The new 10-year plan for the NHS was published on Monday, after being delayed since the end of last year. The 136-page blueprint sets out how a £20.5bn annual budget increase will be spent.
Key areas of focus included in the NHS Long Term Plan and highlighted by the Department of Health and social Care included:
- improving outcomes for major diseases, including cancer, heart disease, stroke respiratory disease and dementia
- better access to mental health services, giving 370,000 adults with severe mental illness and 345,000 children greater support, with an additional £2.3bn being invested in mental health by 2023 to 2024
- ensuring all children get the best start in life by continuing to improve maternity safety, including halving the number of stillbirths, maternal and neonatal deaths and serious brain injury by 2025
- boosting out-of-hospital care, supporting primary medical and community health services with spending on these services £4.5bn higher in five years’ time
- supporting older people through more personalised care and stronger community and primary care services
- making digital health services a mainstream part of the NHS
What people said about the NHS Long Term Plan by sector
Department of Health and Social Care
Matt Hancock, the health and social care secretary, said: “The NHS long term plan, backed by a historic commitment of an extra £20.5bn a year from taxpayers, marks an important moment not just for the health service but for the lives of millions of patients and hardworking NHS staff across the country.”
He said: “Whether it’s treating ever more people in their communities, using the latest technology to tackle preventable diseases, or giving every baby the very best start in life.
“This government has given the NHS the multi-billion pound investment needed to nurture and safeguard our nation’s health service for generations to come.”
Labour health spokesman Jonathan Ashworth said: “The fact NHS bosses are now proposing significant changes to the Health and Social Care Act confirms what a wasteful, bureaucratic disaster it was in the first place.”
“The reality is the NHS will continue to be held back by cuts and chronic staff shortages”
He said: “Labour has long called for this act to be binned and will study legislative proposals carefully.
“The Tories must apologise for wasting billions of taxpayers’ money on the privatisation, constant tendering of contracts, top-down reorganisation and demoralisation of staff this Tory act ushered in.
“The Tories have spent nine years running down the NHS, imposing the biggest cash squeeze in its history, with swingeing cuts to public health services and the slashing of social care services.
“They have failed to recruit and train the staff desperately needed, leaving our NHS struggling with shortages of over 100,000 staff.
New shadow health secretary in latest Labour reshuffle
“What’s more, it’s a damning indictment of the impact of Tory austerity, cuts to public services and rising poverty that the NHS today admitted that socioeconomic inequality causes £4.8bn a year in greater numbers of hospitalisations.
“While the aspirations for improving patient care NHS England has outlined today are welcome, the reality is the NHS will continue to be held back by cuts and chronic staff shortages. Labour will give the NHS the funding it needs to provide quality care and recruit the staff for the future.”
Liberal Democrat health spokesman Norman Lamb said: “Delivering this ambitious plan is likely to be fatally undermined by insufficient resources, a staffing crisis and a failure to address the disastrous situation with social care.”
“The government’s commitment to a new focus on prevention rings hollow”
He said: “The government’s commitment to a new focus on prevention rings hollow when the very services which help prevent elderly people ending up in hospital are at breaking point and vital public health budgets are progressively cut back.
“The Liberal Democrats will continue to demand that the government works with other parties to achieve a genuine long term, sustainable settlement for the NHS and social care.
“We will keep making the case for a new, dedicated NHS and care tax to guarantee a modern, effective and efficient NHS and care system which will be there for our loved ones when they need it.”
NHS England chief executive Simon Stevens said: “The NHS has been marking its 70th anniversary, and the national debate has rightly centred on three big truths.”
“It keeps all that’s good about our health service and its place in our national life”
He said: “There’s been pride in our health service’s enduring success, and in the shared social commitment it represents.
”There’s been concern – about funding, staffing, increasing inequalities and pressures from a growing and ageing population. And there’s also been legitimate optimism – about the possibilities for continuing medical advance and better outcomes of care.
Source: Wilde Fry
“In looking ahead to the health service’s 80th birthday, this NHS Long Term Plan acts on all three of these realities. It keeps all that’s good about our health service and its place in our national life.
”It tackles head-on the pressures our staff face. And it sets a practical, costed, phased route map for the NHS’s priorities for care quality and outcomes improvement for the decade ahead.”
Ian Dalton, chief executive of NHS Improvement, said: “At the heart of the NHS are hard-working staff who pull out all the stops to care for patients every day.”
“This means breaking down organisational barriers to take a more holistic approach”
He said: “It is thanks to their dedication that the NHS is admired around the world and that it has taken great strides over the last seven decades.
“We need to build on these achievements and make the best use of the new investment to fundamentally reset how the NHS is run so that our growing and ageing population can get the right care at the right time and in the right place.
“This means breaking down organisational barriers to take a more holistic approach to how care is delivered and paid for, embracing new and existing forms of technology, recruiting and retaining the right number of staff, and shifting the focus away from hospitals to prevention and care in the community.
“Developed by those working within the NHS, the long term plan sets out an exciting roadmap for how we will do this together for the benefit of patients.”
Sarah Wilkinson, chief executive of NHS Digital, said: “This plan offers a hugely exciting vision for the future of the NHS.”
“This plan offers a hugely exciting vision for the future of the NHS”
She said: “We are particularly pleased that the plan recognises the extent to which new and improved technology and digital services can enable many of the goals set-out, all of which we whole-heartedly support.”
She said: “Over the coming years, we in NHS Digital, working closely with our partners across the system, will work to make digital access to health and care services as pervasive as it is now across other sectors.
“The sophistication of commodity technology services, the plethora of advances in health technology, the track-record of reliable delivery which we have quietly laid down over recent years, and the passion and commitment of this Secretary of State to transforming these capabilities combine to make this a time of enormous opportunity and potential.
