The new NHS long-term plan is a significant opportunity for the health service. It can set out a clear and achievable path for sustaining and improving patient care, and help cement political and public trust in the NHS.

In recent years, despite growing workforce and financial pressures, the NHS provider sector has delivered significantly more for patients. It has: 

  • treated more patients than ever before within constitutional standards, with the NHS as a whole seeing more than 1.4 million patients every 24 hours
  • maintained and, in many cases, improved the quality of care
  • realised very large levels of efficiency savings and gained control of the sector deficit
  • pioneered new models of care and supported system working, playing a key role in joining up health and care services

The NHS is a high performing but complex system. There is a long path ahead if we are to fulfil our ambitions for the service. The plan needs to set out where the NHS needs to be and how it will get there. But it must also be firmly grounded in the reality of where the NHS currently is. The provider sector comprises 227 NHS foundation trusts and trusts across England delivering acute, ambulance, community and mental health services. In 2017/18 it accounted for £84bn of the NHS’s £110bn budget. Yet it ended 2017/18 with a deficit of nearly £1bn, sustained underperformance against constitutional targets, an ageing infrastructure misaligned with care needs, and an overall 8% staff vacancy rate.

The last four years have shown that setting trusts an unrealistic task locks them into a debilitating cycle of failure where they can’t meet financial and operational targets, irrespective of how hard their frontline staff work. 

This is why the long-term plan must not just set out a bold and ambitious vision for the next ten years. It must also reset what is asked of providers so that the vast majority of trusts, performing well, can return to being successful. It is vital that frontline trust leaders and staff are confident the plan achieves both these objectives.


The long-term plan and the funding uplift are not the end of the story

The NHS will receive increased real terms funding of £20.5bn over five years, an average 3.4% per year overall. That funding uplift will sit within the NHS ringfence, and does not include public health, training and education, and capital spending. Neither does it take account of the significant external risks, in particular, social care and the question of how Brexit will impact the NHS. The government must therefore ensure that we:

  • secure a Brexit agreement that protects the NHS
  • sustainably solve the current crisis in social care
  • have a fully funded multi-year plan to meet the NHS’ capital needs and its education and training needs
  • invest the amount required in public health to meet our long-held ambitions on prevention and promoting health and wellbeing.


These are integral to the NHS’ ability to make best use of the increased funding and see sustained improvements across outcomes and service delivery. 


Five NHS provider sector tests

Our five tests are therefore:


The tests we set out here are focused on establishing the building blocks of an ambitious and sustainable public service. They are written from the perspective of the provider sector – 227 NHS foundation trusts and trusts delivering acute, ambulance, community and mental health services – who account for £84bn of the NHS’ £110bn budget and will play a lead role in delivering the plan.