Unfinished business: the need to invest in the whole health and care system

17 / 06 / 2019

The Long Term Plan in January 2019 set the future direction for the NHS in England. Backed by £20 billion of additional funding, the health service is now set to deliver changes that should help to keep millions of people independent and in their own homes over the next ten years. This can and should be an exciting time of renewal. 

The NHS Confederation is working closely with its members to gauge their views on the plan and to assess what they see as the barriers and enablers on this journey. 

This report, published alongside analysis from the Health Foundation, is the first output in that process. It reveals a strong commitment and real enthusiasm for the key planks of reform articulated in the plan. It shows that leaders across the NHS in England, spanning trusts, clinical commissioning groups and integrated care systems, are optimistic and keen to deliver the plan’s vision: more services in the community, backed by technology and new models of care. 

Indeed, it is clear that there is near universal support for creating a system of integrated health and care, which will be focused on population health, with greater investment and focus on community, primary care and mental health services. It is seen as the only way of creating a sustainable future for the health and the care system in the face of rising demand.

At the same time though NHS leaders have serious concerns. This is a service which already has 100,000 vacancies, is struggling to cope with ever rising demand, and is faced with a chronic lack of investment in buildings, equipment and other critical infrastructure. Combined with the drastic cuts to social care and public health, these factors continue to mean we have a service struggling to cope, with extra demand on A&E and other front-line NHS services. 

Many of these underlying challenges sit outside the NHS England budget and are the responsibility of Government and they must be addressed in the forthcoming spending review. Failure to do so will put the ambitions of the NHS plan in jeopardy.  

This report is a temperature check six months on from the publication of the plan. It is justifiably optimistic – there is too much doom and gloom around the NHS, but we also need to be realistic about what is still needed to make the plan work and we need an honest debate about what is feasible. It is now time for politicians to be straight with the public about what can and cannot be delivered over the next decade. 

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