Search for coherence

We stand on the verge of the promised long-term plan. Informed by 17 working groups covering everything from prevention and personal responsibility, through clinical priorities such as cancer, to the nuts and bolts of funding and the financial architecture – we can expect plenty of detail. The trick will be making it coherent with all the components aligned with the overall achievement of better, more integrated and sustainable services.

We have already seen high-level commitments emerging. At least £2bn of the overall £20bn real-terms increase by 2023/24 will go to mental health, while primary and community care can expect a £3.5bn boost.

Both sectors have been told they can expect to receive an increased share of overall funding. And there have also been good words about shifting the balance of funding between treatment and prevention.

Few would argue with these commitments. Mental health has for a long time been the last in line for funding and low in the list of priorities. The mental health investment standard has attempted to stop further decline by ensuring mental health services get their fair share of local funding increases. But there has been no account taken of previous underfunding and very little recognition of the increasing demand being met by core and new services.

Mental health providers also continue to point out that they are not seeing their own income rising in line with overall growth, as spending by commissioners on other aspects of mental health also counts against the standard.

As an overarching commitment, giving mental health a greater share of spending makes sense. But it mustn’t be at the expense of other services that have an impact on mental health. Cuts in community services can mean people with mental health conditions don’t get identified and supported earlier – leading to potentially increased activity for both acute and mental health services further along the pathway.

The commitment to mental health is important. Better mental health services will deliver better services to patients but also take pressure off other services. So it needs to be the overall outcomes that we measure success by – not whether we have hit a new investment target.

We need a holistic approach to funding that recognises the interwoven nature of key services. Social care, for example, is also vital to how the NHS can regain its performance levels and develop truly sustainable models of care.

And even where funding is increased, NHS bodies won’t be able to make efficient use of it unless the right staff are available. A workforce plan needs to have both a short-term and a long-term focus, focusing on training, recruitment and retention. Skimping now will be a false economy. Pathways need to be rethought to make appropriate use of the right clinicians, with staff trained for new roles where this makes sense.

And then the financial levers need to support all of this – delivering funding that covers the efficient costs of healthcare delivery with the right incentives to improve outcomes that matter to patients.

This is a huge agenda and the refinement of approach is unlikely to stop with the publication of the long-term plan. It is made all the more difficult by a five-year settlement that, while generous compared with other spending departments, is widely held to fall short of what is really needed.

What is most important is that the plan is coherent. Its component parts need to be pulling in the same direction and not at odds with each other. A healthcare delivery plan without an underpinning prevention strategy will be flawed. The plan will also struggle if there is not a similar ambitious vision for social care.

It won’t solve all the problems and it won’t be deliverable overnight. It needs to be ambitious but grounded in reality – working within the confines of the NHS settlement and (hopefully) a similar deal for social care.

If it can achieve this, it is an opportunity to set the NHS firmly in the right direction for the next generation.