The NHS’s Long Term Plan was launched on 7 January 2019. This important document is a further development of themes initially set out in the five-year forward view for the NHS that was published in October 2014. What are the highlights for the care and support sector?
The key emphases in the 10-year plan are on reducing health inequalities; integration of health and social care (despite the continued delay in the publication of the long-awaited Social Care Green Paper); development of new models of care via the Sustainability and Transformation Partnerships/Plans (STPs) and Integrated Care Partnerships (ICPs). There is also a focus on integrating care for older people, frail people, those with complex needs, children from 0 to 25, and a clear emphasis on improving population health.
The 10-Year Plan includes a healthy dose of realism. While there will be significant investment in primary and community care, digital and self-care, and a more pro-active management of population health and preventative approaches to changing individual behaviours, there is also an acceptance that none of these initiatives will reduce the need for hospital beds.
Primary and community care
The plan promises a £4.5 billion increase in funds for primary and community care by 2023/24. Focusing on assessing the health of local populations, developing digital services and online/phone GP consultations. There is also a commitment to provide fully integrated community-based healthcare by increasing the numbers of pharmacists, district nurses and allied health professionals, as well as social prescribing, by recruiting 1,000 trained link workers by 2020/21.
These initiatives, it is hoped, will ensure people’s health issues are addressed in their community, and that GPs are not always the first and last port of call for individuals when they are ill. Linked to this ambition are commitments to increase personalised health budgets and provide digital primary care services by 2024 – e.g. supporting healthcare at home through wearable monitoring devices. This is all part of what the plan calls a “shared responsibility for health”.
Care homes
For care homes there is a commitment to support each home with teams of healthcare professionals and a named GP. Again, this is aimed at reducing the flow into hospitals and focusing instead on caring for people in the community.
Mental health
There will be a £2.3 billion increase in investment, including a capital fund to improve therapeutic environments, and a redesign of core mental health services by 2020. The aim is to create a single point of access and provide 24/7 and crisis support, as well as increase access to talking treatments. There is also a commitment to provide mental health support in schools and a £30 million fund to provide support, including specialist mental health, to rough sleepers.
Learning disabilities and autism
On learning disabilities and autism, the plan undertakes to invest in intensive, crisis and forensic services in the community reducing in-patient provision by less than half the amount in 2015.
A&E
The plan promises to roll out Urgent Treatment Centres (UTCs) to act as alternatives to A&E, and add clinical assessment services to the 111 phone service. The aim is to provide same-day A&E discharges rather than, for example, keeping people in overnight for observation. By reforming how outpatients are treated and using new technology it is hoped, outpatient appointments/treatments will be reduced by one third.
Integrated Care Systems
The plan places great emphasis on the Integrated Care Systems (ICS) seeing these as key to tackling health inequalities and providing mental health and community based services that respond to the health needs of local populations. The plan suggests there will be one Clinical Commissioning Group per ICS to streamline commissioning. The NHS funding formula will change from activity-based payments to population-based payments to support this shift. The funding will also shift towards areas with the highest health inequalities.
Local authorities
There will also be a duty to work with local authorities and the voluntary sector, as well as a reduction in the emphasis on competition in the NHS. Additionally, there will be an undertaking to invest £2.3 million in NHS volunteering via the NHS Helpforce initiative.
Workforce
Workforce issues are also addressed with a commitment to provide an online nursing degree with guaranteed clinical placements and funding for more training places. In addition to improving population health, there is a focus on prevention through fostering behavioural change. For example, putting in place alcohol care teams in a quarter of hospitals, and tackling smoking, diabetes and pollution.
Finally, there will be a push for consolidation with mergers between Trusts ‘green lighted’.
Summary
In summary, the big messages are about making changes that divert people from costly GP, A&E, and hospital services by putting resources in the community and emphasising prevention, self reliance and self-servicing of health needs through new technology, volunteering, social prescribing – creating a more social model of healthcare services. For this aim to truly become a real possibility, the Social Care Green Paper will have to dovetail with the 10-year plan. The opportunity exists, so hopefully the government will take it.
For more information or to discuss this report contact: liz.zacharias@campbelltickell.com
This article also appears in CT Brief – Issue 41: Health, Care & Support
