The NHS 10-Year Plan: Big Promises, Bigger Questions

By Dr Nichola Stefanou, Chief Executive Officer – Healthcare Management Trust (https://hmt-uk.org/)

It’s fair to say the NHS 10-year plan received a mixed response from across the sector. It was met with praise and positivity from some, while some approached it with scepticism, and some were left with more questions than answers. And it’s easy to see why.

In nearly 200 pages, it set out plans to refocus the NHS on prevention rather than cure, to usher in a new digital age and to create a community service where patients are treated nearer to home instead of big, acute hospitals. These are big ideas, which will require big planning, big buy-in from all corners of healthcare, not just the NHS, and big budgets. I shared in the mixed response. Parts are very welcome and exciting, and there were parts where I was left with the question: ‘how will this play out in reality?’

Community positivity but how will social care fit in?
The proposal to move to more community-based services is positive. As a care provider reaching marginalised communities, we know the benefits this can bring to patients and their families. Patients feel in control of their care, they feel heard when they’re in more familiar surroundings and for some, reduced travel times to receive treatment will improve their outcomes. All of this should be commended and supported as community hubs begin to be planned and implemented.

However, as a social care provider, it was somewhat disappointing to see only fleeting mentions of social care throughout the plan. The NHS relies on social care and vice versa. You cannot have one without the other. If you reform the NHS, you must reform social care and this iteration of the 10-year plan does not convince me that the government sees social care in the same light as the NHS and worthy of reform.

What was pleasing to read, however, was that social care professionals will be part of community teams and their involvement in rehabilitation, recovery and frailty prevention will deepen. This is good news. I have often talked about the need to provide enough resources to social care providers to ensure they are able to offer patients reablement or rehabilitation that will actually improve health outcomes and quality of life. If not, patients in the community are likely to deteriorate more rapidly, leading to hospital admissions. It’s a vicious cycle that needs to be broken. I am hopeful that this is the first step to breaking that cycle.

It was also good to see a commitment to improving pay terms and conditions for social care staff through Fair Pay Agreements. However, providers in the sector are all concerned about where the money will come from to cover this rise in costs. The likelihood of increased hourly contract values are slim therefore posing the question, ‘Will providers now be expected to find more money from contract values that already don’t cover existing costs?’ If we lose capacity in social care and decrease the quality of community placements, this will ensure many return back to hospital beds, which directly flies in the face of the new NHS plan.

I also welcome the commissioning responsibilities for ICBs and the intention to simplify the commissioning process. Removing layers of bureaucracy is always positive and ensuring the money goes from one commissioning body straight to providers is a positive move. We are in the business of caring for people and communities so making this simpler is always a win in my opinion.

However, again, I am left with questions. How will the ICBs be able to be responsible for all but the most specialised commissioning using multi-year budgets? How will they decide where they spend that budget, and how are we telling leaders to be more innovative when they have only ever known an outdated and old-fashioned (in some areas) NHS? We could end up with a dichotomy: innovative plans working against a traditional, cumbersome system.

The private sector POV
HMT is a not-for-profit private provider. For decades, we have supported our NHS colleagues and strongly believe the private sector has a responsibility to support the NHS wherever possible. It was rewarding to see the relationship between the NHS and private providers included in the 10-year plan, especially that there will be more discussions with private providers to expand NHS provision in the most disadvantaged areas. We are proud to provide thousands of NHS treatments across our sites to help alleviate pressures and ensure that patients receive timely and effective care, and we will continue to provide this support.

However, we know that in some areas, there are NHS organisations that are not as open to working with private providers as others. We must remove the political prejudices and be pragmatic in allowing independent providers to the table to help tackle the challenges the NHS faces. Alongside the 10-year plan, the agreement to allow the NHS to make better use of the independent sector to tackle waiting lists as well as providing millions more appointments, which was reached earlier this year, is a welcome step in the right direction. I hope it will also encourage longer-term contractual relationships to be established, enabling further independent sector investment in NHS capacity, but also providing stability and security for the social care sector.

As with all government announcements, we will only know how successful it is in a decade’s time or if a new government are voted in. The 10-year plan is ambitious and rightly so – it needs to be. But ambition alone won’t drive change, and I am still left with the question ‘how will this play out in reality?’

True progress will depend on how these ideas are translated into action, how well social care is integrated into the bigger picture, and how openly all sectors – public, private, and community -based – are brought to the table. Only time will tell.