Is the NHS's long-term plan workable?

Pouring a bucket of cold water over his head Image copyright Getty Images
Image caption Has a bucket of cold water been poured over the long-term plan for the NHS?

There was a fanfare of a launch for the NHS's long-term plan for England earlier this month.

The prime minister and the head of NHS England shared a platform at a hospital in Liverpool and toured children's wards.

Promises to accelerate detection of cancers and invest more in GP, community care and mental health were made.

But now the official financial watchdog, the National Audit Office (NAO), has thrown - if not a bucket then - at least a flask of cold water over the project.

In its annual report on the financial sustainability of the NHS in England, the NAO argues there are many underlying problems which need to be addressed, never mind improving services in line with the ambitions of the plan.

The stark conclusion is that the existence of "substantial deficits" at some trusts along with growing waiting lists "does not paint a picture that is sustainable".

With regard to the long-term plan, the watchdog says there is a "prudent approach to achieving the priorities and tests" set by the government in return for the new funding settlement, which gives NHS England an extra £20.5bn annually in real terms by 2023.

But the NAO then stresses that there are "a number of risks" to delivering the plan.

The report highlights what many health lobby groups were arguing on the day the long-term plan was unveiled in early January, namely that workforce shortages would hold back attempts to reach the ambitious new targets.

There are more than 100,000 unfilled NHS posts in England.

Image copyright Getty Images
Image caption Workforce shortages could derail the long-term plan, the report says

The NAO says that some of the new funding might be swallowed up by bills for expensive agency staff and trusts might not be able to recruit enough new clinicians to provide expanded services.

It goes on to point out that the funding settlement for NHS England is all well and good, but it will be impossible to assess the long-term prospects for the nation's health until other information is available.

It notes that "without a long-term funding settlement for social care" there are concerns that "it will be very difficult to make the NHS sustainable".

Bleak picture

Budgets for public health (including prevention) and training of nurses, doctors and other staff have not yet been set out and, if less generous than the NHS settlement, they could affect the ability of the service to deliver the long-term plan, in the view of the report authors.

And what of the short term? The watchdog paints a bleak picture.

The financial health of some trusts, it says, is getting worse.

The Department of Health and Social Care has had to bail out those in the most fragile state to the tune of £3.2bn in emergency loans over the latest year, up from £2.8bn in 2016-17.

Patients will not need reminding that there are now 4.1 million people on waiting lists for non-urgent operations, up from 2.5 million in 2012-13.

The NAO says getting the list even back to where it was as recently as March 2018 would cost £700m.

'Unfinished business'

The Department of Health says that a detailed workforce plan will be set out later in the year, which will ensure the NHS has the staff it needs now and in the future.

A spokesperson said the long-term plan did set out that "putting the NHS back on to a sustainable financial path was a key priority".

So in effect the jury is still out. Anita Charlesworth, of the Health Foundation charity, concludes that "no-one can argue with the ambitions of the plan but this is unfinished business".

She argues that the NAO report is a "clear articulation of the challenge facing the government" as it works out budgets for public health, staff training and social care.

It is a coincidence that the NAO was finishing its review of NHS finances just as its long-term plan was published, and there was still time to assess it.

And it is also a welcome coincidence for those interested in how the NHS in England will be shaped over the next decade.

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