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The NHS Long Term plan sets out a ten-year strategy for the NHS that will enable it to:

  • Be more joined-up and coordinated in its care,
  • Be more proactive in the provision of services, moving to ‘population health management’, using predictive prevention
  • Be more differentiated in its support offered to individuals

The plan could have far-reaching implications for the voluntary sector and the communities we support. Some of the suggested changes are welcome: £4.5 billion to fund expanded community multidisciplinary teams and increased funding to address mental health services. Some have been met with caution and scepticism, such as the 1,000 social prescribing NHS link workers who will refer individuals to social prescribing schemes.

Although the plan is quite permissive in many respects, it is somewhat light on delivery. The focus on integrating care systems is welcome; but it has been discussed for many years with minimal progress on the ground. There is insufficient reference to other key policy drivers, in particular social care, housing and welfare reforms. The Green Paper on Social Care is long overdue. There isn’t sufficient reference to public health and how it inter-relates to wider well-being. Some voluntary sector commentators are calling for the 2019 Spending Review to reassess social care and public health so that local plans can include these as well.

There is a focus again on local, with Primary Care Networks based around 30,000-50,000 patients, being seen as a ‘building block’. Again the focus on localities is helpful, but the Plan is quite top-down and prescriptive about the professional make-up of the networks. The leadership of the networks isn’t clear. There is minimal appetite within the NHS for another restructure, but some of the current structures won’t make sense and there are questions about the accountability and transparency of Integrated Care Systems.

A greater use of digital technology will certainly make life easier for many practitioners and patients; however the safety of the systems and the need to provide for people who can’t access services digitally needs to be included.

Here are some of the key themes and commitments identified in the Long Term Plan that could impact the voluntary and community sector:

£4.5 billion of new investment and Integrated Care Systems (ICS)

Integrated Care Systems (ICS) are central to the delivery of the NHS Long Term Plan. An ICS brings together local organisations to redesign care and improve population health. ICS’ will also provide stronger foundations for working with local government and voluntary sector partners on the broader agenda of prevention and health inequalities.

The NHS has committed to invest in primary medical and community health services as a share of the total national NHS revenue spend so it will be at least £4.5 billion higher in five years’ time. This is a ‘floor’ level of investment that is being nationally guaranteed, that local clinical commissioning groups (CCGs) and Integrated Care Systems (ICS) are “likely to supplement further”.

The NHS Long Term Plan states that over the next five years, all parts of the country will be asked to increase the capacity and responsiveness of community and intermediate care services. The £4.5 billion of new investment will fund expanded community multidisciplinary teams, comprising a range of staff such as GPs, pharmacists, district nurses, dementia workers and AHPs (Allied Health Professionals) such as physiotherapists, joined by social care and the voluntary sector. The result will be “the creation of fully integrated community-based health care system”. Whilst this is to be applauded, the funding and workforce issues aren’t resolved.

Supporting older people

The NHS Long Term Plan suggests that extending independence as we age requires a targeted and personalised approach, enabled by digital health records and shared health management tools. Primary care networks will from 2020/21 assess their local population by risk of unwarranted health outcomes and, working with local community services, make support available to people where it is most needed. Integrated primary and community teams will work with people to maintain their independence. For example, falls prevention schemes, including exercise classes and strength and balance training, can significantly reduce the likelihood of falls and are cost effective in reducing admissions to hospital.

Increased support for carers

Carers will benefit from greater recognition and support under the NHS Long Term Plan. The latest Census found that 10% of the adult population has an unpaid caring role, equating to approximately 5.5 million people in England – around 1.4 million of whom provide upwards of 50 hours care per week. The NHS Long Term plan commits to improve how they identify unpaid carers, and strengthen support for them to address their individual health needs.

Dementia care

One in six people over the age of 80 has dementia. The NHS Long Term Plan pledges improvements to the care provided to people with dementia and delirium, whether they are in hospital or at home, with a more active focus on supporting people in the community through our enhanced community multidisciplinary teams. The NHS will continue working closely with the voluntary sector, including supporting the Alzheimer’s Society to extend its Dementia Connect programme.

Volunteering

The plan proposes to double the number of volunteers within the NHS and to invest significantly in the Helpforce programme. Whilst this is to be welcomed, and in particular, the involvement of younger volunteers and an increased focus on programmes in deprived areas, there is little recognition of volunteering management and support and all the existing local initiatives and organisations.

Social prescribing

The NHS will ramp up support for people to manage their own health. This will start with diabetes prevention and management, asthma and respiratory conditions, maternity and parenting support, and online therapies for common mental health problems. Through social prescribing, the range of support available to people will widen. Link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained NHS social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24.

