38 COLUMNIST Will the long-term plan help transform the NHS? The long-term plan hit our desks in January, but will it deliver everything it has set out? Senior policy adviser at The King’s Fund Anna Charles shares her views on the subject A fter months of speculation, the NHS has finally launched its long-term plan. Following the Government’s commitment to boost NHS funding by £20.5bn a year by 2023/24, the plan sets out how the money will be spent, and how the NHS will improve services over the next decade. On the face of it, NHS leaders have done what was asked of them. The plan is forward thinking and has avoided a narrow focus on today’s operational pressures and models of care. It does, however, leave some tricky questions, most notably about hospital waiting times. Like many previous policy documents, the plan commits to expanding primary and community services. And these warm words are accompanied by a pledge to increase spending by £4.5bn. There are no assumptions that this investment will reduce acute hospital use. Multidisciplinary community teams are central to the strategy, as are primary care networks, where groups of GP practices deliver enhanced services to populations of 30-50,000. Integrating care and improving collaboration between local services are core aims, continuing the work of the Five-Year Forward View. Integrated care systems (ICSs) will be the main mechanism, with a target to cover all areas in England by April 2021. National bodies have resisted the temptation to be overly prescriptive about ICSs, leaving flexibility for local needs. The long-term plan includes commitments to support leaders with a new NHS-wide leadership code and better talent management. The plan acknowledges that there is a long way to go before leadership cultures are consistent across the NHS, but the document highlights the impact of leadership on patient care. If the plan can be delivered, it should benefit many people in the decade to come. However, this depends on a number of factors Healthcare Leader 2019 Issue 10 that are outside the control of leaders. First, there is no plan to tackle the crisis in social care. The NHS and social care are two sides of the same coin, but publication of the social care green paper has been delayed yet again, and is now promised ‘before April’. Second, the long-term plan’s emphasis on prevention is at odds with cuts to local government funding for public health services. As recently as 19 December, the Government announced further reductions in the local authority public health grant. Decisions about public health and social care funding will not Without a workforce strategy, the NHS cannot deliver the plan be made until the Government spending review, which is not expected until autumn. Finally, and perhaps most worryingly, we have not solved the workforce shortages. Without a workforce strategy, the NHS cannot deliver the long-term plan. The plan recognises this and commits to increase training places and expand international recruitment. However, until the workforce strategy is published later in the year, the jury is still out on whether staff numbers can be boosted. If nothing else, the long-term plan highlights that the NHS can’t exist in isolation. To deliver a sustainable health and care system, action is required on many more fronts.