The NHS Long Term Plan, also known as the NHS 10-Year Plan is a document published by

NHS England NHS England, officially the NHS Commissioning Board, is an executive non-departmental public body of the Department of Health and Social Care. It oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the ...

on 7 January 2019, which sets out its priorities for healthcare over the next 10 years and shows how the NHS funding settlement will be used. It was published by NHS England chief executive

Simon Stevens Simon Laurence Stevens, Baron Stevens of Birmingham, (born 4 August 1966) is a British public policy adviser, former CEO, and independent member of the UK House of Lords. He served as the eighth Chief Executive of the National Health Service ...

and Prime Minister

Theresa May Theresa Mary May, Lady May (; née Brasier; born 1 October 1956) is a British politician who served as Prime Minister of the United Kingdom and Leader of the Conservative Party from 2016 to 2019. She previously served in David Cameron's cab ...

. The plan marked the official abandonment of the policy of competition in the English NHS, which was established by the

Health and Social Care Act 2012 The Health and Social Care Act 2012c 7 is an act of the Parliament of the United Kingdom. It provided for the most extensive reorganisation of the structure of the National Health Service in England to date.''BMJ'', 2011; 342:d408Dr Lansley's Mon ...

Integrated care system In England, an integrated care system (ICS) is a statutory partnership of organisations who plan, buy, and provide health and care services in their geographical area. The organisations involved include the NHS, local authorities, voluntary and cha ...

s are to be created across England by 2021,

Clinical Commissioning Group Clinical commissioning groups (CCGs) were NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished and replaced by Integra ...

s are to be merged and NHS England with

NHS Improvement NHS Improvement (NHSI) was a non-departmental body in England, responsible for overseeing the National Health Service's foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. It supported providers to ...

appear to be merging, unofficially, though this is all to happen without actually repealing the legislation.

The plan

The plan proposes to shift resources out of hospitals into community services and primary care and in particular to improve mental health support in schools and 24-hour access to mental health crisis teams. The NHS budget is to increase by £20 billion a year by 2023. This is the equivalent of annual rises of just under 3.5%, but this has been widely criticized as below the historic trend of health funding, which in most developed countries has been rising at about 4% a year. The plan is also criticised for its failure to address very significant shortages of clinicians. The main disease priorities are

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...

stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

respiratory disease Respiratory diseases, or lung diseases, are pathology, pathological conditions affecting the organs and tissues that make gas exchange difficult in Breathing, air-breathing animals. They include conditions of the respiratory tract including the t ...

and

mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...

and some quite detailed targets. There is a specific emphasis on digital access which will be used to redesign services to avoid up to a third of hospital outpatient visits. The particular focus on children's health includes halving the number of

stillbirths Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term ...

maternal mortality Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...

and

neonatal deaths Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...

and serious brain injuries at birth by 2025. There is a considerable stress on preventative work, with claims that this could save up to 500,000 lives a year. Hospitals will run the Diabetes Prevention Programme,

smoking cessation Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often make ...

programmes and Alcohol Care Teams in the hospitals with the highest rate of alcohol dependence-related admissions. More patients with severe mental health problems will receive physical health checks each year. This has been criticised as secondary prevention, while public health and primary prevention which were transferred to local authorities by the 2012 legislation have suffered reductions in funding. The plan says "“Action by the NHS is a complement to, but cannot be a substitute for, the important role for local government… in recent years it has also become responsible for funding and commissioning preventive health services, including smoking cessation, drug and alcohol services, sexual health, and early years support for children such as school nursing and health visitors." The plan includes the proposed

repeal A repeal (O.F. ''rapel'', modern ''rappel'', from ''rapeler'', ''rappeler'', revoke, ''re'' and ''appeler'', appeal) is the removal or reversal of a law. There are two basic types of repeal; a repeal with a re-enactment is used to replace the law ...

of the specific procurement requirements in the Health and Social Care and the NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013. This would allow NHS commissioners to decide the circumstances in which they should use

procurement Procurement is the method of discovering and agreeing to terms and purchasing goods, Service (economics), services, or other works from an external source, often with the use of a tendering or competitive bidding process. When a government agenc ...

procedures, subject to statutory guidance and a best value test to secure the best outcomes for patients and the taxpayer.