“A key focus of the technology and digital agenda, as with the plan overall, is allowing patients to better manage their own health and care. A broad spectrum of digital services will support individuals to take a much more proactive and responsible approach to monitoring their own health and well-being, enabling them to recognise their individual health risks and symptoms as early as possible, and manage their personal response to these risks. This, in turn, reduces the demand for health and care services.
“We know how challenging it can be for organisations, particularly those under constant pressure to deliver critical services, to adopt new technology and digital systems. We are completely committed to supporting NHS organisations on all aspects of this journey from technical education, to integrating new technology into services and care pathways to the design of highly usable and accessible patient-facing solutions.”
West London NHS Trust
Carolyn Regan, chief executive of West London NHS Trust, said: “I’m pleased to see the prominence given in the plan to mental health, backed up with £2.3bn a year more funding in real terms.”
“The delivery of the very best healthcare depends on having a modern environment in which to provide treatment”
She said: “Mental illness often starts in childhood, so the emphasis on children and adolescents and the promise to provide mental health care to 350,000 more young people is particularly important.
“The commitment to young people that they will no longer need to restart their treatment with adult services when they turn 18 is also a vital step forward.
Broadmoor trust’s nurse staffing problems remain
“At West London NHS Trust, we believe that people do best when their mental and physical care needs are treated in an integrated way. I’m pleased to see that this is recognised throughout today’s plan.
”However, the delivery of the very best healthcare depends on having a modern environment in which to provide treatment.
“Many of our buildings are ageing and pre-date the NHS itself, so we want to seize every opportunity today’s plan provides to upgrade our facilities and deliver the very best care we can to our community.”
Royal College of Nursing
Dame Donna Kinnair, acting chief Executive and General Secretary of the RCN, said: “We welcome the ambitions outlined in the plan, and it deserves to succeed.”
“It is strange then that this plan offers no money for nurses to develop the specialisms and skills patients need”
She said: “But translating good intentions into better treatment and care for patients relies on having the right number of nurses with the right skills across our NHS. Three priorities of the plan are cancer treatment, mental health and caring for patients at home.
“This is undoubtedly the right direction, yet with 40,000 nurse vacancies in England, cancer centres are struggling to recruit specialist cancer nurses, we have lost 5,000 mental health nurses since 2010, and district nurse numbers fell almost 50% in the same period.
“As the prime minister said in her speech today, the NHS’s biggest asset is its staff. It is strange then that this plan offers no money for nurses to develop the specialisms and skills patients need.
Leading nurse becomes patient safety charity patron
Source: Kate Stanworth
“And it is equally concerning that online courses are presented as a magic bullet to solve the workforce crisis.
“Nursing degrees demand both academic and practical skills which student nurses learn from contact with professionals and peers, a model not easily replicated online, even with clinical placements.
“Nursing is career like no other, and it takes the right values and ambition to succeed. Entry standards are rigorous because they have to be – it is what safe patient care demands.”
Sara Gorton, head of health at Unison, said: “Finding the NHS more staff, and holding on to those it already has, is key to the success of the government’s plan.”
She said: “The plan is honest about the scale of the staffing challenge. But nothing will happen without more money to attract new recruits and train existing employees. The government must act now, or its plan will fall at the first hurdle.
sara gorton for index
“Repealing the despised Health and Social Care Act would spare the NHS from the costly and time-wasting need to compete against itself.
”The market-obsessed system created by the 2012 legislation has failed to tackle the huge health inequalities that exist across the country, and added to the pressures being felt in every part of the NHS.”
Royal College of Midwives
Gill Walton, chief executive and general secretary of the RCM, said: “It is very encouraging to see maternity front and centre of this plan.”
“It is very encouraging to see maternity front and centre of this plan”
She said: “There is much in the plan to welcome such as the commitment to reduce health inequalities, the renewed commitment to the Maternity Transformation Plan, and the pledge of a job guarantee for midwives after they qualify. Also very welcome is the announcement of the first chief midwifery officer. This is an ambitious plan and good leadership will be needed to implement it, in midwifery and in other health professions.
“However, there is right now a gap between the ambitions for our maternity services and the reality on the ground. This plan adds yet more aspirations but we need to know how the government will bridge this gap and give us the services they have promised.
“The issue of funding services also rears its head. There are some commitments in the plan to postnatal care yet this is an area that has long been underfunded. Key elements of the plan also talk about prevention of poor health such as reducing the numbers of people smoking. But we are seeing budgets for public health services such as smoking cessation cut.
New chief executive takes over at midwives’ union
“It is therefore vitally important that sufficient funding is made available and that we have the right numbers of midwives and other staff in place. It is not just about a shortage of midwives, but also a shortage of other health professionals which can impact on midwives. The whole system has to be staffed adequately otherwise the system falls down.
“What is now important is seeing the details of how this will be translated for people where they live through local maternity plans. For example, we would want to see how the plan’s commitments to improve perinatal mental health actually look when the services are delivered, such as ensuring every trust has a specialist perinatal mental health midwife.
“It is an ambitious plan and we look forward to working with the government and other health organisations to make it a reality.”
Colenzo Jarrett-Thorpe, Unite national officer for health, said: “This new cash is, in reality, putting in the funding that the government removed a decade ago.”
“There are an estimated 100,000 vacancies in the NHS, which are compounding the current crisis”
He said: “‘Smoke and mirrors’ is the name of the game. The money that is now coming on stream is not enough to meet the ambitious targets to save the almost 500,000 lives outlined in the long-term plan.
