Q members reflect on the NHS 10-Year Health Plan for England: Emma Snow

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.

Overall, we are delighted to see that the NHS 10-Year Plan has taken on board the recommendations of Lord Darzi and so many of us who contributed to the Change NHS consultation as patients, carers and staff. 

The plan is a great step forward in many ways, and is going in the right direction. The three shifts are the right priorities for the NHS now. We also welcome the plans for the NHS to be more patient centred, putting a megaphone to the mouth of every patient, as Nye Bevan himself proposed. 

We are incredibly pleased that the plan recommends a shift from sickness to prevention, so that the social determinants of health, the Beveridge Report’s ​‘five giants’ that hinder prosperity (idleness, ignorance, disease, squalor and want) and the concept of systems thinking are taken into account. We urge that all NHS staff are trained on the five giants and systems thinking in order to put prevention into practice and expand prevention further over time.

We urge the use of systems thinking groups led by patients. These are a great way to fully involve patients in the effective design of NHS services, to improve outcomes and reduce cost. Systems thinking groups can find ways to radically simplify current services and reduce costs while also improving outcomes. 

Once systems thinking suggestions have been developed by individual groups, they should be rolled out nationally by the Department of Health. This is particularly important because, as noted in the plan, the NHS has a historic tendency to make services increasingly complicated and add more and more of them, all delivered by different teams who don’t talk to each other. There is hardly ever any stripping back and simplification. The services get so complicated that no one can see that certain groups of people are being excluded from services, which then causes health inequalities. 

A systems thinking expert also pointed out that the plan does not show senior decision makers how their understanding of how health works, how the NHS works and how the plan will work requires new ways of managing, and most importantly, new ways of enabling the reform to happen. Some additional detailed work and consultation is required on certain areas, such as how to get unemployed people with disabilities into work, the exact GP and community service delivery plan and a detailed plan for the NHS single patient record. 

The only key area completely missing is social care. Improved social care would immediately help reduce the NHS budget by keeping people out of hospital. We urge that interim steps are taken, for example immediately allowing NHS organisations to pay for social care where there is a business case to do so, as an emergency measure. Ways to fully sort out social care could be piloted in some local areas at relatively low cost.