The NHS Long Term plan, released today, identifies the right priorities –including prevention, health inequalities and integration – to put services on a more sustainable path. However, delivering these priorities will require cross government accountability for health outcomes and further financial headroom.
Health is vital for inclusive growth, and a focus on prevention, health inequalities and system integration is needed to deliver a healthy population. As part of its focus on prevention, the Long Term Plan is right to recognise the importance of addressing inequalities in health outcomes. As we highlight in our recent report these are the major barriers to the nation’s good health, and are getting worse. We agree that the NHS cannot tackle health inequalities alone, as these are primarily driven by wider social determinants, not differences in treatment. This calls for government to align powers and accountability for health outcomes in England.
The Plan also recognises the critical importance of integrated and accountable health services in local places. The development of Integrated Care Systems (ICSs) everywhere is NHS England’s proposed solution. These will help align different NHS bodies across local areas to achieve clearer accountability, but it is unclear how ICSs can bridge the gap of accountability, geography and financial responsibility between NHS and local government – an issue we found to be linked to worse patient outcomes. A detailed plan for integration with social care will have to wait for government to publish its social care Green Paper.
It is also not apparent that the NHS yet has the funds needed to deliver on its plans. Focusing on prevention, on health inequalities and on integration is the right approach to reduce demand but this will take time to yield results. In the short-term, the NHS’s £20 billion funding settlement is only enough to match trend demand growth, whilst there will be additional latent demands from recent underfunding and double-running costs whilst services shift towards more preventative measures. There is a real danger that effective strategic change will be made impossible by short-term spending pressures.
This Plan by NHS England presents a coherent strategy on how to move health care services onto a more sustainable path. To deliver the strategy, government will need to support NHS England with a clear power and accountability structure for health, not just health care, a complementary strategy for social care, and additional funding to shift to a preventative healthcare system.