”The NHS is like a Rolls-Royce that needs constant care and attention – the Tories, since 2010, have neglected its annual maintenance. The NHS requires an immediate cash injection to meet increasing demand. That’s the grim reality.”
“We know that even the projected boost of government funding to the NHS over the next four years does not meet the historic average increase in NHS funding over the last 70 years, which has run at about 3.9% compared to the 3% minsters are proposing.
Pay restraint for NHS nurses set to continue to 2020
”From 2010 up till now, increases in the NHS budget have been barely 1%. For example, because of the massively flawed Health and Social Care Act, many of our public health services have been transferred to local authorities since 2013 and funding in public health has fallen by eight per cent since 2013-14, according to the Kings Fund.
“How can this long-term plan be implemented if the government gives with one hand and takes away with the other? This plan is doomed to failure if ministers do not reverse cuts to local authority budgets or give incentives to councils not to cut public health or community health budgets.
”On top of all this, there are an estimated 100,000 vacancies in the NHS, which are compounding the current crisis. As a country, we also rely on the 63,000 EU citizens working in the NHS in England whose future is being blighted by the unpleasant atmosphere created by Brexit.”
Council of Deans of Health
Professor Brian Webster-Henderson, chair of the council, said: “There is much to welcome in the long-term plan, including its focus on public health, recognition of the importance of continuing professional development, commitment to workforce expansion over the next 10 years and its focus on restoring growth in undergraduate education as central to the success of the plan.”
“They often struggle to attract students to mental health, learning disability, and adult nursing”
She said: “We are pleased that the government recognises the importance of placement availability to workforce growth and we welcome the commitment to fund as many clinical placements for nurses and midwives as universities can fill (up to a 50% increase on current numbers). This commitment will need to be supported by additional funding for continuing professional development in the existing workforce to create the necessary additional capacity in workplace education.
“The council whole-heartedly supports the announcement of annual recruitment campaigns and will work with the government to discuss its plans for ‘earn and learn’ schemes for mental health and learning disability nursing courses for mature students. The focus on learning disability nursing is particularly important if the long-term plan’s aspirations for improved learning disability care are to be realised.
“Employment rates for nurse, midwife and allied health profession graduates are already very high (with 94% of nurses in employment a year after graduation) but applicants may be reassured by the new five-year job guarantee announced by the plan.
“My main concern about today’s publication is its statement that thousands of highly motivated and well-qualified applicants are being turned away by universities. This is simply not the experience of our members. We know that while universities are easily recruiting to some healthcare courses, such as child nursing and physiotherapy, they often struggle to attract students to mental health, learning disability, adult nursing and some allied health profession courses.
Mental health nurse to be next chair of Council of Deans
“We need to see further details on this [new online nursing degree]. Nursing is a high cost subject and is unlikely to be much cheaper when accessed online so the government would need to subsidise this route. I am concerned that without careful implementation this option could undermine the important local relationships between employers and universities.”
“Universities are absolutely key in delivering the workforce growth required by the NHS Long Term Plan. We urge NHS Improvement, NHS England and Health Education England to ensure that universities are represented on the national workforce group. We welcome the long-term plan’s focus on allied health professions, nurses and midwives and support its announcement of the introduction of a chief midwifery officer.”
Chris Hopson, chief executive of NHS Providers, said: “There will be strong support across the NHS for the vision and ambition set out in the document.”
“We need urgent action to solve what trust leaders current describe as their biggest problem”
He said: “Trusts and their staff are strongly committed to creating world class services and continuously improving patient outcomes.
”They also recognise the need to transform the way they provide care to reflect 21st century health and care needs. There is a huge amount to do across a wide range of areas. Successful delivery will depend on four key factors.
“First, ruthless prioritisation and effective implementation. To plan is to choose. We now need a detailed implementation plan that sets out exactly what will be delivered when. This must clearly match the priorities for each year to the available money and staff, ensuring that the trusts who have to deliver the plan are actually able to do so.
“Second, a rapid solution to current workforce shortages. This plan cannot be delivered whilst trusts still have 100,000 workforce vacancies. We need urgent action to solve what trust leaders current describe as their biggest problem. It’s a major concern that we will have to wait longer to get the comprehensive plan that is needed here.
“Third, a clear path to recovering performance in areas like urgent and emergency care and routine surgery. Despite trusts working flat out, the NHS has fallen behind where it needs to be, missing all its key performance targets over the last four years. Whilst trusts are ready to look at updating these targets, we mustn’t lose the enormous gains trusts made in cutting waiting lists and improving care in the early 2000s.
“Fourth, there are a range of other issues central to the success of the NHS that must be satisfactorily resolved through the spending review – social care, public health and NHS training budgets. The ambition and vision are welcome. But they need to be delivered.
“We welcome the commitment to an open and consultative process in developing a detailed implementation plan over the next few months. It is vital that the expertise and concerns of NHS trusts are central to those discussions. We look forward to making a full and positive contribution.”
Mental Health Network
Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, said: “The Long Term Plan represents vital progress towards parity of esteem for mental health services and has come through genuine and meaningful engagement with the sector.”
“The mental health sector has been stung particularly hard by the workforce shortages”
He said: “The £2.3bn ringfenced local investment fund for mental health will help alleviate the severe pressures on the system as well as improve and increase access to mental health services.
”We welcome the commitment to focus on increased spending for children and adolescent services which will help treat 345,000 more children and young people by 2023-24.
“Implementing clear access standards for community and emergency mental health care is a step towards putting mental and physical health on an equal footing.
“Meeting these standards will improve the care people receive while at their most vulnerable. But there are challenges to achieving this bright vision. The mental health sector has been stung particularly hard by the workforce shortages, with 20,000 vacancies.
