Q members reflect on the NHS 10-Year Health Plan for England: key themes

Following the release of the NHS 10-Year Health Plan for England, we asked Q members to share what they found exciting about the plan, what is missing and where they think improvement approaches can play a role.

Drawing on our diverse community spanning the UK and Ireland, we shared reflections from seven members across England. Members in Wales, Ireland and Northern Ireland also shared examples those delivering the plan in England can learn from to realise its three shifts and implement large-scale change.

Q members hold a range of roles and work across a variety of organisations, yet their reflections had some common themes. Here, we share some of the key themes highlighted by those working to improve health and care. These themes can serve as a signpost for where to focus efforts towards achieving the plan’s goals.

The government sought to co-develop the 10-year plan with members of the public, health and care staff and partner organisations. Through Change NHS, it received over a quarter of a million contributions from the public, health and care staff, health system leaders and organisations – ​‘the biggest ever conversation on the future of the NHS’.

As Andrea Gibbons, The QI Hub and Senior Manager, Somerset NHS Foundation Trust, and Emma Snow, CEO, Five Giants Foundation, noted, the plan itself commits to moving towards a more patient-centred NHS – putting more power in the hands of patients, carers and front-line staff. This starts with listening. 

While the public engagement thus far has been promising, several members, including Clifford Mitchell, Anita Rowe, Domenica Gilroy, Levette Lamb, Senior Team Members, Health and Social Care Quality Improvement (HSCQI) Northern Ireland, highlighted the importance of continuing such engagement during the plan’s implementation.

In doing so, it will be important to consider what happens with the feedback received. Miles Sibley, Patient Experience Library and Chris Pavlakis, Patient experience perspective, Group coordinator, Other ways to care, cautioned against a focus on collecting feedback data without also tackling the conditions and culture necessary to meaningfully act on it. 

Notably absent from the plan was an expected chapter detailing a delivery strategy. According to NHS England chief executive Sir Jim Mackey, a delivery approach to some key elements of the plan is being developed in consultation with NHS staff and leaders over the summer. 

Many members reflected on the importance of sharing a detailed approach to implementing the plan, while not becoming overly prescriptive. The plan suggests piloting some approaches regionally before scaling and spreading them to other areas, Felicity Hamer, Head of Strategic Quality and Safety Quality, Safety and Improvement NHS Wales Performance and Improvement, stressed the need to be mindful of local contexts and not simply adopt into other regions. 

Clifford Mitchell, Anita Rowe, Domenica Gilroy and Levette Lamb queried how local systems will be supported to deliver the changes outlined in the plan, especially in under-resourced areas. How the changes will be implemented amid restructuring and redundancies is a pressing concern we’re hearing from members across the Q community.

Improvement approaches can help to both successfully implement the plan and realise its longer-term ambitions. Anna Burhouse, Director of Quality Development, Northumbria Healthcare NHS Foundation Trust, shared how improvement approaches can help with staff engagement, particularly around resistance to change. They can also help to measure and monitor outcomes and experience to inform how changes are rolled out. As the success of different efforts is determined, improvement techniques can then be used to scale and spread best practice across the NHS.

In her reflections, Emma Snow detailed how systems thinking can be used to involve patients in the design of services, improve outcomes and reduce cost. And Clifford Mitchell, Anita Rowe, Domenica Gilroy, and Levette Lamb highlighted how quality improvement and related methodologies such as implementation science can support local teams in testing, evaluating, implementing and scaling innovations. 

As Dr. Orla Healy, National Clinical Director of Quality and Patient Safety, Health Service Executive, Ireland, mentioned, quality improvement can be used in the redesign of care pathways, focusing on the safety of care transitions and acceptability to patients. A common thread through all the responses was the importance of collaboration and engagement with staff, patients and the public – an area where improvement approaches can make a significant contribution. 

Responses to the planned shift from analogue to digital were largely positive. Some cited ways technology is already making a difference to patient identification and support. 

Yet as Miles Sibley, pointed out, the appropriate training of staff is essential for technology to reach its potential. And just as important as the technology itself is how it is implemented in practice.

Also welcome was the planned shift of care from hospitals into local communities, with some members highlighting the success of existing initiatives to bring care into the community. 

As Rammya Mathew, GP, Kings Edge Medical Centre, Borough Medical Director – Brent, said, a shift to neighbourhood health can help to deliver personalised care for patients by coordinating and simplifying a complex web of care.

It will also allow greater consideration of how the building blocks of health, like social connection, warm and safe housing, and access to essential services, impact patient experience, as noted by Miles Sibley.

David Seamark, President, Community Hospitals Association, shared how the benefits of this approach can already be seen in the success of community hospitals. These bridges between acute hospital services and the community can help relieve pressure on acute services as well as allow patients to receive care closer to home in familiar surroundings. 

Lastly, members reflected on the value of the Q community in supporting the successful implementation of the plan. As Dr. Orla Healy mentioned, the plan is strong on a data-driven, learning-oriented system – Q’s forte. Our community can also play a key role in sharing learning and what works.

We will continue to collect members’ views on the plan and its implementation, bringing people together to learn and support one another on the path forward.