- As expected, the long term plan consolidates the national policy direction since the Five year forward view in placing considerable onus on system working as the key driver of change and improvement in the NHS. The opportunity to support collaboration and develop more integrated services is welcome, and we look forward to working with providers and their partners and the national bodies to make the long term plan a reality.
- However, the plan raises a number of new questions about how this vision can best be implemented and how local systems will be supported to deliver meaningful five-year plans. We hope that the national implementation framework due in spring 2019 will address some of these questions.
- The plan includes a commitment for ICSs to cover the whole country by April 2021. Given that progress in moving to a model of system working will be vastly different from place to place, this deadline is ambitious. If the ICS ‘brand’ is to remain meaningful, all systems will require tailored support and investment on their journey to developing new, collaborative relationships.
- The long term plan makes clear the expectation that every ICS has a partnership board with a non-executive chair, held to account for system-wide goals and performance measures. These proposals raise unanswered questions about governance and accountability within a system context, where responsibilities and accountabilities remain held at organisational levels.
- Given the key roles that public health and social care play in effective health and care systems, it is unfortunate that the long term plan had to be published in the absence of the green papers expected on these topics. Securing sufficient funding for public health, social care, capital spending and education and training remains fundamental to the successful delivery of the plan.
- The new integrated care provider (ICP) contract would offer one means to successfully integrate primary, community, acute and mental health care while also allowing trusts to influence population health. However, this remains one vehicle among many different partnership options for commissioners, trusts and their partners and it is vital that local areas are not pushed into any one arrangement.
- Integration and population health management is likely to be easier to achieve in areas where good relationships already exist but more challenging in areas where this is not the case.
- While the proposals for legislative change included in the plan rightly identify a number of the challenges which local partners are experiencing as they seek to implement system working, in our view, legislative change may not be the most appropriate means to remove these barriers to change.