Health Service Staffing Concerns Over NHS England 10 Year Plan

Peter Russell

January 07, 2019

The much-anticipated 10 year plan for the NHS in England could save up to half a million lives, according to NHS bosses.

The blueprint published today sets out practical steps to focus on major killer conditions such as cancer and heart disease, and strengthen prevention.

The commitment to tackle major physical conditions comes alongside an investment in mental health services which is set to rise to at least £2.3 billion a year by 2023-24.

Many of the measures have been broadly welcomed but the British Medical Association (BMA) said the plan was short on detail, while the Patients Association criticised the Government for failing to publish its green paper on how to end the crisis in social care.

Health service leaders said the proposals would help to prevent 150,000 heart attacks, strokes and dementia cases, while more than 3 million people would benefit from new and improved stroke, respiratory, and cardiac services over the next decade.

There would also be improved neonatal care for new parents and babies, while there would be a focus on keeping older people out of hospital, living longer and more independent lives.

The NHS 'Is My Number One Spending Priority': Theresa May

Announcing the plan at Alder Hey Children's Hospital in Liverpool, the Prime Minister, Theresa May, linked the future security of NHS finances with her current attempts to get a Brexit deal through parliament. 

She said: "Over the next 5 years, the NHS England budget will increase by £20.5 billion in real terms compared to today. And this commitment is possible because of our strong public finances and because as we leave the EU and take back control of our money we will no longer be sending vast annual sums to Brussels. And crucially we funded this commitment with no increase to people's taxes.

"The NHS is the public's priority, and so I've made it my number one spending priority."

She added: "Together, the 5 year funding settlement along with the 10 year plan will provide both the certainty and long-term direction needed to transform patient care and secure the future of our NHS."
 

Primary Care and Accident and Emergency Pressures

A principal focus will be to move some of the workload of hospital outpatients to GP practices. The plan envisaged relieving pressures on primary care with new funding for GP practices to create integrated teams of GPs, community health, and social care staff.

Over the next 5 years, every patient would have the right to online 'digital' GP consultations, while redesigned hospital support would mean up to a third of outpatient appointments would be unnecessary, saving patients 30 million trips to hospital, and saving the health service over £1 billion a year in new expenditure.

NHS Digital welcomed the focus on digital technology. Chief executive Sarah Wilkinson, commented: "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."

Health service leaders acknowledged that the emergency care system is under "real pressure". However, they that new service channels such as urgent treatment centres are growing faster than demand for traditional A&E attendances.

Further pressure would be relieved by increasing the proportion of acute admissions typically discharged on day of attendance from a fifth to a third.

However, the Society for Acute Medicine (SAM) said hospitals faced a "near-on impossible task" of managing increasing demand while faced with decreasing capacity, funding issues, and a recruitment crisis.

Its president, Dr Nick Scriven, said: "The harsh reality right now is that the NHS is at least 3100 beds short of what it required last winter, more than 45% of consultant posts are unfilled along with 11.6% of nursing posts, and the proposed green paper on social care is nowhere to be seen."
 

Health Prevention

The long-term plan sets out an ambition to improve health prevention. 

It promises new funding for programmes to cut smoking, reduce obesity rates, increase enrolment in the type 2 NHS diabetes prevention programme, limit alcohol-related A&E admissions, and lower air pollution.

It also sets out action to cut smoking rates among pregnant women and those with mental health problems.
 

NHS Staff

The plan also addresses health service staff issues, promising wider reforms to address workplace pressures once new plans and budgets are agreed later this year.

However, there are short-term measures to expand clinical nursing placements by up to 25% in the current financial year and by 50% in 2020-21.

The plan would also:

  • Provide genetic testing for a quarter of people with dangerously high inherited cholesterol, reaching around 30,000 people

  • Give mental health help to 345,000 more children and young people through the expansion of community based services, including in schools

  • Use cutting edge scans and technology, including the potential use of artificial intelligence, to help provide the best stroke care in Europe with over 100,000 more people each year accessing new, better services

  • Invest in earlier detection and better treatment of respiratory conditions to prevent 80,000 hospital admissions

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. 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.

"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."

Reaction to the Plan

The BMA applauded an "ambitious set of aims for the health service" but said these had to be underpinned by a strong set of deliverable actions.

BMA council chair, Dr Chaand Nagpaul, commented: "While the Government has highlighted plans to expand capacity and grow the workforce, very little has been offered in the way of detail. Given that there are 100,000 staff vacancies within the NHS, the long-term sustainability of the NHS requires a robust workforce plan that addresses the reality of the staffing crisis across primary, secondary and community care. This will require additional resources for training, funding for which has not been mentioned in the long-term plan.

"There is also a pressing need to address immediate and short-term pressures given that doctors and NHS staff are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout."

Health think-tank, The King's Fund, agreed that successful delivery of the plan depended "critically on tackling workforce shortages". Commitments to increase international recruitment would depend on immigration policies and a new workforce plan which would not be delivered until later in 2019, it said.

Chief executive Richard Murray said: "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 [to] 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."

The Patients Association said NHS England had fulfilled its role by developing a coherent plan for the future but that government now needed to address a lack of strategic ambitions. Chief executive, Rachel Power, 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.

"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."
 

Health Charities Welcome a Plan

Mental health charity, Mind, said it was pleased to see a spending commitment to ensure mental health spending grows faster than the overall increase in NHS funding "to put mental health on an equal footing with physical health".

Cancer Research UK warned that without enough specialist staff, the Government's ambition to improve cancer survival could stall. Emma Greenwood, the charity's director of policy and public affairs said: "We’re pleased that commitments to transform cancer survival features strongly in this plan. The scale of the challenge is huge and this plan is a good starting point."

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.

"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."
 

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