Monday morning started early, with one shiny new 136-page plan for the NHS in England and two Mays at Alder Hey.
That’s right, after six months of development and a Brexit-induced delay over Christmas, the NHS Long Term Plan finally landed on Monday.
It was an early start for the new chief nursing officer for England, Ruth May, who tweeted that she was up at 3.20am to be in Liverpool in time to hear prime minister Theresa May’s speech at the launch event. A very long first day at work as the country’s new CNO, followed no doubt by a long week. Certainly not a gentle or easy introduction to life in Jane Cummings’ recently vacated chair.
While there have been a number of Forward View documents over the past few years, plus a couple of nursing strategies to boot, a plan of this breadth and timescale is unusual for the NHS.
”It certainly says many of the right things, though many of them are not new”
The last time a 10-year strategy document was drawn up covering the whole health service in England was in 2000 when the Labour government under Tony Blair published the equally sparingly titled NHS Plan – that’s right, nearly 20 years ago.
I was a fresh-faced reporter back then, eager to hear more and yet to become wary of the same old promises to the same old problems. But while I am hopefully now wiser to political soundbites and pledges, I must admit I got into work on Monday extremely excited to see what was in the new plan.
Some of it, of course, was cleverly trailed in the weeks before Christmas to try to garner the most positive coverage, but the bulk of it was still there waiting to be read through and analysed.
Hopefully, as it’s supposed to be a 10-year plan, the ideas in it will be allowed to develop and evolve over the next decade, rather than be whipped away by the next political whim. We shall see. But the fact that the Department of Health and Social Care and the prime minister herself have linked themselves to what is essentially NHS England’s – and its boss Simon Stevens’ – plan means it is not entirely free of political vulnerability at a time when the government itself is vulnerable.
So, is it a good plan? Well, it certainly says many of the right things, though many of them are not new. For example, there is the oft-repeated ambition to move more services into the community and therefore closer to patients, as well as headline-grabbing moves to try to keep people out of emergency departments, such as ‘rapid response teams’. There is, however, a stronger mention than usual for mental health, hopefully reflecting its rise up the political agenda.
One particularly interesting section, subsequently backed by health secretary Matt Hancock in the Commons, suggests that those in power may be preparing to look again at commissioning arrangements for public health.
Could responsibility for commissioning key public health services, including health visiting, school nursing and sexual health, revert to the NHS? I hope so, as I don’t feel the local authority experiment has been a particular success for anyone involved.
As you might expect, given Mr Hancock’s well-documented interest in technology, much of the plan has digital ambitions woven through it. Not necessarily a bad thing, but the NHS doesn’t have the best track record on introducing technology such as electronic patient records and the NHS National Programme for IT – the latter costing £10bn before it was put out of its misery.
I hope the idea of an online nursing degree will end up on the same scrapheap as the aforementioned NPfiT, but preferably before it gets too far into development, unless I’ve missed something good about it (let me know).
On workforce generally, the plan promises funding for 5,000 more student nurse placements, a focus on ethical overseas nurse recruitment in the short-term, investment in continuing professional development to boost retention, more neonatal nurses and pledges to improve diversity at the top of the service.
All these ideas sound quite good, right? – though I noticed that the word bursary is absent from the document.
”I hope that some of what seems to be good in the plan does eventually reach the frontline”
But to work out how these welcome ambitions will all be achieved, we must wait for a separate “comprehensive” workforce plan, which is due later in the year – the so-called workforce implementation plan, which will accompany an overarching implementation plan for the whole thing. Yes, that’s right, three plans in total by the end of the year. How many plans does it take to make a strategy, I wonder? Anyway, I digress.
At this point, as with most new national plans, it is merely a wad of paper or a PDF. Much of the health service and its nursing and other staff will carry on doing their jobs as normal while their organisations pore over it and work out what it means for them.
But I hope that some of what seems to be good in the plan does eventually reach the frontline and has the positive impact promised for both staff and patients. At present, everything is to play for.