these proposals. Watch this space!

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