Our analysis shows the following key issues need to be addressed in support of a sustainable NHS provider sector, well placed to play its role in delivering the long term plan. Trusts need:


  • Realism about the scale of the challenges facing the NHS, underpinned by an informed public debate on its future direction
    The long term plan rightly sets out an ambitious vision for the NHS over the next ten years, but transformation at scale will take time and investment beyond the additional funding government has provided. As demand for services grows, current models of delivery are strained. Public satisfaction with the NHS is falling and many of the standards in the NHS constitution have not been delivered for some time. 91% of respondents to our survey said we need more public debate about the future direction of the NHS. Trust leaders would therefore welcome: 
    • continued support from the national bodies, particularly NHS England and NHS Improvement, in making the case for sufficient and timely investment in the NHS to support the ambition of more integrated, personalised care
    • engagement from politicians in an open and informed public debate about the future direction of the health service, what it is expected to deliver and the level of investment required to ensure its sustainability
    • renewed political commitment to ensure a sustainable social care system.



  • A funded, credible NHS people plan
    Only 29% of respondents were confident that their trust has the right numbers, quality and mix of staff in place to deliver high quality healthcare to patients and service users, and almost six in 10 (59%) were worried this was not in place. The interim people plan has been a positive step forward in prioritising and addressing these issues, however, solutions to longstanding issues in workforce planning will take time. The main barriers can be overcome by:
    • focusing nationally, regionally and locally on culture and modelling positive, inclusive leadership behaviours at all levels of the system
    • a significant increase in national funding to train up more people with the right skills, with an eye on new and more integrated roles
    • a flexible immigration system that ensures that trusts can continue to recruit all the staff that local services need, now and in the future.



  • Clarity around the quality standards the public can expect from the NHS, with the underpinning resources for trusts and their partners to deliver them
    Despite trusts working flat out, the NHS has missed all its key performance targets over the last four years. Although trusts were positive about the quality of care they provide, concern about demand featured strongly in our survey, with 61% of respondents saying they were worried about whether their trust had the capacity to meet demand for services over the next 12 months. High quality, and safe care in the NHS can be supported by:
    • a focus on developing open, ‘no blame’ cultures by trust boards in line with the national patient safety strategy, with investment in quality improvement methodologies
    • ensuring learning from the clinical review of access standards is central to a debate with government, politicians, healthcare bodies, clinicians and the public about the funding required to ensure the health and care sector can meet the public’s expectations.



  • Whole system investment
    Despite the £20.5bn funding settlement, and welcome commitment to return the provider sector to balance by 2023/34, only 35% of respondents thought their trust’s financial performance would improve over the next 12 months, with 23% predicting it would deteriorate. For the NHS to thrive and derive maximum value from the additional money it has received, there needs to be:
    • a multi-year capital settlement which brings investment in the NHS in line with comparable western countries; and a streamlined approach for providers to access capital
    • sufficient funding for public health and a sustainable social care system supported by a long term funding settlement.



  • Support for integrated care and system working
    The long term plan places system working at the heart of work to improve care quality and sustainability. However, the measures set out in the plan are ambitious and will pose challenges in areas where relationships between NHS organisations and other stakeholders are less well developed. Only 29% of respondents were confident that transformation activity in their local system would progress as well as it needed to over the next 12 months to deliver the plan’s aspirations. Ensuring the success of system working relies on:
    • maintaining good governance as local health and care systems evolve, ensuring proposed changes to legislation are developed with the sector
    • holding trusts and local system partners to account through proportionate and efficient regulation and oversight which is aligned with the new model of system working
    • ensuring trusts have access to the investment and support they need to take advantage of new technologies and innovations to transform care.