NHS long-term plan: Non-hospital care to get biggest funding rise

By | January 7, 2019

GPs, mental health and community care are the services to get the biggest increases in funding as part of a new long-term plan to overhaul the NHS.

The aim is to curb the reliance on hospitals, which will get a smaller cut of the budget as health chiefs overhaul the way the service works in England.

NHS bosses say it will kick-start a greater focus on preventing ill-health – and could save up to 500,000 lives.

But senior doctors said hospitals were facing a “near-on impossible task”.

Society of Acute Medicine president Dr Nick Scriven said he was “staggered” by the plans given the problems facing hospitals.

Many trusts are missing all three key waiting time targets for A&E, cancer care and routine operations, and are struggling to balance the books.

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The full details of the 10-year plan are to be unveiled later by NHS England chief executive Simon Stevens and Prime Minister Theresa May.

But ahead of the publication, NHS England confirmed a third of the extra £20bn the NHS will get in 2023 will go on GPs, community care and mental health.

Currently they account for less than a quarter of spending, while hospitals take up around half of the £114bn frontline budget.

NHS England said spending on hospitals would still rise overall, just not as quickly as other areas, and that in turn would relieve the pressure on hospitals and create a “new model for the 21st century”.

Mr Stevens called it a “practical, costed and phased route map” for the decade ahead.

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What will the money be spent on?

Mental health is due to get £2.3 billion extra of the £20bn, while GP and community care is to get £4.5 billion.

NHS England said that will help pay for:

  • Mental health support in schools and 24-hour access to mental health crisis care via the NHS 111 service
  • Extra support in the community so patients can be discharged quickly from hospital
  • Digital access to health services, including online GP booking
  • Healthy living programmes for patients struggling with ill-health
  • New testing centres for cancer patients to ensure earlier diagnosis
  • DNA testing for children with cancer and those with rare genetic disorders to help select the best treatment

NHS England believes combined the new vision could save 500,000 lives through preventing diseases, such as strokes, heart problems and cancer, and spotting them earlier to improve the chances of survival.

As healthcare policy is politically devolved, the plan only applies to the NHS in England.

But the other UK nations are drawing up their own plans. Under the government’s funding system they are getting an extra £4bn between them by 2023.

What is this 10-year NHS plan?

The prime minister asked for the plan to be drawn up when she unveiled extra funding for the health service in the summer to mark its 70th birthday.

The budget will grow by £20bn a year by 2023 – the equivalent of annual rises of just under 3.5%.

She said a long-term plan for the next decade was needed to ensure the money was wisely spent.

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The last time a 10-year plan was set out was in 2000 under Tony Blair.

Speaking about the plan on Sunday, Mrs May said it was a “historic” moment for the NHS and would help pay for “world class” treatments.

But Shadow Health Secretary Jon Ashworth said the plan lacked both the staffing and funding to succeed and accused the government of “mismanagement” of the health service.

“The NHS needs a credible fully-funded plan for the future, not a wish list to help Theresa May get through the coming months.”

What do others make of it?

The ambitions are being welcomed. Prof Carrie MacEwen, of the Academy of Medical Royal Colleges, said: “It’s good to have a plan which sets a clear direction for the NHS.”

But unions have warned the workforce shortages could undermine the programme – currently one in 11 posts are vacant.

Unison head of health Sara Gorton said: “Without the staff, there is no NHS.

“Ministers must say more about how they plan to address the staffing shortages.”

There is also unease that other parts of the wider health system have been cut – the £20bn promise only applies to NHS England’s budget for frontline health care.

It does not cover other areas such as training and public health. The money made available to councils to pay for initiatives such as smoking cessation and healthy weight programmes is being cut by more than 4% next year once inflation is taken into account.

What is more, the government has yet to publish its green paper on social care despite promising to in 2017.

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Councils and care homes have warned care homes and home help services for the elderly and adults with disabilities are at risk because of insufficient funding.

Chris Hopson, chief executive of NHS Providers, which health managers, said the focus on out-of-hospital care should help relieve the pressures on hospitals.

But he added: “If we are serious about helping people to stay well and live independently for as long as possible it is vital that we also see appropriate investment and support for social care and public health.”

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