NHS welcomes long-term plan but raises delivery questions

The NHS long-term plan for England has been welcomed as a wide-ranging programme to refocus the health service in terms of finances and services, but MPs have been told it may not be delivered in full without more money and staff.

The long-term plan, issued in January, outlines an ambitious programme, including moving more care out of hospital and into the community; greater prevention of ill-health; better outcomes and earlier diagnosis and treatment of major diseases; and using technology to deliver innovative care.

It also seeks to ensure that all NHS organisations in England return to financial balance by 2023/24 at the latest.

There is an emphasis on collaboration and integration – integrated care systems (ICSs) that bring together providers and commissioners will cover the whole of England by April 2021. They are expected to drive the plan forward, with commissioners and providers working together on service and financial planning.

NHS England chief executive Simon Stevens promised funding for primary and community services would grow faster than the overall NHS budget. This will create a ring-fenced fund worth £4.5bn a year in real terms by 2023/24 to support this new service model.

The focus on financial balance has a number of aspects, including a new financial recovery fund (worth £1bn in 2019/20); boosting tariff prices, particularly by transferring £1bn from the provider sustainability fund into non-elective prices; further efficiencies; and an accelerated turnaround process for the 30 trusts with the worst financial positions. The number of trusts in deficit is expected to fall by at least 50% in 2019/20.

However, NHS Providers chief executive Chris Hopson told a hearing of the Commons Health and Social Care Committee that he was unsure whether the service could deliver high-quality care within the financial settlement and in the face of increasing demand.

‘There are a lot of very good things in the plan, but does it answer the question of whether we can deliver the right quality of care for the money that is available?’ he asked.

‘I can make a relatively confident prediction here today that everything in the plan is not going to be delivered. There is simply too much to do for the money and the workforce we have available.’

He added that, at least initially, much of the growth funding would have to go into the acute sector to tackle deficits rather than community and primary care. ‘How that balance changes over time will be key, and part of it will be how fast we can recover the acute sector deficits.’

Witnesses also told MPs they were concerned that the plan did not include enough information about capital funding and plugging gaps in the workforce.

Health Foundation chief executive Jennifer Dixon said that the funding settlement broadly matched calculations of the amount the NHS would need to get back into balance, cope with the ageing population and meet NHS Constitution targets. But there was not much room for manoeuvre, and she was concerned the additional funding for primary and community care could be raided to stabilise the financial position in other sectors.

‘One of the big priorities signalled is to shift money into primary, community and mental health, which has to be a good thing. But you can only worry that that would be at stake, and first off the line, if the productivity could not be made and demand could not be quelled.’