At last, after several delays, the NHS Long Term Plan, previously heralded as the 10 Year Plan is with us. Was it worth the wait and does it contain what it says on the tin?
I sat down with my team this afternoon to go through the plan in some detail, having shared the 7 chapters out between 7 team members to prepare a briefing.
We did welcome the extra ring fenced £4.5bn funding promised for primary and community care and we sincerely hope it is not too little too late. Our worry is that it will all be swallowed up in extra “administrative” costs such as indemnity and increased pension contributions rather than workforce, and necessary infrastructure to improve services. There is also a worry that throwing money at workforce may not actually see any immediate benefits if the workforce isn’t there to be recruited.
Extra resources for primary and community care apart, I am sad to say that our general conclusion on the NHS Long Term Plan was one of disappointment. Much of what it says is already known and it seems to us that a group of people have come together to brainstorm what is happening somewhere in the Country and put it all together as a “Plan” as to what needs to happen everywhere.
There are some old chestnuts in there that I have seen as national initiatives in the past. I am meaning such things as national centralised procurement, Pathology and Radiology Networks, Care Closer to Home and streamlined Cancer Pathways. What makes it even more frustrating is that some of the brand new shiny initiatives that are going to transform care, such as rapid access community teams to prevent hospital admissions, community-based physiotherapists to divert MSK workload from practices and community teams wrapped around practices were all things I personally introduced some 20 years ago. Has someone been going around busily dismantling these initiatives after I moved on?
A similar case in point is Mental Health Services, which are no seen as a priority by everyone. Well if that’s the case, why has the comprehensive and integrated community, secondary and tertiary mental health service that had developed some 20 years ago in certain parts of the country completely disappeared.
Much of the plan therefore is an attempt to put back in place what health service commissioners and managers have been busily decommissioning and asset stripping over the last few years. What confidence do we have that it will work this time round!
There is little in the plan that anyone can object to – most of the ideas and initiatives are well intentioned and are to be welcomed. However, there are a lot of initiatives and it is questionable if there is sufficient capacity in the system, both clinically and managerially to implement a modest proportion of the Plan. This is at a time when management costs are being reduced and the service will be going through a significant reconfiguration.
Speaking of which it would appear that the only show in town is going to be Integrated Care Systems (ICSs) and Primary Care Networks. (PCNs) We are fortunate in our part of England that both are at a reasonably advanced stage – well ahead of the pack by all accounts. Our PCNs are at least established across most of the patch and are finding their feet in terms of assessing local need and priorities. However, their governance arrangements and infrastructure support can best be described as at the early stage of development! The Plan seems to be keen to formalise these arrangements and make PCNs integral to the governance arrangements of the ICS. Given there are an estimated 50 PCNs in a typical ICS this is going to be interesting. Most conspicuous by its absence is any mention whatsoever within the Plan of the Integrated Care Partnerships (ICPs) that we have been working on locally in each natural health care system, based around the catchment areas of secondary care. We have made great strides in some areas in establishing this partnership working across local stakeholders and primary care has been an integral part of these discussions and representation throughout the governance arrangements. Are these to be scrapped now and everything sucked up to the mega ICS level. Or have they just been forgotten. I did get excited where I saw the acronym ICP mentioned once, only to be disappointed to see it referred to an “Integrated Care Provider” This seems to put on the table again the desire to have a statutory “Provider” rather than “Partnership” and will ignite concerns again about the GP Contract.
In conclusion I am left still wondering where we are all going, what will stick that couldn’t be made to stick before and how it will all be managed and monitored. And on that note, I will end this blog.