NHS Assembly

56 people were recruited in early 2019 to form a forum which is to advise on the implementation of the plan. The assembly is to be chaired by Dr

Clare Gerada Dame Clare Mary Louise Francis Gerada, Lady Wessely, (born November 1959) is a London-based general practitioner who is President of the Royal College of General Practitioners (RCGP) and a former chairperson of the RCGP Council (2010–2013) ...

and Professor Sir

Chris Ham Sir Chris Ham (born 15 May 1951), is a health policy academic who started life as a political scientist. He was chief executive of the King's Fund from 2010 to 2018. He was professor of health policy and management at University of Birmingham ...

and will meet four times a year. It has a very varied membership including people from the voluntary sector, Rachel Power, the Chief Executive of the

Patients Association The Patients Association is an independent charity operating in the UK that aims to improve patients' experience of healthcare. Established in 1963, it became a registered charity in 1991. The Patients Association works with patients directly: ...

, Charlotte Pickles, who previously advised

Iain Duncan Smith Sir George Iain Duncan Smith (born George Ian Duncan Smith; 9 April 1954), often referred to by his initials IDS, is a British politician who served as Leader of the Conservative Party and Leader of the Opposition from 2001 to 2003. He was S ...

Polly Toynbee Mary Louisa "Polly" Toynbee (; born 27 December 1946) is a British journalist and writer. She has been a columnist for ''The Guardian'' newspaper since 1998. She is a social democrat and was a candidate for the Social Democratic Party in the 19 ...

, and the president of the Royal College of Nursing

Anne Marie Rafferty Dame Anne Marie Rafferty FRCN (born 7 May 1958) is a British nurse, academic and researcher. She is professor of nursing policy and former dean of the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King's College L ...

Response

The

Royal College of Midwives The Royal College of Midwives (RCM) is a British midwives organisation founded in 1881 by Louisa Hubbard and Zepherina Veitch. It has existed under its present name since 1947, and is the United Kingdom's only trade union or professional organis ...

were encouraged to see that maternity care was a key point. They welcomed promises to build on the Maternity Transformation Programme (MTP) and the key pledges around

continuity of care Transitional care refers to the coordination and continuity of health care during a movement from one healthcare setting to either another or to home, called care transition, between health care practitioners and settings as their condition and care ...

for most women by March 2021 and halving the rates of stillbirth and neonatal and maternal deaths by 2025. However, they questioned the lack of clarity on how these changes intend to be implemented and on workforce planning. The ''

Financial Times The ''Financial Times'' (''FT'') is a British daily newspaper printed in broadsheet and published digitally that focuses on business and economic current affairs. Based in London, England, the paper is owned by a Japanese holding company, Nik ...

'' commented that "Nothing much will change until the NHS begins to fill an estimated 100,000 vacancies" and urged ministers to "take on those interest groups lobbying against the changes needed to promote healthier lifestyles."

History and background

In the summer of 2018, the government asked the NHS to come up with a 10-year plan for how an increase in funding over the following five years should be used. This budget settlement for the NHS was announced by the Prime Minister that summer as being £20.5 billion. In addition, at this time, Simon Stevens disclosed the five major priorities for the 10 year NHS plan. Following the introduction of competition into the NHS in the 1990s, a number of NHS plans, with varying goals, effects and achievements have included; *"The

NHS Plan 2000 The NHS Plan 2000 was a ten year plan of the Blair ministry for the National Health Service (England). It combined a commitment to substantial investment with some quite radical changes. The most controversial aspect of the plan was the introducti ...

", which encouraged outsourcing and public-private partnerships It promised an increase in staff, hospital beds and equipment and modernised premises. In addition, it proposed to reduce waiting lists and bring in new targets and standards. *"The NHS improvement plan 2004", which also aimed to reduce waiting times for treatment and increase patient choice. It also listed disease prevention, inequalities and chronic conditions as priorities. *"Our health, our care, our say 2006", that emphasised a move from hospital care to the community, with an accompanying shift in funding. *"High quality care for all 2008", which focused on improving quality of care and patient safety. *"Healthy lives, healthy people 2010", which projected a long-term view for public health in England, encouraging prevention measures. *"Equity and excellence: liberating the NHS 2010", which extended the role of competition. *"The Health and Social Care Act 2012" doubled private sector outsourcing and allowed foundation trust hospitals to make up to half their income from private patients. *"The NHS five year forward view 2014", which lobbied for further disease prevention and tackling inequalities. It also established the foundations of the longterm NHS plan.

References

External links