“It is vital we have the right staff in the right places to provide care, and they need the right facilities to do so. We look forward to the publication of the NHS workforce implementation plan and the capital settlement as part of the comprehensive spending review.”
Matthew Winn, chair of the Community Network, established by the NHS Confederation and NHS Providers, said: “It is extremely positive that community services, working in partnership with primary care, will play a central role in supporting a sustainable NHS for the long-term future; this is something the Community Network has argued for.”
“Working together, primary and community health services will be able to make major changes”
He said: “A shift in focus towards prevention and community care will help ensure people can live healthier, longer lives, and receive care in or close to their homes, reducing admissions and demand on already over-stretched hospitals.
“The commitment of at least an extra £4.5bn a year in real terms by 2023-24 for primary and community care is hugely welcome. However, it will be imperative for investment to reach the front line, and to address the workforce challenges the sector must address if we are to make this ambition a reality.
“Working together, primary and community health services will be able to make major changes in the way people are supported, especially those who are frail and vulnerable.
“We now need to translate this plan into deliverable action, and with involvement from the front line, set out how these ambitions will be balanced against the other priorities in the NHS Long Term-Plan and the funding available.”
Professor Martin Green, chief executive of Care England, said: “We welcome the recognition that the NHS should offer better support to people living in care homes.”
“The challenge for the NHS, and indeed the entire system, will be a cultural one”
He said: “As long ago as 2008, Care England identified the difficulties of getting appropriate NHS support for people living in care homes ‘Can We Afford the Doctor’. The challenge for the NHS, and indeed the entire system, will be a cultural one.
“It is important that in the future we move towards a fully integrated system, where the money that is available is used to deliver outcomes for citizens, rather than the maintenance of organisations.
”Care England is committed to working with the government on a long-term strategy for the NHS, and a long-term strategy for social care.”
Faculty of Public Health
Professor John Middleton, president of the faculty, said: “We’re delighted to see prevention and early-intervention feature so strongly throughout the NHS long-term plan, alongside commitments to tackle health inequalities and shift NHS organisations towards a population health focus.”
“The long-term plan is right to stress that the NHS alone cannot deliver prevention and reduce health inequalities”
He said: “Investing in NHS prevention interventions, such as alcohol care teams, that we already know work if implemented well will keep our communities healthier, reduce pressure on acute services, and contribute to the long-term sustainability of all of our public services.
“At FPH, we have long recognised the vital work that NHS staff and organisations do in delivering the wider prevention agenda alongside all of their other priorities. That’s why we’re undergoing a programme of work in collaboration with health care leaders and FPH members to identify how we can implement prevention more effectively across the NHS.
“We hope to gain a better understanding of the barriers and enablers to ‘good’ prevention activity across primary, community, and acute settings and clarify where NHS organisations can add the most value to system-wide prevention activity as it implements the proposals published today.
“The long-term plan is right to stress that the NHS alone cannot deliver prevention and reduce health inequalities; we all have a role to play. In particular, local authorities have enormous potential to improve the public’s health in concert with the NHS, but to do that they require dedicated funding that can be spent in a way that will best meet local needs and challenges.
”At the moment, our members leading local government public health teams are telling us that they don’t have enough resources to deliver all that is being asked of them.
“So, while we welcome the prevention commitments made today in the NHS long-term plan, we’re also calling on the government to invest in a £1-2bn per year Prevention Transformation Fund in this year’s spending review.
”The fund would give a much-needed boost to local authority budgets, and would support the upgrading of prevention in local communities across the country.”
Royal Society for Public Health
Duncan Stephenson, director of external affairs at the society, said: “There is much within the forthcoming NHS Long Term Plan to welcome – particularly in terms of secondary prevention – from reducing hospital admissions, providing support to smokers and heavy drinkers and the introduction of ambitious targets to reduce deaths from some of our biggest killers.”
“There is an urgent need for the government to fund primary prevention”
He said: “It is also encouraging to see further investment and support in mental health services, which are so vitally important – particularly the commitment to provide new support teams in schools to help identify mental health problems earlier and those in need.
“However, while there is much to welcome from NHS England, in terms of secondary prevention, improving diagnosis and embracing new technologies, the best laid plans can go to waste if not backed up by sufficient funding.
“In 2014, the NHS Five Year Forward View promised a radical upgrade for public health and prevention, although this has to some degree been undermined by a series of assaults on Local Authority public health budgets. There is an urgent need for the government to fund primary prevention, which has the potential to stop some of the killer diseases we face from developing in the first place.”
Association of Directors of Adult Social Services
Glen Garrod, president of ADASS, said: “The new financial settlement for the NHS is the largest single increase for any public service in recent times outside of the spending review.”
“The proposed expansion of personal health budgets is also very welcome”
He said: “ADASS welcomes the publication of the long-term plan as an opportunity to assess how the additional money will be used to improve the overall health and wellbeing of local communities and not just to relieve current pressures on hospitals.
“ADASS is pleased to see that priority will be given to primary care, mental health and community services. Alongside social care and housing, these services are vital to enable people to live as independently as possible in their own homes and communities through the right mixture of joined-up services thus reducing the need for admission to hospital for mental or physical health reasons and or long-term care.
“We reiterate our commitment to work collaboratively with the NHS at local, regional, and national levels to achieve these goals. The proposed expansion of personal health budgets is also very welcome, there is much that can be learnt from the experience of social care in implementing personal budgets in extending choice and control.
“It is encouraging that the new plan recognises the importance of prevention. However, it is hard to see how this can be delivered with continuing cuts to public health budgets, where spending per person has fell by nearly a quarter since 2015-16. The contribution that local government generally makes, for example in leisure and housing, to prevention needs to be recognised in this context.
