Dr Eleanor Roy, CIPFA Policy Manager on Health and Integration
At first glance, the 10-Year Health Plan (10YHP) paints a dazzling vision of a future health service so bright, that a pair of shades are required. Yes, some of the ideas have already been around the block a few times, others verge on sci-fi (or maybe that’s my tech threshold), and a few prompts uneasy questions – particularly around the ethics ofa genomics-based population health service, or the idea of having a “doctor in my pocket”! Yet, as visions go, it’s bold, inspiring, and even the most hardened cynic might find something to support.
But how do we actually get there? Where’s the plan? I’m not suggesting there should be a centrally mandated to-do list, but without a clearer sense of priorities, there’s a real risk this becomes a pick-n-mix counter - or worse, everything, everywhere, all at once.
On resourcing, it doesn’t take much reading between the lines to notice the suggestion that reforms will somehow pay for themselves. One line even promises that the three shifts will offer ‘clear routes to secure financial sustainability’.
There are examples scattered throughout of potential ‘savings’ and ideas to free up time and resources. But many of these are vague. The suggestion that spending on hospital care ‘will fall’, with ‘proportionally greater’ spend on out-of-hospital care - what does that really mean? How does it compare to the actual cost of reforms required on both ends of the system?
Then there’s the claim that by 2035, ‘fewer staff’ will be needed than previously projected. That raised a few eyebrows - but again, what does it actually mean?
Perhaps most strikingly, the 10YHP states that ‘the NHS will establish its own self-financing improvement capability’ – that’s a big claim, with not a lot of detail. And it is facing up against a lot of proposed ideas and innovations, some of which will have potentially colossal costs.
The plan’s focus on ‘financial sustainability’ is certainly consistent - the term appears 32 times across 168 pages. But it sits awkwardly next to the ‘five big bets’ laid out in the transformation chapter. This may be the first time I’ve seen gambling presented as a route to financial stability in a policy document.
Much of the 10YHP feels like a ‘to be continued’ - many reforms will require – legislation, and further details are expected through future strategies, frameworks and guidance. One such area is e the commitment to ‘reinvent’ the financial model with a focus on value-based healthcare and outcomes. This is largely welcome, but we’ll need to see the detail.
The plan again leans on the promise of ‘financial sustainability’ and self-financing reform, requiring all NHS organisations to allocate 3% of their annual spend each year toward transformation. But when combined with 2% annual productivity targets and the return of strict financial controls - including the withdrawal of deficit support - that’s going to be a very tall order.
Implementation and delivery plans are expected over the summer so hopefully some clarity may emerge in the Autumn. But given the current financial challenges, the restructuring of Integrated Care Boards (ICBs) and upheaval at the centre itself, many in the NHS might feel that the path to a brighter future runs along some very dark roads – and that the place we’re starting from is far from ideal.