Q members reflect on the NHS 10-Year Health Plan for England: Chris Pavlakis

The NHS 10-Year Health Plan for England has laid out ambitions for three shifts: from care delivered in hospitals to in communities, from a focus on treatment to prevention and from analogue to digital.

In the spirit of collaboration and learning, we asked members to share what they found exciting about the plan, what is missing and where they think improvement approaches can play a role. 

For the next week, we will be sharing reflections from members across England on the plan and the culture and conditions needed for its implementation. Our diverse community of people working to improve health and care is uniquely placed to make a real difference to the success of its implementation. These reflections can help us all take stock of where we are and think together about how to get where we need to go.

168 pages. A significant number of policy proposals setting out ambitions for the NHS over the next 10 years. The government has been saying for the past year that the NHS is broken – the plan clearly states that ​‘the choice for the NHS is stark: reform or die’. Especially for patients, what cuts through the most when we look at the plan?

First, there is a recognition of the frustrations people accessing and interacting with the existing health system and what needs to change. Issues that have driven public satisfaction with the NHS to historically low levels over the past few years include a lack of access to services, poorly coordinated care, poor admin that means appointment letters arrive after an appointment was meant to happen and fears of staff burnout. The ambition to move patients from ​‘passive recipients of care’ to ​‘active partners’ is also a clear thread, from the introduction of a ​‘doctor in your pocket’ to more personalised care plans. 

The commitment to ​‘reform the complaints process and improve response times to patient safety incidents’ is much needed. There is a focus on obtaining and assessing patient feedback in a more systematic and comparable way. This is a positive measure and recognises that how the NHS collects feedback from patients has grown over time, yet not in a coherent way.

But the challenge has been how to use such feedback to drive change in organisations that too often have poor cultures and react in defensive ways to negative feedback from patients. Collecting more feedback or changing how it is collected does not lead to change in and of itself. It will take focus and a shift in culture at both national and local levels of the NHS to ensure patient experience is at the heart of everything organisations do. 

The plan includes a range of proposals to better hear the individual voice of patients to drive improvements in services. But more thought should also be given to how the NHS can benefit from hearing the collective patient voice. The decision to abolish Healthwatch [Healthwatch duties will move to other bodies] will come with consequences that need to be considered.

Another ​‘mechanism for change’ is to give people a choice of provider. Here, it is important to remember that not all people are able to exercise choice in the same way; access to information and digital tools varies across populations. Some areas will have fewer providers or limited transport options, and some people don’t have the resources to make choice a reality. How will it be ensured that extending the choice agenda doesn’t inadvertently exacerbate pre-existing health inequalities?

If one accepts this diagnosis that the NHS is broken, then this new plan needs to provide the public and those working in the health system with hope that it can be ​‘fixed’ by setting out a strong and positive vision as well as a credible roadmap for how it could happen.

A lot in the new plan feels familiar because it echoes what NHS reform plans have been saying for much of the past 25 years. After months of engagement with patients and staff and wider stakeholders, this plan needs to go beyond that high-level vision and set out the details on how the NHS will evolve over the next decade, and what will help deliver its ambitions when so many of its predecessors have failed. We cannot afford to miss another opportunity.