“The new plan sets out how the NHS will respond to demographic change, increasing complexity and acuity of needs, rising costs and workforce constraints. These same challenges are driving the pressures on social care. As the previous NHS Five Year Forward View recognised, an effective NHS depends on adequately funded social care – the two services are inter-dependent. Now that there is a long-term plan in place for the NHS, it is deeply disappointing that the promised green paper setting out proposals for sustainable long-term funding for social care has still not been published.
“The green paper and the NHS Long Term Plan should have been developed in parallel. A major opportunity has been missed. The absence of clarity and certainty about future social care funding represents a major risk to the ambitions of this NHS Plan.”
Rachel Power, chief executive of the association, said: “The long-term plan has undoubted strengths. Its commitment to shifting the focus of NHS services much more into the community is exactly the right priority. Integration and prevention are essential focuses, and totally correct.”
“The serious and growing shortages in the health and care workforce are a major threat”
She said: “So, it’s highly unfortunate that failures outside the plan itself mean that on its own it cannot safeguard the future of the health and social care system. The government still lacks any sort of strategy for health and wellbeing, and has not even published its green paper with proposals to end the ongoing social care crisis. Last year’s funding announcement promises another five years of below-trend growth for the NHS, on top of the eight it has just endured, and excluded key areas of expenditure.
“The serious and growing shortages in the health and care workforce are a major threat, and could even make the plan undeliverable. Proposals to solve this problem aren’t expected until around the middle of the year. Training and developing skilled staff cannot be done quickly, and it’s not clear whether the government’s immigration proposals and our exit from the European Union will support recruitment from abroad.
“NHS England has done what was asked of it in terms of developing a coherent plan. The government now needs to do its part, and get serious about addressing the substantial strategic problems that still pose major threats to the health and care system.”
Family Doctor Association
Dr Peter Swinyard, national chair of the FDA, said: “Within general practice, we particularly welcome the re-formation of the primary care team, where GPs, practice nurses, other clinicians, district nurses, midwives, health visitors and mental healthcare workers can meet together to co-ordinate the care of the patient.
“Within general practice, we particularly welcome the re-formation of the primary care team”
“In recent years, the loss of this communication, along with the reduction in numbers of fully trained district nurses, has severely impacted on the co-ordination and efficiency of patient care.
“This primary care team has been given a 2019 rebrand; renamed a multi-disciplinary team and placed at primary care network level but its re-formation is greatly welcomed.”
Medical royal colleges
Royal College of Physicians
RCP registrar Professor Donal O’Donoghue said: “The NHS Long Term Plan published today outlines specific areas of improvement in areas such as heart disease, stroke and cancer that will provide much needed sustainability to significant parts of the NHS.”
“The plan sets out some small but important changes that should help improve doctors’ morale2
He said: “We welcome the focus on changing models of working with greater integration, making sure care is person-centred, and changing outdated systems such as outpatient clinics.
“We know that frontline staff today will be working out what the plan means for them and the patients they care for.
“The plan sets out some small but important changes that should help improve doctors’ morale, from changes to training programmes permitting ‘step in step out’ training and increasing focus on the health and wellbeing of staff.
“However, if we are to see a real reduction in burn out rate, the only way to achieve this in the medium to long term is by dramatically increasing medical school places, and the supply of doctors.
“We encourage ministers to move beyond considering the expansion of the medical training initiative, and to commit to the expansion this week.”
Royal College of Emergency Medicine
Dr Chris Moulton, vice president of the RCEM, said: “On face value, the NHS long-term plan is ambitious, optimistic and considered. Within it there are many fine aims which, if delivered, will improve care for some patients.”
“We fear that there are incompatibilities with expectation and reality”
He said: “However, we fear that there are incompatibilities with expectation and reality; particularly when considering the gap between what is being promised and what is being provided. As others have rightly pointed out, the viability of this plan will not only be conditional on tackling workforce shortages – and ensuring that those staff that we have do not leave the NHS – but also on adequate funding for both public health and social care.
“The plan leans towards prevention rather than treatment, yet there has been no halt to the cuts in public health funding and this settlement does not include any increase. Embedding social care teams in the emergency department may well be a good idea, but social care has been in a dire state for a long time and the green paper on it has been delayed for many years.
“Aiming to relieve pressure on hospitals by shifting towards care in the community is commendable, and patients naturally want to be treated as close to home as possible. But if this change is to work then this care must be available, like emergency care, 24/7. This will need serious commitment on the part of other specialities and agencies.
“While the college welcomes moves to relieve pressure on emergency departments, it is disappointing to find that despite the proposed measures to do this, it has still not resulted in a firm commitment to restoring hospital four-hour performance to 95% – a sensible target that is very much achievable given the right resourcing and desire to do so.
“We also fear that the Clinical Standards Review that the document alludes to but provides scant details of, may not be driven by patient interests alone. Targets ensure patient safety, drive improvement and provide a level of transparency around system performance that is essential for good decision making.
“While experience shows that diversion strategies do not work as desired, most of the aims within the plan are laudable, if perhaps too readily promised. Unfortunately, it appears to be the case that while many patients will benefit, this may be to the detriment of others – those attending A&E will continue to suffer from delays and overcrowding.”
Royal College of Obstetricians and Gynaecologists
Professor Mary-Ann Lumsden, senior vice president of the RCOG, said: “We welcome the government’s announcement of a long-term plan for the NHS and £20.5bn a year additional funding by 2023-4, which marks an important step forward in ensuring the sustainability of the NHS.”