Addressing health inequalities

The NHS will continue to commission, partner with and champion local charities, social enterprises and community interest companies providing services and support to vulnerable and at-risk groups. The NHS Long Term Plan recognises that ‘these organisations are often leading innovators in their field’ and states that innovation will need to be encouraged and supported by Integrated Care Systems (ICS) to address health inequalities in their populations.

NHS England will continue to target a higher share of funding towards geographies with high health inequalities. The NHS will set out specific, measurable goals for narrowing inequalities.

  • By 2020/21, the NHS will ensure that at least 280,000 people living with severe mental health problems have their physical health needs met
  • By 2023/24, all people admitted to hospital who smoke will be offered NHS-funded tobacco treatment services
  • The NHS will do more to ensure that all people with a learning disability, autism, or both can live happier, healthier, longer lives.
  • The NHS will invest up to £30 million extra on meeting the needs of rough sleepers, to ensure that the parts of England most affected by rough sleeping will have better access to specialist homelessness NHS mental health support, integrated with existing outreach services.
  • The NHS will provide a targeted support offer and access to weight management services in primary care for people with a diagnosis of type 2 diabetes or hypertension with a BMI of 30+ (adjusted appropriately for ethnicity)
  • The risk of developing type 2 diabetes is up to six times higher in certain Black, Asian and Minority Ethnic (BAME) groups and expanding the Diabetes Prevention Programme is a key vehicle for tackling health inequalities
  • Hospitals with the highest rate of alcohol dependence-related admissions will be supported to fully establish ACTs (Alcohol Care Teams)

Mental health

The NHS will deliver on its commitments to expand mental health services for children and young people. The Five Year Forward View for Mental Health set out plans for improving mental health services so 70,000 more children and young people will access treatment each year by 2020/21. The NHS will therefore continue to invest in expanding access to community-based mental health services to meet the needs of more children and young people. Mental health support for children and young people will be embedded in schools and colleges and a new approach to young adult mental health services for people aged 18-25 will support the transition to adulthood.

The whole NHS will improve its understanding of the needs of people with learning disabilities and autism, and work together to improve their health and wellbeing. New and integrated models of primary and community mental health care will support adults and older adults with severe mental illnesses.

NHS England’s renewed pledge means mental health will receive a growing share of the NHS budget, worth in real terms at least a further £2.3 billion a year by 2023/24.

Newcastle CVS perspective

The NHS Long Term Plan focuses on many of the health issues identified by us, our member organisations, and the wider voluntary and community sector. Our research, forums and networks have identified mental health and wellbeing as a key concern for many organisations and the individuals they support. Cultural and geographical inequalities create numerous health issues, which is why we continue to progress our work addressing health inequalities through HAREF and our BAME Health and Wellbeing training programme.  

It is encouraging to see that the NHS recognises the voluntary and community sector as playing a vital role in helping to tackle these issues but we must also be mindful that many organisations are already feeling the strain of reduced funding and increased demand for their services. Last year, our report GaN Canny found that for some organisations’ service demand was up two thirds year on year.

“More people than ever before in our working memory are being refused public services (health and social care), have less money and fewer resources, and there is a visible impact on loneliness and isolation and a growth in general mental distress. At the same time we are getting fewer resources than before to deal with this.”

A more integrated approach to health and wellbeing with a focus on preventative measures makes sense. GaN Canny found a willingness and optimism within our local voluntary and community sector in addressing major challenges whilst stressing the importance of involving us at the start of the process. However, funding and sustainability remains a major problem within the NHS, as highlighted in a new report from the National Audit Office:

“In its annual report on the financial sustainability of the NHS, the NAO concludes that the existence of substantial deficits in some parts of the system, offset by surpluses elsewhere coupled with growing waiting lists and year-on-year increases in waiting times, does not paint a picture that is sustainable.  The recent NHS long-term plan sets out a prudent approach to achieving the priorities and tests set by the government in return for its long-term funding settlement but a number of risks remain to the delivery of the plan.”

The National Audit Office stresses there are ‘a number of risks’ to delivering the plan and suggests that workforce shortages could mean some of the new funding is swallowed up by bills for expensive agency staff.

The NHS Long Term Plan is ambitious. How much of it can be implemented remains to be seen. We believe that health is a holistic issue and unless the wider determinants of health e.g. housing, income etc are taken into account, and there is greater involvement of social care and public health, the fine aspirations within this report will not be achieved. 

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Newcastle upon Tyne, NE1 8AF


Tel:      0191 232 7445
Email: information@cvsnewcastle.org.uk

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