Lord Hunt on the NHS Ten Year Plan: real doubts remain while funding flatlines
The government must address social care, workforce and budget challenges for its plan to succeed, writes Lord Hunt
The NHS gives extraordinary care to people in the UK and enjoys huge popularity. Yet austerity has led to a real deterioration in services with a failure to meet any of the core access targets. Add in increased rationing of treatments, inadequate mental health services and a disinvestment in social care, and it’s hardly surprising that the NHS faces unprecedented pressure.
This is what makes the new NHS Ten Year plan so crucial to turning this around. Much in the plan is welcome. Expansion of primary and community health services alongside the drive for integrated care is much needed. So, too, the emphasis on clinical services for young people, cancer, cardiovascular disease, stroke, diabetes and mental health.
Particularly ambitious is the aim to transform services using technology to provide many more online interventions for patients and reducing up to a third of outpatient appointments. The Plan also hints at further centralisation of hospital services for major trauma, stroke and other critical illnesses to improve patient outcomes.
This will not be easy as experience with the failure to deliver its previous plan, the NHS Five Year Forward View shows. Published to much fanfare in 2014, it had many similar themes. But, the Government found that delivering integrated care was very challenging and its approach to the new Plan suggests that it hasn’t learnt many lessons.
A key failure is that it almost solely focused on the NHS. Extraordinarily, it was published in advance of the heavily delayed Green Paper on Adult Social Care and shows scant recognition of the crucial role of local government nor the current crisis in social care. Yet integration of health and social care is simply not possible without the full partnership of local councils and a long-term funding settlement.
Similar challenges await the NHS. The Plan promises increased investment in primary and community care. But, where will it come from when the acute hospital sector is at full stretch and with the number of people with long term conditions set to rise dramatically over the next 20 years?
The Public Accounts Committee warned in last March of the risks of raiding investment funds to meet day to-day spending. There’s little sign of any change since.
Most expert analysts believe that the NHS needs 4% real terms growth per year to keep pace with demography and medical advances. This happens to be what the NHS received from its start in 1948 right up to 2010. Since then, funding has flatlined. Even the injection of five years growth per annum of 3.4% to 2022/23 will not make this up. Nor, does not it cover education and training, public health or research budgets which will be negotiated in the next Spending Review.
The other big problem with the Plan is that it largely ignores the workforce challenge as the workforce implementation plan is not ready. There is currently a severe shortage of essential staff with the Health Foundation estimating this at 100,000 rising to 350,000 by 2030. Investment in education and training has dropped from 5% of the health budget in 2006/7 to 3% in 2018/19. This disastrous trend must be reversed.
The social care workforce faces similar challenges. In many respects, they are even more pressing ones with many care workers being low paid with consequent high turnover rates.
It’s right that the plan has been largely welcomed. But, real doubts remain about its practicability given the lack of a long-term funding settlement and the absence of realistic programmes to increase the workforce in both health and social care. Ministers have a lot more questions to answer.
Lord Hunt of Kings Heath is a Labour peer