“We strongly believe there also needs to be a targeted approach to improve the health of women”
She said: “It is fundamental that we have a laser-sharp focus on making sure that the workforce gets the support, skills and training it needs to deliver the highest quality care for patients. One of the major strengths of the NHS is its staff. We particularly welcome the focus on increased flexibility and the need to rebalance generalist and specialist skills so that we attract and retain a strong workforce.
“Together with key stakeholders, including other royal colleges and organisations that play a major part in workforce planning, we welcome the opportunity to contribute to a new workforce implementation plan by the spring to improve the effectiveness and sustainability of the workforce. This will build on activities which are already an integral part of the Maternity Transformation programme.
“The plan sets out an ambitious roadmap for supporting the NHS to ensure that the UK is the safest place to have a baby. To support this aim, the RCOG is calling for a national maternity centre to be established, bringing together the shared expertise and experience of women and families, frontline maternity teams, academics and policymakers, aimed at reducing the number of stillbirth and pre-term births by 2025.
“Also, since one in five women experience a mental health issue in the first year of her baby’s life, these plans will include the development of maternity outreach clinics offering perinatal mental health support for new parents with children up to two years old
“The RCOG is particularly heartened to see the plan’s focus on addressing health inequalities, across all life stages, including a focus on ethnicity and deprivation in maternity services. It is unacceptable that 34% of women living in deprived areas experience poor health, compared to 17% in other parts of the country.
“We strongly believe there also needs to be a targeted approach to improve the health of women. They represent 51% of the UK population and play an influential role in the nation’s health, yet they are disproportionately affected by inequalities in access to and quality of care. We believe it is crucial to develop a national women’s health strategy.
“Setting up integrated care systems everywhere and to include clinical leadership is a progressive way to ensure we address unmet needs within local health populations. We are calling for a specific and measurable goal around women’s health to be included as local plans are developed.”
Nursing and Midwifery Council
Sue Killen, interim chief executive and registrar of the NMC, said: “Increased investment in the NHS is much needed and today’s long-term plan for the health service in England, setting out how that extra money will be spent, is a step in the right direction.”
“The plan rightly recognises the need for a step change in the way health and care services are delivered”
She said: “Nurses and midwives are the cornerstone of the NHS and the plan rightly recognises the need for greater investment in people – both in terms of attracting more and retaining those we have.
“But more detail is needed on how this will be achieved, particularly in relation to ensuring nurses and midwives get the ongoing support, training and development opportunities they need throughout their careers. We know this is key to retaining staff and improving the quality of care.
“The plan also recognises the vital contribution that those trained outside the UK make to our NHS. As part of our commitment to supporting better, safer care, we’re continuing to improve the way we register nurses and midwives to ensure that those with the right skills can join our register in the quickest and most straightforward way possible.
“The plan rightly recognises the need for a step change in the way health and care services are delivered – moving care away from hospitals and into the community. And while the publication of today’s plan is no doubt a step forward, it’s critical that the NHS is not taken in isolation.
“With over 40,000 nurses on our register working in social care, there is an urgent need for improved integration between the NHS and social care. Ensuring people get the support and care they need, where and when they need it is clearly a priority for the whole health and care system, and the government’s forthcoming social care green paper will be central to this.
“It’s pleasing to see that today’s plan prioritises both mental and physical health, alongside key commitments to enhancing maternity services and safety, preventing illness, improving cancer testing and a smarter use of technology. We also welcome the creation of a new chief midwifery officer role.
“We’ll be working through the detail of the long-term plan for the NHS in the coming days and look forward to the publication of the social care green paper and detailed workforce strategy.”
The King’s Fund
Richard Murray, chief executive at the King’s Fund, said: “This is an ambitious plan that includes a number of commitments which – if delivered – will improve the lives of many people.”
“There should be no illusions about the scale of the challenge ahead”
He said: “NHS leaders should be applauded for focusing on improving services outside hospitals and moving towards more joined-up, preventative and personalised care for patients.
“While NHS leaders have done what was asked of them within the constraints of the funding settlement provided by the government, some significant pieces of the jigsaw are still missing. A number of decisions – notably on hospital waiting times – have been postponed, indicating that trade-offs and difficult choices lie ahead.
“Whether the plan can be delivered relies critically on tackling workforce shortages. While the plan recognises this, commitments to increase international recruitment depend on decisions about immigration policy and we will need to wait for solutions until a new workforce plan is published later this year.
“The NHS and social care are two sides of the same coin, yet publication of the social care green paper has been delayed yet again. And while commitments for the NHS to do more promote public health are welcome, cuts to local government funding for public health services underline the need for a more consistent approach across government to the population’s health.
“We strongly support the ambition to establish integrated care systems in every part of the country by 2021. The plan sends a welcome signal that NHS organisations need to work with local authorities and other partners to deliver improvements in the health of local populations. In short, while today’s plan is a significant step forward, a number of questions remain unanswered. There should be no illusions about the scale of the challenge ahead.”
Nigel Edwards, chief executive of the Nuffield Trust, said: “The goals of this plan look right – carrying on with joining up care and improving services for older people, while pushing vital issues like heart attack survival and children’s health up the agenda.”
“What worries me is how difficult it will be to roll out such wide ranging changes”
He said: “These are the most important issues for patients, and the level of ambition is good. What worries me is how difficult it will be to roll out such wide ranging changes.
”There are several big pitfalls ahead. The extra funding will actually be below the historic average and what experts thought was needed. It’s enough to move forwards, but with little room for manoeuvre. If we face a no deal Brexit, the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks.
“The last few years have seen repeated cuts to public health and social care. The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again. If this goes on, the NHS will be stretched still further as it looks after more people who couldn’t find the help they needed.
