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Will the long term plan solve all the NHS’s problems?

By Wendy Lane NHS Arden & GEM CSU consultancy services director
18 January 2019

The scale of transformation envisaged in the long term plan is vast and sets significant challenges for those tasked with delivery across the health system, says Wendy Lane, consultancy services director, NHS Arden and Greater East Midlands Commissioning Support Unit (Arden & Gem CSU).

The plan continues the pursuit of achieving more successful prevention and early intervention programmes, empowering patients, moving care out of hospital and closer to home, and focusing on integrated high quality care that delivers better outcomes.

But this iteration is clearer in its focus on the care model and organisational reform needed and more ambitious in its pursuit of delivering anticipatory care, underpinned by a seismic shift in the use of cutting edge digital solutions.

If delivered successfully, this will lead to a radical change in how people interact with the NHS, and how services are delivered and experienced.

Encouragingly, the plan broadens the NHS’s focus on the wider determinants of health and its role in working with the broader local economy, but the absence of social care plans puts a significant caveat on delivery.

Alongside this, the NHS has huge workforce challenges, and while there is much in the plan that might help address this in the future, managing the process of getting there with an already pressured workforce may not be easy.

The narrative focuses on what we will have put in place and by when, with some key national documents yet to be published that will give direction on the ‘how’.

Local systems will have to do a lot of interpretation and harness the right skills and capacity to make delivery work in practice. This has real benefits, of course – not least in enabling different areas to adopt the models that work best for their patient population and geographic make-up.

However, against a backdrop of an already overstretched NHS, much of which is heavily committed to service delivery, we must be realistic in our expectations of how much capacity exists for people to continue to innovate locally.

The plan describes a huge shift towards adopting digital solutions. This means significant change in working practices as well as greater engagement with the public.

Digital tools have become the norm in many parts of our lives and there is a strong desire to capitalise on the benefits of technology in the NHS. However, evidence of the impact on productivity and efficiency remains limited; systems are complex and benefits can take many years to become apparent. While there have been positive outcomes in areas where there is enthusiasm for digitisation, there are also many examples of failure to adopt and spread digital solutions elsewhere.

We shouldn’t underestimate the time and challenge in embedding the ‘digital first’ tools and work practices proposed. Making these available is one thing, getting them systematically used in the right way as part of our normal working practices is quite another.

To achieve the service model change required, we will need to properly resource the process of re-engineering how we do things. We must aim for a digital future with a new operational delivery model replacing the old, rather than being bolted on to what we do now. How we approach the transformation required and provide the necessary support for both staff and patients, will be key.

The long term plan is perhaps the most ambitious attempt yet to set the direction for the NHS and drive changes that will deliver high quality, integrated and efficient care, with a greater focus on preventing ill health. There is strong evidence of the positive achievements the NHS has made already, despite its pressures.

But this is just the start. The key challenge for us all in response to the plan is delivering quality services today, while at the same time designing and embedding for tomorrow.

As tomorrow needs to be very different to today, that is a considerable, though exciting task.

Wendy Lane is consultancy services director, NHS Arden & GEM CSU


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