Scotland & the NHS England ten year plan

Monday 7th January 2019

The highly-anticipated long term plan has finally been published for services in England - we take a look at what the UK Government is promising for a health service that is under immense and mounting pressure, and how this compares to the Scottish approach to health and care services.


As in Scotland, there has been no shortage of indicators, reports and publications documenting the growing pressures being placed on health and care services in England, whether they stem from meeting the needs of a population living longer and with more complex health needs, to staffing shortages in various fields not helped by the ongoing uncertainty surrounding the UK’s departure from the EU.


Only last week, NHS England highlighted the immense cost of missed appointments. Patients were called upon to “do their bit” by letting services know whether or not they could attend appointment to help to reduce the £216m missed appointments are estimated to cost the NHS each year. The NHS review of winter 2017-18 documented a “very challenging” period, with significant increases in service use, particularly in terms of A&E attendances and emergency hospital admissions.


In the summer of 2018, the UK Government announced funding increases for the NHS of £20.5bn a year over the next five years, beginning in 2019-20, and at the same time tasked NHS England with producing plans for how the funding was to be used to improve key areas of care.


Before the long term plan for England was to be published, Derek Mackay’s Scottish Budget was delivered.

As a consequence of increases to overall funding announced by the UK Government and how the Scottish Government intended to use what it received in Barnett consequentials, the Cabinet Secretary declared the “record funding” being provided by his administration was evidence health was a top priority for the SNP Government. It included commitments to further shift the balance of care by increasing investment in integration, partly through providing more funding for health and social care partnerships and an increase of almost £500m in real terms for the health resource budget.


More money for Scotland’s mental health services was also announced, taking total funding to £1.1bn in 2019-20, while from April 2019, a new three-year implementation plan would come into being to support public health and care professionals to “overcome the perceived barriers and challenges to practising realistic medicine”. Support would continue for the development of genomic medicine in Scotland, including improved genomics tests. On preventative policies, the Scottish Government promised increased funding for active travel and an additional £42m to improve the range of weight management services offered by the NHS as part of treatment services for people with, or at risk of, type-2 diabetes.


The Plan for England

Unveiled by Prime Minister, Theresa May, and NHS England Chief Executive, Simon Stevens, the new long term plan confirms one third of the additional £20.5bn being provided to the NHS in 2023 will be allocated to mental health, community care and GP services. The inclusion of a “historic commitment” to increase funding for primary and community services faster than the NHS budget as a whole by at least £3.5bn in real terms over the next five years is intended to improve access to frontline services.


Acknowledging significant concerns held by many around “funding, staffing, increasing inequalities and pressures from a growing and ageing population”, NHS England chief executive, Simon Stevens, said the new plan addresses such concerns, tackling head-on the pressures faced by staff. He said:

It sets a practical, costed, phased route map for the NHS’s priorities for care quality and outcomes improvement for the decade ahead. Seventy years after the NHS was founded, the health service will expand care for patients and their families at every stage of life, supporting people to start well, live well and age well.”



Prevention, Early Diagnosis & “World class, cutting edge treatments”

Included in plans to make the NHS in England “fit for the future” are proposals to provide more digital GP consultations and greater use of technology to enable early detection and prevent an estimated 85,000 premature deaths each year. Access to healthcare “at the touch of a button” is promised in the plan through investment in digital services. Simon Stevens urges optimism around the potential for improved outcomes stemming from technological developments in a number of fields.

Whole genome sequencing for children with cancer and young people who have a rare genetic disorder, in addition to adults suffering from certain rare conditions or specific cancers will be provided. “Cutting edge testing services” are promised and intended to mean 75% of cancer patients are diagnosed early.

Improvements to stroke, respiratory and cardiac services are predicted to benefit over three million people over the next ten years, while proposals are also laid out that will look to prevent 150,000 heart attacks, strokes and dementia cases.

The focus on improving prevention and detection of heart and circulatory diseases and their risk factors is praised by chief executive of the British Heart Foundation, Simon Gillespie, as a “welcome and significant step”, while chief executive of Macmillan, Lynda Thomas, has said she is delighted cancer remains a high priority.

A renewed focus on prevention in relation to a number of conditions and diseases includes the expansion of the diabetes prevention programme and an ambition to prevent around 23,000 premature deaths and 50,000 hospital admissions over the next decade by putting over 100,000 patients with heart problems through a healthy living and exercise programme every year.


Dedicated New Addiction Services

NHS England revealed on the 5th January that Alcohol Care Teams are to be established as part of the new NHS Plan, alongside an expansion of support to encourage all smokers admitted to hospital to quit. NHS England predicts the alcohol care teams – which will be rolled out in hospitals with the highest number of alcohol-related admissions – could prevent 50,000 admissions and almost 250,000 bed days over five years. Funding reductions for alcohol and drug partnerships in Scotland have in recent months caused opposition parties to fiercely criticise the Scottish Government.


Mental Health Services

Commitments to tackle major physical conditions come alongside the highest ever investment in mental health services of at least £2.3bn a year by 2023-24: 24-hour access to crisis care is to be provided via NHS 111 and around two million more people suffering from poor mental health are to receive support. Similar to the Scottish Government’s emphasis on young people’s mental health, community- and school-based services in England are to be expanded to deliver mental health help to 345,000 more children and young people. 


Health & Social Care Integration

Reacting to the “exciting roadmap” provided by the plan, chief executive of NHS Improvement, Ian Dalton, has called for new investment to be used to “fundamentally reset” how the NHS is run to enable the needs of a growing and ageing population to be met. Organisational barriers must be broken down, he declares, to ensure a more holistic approach to the delivery of care, one which embraces new and existing technology and recruits and retains the appropriate number of staff needed to shift the balance of care away from hospitals and towards prevention and care in the community. The plan contains a guarantee that investment in primary, community and mental health care will grow faster than the growing overall NHS budget, funding a new service model where “health bodies come together to provide better, joined up care in partnership with local government”.

Integration of services is something the Scottish Government credits itself with being ahead of the curve on, having started the process earlier than other UK nations. Derek Mackay’s funding announcements provided some substance to bolster the Government’s rhetoric on integration but it remains to be seen whether the financial positions of Scotland’s integration authorities and health boards will be improved from their precarious state, reported on in December.


Praising its “clear direction”, Chair of the Academy of Medical Royal Colleges, Professor Carrie MacEwen, welcomed that the plan “tackles many of the issues the Academy has long been saying need to be addressed” if patient care is to be improved, including workforce supply, reducing inappropriate care and unwarranted variation, and integrating services with social care.


By April 2019, Sustainability and Transformation Partnerships and Integrated Care Systems across England are to have published their local plans for 2019-20 and by the autumn of this year they are to have developed five year plans to implement the ambitions of the long term plan.