”In the NHS it is always difficult to take changes from the whiteboard to the ward. Success depends on extra effort and initiative from staff. But relations are frayed by shortages and increasing burnout, so some real leadership will be needed.
“The biggest obstacle of all is the lack of key staff. Our calculations with The King’s Fund and Health Foundation show a shortfall of 250,000 by 2030, which would make delivering even current services near impossible. However, the biggest levers to resolve the workforce crisis are out of NHS England’s hands. Only bold policies on training, immigration and Brexit can deliver enough nurses, GPs and therapists for the next few years. The system of workforce planning has failed us, and needs deep reform.”
Dr Jennifer Dixon, chief executive of the Health Foundation, said: “The prime minister’s promises to improve mental health and other NHS services are welcome, but making them a reality will be extremely tough given growing pressures on services, chronic staff shortages, and cuts to other parts of the health and care system.”
“Continued cuts to public health and local authority budgets will hold back the NHS’s ambitions to keep people healthy”
She said: “While £20.5bn extra funding promised for NHS England by 2023-24 is generous compared with other public services, it is barely enough to keep pace with growing demand for care. This means trade-offs are inevitable, and these must be spelled out clearly so the public know what they can expect from the NHS.
”The NHS’s ability to deliver the long-term plan will also depend on wider political choices. Without a solution to the growing crisis in social care, people will continue to suffer unnecessarily, and more pressure will be piled on the NHS. Yet the government’s green paper on social care funding is still yet to appear, and current funding is not enough to meet rising pressures.
“Continued cuts to public health and local authority budgets will hold back the NHS’s ambitions to keep people healthy and tackle unjust differences in health between the best and worst off. Next year’s public health grant would cut spending by £240m in real terms.
Dr jennifer dixon
”The core public health grant has fallen by a quarter (25%) per person since 2014-15. These funding cuts come at a time when life expectancy improvements are stalling and inequalities are widening.
“And a no-deal Brexit risks making the NHS’s workforce problems even worse. Currently there is a shortage of around 100,000 doctors, nurses and other crucial NHS staff. Securing the future of the NHS is therefore as much about political choices by government as what NHS leaders say in their long-term plan to be published on Monday.”
Future Care Capital
Greg Allen, chief executive of Future Care Capital, said: “The publication of the NHS long-term plan is a welcome start, but there remain a number of significant challenges.
“There are questions about how the ambitions set out in the 10-year plan will complement the options expected to be in the forthcoming adult social care green paper. And, if the 10-year plan is going to be achievable, it needs to be backed by a robust workforce strategy – there still remains uncertainty about how the NHS will address staff shortages.”
“It is good to see a focus on research and innovation which is sorely needed if the NHS is to deliver better patient outcomes. One way this can be achieved is through better harnessing the value of NHS data for public benefit. We need to establish a sovereign health fund to provide the NHS with an additional source of funding to help deliver sustainable long-term provision founded upon revenues from data-driven innovations the NHS enables over the years to come.
“The 10-year plan attempts to steer the NHS away from the cliff-edge and back to a more sustainable footing but it has been published against the backdrop of a challenging political climate. If politicians are serious about delivering a new settlement for health and care provision, they need to embrace a cross-party approach or we will never escape the constant need for strategy development at the cost of meaningful long-term improvements in patient outcomes.”
Paul Farmer, chief executive of Mind, said: “We are really pleased to see that mental health is such a key focus in the NHS long term plan and we welcome the £2.3bn set aside for mental health services.
”This is the kind of sustained investment we need to see to put mental health on an equal footing with physical health and, if delivered, this plan will make a difference to the lives of thousands of people with mental health problems.
“Everyone now needs to work together to develop the workforce needed and to deliver these plans and to ensure the money reaches the frontline. Local decision makers need to develop their own plans and the proof of delivery will be in the experiences of people trying to access the services they need.”
Lynda Thomas, chief executive of Macmillan, said: “It’s been a privilege to work with NHSE shaping the cancer section of the long term plan.
I’m delighted that cancer has continued to remain a high priority. One in two people will get a cancer diagnosis during their lifetime and the plan lays out important milestones around improving survival and ensuring high quality personalised care for every patient.
”I look forward to continuing to work with the NHS to meet these milestones and to improve cancer care for patients now and in the future.”
Chris Askew, chief executive of Diabetes UK, said: “We are really pleased with NHS England’s commitment to maintaining the focus on diabetes care and type 2 prevention.”
“We also welcome the commitment to developing networks to improve the care for children with long term conditions”
He said: “We hope this will build on the good work already done, and further reduce the variations in the quality of diabetes care across England in terms of access to education, treatment targets, inpatient care and footcare.
“The plan confirms recent NHS England announcements of a type 2 diabetes remission pilot, the doubling of the Diabetes Prevention Programme, and the funding of Flash Glucose Monitoring technology.
“We also welcome the commitment to developing networks to improve the care for children with long term conditions, which builds on existing work for children with diabetes. While the overall standard of care has been improving, there is still great variation between services, and therefore huge scope for further improvement.
“We now need more detail about what steps NHS England will take to ensure there are the resources needed to match these bold ambitions. This is exciting news and presents a massive opportunity to improve the lives of people with diabetes and those at risk of type 2 in the future.
“We look forward to continuing our work with NHS England and hope that, together, we can continue to improve the quality of care for people living with diabetes and prevent the further spread of type 2 diabetes.”
British Heart Foundation
Simon Gillespie, chief executive of the British Heart Foundation, said: “This plan is a welcome and significant step in the fight against heart and circulatory diseases, which promises to save thousands of lives in the coming years.”
“It’s now essential that a detailed implementation programme is produced”
He said: “Heart attacks and strokes continue to take a huge toll on the nation’s health. Progress in reducing death rates has stalled in recent years, and we need radical action to continue to reduce avoidable premature deaths and years of disability.
