Much will be written in the coming weeks and months about how the new NHS Long Term Plan is regarded nationally by the various parts of the health service – from think tanks to membership bodies to Royal Colleges. What is perhaps more important, explains Michael Wood, local growth advisor at the NHS Confederation, is how it is seen on the ground by external, local partners. After all, there isn’t much the NHS can achieve in the plan that doesn’t need their support, resources or input.
The NHS’s most important partner is of course local government and it is they who have reason to feel more than slightly aggrieved. While councils wait to discover the results of the fair funding review, and thus what money they will have available after next year, they see their own national long-term plan – the social care green paper – continually pushed into the distance and its associated promises watered down. On paper then, and in more ‘normal’ times, while the commitments of NHS’s long-term plan for a much-improved health service focus on tackling prevention and health inequalities would be warmly welcomed, there are sneaking suspicions that this will more about the NHS ‘taking back control’ rather than truly developing place-based, collaborative socio-economic policy.
Workforce is an issue on which hinges much of what the service plans to achieve and it’s therefore no surprise to see a chapter of the long-term plan devoted to it. While the plan contains many sound ideas, in practice of course the NHS is not, and can never be, solely in control of those it seeks to employ. One hopes the work of the proposed national workforce group will give much more focus to the entry points to health and care, and the role of further education, than the plan does (including acknowledging the increasing importance placed on local skills policy and planning). Further to this, universities are facing their own imminent review into tuition fee funding, with recent whispers causing considerable panic amongst even the Russell Group about future institutional viability. The numerous income streams our university partners operate are critical; rarely does a medical school pay for itself, meaning an over-reliance on cross-subsidisation from elsewhere within the university. Their role in helping an integrated care system make the long-term plan a reality should form part of a wider local discussion about how they operate in a newly regulated market.
Of all the recent NHS policy developments we have seen, population health is the one that has the potential to gain the most traction with local colleagues. With low regional productivity at the heart of the UK’s continued poor economic performance, many of the 38 local enterprise partnerships in England are increasingly looking at the local links between health and wealth and, interestingly, how to further develop and support them. This will involve bringing health service colleagues into the development of their local industrial strategy and thus the drawing down of funding from a variety of new national and local sources. The plan’s explicit commitment for integrated care systems to focus on population health is both important and pleasing, but the partnerships that define this should not exclude local economic and business leaders. Speak to them and you will learn that they have as much to gain, and to lose, through poor population health as we do.
Ironically, it is the appendix which offers most hope to our partners. Credit must go to those who pushed for the inclusion of the points which align the plan with wider social goals. It may appear oddly positioned at the very end of the document but the signals that come from that one single paragraph entitled ‘The NHS as an anchor institution’ are potentially far reaching. This is the NHS understanding its scale, impact and influence and, more importantly, doing something about it. Previously, concepts such as social value may have been spoken about in the margins of NHS meetings but never made the final black and white text of our defining service documents. One would hope that this time it is different and that there is much more to come. Certainly, organisations such as The Health Foundation and the NHS Confederation are already on the ground supporting the development of this work and planning how it can be woven into the standard NHS lexicon.
The strength of the national NHS Long Term Plan is also its weakness; it is national. It can generate front page news across the country, but it cannot understand, assess and respond to the local nuances that dictate strategy. Only local partnerships can do this, and for them to truly develop the story, what local colleagues need to hear is not the national one but the translation our NHS leaders put on it.
Michael Wood is Local Growth Advisor at the NHS Confederation. Follow him at @NHSLocalGrowth