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Reaction to NHS Plan: “Extra funding will be below historic average”

Vice President of the Royal College of Emergency Medicine, Dr Chris Moulton

“On face value, the NHS long-term plan is ambitious, optimistic and considered. Within it there are many fine aims which, if delivered, will improve care for some patients.

“However, we fear that there are incompatibilities with expectation and reality; particularly when considering the gap between what is being promised and what is being provided.

“As others have rightly pointed out, the viability of this plan will not only be conditional on tackling workforce shortages – and ensuring that those staff that we have do not leave the NHS – but also on adequate funding for both public health and social care.

“The plan leans towards prevention rather than treatment, yet there has been no halt to the cuts in public health funding and this settlement does not include any increase.

“Embedding social care teams in the emergency department may well be a good idea, but social care has been in a dire state for a long time and the green paper on it has been delayed for many years.

“Aiming to relieve pressure on hospitals by shifting towards care in the community is commendable, and patients naturally want to be treated as close to home as possible. But if this change is to work, then this care must be available, like emergency care, 24/7. This will need serious commitment on the part of other specialities and agencies.

“While the College welcomes moves to relieve pressure on emergency departments, it is disappointing to find that despite the proposed measures to do this, it has still not resulted in a firm commitment to restoring hospital four-hour performance to 95% – a sensible target that is very much achievable given the right resourcing and desire to do so.

“We also fear that the Clinical Standards Review that the document alludes to but provides scant details of, may not be driven by patient interests alone. Targets ensure patient safety, drive improvement and provide a level of transparency around system performance that is essential for good decision making.

“While experience shows that diversion strategies do not work as desired, most of the aims within the plan are laudable, if perhaps too readily promised. Unfortunately, it appears to be the case that while many patients will benefit, this may be to the detriment of others – those attending A&E will continue to suffer from delays and overcrowding.”

David Morris, Public Sector Health leader at PwC

“A focus on prevention of ill health should be welcomed as an attempt at a long-term response to important societal challenges like an ageing population and the obesity crisis, but it’s also important to remember that the fiscal benefits of this approach will not be immediate.

“We’re still seeing day-to-day cash flow issues for many NHS trusts, with an underlying deficit of £4 billion. A workforce shortage and ongoing economic and political uncertainty adds further pressure.

“The number one challenge for the Government is how to implement strategic long-term changes whilst fire-fighting the daily issues felt by many trusts across the country. To ensure money is put to the very best use for patients it is more important than ever to ensure the NHS puts in place a system to deploy resources efficiently.”

Richard Murray, Chief Executive at The King’s Fund

“This is an ambitious plan that includes a number of commitments which – if delivered – will improve the lives of many people. NHS leaders should be applauded for focusing on improving services outside hospitals and moving towards more joined-up, preventative and personalised care for patients.

“While NHS leaders have done what was asked of them within the constraints of the funding settlement provided by the government, some significant pieces of the jigsaw are still missing. A number of decisions – notably on hospital waiting times – have been postponed, indicating that trade-offs and difficult choices lie ahead.

“Whether the plan can be delivered relies critically on tackling workforce shortages. While the plan recognises this, commitments to increase international recruitment depend on decisions about immigration policy and we will need to wait for solutions until a new workforce plan is published later this year.

“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 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.

“We strongly support the ambition to establish integrated care systems in every part of the country by 2021. The plan sends a welcome signal that NHS organisations need to work with local authorities and other partners to deliver improvements in the health of local populations.

“In short, while today’s plan is a significant step forward, a number of questions remain unanswered. There should be no illusions about the scale of the challenge ahead.”

RCP registrar Professor Donal O’Donoghue

“The NHS Long Term Plan outlines specific areas of improvement in areas such as heart disease, stroke and cancer that will provide much needed sustainability to significant parts of the NHS. We welcome the focus on changing models of working with greater integration, making sure care is person-centred, and changing outdated systems such as outpatient clinics.

“We know that frontline staff today will be working out what the plan means for them and the patients they care for. The plan sets out some small but important changes that should help improve doctors’ morale, from changes to training programmes permitting ‘step in step out’ training and increasing focus on the health and wellbeing of staff.

“However if we are to see a real reduction in burn out rate, the only way to achieve this in the medium to long term is by dramatically increasing medical school places, and the supply of doctors. We encourage ministers to move beyond considering the expansion of the medical training initiative, and to commit to the expansion this week.”

Professor Russell Viner, President of the Royal College of Paediatrics and Child Health

“The health of children and young people is crucial to the future of this country, but England’s levels of care and wellbeing currently lag behind the rest of Western Europe. That’s why we’re delighted to see children and young people at the heart of NHS England’s Long Term Plan.

“The plan lays the foundations for an NHS with infants, children and young people at its core. That is why the setting up of a new Children and Young People’s Transformation Programme is vital. We want to see this Programme deliver a distinct and cohesive child health strategy to deliver improved neonatal care, support for those young people with long term conditions, and timely and appropriate access to services and treatment for children and young people with emotional and mental health needs. We look forward to receiving more detail on this Transformation Programme in due course.

“This is a powerful vision for the future, but it cannot be achieved without significant investment and expansion in the child health workforce. That workforce is made up of paediatricians, specialist nurses, therapists and others who interact daily with young people. It is encouraging to see this acknowledged by NHS England but the Workforce Implementation Plan needs to be produced without delay.

“We are pleased to see Simon Stevens’ plan support our vision that children in England will experience a seamless service delivered by an integrated health and care system, and await more information on how this will work in practice. Children and young people make up over a quarter of our population, so they and their families must be involved in the decision-making process to develop a health system that meets their needs.

“Investment in public health is crucial for the long term. Our College supports the Plan’s focus on prevention and tackling health inequalities which are growing across the UK but the proposals need proper funding for public health services like smoking cessation programmes and weight management clinics. We eagerly await more detail on a public health budget in this year’s comprehensive spending review.”

Nuffield Trust Chief Executive Nigel Edwards

“The goals of this plan look right – carrying on with joining up care and improving services for older people, while pushing vital issues like heart attack survival and children’s health up the agenda. These are the most important issues for patients, and the level of ambition is good. What worries me is how difficult it will be to roll out such wide ranging changes. There are several big pitfalls ahead.

“The extra funding will actually be below the historic average and what experts thought was needed. It’s enough to move forwards, but with little room for manoeuvre. If we face a no deal Brexit, the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks. And if social care and public health continue to be starved of funding, a stretched NHS will have even less to spare.

“In the NHS it is always difficult to take changes from the whiteboard to the ward. Success depends on extra effort and initiative from staff. But relations are frayed by shortages and increasing burnout, so some real leadership will be needed. Some ideas in this plan seem to assume one size fits all. But it often does not in the NHS because the distribution of people and services varies so much across England.

“The biggest obstacle of all is the lack of key staff. Our calculations with The King’s Fund and Health Foundation show a shortfall of 250,000 by 2030, which would make delivering even current services near impossible. However, the biggest levers to resolve the workforce crisis are out of NHS England’s hands. Only bold policies on training, immigration and Brexit can deliver enough nurses, GPs and therapists for the next few years. The system of workforce planning has failed us, and needs deep reform.”

Health and Social Care Secretary Matt Hancock

“The NHS long term plan, backed by a historic commitment of an extra £20.5 billion a year from taxpayers, marks an important moment not just for the health service but for the lives of millions of patients and hardworking NHS staff across the country.

“Whether it’s treating ever more people in their communities, using the latest technology to tackle preventable diseases, or giving every baby the very best start in life, this government has given the NHS the multi-billion-pound investment needed to nurture and safeguard our nation’s health service for generations to come.”

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