Progress | Centre-left Labour politics

The Tories’ NHS plan papers over the cracks they created

When compared to Labour’s NHS Plan nineteen years ago, the Tories Long-Term Plan for the NHS is exposed for what it really is: too little, too late, argues Nathan Hodson

The Long-Term Plan for the National Health Service, published earlier this month, sets out how the government wants to spend the NHS’ so-called 70th birthday present.

The government promised last June to increase NHS funding by an average of 3.4 per cent each year over the next five years. According to the Long-Term Plan this ‘moves closer to returning to the NHS long-term average funding trend of 3.7 per cent per year since 1948 … This extra spending will need to deal with current pressures and unavoidable demographic change and other costs, as well as new priorities.’

After what The Kings Fund called ‘the largest ever sustained reduction in UK NHS spending as a percentage of GDP’, these aims are certainly ambitious. The NHS has been underfunded and even the 3.4 per cent increase represents continued relative underfunding. Without investing in the NHS at the average level, the government claims to be able to address three huge challenges: the damage done by austerity, the ageing population and the digital transition – with plenty left over for ‘other costs’.

That the overall ambition is unrealistic should be unsurprising. Theresa May initially claimed that the funding would come from the imaginary ‘Brexit dividend’. This attracted ridicule even from Tory members of parliament who pointed out that there will be no such dividend. The money must be coming from taxes or borrowing – and rightly so. A real leader would have made the case to the country that the NHS needs us all to come together to support it.

The Long-Term Plan’s aspirations are sensible enough, although details will be published in the coming months. Aiming to improve detection of cancer has the potential to save lives. Although NHS cancer outcomes have improved lately, there are other countries doing better and early detection is crucial to catching up.

The secretary of state for health and social care’s personal passion for technology comes across in passages enthusing about artificial intelligence and digital assistants, although later in the Long-Term Plan it transpires that most NHS hospitals barely have the tech readiness of a Starbucks circa 2010. We read with despair that, ‘Wi-Fi is being installed across the NHS estate’.

Ongoing challenges in children’s mental health receive particular attention. Many 18-year olds with mental health problems find it difficult to transition to adult services and the creation of an 18-25 service will improve continuity. Embedding mental health care within schools and colleges is another compassionate and creative solution – many of my patients benefit from the consistent mental health support within school. A more significant challenge, however, is the promise that at least 345,000 more people aged 25 and under will receive mental health treatment. Expanding service provision will be an uphill struggle when the numbers of child and adolescent psychiatrists are falling year on year.

Across the NHS, staffing shortages are impairing patient care. About nine per cent of posts cannot be filled: that is 100,000 vacancies. The biggest shortfall is in nursing, a reminder of how short-sighted it was for the Tories to end the bursary for nursing students. But the elephant in the room is of course Brexit. Mentioned only twice by name in the Long-Term Plan, Brexit represents a resounding slap in the face for all the skilled European professionals who have come to the United Kingdom to care for our children, our elderly and our sick. In a tone of desperation, the Long-Term Plan insists, ‘We want staff from the EEA that are currently working across the NHS to stay after the UK exits the European Union.’ And in case anybody still thought getting out of the EU would reduce red tape and save the NHS money, we read that ‘many trusts are now meeting the cost of applying for settled status for their staff from the EEA.’

Jennifer Dixon from The Health Foundation said, ‘This is probably as good as it gets: a significant injection of money for the NHS sustained over five years coupled with a comprehensive national plan for the NHS.’

Sorry, just to clarify: Jennifer Dixon said that 19 years ago in the British Medical Journal, in reaction to the Labour government’s ‘NHS Plan’ from the year 2000. The current government’s Long-Term Plan for the NHS is, to its credit, the first 10-year plan since 2000, but the comparison only draws attention to the inadequacy of the present stewardship of the NHS.

There have been numerous plans since 2000, but none has had the ambition or impact of the that plan 19 years ago. Arriving shortly after the devolution of NHS Wales, it set out how the NHS in England would operate over the subsequent 10 years. It was by no means uncontroversial – this was the plan that introduced private finance initiatives – but it set the pace for what can only be described as the glory days of the NHS.

On the basis of this Long-Term Plan, Dixon seems to have been proved right. We have never had it better than the NHS Plan – but it does not have to be that way. With a vision for getting the basics right, focussing on the evidence and treating our international workforce with respect, a Labour government could do it again and some: investing in the NHS, drawing a line between profiteering business and true partnership, and rebuilding a motivated, committed, highly-skilled workforce.

Those do not have to be the glory days. The glory days are to come.

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Nathan Hodson is an honorary fellow at the University of Leicester with a focus on health service leadership. He tweets @NathanHodson

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