With the health service facing clear funding pressures, NHS Clinical Commissioners’ member network and policy manager Thomas Marsh analyses whether the NHS Long Term Plan stacks up.
For the first time in October 2018, NHS Clinical Commissioners (NHSCC), NHS Confederation and NHS Providers came together to outline the reality behind the government funding settlement for the NHS. Our infographic drew upon findings from the Institute for Fiscal Studies and the Health Foundation which estimated that by 2024 there would be a £10.5bn shortfall between the allocated funding and what would be needed to meet demographic and other pressures.
To make the settlement work, we outlined seven criteria that were needed in the NHS Long Term Plan. With this now published, to what extent have these been met?
1. Prioritises what the NHS can achieve with the funding available
The plan contains thirteen clinical priorities alongside the delivery of new service models and the need for action on prevention and health inequalities. While the NHS is always up for the challenge of managing change and improving outcomes, it may be difficult for local areas to determine which to prioritise and in what order.
2. Identifies what we could stop doing to remain sustainable for the future and focus funding on what works for patients
A key role of commissioners is ensuring that allocated funding is spent most effectively and efficiently for their local population. This can sometimes mean restricting access to unsafe or overpriced medicines (including those available to purchase over the counter), and interventions which only work in certain circumstances. NHSCC has been working with NHS England to produce national guidance on low priority prescribing and evidence based interventions which although recognised in the plan, falls short of identifying any specific things the NHS should stop doing, with the focus on continued efficiency and reducing waste.
3. Sets realistic levels of efficiency savings
The plan sets an achievable and realistic efficiency target of 1.1 per cent a year over the next five years - a considerable reduction from the two to three per cent targets in previous years. NHS organisations have consistently argued that ongoing high levels of efficiency savings are not realistic and in recent years are beginning to directly impact on patients. NHSCC is working closely with NHS England and our members to realise 20 per cent running cost savings in CCGs, stopping those things that do not add value whilst maintaining essential planning and commissioning functions.
4. Supports collaboration, by removing financial and regulatory barriers to local integration
The document proposes eight legislative changes, developed with clinicians and NHS leaders, that will support collaboration and greater integration through the removal of current barriers. These closely match NHSCC’s enabling asks for successful delivery of integrated health and care although more must be done to outline the structures at a ‘place’ level.
We’ve also seen the ‘blended payment’ approach for emergency care in the recent planning guidance, which is a welcome first step towards payment reform that supports integration. NHSCC have identified some of the early learning from those systems that have moved furthest along this journey in Driving Forward System Working and some of the challenges for effective governance and accountability in integrated health and care.
5. Outlines support for the current and future workforce
The plan is clear on the need for more staff, working in rewarding jobs and a more supportive culture. The national workforce implementation plan to be published in 2019 is urgently needed, as is the assurance of adequate government funding for Health Education England. Our members consistently recognise workforce shortages as the greatest challenge to the successful delivery of the future NHS outlined in the plan.
6. Focuses on prevention and reducing health inequalities
Both areas are highlighted, although there is recognition that the former is not the responsibility of the NHS alone. A formula that allocates more fairly on the basis of health inequalities is a useful administrative approach, but more can be done to understand and share what effective policies to tackle health inequalities have been implemented locally.
7. Is coupled with a resourced and robust financial plan for social care
We still await further detail from government on the future of social care. The plan states that it has been developed based on sufficient social care funding being available so that it does not impose any additional pressure on the NHS. This will be vital to the effective delivery of the plan.
On balance, the plan meets or makes good progress towards the majority of the criteria we set out last year, with the major exception of social care funding. To plan effectively for the challenge that it faces the NHS needs a clear funding plan and direction for the social care sector which does not heap further pressure on an already challenged system. In June 2018 then Secretary of State Jeremy Hunt stated that it is '…not possible to have a plan for one sector without having a plan for the other'. Now we have a plan for the NHS, we need the same for social care.
Thomas Marsh is Member Network and Policy Manager at NHS Clinical Commissioners, the independent membership organisation for clinical commissioning groups. Follow NHSCC @NHSCCPress and Thomas @thomasmarshnhs