Notes on the NHS Long Term Plan: What it is actually for, and what we should do with it

09 January 2019
Following their recent announcement of plans to allocate more funding to children’s hospices (more here), NHS England have published their Long Term Plan in which it states that children’s palliative and end of life care is “an important priority for the NHS”.  Demelza’s Chief Executive Ryan Campbell CBE has taken some time to digest the plan in full, and has prepared some thoughts about what it really means for organisations like ours.

  1. It’s not a 10 year Plan

    There is no such thing as a 10 year Plan, because no-one knows what will be happening in 10 years’ time.  What this is, is a statement of intended direction for the next 10 years.

    That is a different thing and the distinction is significant.  This is not a blueprint that people will still be reading in 10 years’ time, or eight, or probably even three years.  All the important decisions will happen (or not) in the next two years, although the impact of those may still be felt in 10 years’ time. 

    It means we have a two-year timescale to generate tangible action in this long-term direction or it will fail.  So we need to get moving.

  2. It’s hard to do anything but welcome the report

    Demelza has welcomed the mention of children’s palliative care and increased funding, and every interest group has welcomed their own little bit, basically because this is a document that mentions most areas of healthcare and says it will improve each one.  But some of what is promised isn’t even possible yet.  We need to work on, perhaps fight for, the actual Plans, to ensure those improvements are delivered.

  3. Modernising infrastructure is a given

    The Plan is specific on some technology improvements to NHS infrastructure.  But in a 10 year timescale something like that should really happen anyway.  It’s certainly not a bad thing, but it’s not a revolution.

  4. Children’s palliative care

    We welcome the statement that children’s palliative care will be a priority (see Point 2. above).

    The Plan says that there will be an increase in funding to make up for historic underinvestment.  We welcome that statement as well.  It even mentions a figure: £25m total annual funding, linked to local NHS spending, rising from the current children’s hospice grant of £11m.

    In an ideal world this could be brilliant.  Local NHS bodies, NHS England, children’s hospices and everyone else will get together, look at implementing all the stuff in the 2016 NICE Guidance which isn’t in place, get some funding from NHS England to supplement the local budgets, and children’s hospices will get a greater amount of funding than they do now for providing essential healthcare services to the highest quality.

    But that’s a complicated amount of aligning of interests to do.  If it goes wrong the money could be misspent and hospices could end up with less than they get now.

    I don’t think that will happen.  The vision is worth going for.  Demelza will go for it, and I think NHS England are pretty committed to it too.  But there are big risks here and a lot of work to be done.  As a starting pledge, it’s a good one.

  5. Workforce
    Everyone agrees that the measures proposed so far will not be sufficient to meet workforce requirements in the future.

    However, there’s a slightly hidden bit in the Plan which is very ‘techy’ and not obviously connected to workforce, but which I think could have an extraordinarily positive impact.

    NHS England are asking for the Health and Social Care Act of 2012 to be amended so that care services with a value of more than £615k do not have to be regularly retendered.

    Very dull I know, unless you’ve worked in those services, which I and thousands of other healthcare workers have done.

    What happens now is that healthcare services go up for tender usually every three to five  years, and often change provider, because people who make decisions that don’t affect them like to change things.  That means that the workforce is ‘transferred’ each time, to new employers, structures and new models.  These models are sometimes unsuitable because the new provider hasn’t been allowed to talk to the people providing the service about what should be provided.  Employment terms and conditions, including salary, are protected, but you are not protected from redundancy, and there always are some. 

    As a care professional, you get that every few years.  You obviously do not develop any connection to your employer, because you haven’t chosen to work for them, and what’s the point, you’ll be transferred again next time round?  You may have thought you were joining the NHS, or a charity, and end up working for a profit-making company; people who believe in the NHS and see it as a vocation really don’t like that.  Performance and quality dip on each transfer and you have to claw it back every time to where it was. 

    And every single time this happens you are forcibly reminded that you’re just a cog in a machine and the system does not care what you think, who you are or what you might want.  You have to do the work but no-one even asks your opinion on matters that affect you directly.

    I haven’t seen any studies on this but I’m going to guess that removing this foul way of mistreating a workforce might have positive benefits to retention, recruitment and productivity.

    I came to work in the hospice sector to get away from that system.  For the sake of those I left behind I truly hope this part of the Plan is enacted.

Ryan Campbell CBE
Chief Executive

Read the full Long Term Plan at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf