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7th January 2019

The NHS Long Term Plan was been published today and can be accessed here

A new service model for the 21st century

The plan sets out  five changes to the NHS service model to bring more joined-up and coordinated care; proactive services and individual support over the next five years. According to the plan, the NHS will:

  • Boost ‘out-of-hospital’ care, and finally dissolve the historic divide between primary and community health services.

  • Redesign and reduce pressure on emergency hospital services.

  • People will get more control over their own health, and more personalised care when needed.

  • Digitally-enabled primary and outpatient care will go mainstream across the NHS.

  • Local NHS organisations will increasingly focus on population health and local partnerships with local authority-funded services, through new Integrated Care Systems (ICSs) everywhere.


More NHS action on prevention and health inequalities


The Long Term Plan sets out new commitments for action that the NHS will take to improve prevention. It does so while recognising that a comprehensive approach to preventing ill-health also depends on action by individuals, companies, communities and national government to hardwire health into social and economic policy. Indeed, the costly impact of socioeconomic inequality has been calculated to cost the NHS as much as £4.8 billion a year in greater hospitalisations alone.


It focuses on the following issues: smoking, obesity, alcohol, air pollution, antimicrobial resistance. 


Further progress on care quality and outcomes


The plan sets out costed improvement priorities for the biggest killers and disablers of our population. It largely does so using the latest epidemiological evidence from the Global Burden of Disease study for England, supplemented by the views of patients and the public on their priorities for improvement. These confirm that the Plan needs to stick with and make further advances on our current improvement agenda for cancer, mental health, multimorbidity and healthy ageing including dementia, while intensifying the NHS’s focus on children’s health, cardiovascular and respiratory conditions, and learning disability and autism, amongst others. It also affirms the importance of therapies and planned surgical services for conditions that limit independence and affect quality of life.


NHS staff will get the backing they need


This Long Term Plan sets out a number of specific workforce actions developed by NHS Improvement and others that can have a positive impact now. The Plan also sets out wider reforms for the NHS workforce which will be finalised by NHS Improvement and the Department of Health and Social Care when the education and training budget for HEE is set in 2019. The idea behind this is that, in order to  make the plan a reality, the NHS will need more staff, working in rewarding jobs and a more supportive culture. By better supporting and developing staff, NHS employers can make an immediate difference to retaining the skills, expertise and care their patients need. 


Digitally-enabled care will go mainstream across the NHS


The NHS will offer a ‘digital first’ option for most, allowing for longer and richer face-to-face consultations with clinicians where patients want or need it. Primary care and outpatient services will have changed to a model of tiered escalation depending on need. Senior clinicians will be supported by digital tools, freeing trainees’ time to learn. When ill, people will be increasingly cared for in their own home, with the option for their physiology to be effortlessly monitored by wearable devices. People will be helped to stay well, to recognise important symptoms early, and to manage their own health, guided by digital tools.


Practical priorities will drive NHS digital transformation

  • Create straightforward digital access to NHS services, and help patients and their carers manage their health.

  • Ensure that clinicians can access and interact with patient records and care plans wherever they are.

  • Use decision support and artificial intelligence (AI) to help clinicians in applying best practice, eliminate unwarranted variation across the whole pathway of care, and support patients in managing their health and condition.

  • Use predictive techniques to support local health systems to plan care for populations.

  • Use intuitive tools to capture data as a by-product of care in ways that empower clinicians and reduce the administrative burden.

  • Protect patients’ privacy and give them control over their medical record.

  • Link clinical, genomic and other data to support the development of new treatments to improve the NHS, making data captured for care available for clinical research, and publish, as open data, aggregate metrics about NHS performance and services.

  • Ensure NHS systems and NHS data are secure through implementation of security, monitoring systems and staff education.

  • Mandate and rigorously enforce technology standards (as described in The Future of Healthcare) to ensure data is interoperable and accessible.

  • Encourage a world leading health IT industry in England with a supportive environment for software developers and innovators.


Taxpayers’ investment will be used to maximum effect


The new funding settlement announced by the Prime Minister in June 2018 promised NHS England’s revenue funding would grow by an average of 3.4% in real terms a year over the next five years delivering a real terms increase of £20.5 billion by 2023/24.


Putting the NHS back onto a sustainable financial path is a key priority in the Long Term Plan and is essential to allowing the NHS to deliver the service improvements in this Plan. This means:

  • the NHS (including providers) will return to financial balance;

  • the NHS will achieve cash-releasing productivity growth of at least 1.1% a year, with all savings reinvested in frontline care;

  • the NHS will reduce the growth in demand for care through better integration and prevention;

  • the NHS will reduce variation across the health system, improving providers’ financial and operational performance;

  • the NHS will make better use of capital investment and its existing assets to drive transformation.


The NHS Long Term Plan looks at how these five tests can be met. 


Next steps


The approach to delivering the Long Term Plan will balance national direction with local autonomy to secure the best outcomes for patients. Local implementation will be led by the clinicians and leaders who are directly accountable for patient care and making efficient use of public money. This will ensure local health systems have the ability and accountability for shaping how the Plan is implemented.


The plan provides the framework for local planning for the next five years and beyond. Existing commitments in the Five Year Forward View and national strategies for cancer, mental health, learning disability, general practice and maternity will all continue to be implemented in 2019/20 and 2020/21 as originally planned. 


ICSs will be central to the delivery of the Long Term Plan and by April 2021 the plan wants ICSs covering all of the country.

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