“Our figures show that millions of people are currently at unnecessarily high risk of a heart attack or stroke due to poor diagnosis rates for high blood pressure, raised cholesterol and atrial fibrillation.
”The plan’s strong focus on improving prevention and detection of heart and circulatory diseases and their risk factors has the potential to make a huge difference, ensuring that deaths rates fall further in the future.
“The plan’s aim of improving uptake of cardiac rehabilitation will transform the lives of thousands of people, and better care and support for people living with heart failure will significantly improve quality of life for many.
”It’s now essential that a detailed implementation programme is produced, and that work gets underway on making this transformational plan a reality.”
British Thoracic Society
Dr Jonathan Bennett, chair of the society’s board and consultant lung specialist, said: “We are delighted that lung disease is now a clinical priority area for the NHS in England.
“This is potentially a big step forward in helping improve the nation’s lung health. The emphasis on diagnosing lung disease much earlier is very welcome. Training and accrediting more healthcare staff to deliver and interpret spirometry, a key breath test, is pivotal.
“We also believe that rolling out a programme of ‘lung MOTs’ for higher risk groups across the country, could save thousands of lives. We look forward to working with the NHS on the detail of how the plan will be funded and delivered. It is also important that it is ‘joined up’ with wider activities to prevent lung disease through public health programmes – and policies to address critical shortages in the NHS lung specialist workforce.”
Heidi Travis, chief executive of Sue Ryder, said: “It is extremely disappointing that neurological care has not been significantly addressed in today’s long-term plan for the improvement of the NHS.
“This was a real and timely opportunity for the health system to commit to improving things for people with neurological conditions, but instead they have once again been omitted from high profile planning in the NHS.
“It is however encouraging to see that the importance of end of life care has been recognised. A new emphasis on proactive and personalised care planning will help to avoid emergency hospital admissions and will allow more people to die in their place of choice.”
Paul Edwards, Dementia UK’s director of clinical services, said: “The NHS 10-year plan is a welcome step in the right direction and it is pleasing to note that there is attention paid to preventing long-term health conditions such as dementia.”
“There needs to be a serious commitment to providing more access to skilled professionals”
He said: “However, in order to put weight behind these proposals, there needs to be a serious commitment to providing more access to skilled professionals, such as dementia specialist Admiral Nurses, as well as moving away from cuts which have long marred the public health landscape.
“The long-awaited adult social care green paper also represents the missing puzzle piece in this area. It is all well and good to focus on preventing conditions like dementia but we need to give due regard to people who are facing health challenges in the here and now.
New director of clinical services
“This is where social care comes in to help people through community support and timely help in the home.
“Allowing more access to funding for social care will undoubtedly help to relieve the pressures on a struggling NHS, ultimately leading to a more joined-up health and social care landscape. This is what we’re committed to doing at Dementia UK.”
Alzheimer’s Research UK
Hilary Evans, chief executive at Alzheimer’s Research UK, said: “Dementia is the health crisis of our time.”
“We must also be ready for life-changing breakthroughs in research in the coming years”
She said: “In just two years, the number of people living with dementia in the UK will increase to over a million and the condition will cost our economy over £30bn each year.
“The steps outlined in the long-term plan work towards overcoming the challenge dementia presents to our health care system today, but we must also be ready for life-changing breakthroughs in research in the coming years, including preparing for future treatments and improving diagnostic tools.
“Through the Challenge on Dementia and future plans for the NHS, we need to see infrastructure that supports research including encouraging people to take part in dementia studies at the point of diagnosis.
“Without advanced research and the development of an effective treatment for dementia, we will see this condition continue to harm our loved ones, the UK economy and the health system.”
Dominic Williamson, executive director of strategy and policy at St Mungo’s, said: “We are pleased that ministers have listened and that the NHS Long Term Plan makes a specific commitment to improving healthcare provision for people sleeping rough.
“This commitment must be the start of a real effort to reduce the shocking health inequalities and premature deaths of people who are homeless.
“This means investing in specialist services and ensuring people with the most complex needs can access vital support to improve their health, including mental health and substance use problems.”
British Red Cross
Mike Adamson, chief executive of British Red Cross, said: “Ultimately it would be better for everyone to be able to avoid going to hospital in the first place if they don’t need to be there.
“Currently, too many people are getting stuck in hospital, or repeatedly going in and out hospital often because of a lack of care closer to home – particularly for those living on their own. It makes sense to provide more preventative care closer to people’s homes, and support them to return there after an A&E visit to avoid ward admissions wherever possible.
“These steps will improve people’s health outcomes, encourage closer and better working across the whole sector, as well as meaningful partnerships with the voluntary community sector. We hope the anticipated social care green paper will further outline how health and care can be better integrated to make this happen.”
David Morris, public sector health leader at PwC, said: “A focus on prevention of ill health should be welcomed as an attempt at a long-term response to important societal challenges like an ageing population and the obesity crisis, but it’s also important to remember that the fiscal benefits of this approach will not be immediate.”
“It’s also important to remember that the fiscal benefits of this approach will not be immediate”
He said: “We’re still seeing day-to-day cash flow issues for many NHS trusts, with an underlying deficit of £4bn. A workforce shortage and ongoing economic and political uncertainty adds further pressure.
“The number one challenge for the government is how to implement strategic long-term changes whilst fire-fighting the daily issues felt by many trusts across the country.
“To ensure money is put to the very best use for patients it is more important than ever to ensure the NHS puts in place a system to deploy resources efficiently.”
Extensive coverage of the plan by Nursing Times includes the following stories: