What does the NHS Long term plan mean for governors?

The much anticipated NHS long term plan was published on 7th January 2019. This builds on the policy laid out in the NHS five year forward view which expressed the need to integrate care to meet the needs of a changing population. The long term plan sets out the priorities for healthcare over the next ten years and how the health service in England will seek to make the most of the extra the £20.5billion funding increase announced by the government in June 2018 over the next five years.

This settlement represents an average annual rise of 3.4% above inflation for the next five years, a substantial improvement on the funding growth the NHS has seen since 2009/10, which has averaged approximately 1% a year in real terms. However, it sounds less impressive when you compare it to average funding increases of 3.7% per year since 1948, and take into account the fact that experts say the NHS needs annual rises of 3.3% to just keep up with rising costs and demand. In any case, in return for the additional investment the NHS was asked to produce a long term plan, setting out how it would use this funding.

Of special note for governors is the plan recognises the important role that volunteers play in the NHS, committing £2.3 million to Helpforce, which has been charged with scaling capacity for volunteering in the NHS.

There is also an increasing focus on NHS organisations working with their local partners, as ‘Integrated Care Systems’, to plan and deliver services which meet the needs of their communities. ‘Integrated Care Systems’ are groups of local NHS organisations working together with each other, local councils and other partners. There is a planned roll out of ICSs across the country by 2021.

There is a priority to prevent people becoming ill in the first place, reducing avoidable demand, and narrowing unjust gaps in health between the best and worst off. The NHS is going to fund prevention programmes to help people stop smoking, overcome drinking problems and avoid Type 2 diabetes is outlined.

Technology is continually opening up new possibilities for prevention, care and treatment. Making better use of data and digital technology is an integral part of the long term plan. There will be more convenient access to services and health information for patients, with the new NHS App as a digital ‘front door’, better access to digital tools and patient records for staff, and improvements to the planning and delivery of services based on the analysis of patient and population data.

The plan also makes welcome commitments to improve care in key service areas – including cancer, maternity and mental health. There are also priorities to identify ways to reduce duplication in how clinical services are delivered, make better use of the NHS’ combined buying power to get commonly-used products for cheaper and reduce spend on administration. The NHS expected to save £700m from admin costs in the next five years.

The critical importance of the NHS workforce is recognised in the long term plan. The NHS will continue to increase the workforce, training and recruiting of more professionals – including thousands more clinical placements for undergraduate nurses, hundreds more medical school places, and more routes into the NHS such as apprenticeships. The detail of these plans will be included in a national workforce implementation plan due to be published later this year. There is also a priority to make the NHS a better place to work, so more staff stay in the NHS and feel able to make better use of their skills and experience for patients. There is also a worthy ambition to tackle the implications of Brexit and immigration policy.

What does this mean for governors?

In practice, Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs) now need to develop and implement their own strategies for the next five years. These strategies will set out how they intend to take the ambitions that the NHS Long Term Plan details, and work together to turn them into local action to improve services and the health and wellbeing of the communities they serve – building on the work they have already been doing.

Governors have a core statutory duty to represent the interests of members and the public so could play a considerable part in the development of new closer relationships between the health service and local communities. Their role will be vital in ensuring essential changes outlined in the long term plan take place and can play an important role in making the case for that change with the public.

Governors can also use their holding to account duty to question whether the STP and ICS provision is meeting the needs of current and future needs of the populations they serve and how the new direction of travel will facilitate long term whole system sustainability and transformation.

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