Those reading the long-awaited long term plan might be forgiven for feeling that they have read it before and that, having done so, they still have the same questions.
This is a plan that has been announced in stages, starting as far back as October with the Prime Minister’s announcement on cancer early diagnosis. Voter-friendly policies on mental health, maternity, diabetes, veterans, and genomics have all been extensively trailed in recent weeks. Of course the plan was meant to be published some time ago but Brexit chaos intervened. Judging by the weekend political programmes, it is still getting in the way of the Government’s NHS message.
The second reason that much of the plan will seem familiar is that it is a continuation of a theme. This is not a radical departure from the Five Year Forward View, but instead an extension of many of the ideas originally set out in 2014 (albeit with a lot more detail). Those in the service will wonder whether the same issues which derailed the Five Year Forward View have been addressed. NHS England has attempted to manage expectations more firmly this time. The next couple of years will all be about recovery and, assuming that is delivered, attention will then shift to the sunnier uplands of transformation.
Will the resources be enough to deliver on the aspirations?
The additional funding sounds impressive but comes after a prolonged period of austerity for the health service. Welcome though the money is, this is not a Blair era style injection of largesse, but rather a return to historical norms. The first job may be simply to catch up, but this is not a small task. When repeatedly pressed on whether existing targets would be met, Simon Stevens was careful not to commit. This one can be expected to run and run.
Will the workforce exist to deliver?
Workforce planning was a gaping hole in the Five Year Forward View and everyone is clear about the diagnosis of workforce shortages, as Chapter 4 of the long term plan recognises, but we will have to wait a while longer to hear the full remedy. The scepticism of stakeholders on this is unsurprising given the inglorious record of the NHS on workforce planning.
What about public health?
The aspiration to save 500,000 more lives is as ambitious as it is headline-grabbing. Yet success will depend upon prevention and earlier diagnosis, both at least partially the domain of public health, which – again – does not yet have clarity on future funding. Announcements on new hospital support for problem drinkers and smokers are sensible, but will only go so far.
What about social care?
Remember, one of Simon Stevens’ opening gambits in the bid for more funding was that social care should be at the front of the queue. The NHS has got its funding settlement and yet social care is still waiting. The Green Paper, when it eventually comes, will be some way short of an immediate action plan.
How will national ambitions be translated into something meaningful for patients?
The NHS’ delivery infrastructure is still evolving and much will depend on the waiting time standards review, a ‘national implementation framework’ to be published in the spring and a detailed national implementation programme by the autumn, which will reflect (hopefully) clarity on the many unanswered questions on workforce, prevention etc.
What about legislation?
NHS England argues that fresh legislation is not necessary for implementation, but is desirable. What follows is a shopping list of potentially far-reaching changes, including ripping up the competition, procurement and payment regimes, imposing new duties on NHS organisations, curtailing the autonomy of foundation trusts and changing the way some public health funding is routed. None of this will be simple or uncontroversial, particularly in a Parliament where any legislation appears increasingly difficult.
And then there is Brexit.
Ministers and NHS leaders made a valiant effort to keep the story on the long-term plan over the weekend but until there is clarity on if, when and how, the UK will leave the European Union, it will be difficult to focus on much else. The long term plan poses as many questions as it answers, so there will be plenty to focus on when we finally get to that day.