The NHS Long Term Plan needs politicians to help deliver it
Nick Samuels, healthcare consultant at Freshwater, dissects the NHS Long Term Plan and highlights where the real transformation is needed.
The NHS Long Term Plan (LTP) is a long read, but worth it. It is modern, rich in detail, ambition and direction. It covers the issues facing the NHS today and the weaknesses in health policy since 2010. It sums up a lost decade of progress for the NHS that has seen predictable demand being unmet, targets missed and unpreparedness for what is to come. The LTP tackles much of this head on and looks beyond. The ambition and vision for our health and care and what our NHS can provide is on every page. It knows what it is asking of us who work in it, use it, rely on it and pay for it.
So what’s missing? Well, the ability to staff it, fund it and partner with an adequate social care system. And there is one other thing – it has no political leadership or ownership. In fact, that has been the common theme of health policy this decade – there has been none, beyond the disastrous 2012 Health and Social Care Act. Now, given the state of current national political leadership, this might be welcome. A health policy created by health professionals and handed to disinterested or distracted politicians has many merits as far as quality policy-making goes. But here’s the rub; without political ownership and support for the policy, its implications and application run into political trouble.
In the past, we have even seen Secretaries of State campaign against the implementation of their own health policies in their own constituencies. But what we have in the LTP will have radical implications for how we receive healthcare – and politicians of all backgrounds tend to become very conservative, with a small C, when those radical changes are proposed in their own constituencies.
The LTP will change, and improve, many dynamics of healthcare everywhere with prevention at its core. Its central premise is that we must stop thinking of the NHS as going to the GP or going to hospital. The NHS will be about trying help you avoid illness and keep fit and well; helping you live as happily and independently as possible when you are not well; supporting you with frailty as that beckons and having the specialist support for when it’s needed.
The clinical science, expertise, tech and the knowledge exists to allow that sort of NHS to take shape and the LTP gives it the vision, direction and architecture to enable it. This is very different from when we were building hospitals 40 years ago, designed to fix us when we were broken. However, hospitals and GP surgeries remain a cultural and physical representation of what many, especially politicians, consider to be what the NHS is solely about. Mental health, social and community care have been Cinderella services for so long in part because no politician ever thought they were going to lose their seat over them.
Tinker with a hospital, on the other hand, and they are holding up the first banner at the demonstration that follows. I remember one local politician telling me once that he was doing what his constituents wanted by opposing a change that would deliver higher quality care. And in response to the suggestion that lives would be saved he said: “Ah yes, but it’s those who are left who will vote for me.”
The LTP will move the health furniture around massively. It will have implications that require progressive change for all existing services and will harness digital technology and behaviour which we take for granted in most other parts of our lives. But for every outpatient change, move to create different sorts of emergency care, new service and type of delivery, we will need to engage, involve and collaborate with patients, staff and communities. The LTP needs the staffing, the resources and a credible care system that politicians can deliver. But it also needs the politicians to back its vision, not just in theory but in practice.