NHS Long Term Plan: Implementation debate

University of Leeds student Phe Hayhurst recently joined the Principle team for a fortnight work experience placement and produced this summary of Monday’s NHS Long Term Plan: Implementation debate.

A statement to update the House of Commons on the implementation of the NHS Long Term Plan and improvements to the NHS was made on Monday (1^st July), marking the agreement of the Plan’s implementation framework the previous Thursday by the boards of NHS England and NHS Improvement. In his statement, the Secretary of State for Health and Social Care Matt Hancock highlighted three key priorities in the Plan: cancer care, mental health services, and staffing within the NHS. A range of questions were asked relating to these areas and several other issues, including the ongoing absence of Green Papers for social care and prevention and the question of funding.

The issue of staffing, in particular staffing shortages, was raised by a number of MPs. Despite Hancock’s declaration that three-quarters of NHS funding goes on staff, indicating recognition given to it as a priority, there still appears to be shortfalls, with Alex Chalk (Cheltenham, Conservative) citing difficulties in recruiting A&E doctors as a key hindrance to A&E expansion. Jonathan Ashworth (Shadow Secretary of State for Health and Social Care, Leicester South, Labour) highlighted the fact that there are currently 100,000 vacancies across the NHS and that the interim people plan “is all good and fine” but lacks concrete cash proposals to support its implementation. However, Vicky Ford (Chelmsford, Conservative) raised the point that the new medical schools referenced by Hancock in his statement are vastly oversubscribed, with the Chelmsford school being 12 times oversubscribed for next year, suggesting that despite the need for more staff within the NHS the resources to supply this are not there. Despite this, there are record numbers of GPs in training and an increase in nursing associate apprenticeships, up by 2,500 from 5,000 last year, which will hopefully go some way towards relieving the staffing pressures on the NHS.

Mental health received a fair amount of attention, with the Secretary of State promising to ensure that it receives parity with physical health. Mental health proposals included an extra £2.3 billion pledged towards the expansion of mental health services, access to mental health services being widened to 380,000 more adults and 345,000 more children and young people, and the introduction of four-week waiting-time targets for young people regarding mental health issues. The Shadow Secretary of State raised a noteworthy counter-point: only 1.6% of public health budgets is currently spent on mental health, so how did the Secretary of State intend to mandate local authorities to ensure that they do not “raid” their mental health budgets in order to fill the wider gaps in their health expenditure. Hancock responded that this would be a requirement but gave no details of how this would be enforced.

Funding and its sources were also naturally widely discussed. Hancock stated that the NHS would receive a £33.9 billion cash settlement as part of the Plan, describing it as the “longest and largest cash settlement in the history of the NHS,” and stated that it had support “right across our party,” seemingly seeking to assure MPs that these proposals would be delivered no matter what the outcome of the upcoming Tory leadership election or the ongoing Brexit uncertainty. However, this settlement has come under scrutiny both from MPs taking part in the debate and external analysts, with the NHS Confederation claiming that the settlement in real terms falls far short of what is required to develop a modernised NHS, therefore requiring trusts and CCGs to continue to make savings. Ashworth pointed out that adult social care has seen funding cut by £7 billion since 2010 and, with the social care Green Paper still missing, the future of this sector seems vague, despite Hancock’s claims that funding for social care has risen by 11% over the last three years.

Also still missing is the Green Paper on prevention, which was raised by Chris Leslie (Nottingham East, Change UK) in a question which stressed the importance of early intervention as a way to prevent four out of five cases of certain diseases and illnesses. Several MPs also drew attention to the importance of early diagnosis, something which is frequently referenced in the Plan. Nic Dakin (Scunthorpe, Labour) asked what steps would be taken to ensure that less survivable cancers are not neglected in achieving the target of diagnosing 75% of cancers at stage 1 and stage 2, something which has been a recurring concern since the first publication of the Long Term Plan; the response from the Secretary of State was a promise, albeit a rather vague one, that less survivable cancers would not be missed. Luke Graham (Ochil and South Perthshire, Conservative) also asked about plans for the roll-out of early diagnosis centres, citing the recent death of a family member whose cancer was discovered at a late stage – this was met with sympathy from the Secretary of State, but again there were no details on when or even if such centres will appear.