The highly anticipated release of the 10 Year Health Plan for England arrived at the beginning of July, after an extended period of gestation. If you were looking for a clear marker of change, I would direct you to the top left-hand corner of the cover page; the only logo to adorn the Long Term Plan and the Five Year Forward View was that of the NHS. The UK Government logo gives us a frank reminder of the upheaval facing the NHS at a National and Regional level.
More widely, there are further indicators of change in the plan. The prevalence of the hyper-local, Neighbourhood model of care runs throughout the document. A scan of the document highlights that ‘Neighbourhood’ occurs 124 times in the plan. By contrast, it is written a measly three in the Long-Term Plan, published in 2019. If you are looking for a direct comparison in last week’s document, ‘Quality’ crops up on 168 occasions.
In fleshing out the neighbourhood model, the plan acknowledges the good work that Neighbourhood pilots have done and suggests that they will ‘convene’ services locally. How the transaction, convention and relationship management costs will be covered is still up for debate. This, in addition to the development of neighbourhood provider contracts, will mean much upheaval for Primary Care services, which are still awaiting the long-touted left shift in care.
What has been made clear, is that money previously spent on Deficit Support Funding (DSF) will be coming to an end, with the finances previously handed to challenged systems redirected to “working-class communities that need it most”. This shift in financial settlement goes some way to bridging the reduced emphasis on Health Inequalities in the 10 Year Plan (mentions of which are down by 65% in the 2025 document). The challenge this will represent for systems in receipt of DSF, many of whom serve some of the most excluded citizens in England, will be enormous, with further efficiency savings and difficult decisions required.
Health inequalities have widened significantly since Covid-19 and are the target of the preventative and neighbourhood health models outlined in the 10 Year Plan, which seems at odds with the significant reduction of mentions. With the increased emphasis on delivery vehicle and the change in focus on the outcome, we should perhaps question how we ensure health inequalities are narrowed rather than exacerbated in the future NHS.
As an expatriate Sangronian, and noting that the plan was launched at Bloomfield Road, it did not shock me that Blackpool continues to be the place of reference for deprivation and health inequality, for the third NHS Plan in a row. Is this a perhaps metaphor for how little has really changed over the three plans, despite the change in emphasis?
Similarly, there are continuations of threads from previous NHS plans. The new document has strengthened build outs for both the NHS App, which grows from its Primary Care base in the 2019 plan to increasingly cover secondary care, and Population Health Management, which has matured from a discourse of platforms to an enabler of proactive, personalised care.
“Above all, the ability for national, regional and local teams to deliver on these challenges whether old or new will be severely tested, given the amount of upheaval likely to happen over the course of this financial year and the next one.”
